Coordinated Response To Child Abuse and Neglect

CHILD ABUSE AND NEGLECT
USER MANUAL SERIES
A Coordinated Response
to Child Abuse and Neglect:
The Foundation
for Practice
U.S. Department of Health and Human Services

Administration for Children and Families
Administration on Children, Youth and Families
Children's Bureau
Office on Child Abuse and Neglect
A Coordinated Response
to Child Abuse and Neglect:
The Foundation for Practice
Jill Goldman
Marsha K. Salus
with
Deborah Wolcott
Kristie Y. Kennedy
2003
U.S. Department of Health and Human Services
Administration for Children and Families
Administration on Children, Youth and Families
Children's Bureau
Office on Child Abuse and Neglect
PREFACE ........................................................................................................................................................................... 1
ACKNOWLEDGMENTS........................................................................................................................ 3
1. PURPOSE AND OVERVIEW .......................................................................................................................... 7
2. WHAT ARE THE PHILOSOPHICAL TENETS OF CHILD PROTECTION? .............................. 9
Key Principles of Child Protection ...............................................................................................................9
Philosophical Tenets ...................................................................................................................................... 10
3. WHAT IS CHILD MALTREATMENT? ..................................................................................................... 13
Definitions in Federal Law .......................................................................................................................... 13
Sources of Definitions in State Law ........................................................................................................... 15
General Definitions by Type of Maltreatment ......................................................................................... 16
4. WHAT IS THE SCOPE OF THE PROBLEM?......................................................................................... 23
Reported Child Maltreatment Victims ...................................................................................................... 23
Child Maltreatment Perpetrators................................................................................................................ 24
Nonreported Child Abuse and Neglect..................................................................................................... 25
5. WHAT FACTORS CONTRIBUTE TO CHILD ABUSE AND NEGLECT?.................................. 27
Parent or Caregiver Factors.......................................................................................................................... 28
Family Factors ................................................................................................................................................ 29
Child Factors .................................................................................................................................................. 32
Environmental Factors ................................................................................................................................. 33
Protective Factors ........................................................................................................................................... 34
6. WHAT ARE THE CONSEQUENCES OF CHILD ABUSE AND NEGLECT? ........................... 35
Health and Physical Effects ......................................................................................................................... 36
Cognitive Development and Academic Achievement ............................................................................ 37
Emotional, Psychosocial, and Behavioral Development........................................................................ 37
Resilience......................................................................................................................................................... 38
A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice i
7. WHAT CAN BE DONE TO PREVENT CHILD ABUSE AND NEGLECT?................................ 41
Prevention as a Strategy ................................................................................................................................ 41
Types of Prevention Activities ..................................................................................................................... 42
Major Prevention Program Models ............................................................................................................ 43
Role of Various Entities in Prevention Efforts......................................................................................... 47
8. WHICH LAWS AND POLICIES GUIDE PUBLIC INTERVENTION
IN CHILD MALTREATMENT? ................................................................................................................... 51
The Federal Role in Addressing Child Abuse and Neglect ................................................................... 51
Basis for State Intervention.......................................................................................................................... 55
9. WHAT DOES THE CHILD PROTECTION PROCESS LOOK LIKE?.......................................... 59
Identification .................................................................................................................................................. 59
Reporting......................................................................................................................................................... 61
Intake ............................................................................................................................................................... 65
Initial Assessment or Investigation ............................................................................................................ 66
Family Assessment......................................................................................................................................... 68
Planning........................................................................................................................................................... 70
Service Provision ............................................................................................................................................ 70
Evaluation of Family Progress..................................................................................................................... 71
Case Closure ................................................................................................................................................... 72
10. WHO SHOULD BE INVOLVED IN CHILD PROTECTION
AT THE COMMUNITY LEVEL? ................................................................................................................. 73
Child Protective Services .............................................................................................................................. 73
Law Enforcement ........................................................................................................................................... 73
Educators and Early Child Care Providers............................................................................................... 74
Health Care Providers................................................................................................................................... 75
Mental Health Professionals........................................................................................................................ 75
Legal and Judicial System Professionals .................................................................................................... 75
Substitute Care Providers ............................................................................................................................. 77
Faith Community.......................................................................................................................................... 77
Community Organizations and Support Services Providers................................................................. 77
Concerned Citizens ....................................................................................................................................... 78
11. HOW CAN ORGANIZATIONS WORK TOGETHER TO PROTECT CHILDREN? .............. 79
Principles to Guide Collaboraton .............................................................................................................. 79
Effective Leadership·An Essential Component of Successful Collaboration ................................... 80
Collaborative Models.................................................................................................................................... 81
Conclusion...................................................................................................................................................... 81
ENDNOTES .................................................................................................................................................................... 83
Table of Contents
APPENDICES:
APPENDIX A·GLOSSARY OF TERMS .................................................................................................... 91
APPENDIX B·RESOURCE LISTINGS OF SELECTED NATIONAL
ORGANIZATIONS CONCERNED WITH CHILD MALTREATMENT ...................................... 97
APPENDIX C·STATE TOLL-FREE TELEPHONE
NUMBERS FOR REPORTING CHILD ABUSE .................................................................................. 103
A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice iii
E ach day, the safety and well-being of some
children across the Nation are threatened by
child abuse and neglect. Intervening effectively
The Office on Child Abuse and Neglect (OCAN)
within the Children's Bureau of the Administration
for Children and Families (ACF), U.S. Department
in the lives of these children and their families of Health and Human Services (DHHS), has
is not the sole responsibility of any single agency developed this third edition of the User Manual
or professional group, but rather is a shared Series to reflect the increased knowledge base and
community concern. the evolving state of practice. The updated and
new manuals are comprehensive in scope while also
Since the late 1970s, the Child Abuse and Neglect succinct in presentation and easy to follow, and
User Manual Seriess has provided guidance on they address trends and concerns relevant to today's
child protection to hundreds of thousands of professional.
multidisciplinary professionals and concerned
community members. The User Manual Series This manual, A Coordinated Response to Child
provides a foundation for understanding child Abuse and Neglect: The Foundation for Practice,
maltreatment and the roles and responsibilities of provides the keystone for the series. The manual
various practitioners in its prevention, identification, addresses the definition, scope, causes, and
investigation, assessment, and treatment. Through consequences of child abuse and neglect. The manual
the years, the manuals have served as valuable also presents an overview of prevention efforts and
resources for building knowledge, promoting the child protection process from identification and
effective practices, and enhancing community reporting through investigation and assessment to
collaboration. service provision and case closure. Because child
protection is a multidisciplinary effort, the manual
Since the last update of the User Manual Series in describes the roles and responsibilities of different
the early 1990s, a number of changes have occurred professional groups and offers guidance on how
that dramatically affect each community's response the groups can work together effectively to protect
to child maltreatment. The changing landscape the safety, permanency, and well-being of children.
reflects increased recognition of the complexity The primary audience for this manual includes
of issues facing parents and their children, new new child protective services (CPS) caseworkers
legislation, practice innovations, and system reform and other professionals working with children and
efforts. Significant advances in research have families. Schools of social work may add it to class
helped shape new directions for interventions, while reading lists to orient students to the field of child
ongoing evaluations help us to know „what works.‰ protection. In addition, other professionals and
A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice 1
concerned community members may consult the Series. These include, for example, Child Protective
manual for a greater understanding of child abuse Services: A Guide for Caseworkers and The Role of
and neglect. Educators in the Prevention and Treatment of Child
Abuse and Neglect. More detailed information on
This manual is intended to accompany each specific topics can be found in the profession-
profession-specific manual in the User Manual specific and special issue manuals.
User Manual Series
This manual·along with the entire Child Abuse and Neglect User Manual Series·is available from the
National Clearinghouse on Child Abuse and Neglect Information. Contact the Clearinghouse for a full
list of available manuals and ordering information:
National Clearinghouse on Child Abuse and Neglect Information

330 C Street, SW
Washington, DC 20447
Phone: (800) FYI-3366 or (703) 385-7565
Fax: (703) 385-3206
E-mail: [email protected]
The manuals also are available online at www.calib.com/nccanch/pubs/usermanual.cfm.
Preface
PRIMARY AUTHORS ACKNOWLEDGMENT OF PRIOR EDITIONS
Jill Goldman, M.B.A., a consultant with Caliber This manual, originally published in 1992 as
Associates, has spent the last 10 years conducting A Coordinated Response to Child Abuse and
research and writing publications on child Neglect: A Basic Manual by Diane DePanfilis and
maltreatment and other issues related to children, Marsha K. Salus, was revised and expanded by Jill
youth, and families. She previously served as Goldman and Marsha K. Salus in 2002. The first
manager of product development and program edition of the manual was published in 1979 as
services for the National Clearinghouse on Child A Community Approach: The Child Protection
Abuse and Neglect Information. Coordinating Committee by James L. Jenkins,
Robert A. MacDicken, and Nancy J. Ormsby. The
Marsha K. Salus, M.S.W., is a social work prior work informed and contributed significantly
consultant. She has worked in the child welfare field to the content of this publication.
for 27 years. She began her career as a CPS worker
and supervisor. She has developed several national
curricula for child welfare workers and supervisors. REVIEWERS
She developed a number of preservice and inservice
training programs for child welfare workers and
Diane DePanfilis, Ph.D.
supervisors in a variety of States. She has worked
University of Maryland at Baltimore
with several States to establish standards of practice
School of Social Work
for child welfare supervision.
Sgt. Richard Cage
Montgomery County Police Department
CONTRIBUTORS
Family Services Division
Deborah Wolcott, Ph.D., Fairfax County Public Wayne Holder

Schools, developed the chapter on prevention. National Resource Center on Child Maltreatment
Kristie Y. Kennedy, J.D., M.A., American Bar Sandi McLeod

Association, provided input on the Federal basis for National Clearinghouse on
intervention and statutory issues. Child Abuse and Neglect Information
Barry Salovitz
TECHNICAL ADVISORY PANEL Child Welfare Institute/National Resource Center
on Child Maltreatment
The following were members of the January 2001 Glenmont, NY
Technical Advisory Panel for the User Manual Series
Sarah Webster
contract. The organizations identified reflect each
Texas Department of Protective and Regulatory
member's affiliation at that time.
Services
Carolyn Abdullah Austin, TX
FRIENDS National Resource Center
Ron Zuskin
Washington, DC
Lien Bragg School of Social Work
American Public Human Services Association Baltimore, MD
Washington, DC
The following members were subsequently added to
Sgt. Richard Cage the Technical Advisory Panel:
Montgomery County Police Department
William R. (Reyn) Archer III, M.D.
Wheaton, MD
Hill and Knowlton, Inc.
Diane DePanfilis, Ph.D. Washington, DC
Douglas Besharov
School of Social Work
American Enterprise Institute
Baltimore, MD
Washington, DC
Pauline Grant
David Popenoe, Ph.D.
Florida Department of Children and Families
National Marriage Project
Jacksonville, FL
Princeton, NJ
Jodi Hill
Bob Scholle
Connecticut Department of Children and Families
Independent Consultant
Hartford, CT
Pittsburgh, PA
Robert Ortega, Ph.D.
Brad Wilcox, Ph.D.
University of Michigan School of Social Work
University of Virginia
Ann Arbor, MI
Department of Sociology
Nancy Rawlings Charlottesville, VA
Kentucky Cabinet for Families and Children
Frankfort, KY
Acknowledgments
Catherine Nolan, Director, Office on Child Abuse
ADDITIONAL ACKNOWLEDGMENTS and Neglect.
Also providing input and review were Sally Flanzer,
The third edition of the User Manual Series was

Director, Division of Data, Research, and Innovation,
developed under the guidance and direction of
and Susan Orr, Associate Commissioner, Children's
Irene Bocella, Federal Task Order Officer, and
Bureau.
This manual was developed and produced by Caliber Associates, Fairfax, VA, under
Contract Number HHS-282-98-0025.
CHAPTER 1
C hild abuse and neglect is a community concern.

Each community has a legal and moral obligation
to promote the safety, permanency, and well-being of
activities and working collaboratively. It is intended to
provide the basic information that professionals and
the public need to become involved in, and enhance,
children, which includes responding effectively to their community's response to child maltreatment.
child maltreatment. At the State and local levels, While the manual is comprehensive in scope and
professionals assume various roles and responsibilities touches on major issues, it cannot reflect all the
ranging from prevention, identification, and detailed information related to this complex problem.
reporting of child maltreatment to intervention, It is intended, therefore, as a starting point.
assessment, and treatment. Child protective services
This manual answers the following 10 questions:
(CPS) agencies, along with law enforcement, play a
central role in receiving and investigating reports of • What are the philosophical tenets of child
child maltreatment. To protect children from harm, protection?
CPS also relies on community members to identify
and report suspected cases of child maltreatment, • What is child maltreatment?
including physical abuse, sexual abuse, neglect, and
psychological maltreatment. Many community • What is the scope of the problem?
professionals (including health care providers, mental
• What factors contribute to abuse and neglect?
health professionals, educators, and legal and court
system personnel) are involved in responding to child • What are the consequences of abuse and neglect?
abuse and neglect and providing needed services. In
addition, community-based agency staff, substance • What can be done to prevent abuse and neglect?
abuse treatment providers, domestic violence victim
advocates, clergy, extended family members, and • Which laws and policies guide public intervention
concerned citizens also play important roles in in child maltreatment?
supporting families and keeping children safe. • What does the child protection process look
This manual·the first in the series·provides an like?
overview of the problem of child abuse and neglect • Who should be involved in child protection at
and the prevention and intervention processes. It the community level?
describes not only the activities involved in child
protection, but also the roles and responsibilities of • How can organizations work together to protect
various community members in conducting these children?
CHAPTER 2
T he importance of the family in U.S. society is

central to the Nation's history and tradition.
Parents have a fundamental right to raise their
process of its latest reauthorization. ASFA was signed
into law in 1997 (P.L. 105-89) and built upon earlier
laws and reforms to promote the safety and well-being
children as they see fit, and society presumes that of maltreated children. These laws and other guiding
parents will act in their children's best interest. legislation are referenced throughout this publication
When parents do not protect their children from and are specifically discussed in „Federal Legislation
harm and meet their basic needs·as with cases of and Programs‰ in Chapter 8. ASFA promotes three
child abuse and neglect·society has a responsibility national goals for child protection:
to intervene to protect the health and welfare of
these children. Any intervention into family life v Safety. All children have the right to live in an
on behalf of children must be guided by State environment free from abuse and neglect. The
and Federal laws, sound professional standards for safety of children is the paramount concern that
practice, and strong philosophical underpinnings. must guide child protection efforts.
This chapter presents key principles underscored
v Permanency. Children need a family and
in Federal legislation and the philosophical tenets
a permanent place to call home. A sense of
on which the community's responsibility for child
continuity and connectedness is central to a
protection is based.
child's healthy development.
v Child and family well-being. Children

KEY PRINCIPLES OF CHILD PROTECTION
deserve nurturing environments in which their
physical, emotional, educational, and social
The key principles guiding child protection needs are met. Child protection practices must
are largely based on Federal statutes, primarily take into account each child's needs and should
delineated in the Child Abuse Prevention and promote healthy development.
Treatment Act (CAPTA) and the Adoption and
Safe Families Act (ASFA). CAPTA, in its original In addition, ASFA underscored the importance
inception, was signed into law in 1974 (P.L. 93-247) of accountability of service delivery systems in
and is reauthorized by Congress every 5 years. As achieving positive outcomes for children related to
of the publication of this manual, CAPTA is in the each of these goals.
best cared for in their own families. Children
PHILOSOPHICAL TENETS naturally develop a strong attachment to their
families and when removed from them, they
The following philosophical tenets expand upon typically experience loss, confusion, and other
the principles set forth in ASFA and the values that negative emotions. Maintaining the family as
underlie sound practices in community responses to a unit preserves important relationships with
child abuse and neglect: parents, siblings, and extended family members
and allows children to grow and develop within
v Prevention programs are necessary to their own culture and environment.
strengthen families and reduce the
likelihood of child abuse and neglect. v When parents (or caregivers) are unable or
Child maltreatment results from a combination unwilling to fulfill their responsibilities
of factors: psychological, social, situational, to provide adequate care and to keep
and societal. Factors that may contribute to their children safe, CPS has the mandate
an increased risk for child abuse and neglect to intervene. Both laws and good practice
include, for example, family structure, poverty, maintain that interventions should be designed
substance abuse, poor housing conditions, to help parents protect their children in the
teenage pregnancy, domestic and community least intrusive manner possible. Interventions
violence, mental illness, and lack of support should build on the family's strengths and
from extended families and community address the factors that contribute to the risk
members. To reduce the occurrence of of maltreatment. Reasonable efforts must be
maltreatment, communities should develop and made to maintain child safety and keep the
implement prevention programs that support children with their families except when there is
children and families. significant risk to child safety. Referral to court
and removal of children from their families
v The responsibility for addressing child should only be done when it is determined
maltreatment is shared among community that children cannot be kept safely in their own
professionals and citizens. No single agency, homes.
individual, or discipline has all the necessary
knowledge, skills, or resources to provide the v Most parents want to be good parents
assistance needed by abused and neglected and have the strength and capacity, when
children and their families. While public adequately supported, to care for their
child protective services (CPS) agencies, law children and keep them safe. Underlying
enforcement, and courts have legal mandates CPS intervention is the belief that people have
and primary responsibility for responding to the strength and potential to change their lives.
child maltreatment, other service providers Professionals must search for and identify the
working with children and families·along with strengths and the inner resiliencies in families
community members·play important roles in that provide the foundation for change.
supporting families and protecting children.
v To help families protect their children and
To be effective in addressing this complex
meet their basic needs, the communityÊs
problem, the combined expertise and resources
response must demonstrate respect for
of interdisciplinary agencies and professionals
every person involved. All people deserve
are needed.
to be treated with respect and dignity. This
v A safe and permanent home is the best place means showing respect for a person, while not
for a child to grow up. Most children are necessarily approving or condoning his or her
What Are the Philosophical Tenets of Child Protection?

actions. In addition to caregivers and children, v Interventions need to be sensitive to the
service providers should demonstrate respect cultures, beliefs, and customs of all families.
for mothers, fathers, grandparents, other family Professionals must acknowledge and show
members, and the family's support network. respect for the values and traditions of families
from diverse cultural, ethnic, and religious
v Services must be individualized and tailored. backgrounds. To become culturally competent,
While people may have similar problems, there professionals must first understand themselves
are elements that will vary from family to and the effects of their own background on
family. In addition, each family's strengths their values, behaviors, and judgments about
and resources are different. The community's others.1 In working with children and families
response, therefore, must be customized to different from themselves, professionals need to
reflect the particular circumstances, strengths, be aware of the context of the family's culture
and needs of each family. and background in order to help provide access
to culturally relevant services and solutions.
v Child protection and service delivery
approaches should be family centered. v To best protect a childÊs overall well-being,
Parents, children, their extended families, and agencies must assure that children move to
support networks (e.g., the faith community, permanency as quickly as possible. Along
teachers, health care providers, substitute with developing plans to facilitate reunification
caregivers) should be actively involved as of children, agencies must develop alternative
partners in developing and implementing plans for permanence from the time the child
appropriate plans and services to reduce or enters care. For those children who cannot be
eliminate the risk of maltreatment. Tapping safely reunified with their families, timely efforts
into the strengths and resources of a family's must be made to ensure a stable, secure, and
natural support network is fundamental to permanent home for the child through adoption
enhancing family functioning. or other permanent living arrangements.
CHAPTER 3
T o prevent and respond to child abuse and

neglect effectively, there needs to be a common
understanding of the definitions of those actions
DEFINITIONS IN FEDERAL LAW
and omissions that constitute child maltreatment. The Child Abuse Prevention and Treatment Act
Unfortunately, there is no single, universally applied (CAPTA) provides minimum standards for defining
definition of child abuse and neglect. Over the past physical child abuse, child neglect, and sexual abuse
several decades, different stakeholders·including that States must incorporate in their statutory
State and Federal legislative bodies, agency officials, definitions to receive Federal funds. Under CAPTA,
and researchers·have developed definitions of child abuse and neglect means:
maltreatment for different purposes. Definitions
vary across these groups and within them. For • Any recent act or failure to act on the part of a
example, legal definitions describing the different parent or caretaker that results in death, serious
forms of child maltreatment for reporting and physical or emotional harm, sexual abuse, or
criminal prosecution purposes are found mainly exploitation;
in State statutes, and definitions vary from State
to State. Similarly, agency guidelines for accepting • An act or failure to act that presents an
reports, conducting investigations, and providing imminent risk of serious harm.
interventions vary from State to State and sometimes
The definition of child abuse and neglect refers
from county to county. In addition, researchers use
specifically to parents and other caregivers. A „child‰
varying methods to measure and define abuse and
under this definition generally means a person who
neglect, making it difficult to compare findings
is under the age of 18 or who is not an emancipated
across studies. Despite the differences, there are
minor. In cases of child sexual abuse, a „child‰ is one
commonalities across definitions. This chapter
who has not attained the age of 18 or the age specified
describes sources of definitions in Federal and State
by the child protection law of the State in which the
laws and summarizes those elements commonly
child resides, whichever is younger.
recognized as child maltreatment.
While CAPTA provides definitions for sexual abuse
and the special cases related to withholding or
failing to provide medically indicated treatment,
it does not provide specific definitions for other
types of maltreatment·physical abuse, neglect, or
psychological maltreatment.
CAPTA Definition of Sexual Abuse
CAPTA defines „sexual abuse‰ as:
„[T]he employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or
assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for
the purpose of producing a visual depiction of such conduct;‰
„[T]he rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation,
prostitution, or other form of sexual exploitation of children, or incest with children.‰
CAPTA Definition of
Withholding of Medically Indicated Treatment
CAPTA defines the „withholding of medically indicated treatment‰ as:
„[T]he failure to respond to the infant's life-threatening conditions by providing treatment⁄which, in

the treating physician's reasonable medical judgment, will be most likely to be effective in ameliorating
or correcting all such conditions.‰
The term „withholding of medically indicated treatment‰ does not include the failure to provide
treatment (other than appropriate nutrition, hydration, and medication) to an infant when, in the
treating physician's reasonable medical judgment:
• The infant is chronically and irreversibly comatose;
• The provision of such treatment would merely prolong dying;
• The provision of such treatment would not be effective in ameliorating or correcting all of the
infant's life-threatening conditions;
• The provision of such treatment would otherwise be futile in terms of the survival of the infant;
• The provision of such treatment would be virtually futile in terms of the survival of the infant, and
the treatment itself under such circumstances would be inhumane.2
What Is Child Maltreatment?

and abandonment, emotional and physical
SOURCES OF DEFINITIONS IN STATE LAW abuse, child pornography, child prostitution,
computer crimes, rape, deviant sexual assault,
While the Federal legislation sets minimum indecent exposure, child endangerment, and
definitional standards, each State is responsible reckless endangerment.
for providing its own definition of maltreatment
v Juvenile court jurisdiction statutes provide
within civil and criminal contexts. The problem
definitions of the circumstances necessary for
of child maltreatment is generally subject to State
the court to have jurisdiction over a child
laws (both statutes and case law) and administrative
alleged to have been abused or neglected. When
regulations. Definitions of child abuse and neglect
the child's safety cannot be ensured in the home,
are located primarily in three places within each
these statutes allow the court to take custody of
State's statutory code:
a child and to order specific treatment services
v Mandatory child maltreatment reporting for the parents and child.
statutes (civil laws) provide definitions of
Together, these legal definitions of child abuse and
child maltreatment to guide those individuals
neglect determine the minimum standards of care
mandated to identify and report suspected
and protection for children and serve as important
child abuse. These reports activate the child
guidelines for professionals regarding those acts and
protection process. (See Chapter 9, „What Does
omissions that constitute child maltreatment.
the Child Protection Process Look Like?,‰ for
more information on mandated reporters and Child protective services (CPS) workers use statutory
reporting procedures.) definitions of child maltreatment to determine
whether maltreatment has occurred and when
v Criminal statutes define those forms of child
intervention into family life is necessary. For
maltreatment that are criminally punishable.
particular localities within a State, local CPS policies
In most jurisdictions, child maltreatment is
and procedures, based on statutes and regulations,
criminally punishable when one or more of the
further define different types of maltreatment
following statutory crimes have been committed:
and the conditions under which intervention and
homicide, murder, manslaughter, false
services are warranted.
imprisonment, assault, battery, criminal neglect
State Statutes
To review a summary of reporting laws, visit the State Statutes section of the National Clearinghouse
on Child Abuse and Neglect's Web site at www.calib.com/nccanch/statutes.
Although an injury resulting from physical abuse
GENERAL DEFINITIONS BY is not accidental, the parent or caregiver may not
TYPE OF MALTREATMENT have intended to hurt the child. The injury may
have resulted from severe discipline, including
There are four commonly recognized forms of child injurious spanking, or physical punishment that is
abuse or maltreatment: inappropriate to the child's age or condition. The
injury may be the result of a single episode or of
• Physical repeated episodes and can range in severity from
minor marks and bruising to death.
• Sexual
Some cultural practices are generally not defined as
• Neglect physical abuse, but may result in physically hurting
children. For example:
• Psychological
• „Coining‰ or cao gio·a
· practice to treat illness
There is great variation from State to State regarding
by rubbing the body forcefully with a coin or
the details and specificity of child abuse definitions,
other hard object.
but it is still possible to identify commonalities
among each different type of child maltreatment. v Moxabustion·an Asian folkloric remedy that
These commonalities, in part, reflect societal views burns the skin.
of parental actions that are seen as improper or
unacceptable because they place children at a risk of As Howard Dubowitz, a leading researcher in
physical and emotional harm. the field, explains: „While cultural practices
are generally respected, if the injury or harm is
Physical Abuse significant, professionals typically work with
parents to discourage harmful behavior and suggest
preferable alternatives.‰3
Generally, physical abuse is characterized by physical
injury, such as bruises and fractures that result from:
Sexual Abuse
• Punching
Child sexual abuse generally refers to sexual acts,
• Beating
sexually motivated behaviors involving children, or
• Kicking sexual exploitation of children.4 Child sexual abuse
includes a wide range of behaviors, such as:
• Biting
• Oral, anal, or genital penile penetration;
• Shaking
• Anal or genital digital or other penetration;
• Throwing
• Genital contact with no intrusion;
• Stabbing
• Fondling of a child's breasts or buttocks;
• Choking
• Indecent exposure;
• Hitting with a hand, stick, strap, or other
object • Inadequate or inappropriate supervision of a
child's voluntary sexual activities;
• Burning

• Use of a child in prostitution, pornography, Physical Neglect
Internet crimes, or other sexually exploitative
v Refusal of health care·the failure to
activities.
provide or allow needed care in accordance
Sexual abuse includes both touching offenses with recommendations of a competent health
(fondling or sexual intercourse) and nontouching care professional for a physical injury, illness,
offenses (exposing a child to pornographic materials) medical condition, or impairment.
and can involve varying degrees of violence and
v Delay in health care·the failure to seek timely
emotional trauma. The most commonly reported
and appropriate medical care for a serious
cases involve incest·sexual abuse occurring among
health problem that any reasonable layman
family members, including those in biological
would have recognized as needing professional
families, adoptive families, and step-families.5
medical attention.
Incest most often occurs within a father-daughter
relationship; however, mother-son, father-son, and v Abandonment·the desertion of a child without
sibling-sibling incest also occurs. Sexual abuse is arranging for reasonable care and supervision.
also sometimes committed by other relatives or
caretakers, such as aunts, uncles, grandparents, v Expulsion·other blatant refusals of custody,
cousins, or the boyfriend or girlfriend of a parent. such as permanent or indefinite expulsion
of a child from the home without adequate
Child Neglect arrangement for care by others or refusal to
accept custody of a returned runaway.
Child neglect, the most common form of child v Inadequate supervision·leaving a child
maltreatment, is generally characterized by omissions unsupervised or inadequately supervised for
in care resulting in significant harm or risk of extended periods of time or allowing the child
significant harm. Neglect is frequently defined in to remain away from home overnight without
terms of a failure to provide for the child's basic the parent or caretaker knowing or attempting
needs·deprivation of adequate food, clothing, to determine the child's whereabouts.
shelter, supervision, or medical care. Neglect laws
often exclude circumstances in which a child's needs v Other physical neglect·includes inadequate
are not met because of poverty or an inability to nutrition, clothing, or hygiene; conspicuous
provide. In addition, many States establish religious inattention to avoidable hazards in the home;
exemptions for parents who choose not to seek and other forms of reckless disregard of the
medical care for their children due to religious beliefs child's safety and welfare (e.g., driving with the
that may prohibit medical intervention. child while intoxicated, leaving a young child in
a car unattended).
The Department of Health and Human Services'
Third National Incidence Study of Child Abuse and Educational Neglect
Neglect (NIS-3)6 is the single most comprehensive
source of information about the current incidence v Permitted chronic truancy·habitual
of child maltreatment in the United States. NIS-3 absenteeism from school averaging at least
worked with researchers and practitioners to define 5 days a month if the parent or guardian is
physical, educational, and emotional neglect in a informed of the problem and does not attempt
succinct and clear manner, as described below. to intervene.
v Failure to enroll or other truancy·failure to v Permitted drug or alcohol abuse·
register or enroll a child of mandatory school encouragement or permitting of drug or alcohol
age, causing the child to miss at least 1 month use by the child.
of school; or a pattern of keeping a school-aged
child home without valid reasons. v Permitted other maladaptive behavior·
encouragement or permitting of other
v Inattention to special education need·refusal maladaptive behavior (e.g., chronic delinquency,
to allow or failure to obtain recommended severe assault) under circumstances where the
remedial education services or neglect in parent or caregiver has reason to be aware of
obtaining or following through with treatment the existence and seriousness of the problem but
for a child's diagnosed learning disorder or does not intervene.
other special education need without reasonable
cause. v Refusal of psychological care·refusal to
allow needed and available treatment for a
child's emotional or behavioral impairment
Emotional Neglect
or problem in accordance with a competent
v Inadequate nurturing or affection·marked professional recommendation.
inattention to the child's needs for affection,
emotional support, or attention. v Delay in psychological care·failure to seek or
provide needed treatment for a child's emotional
v Chronic or extreme spouse abuse·exposure or behavioral impairment or problem that any
to chronic or extreme spouse abuse or other reasonable layman would have recognized as
domestic violence in the child's presence. needing professional, psychological attention
(e.g., suicide attempt).

Spotlight on Chronic Neglect
One issue in defining child neglect involves consideration of „incidents‰ of neglect versus a pattern
of behavior that indicates neglect. Susan J. Zuravin, from the University of Maryland at Baltimore
School of Social Work, recommends that if some behaviors occur in a „chronic pattern,‰ they should
be considered neglectful.7 Examples include lack of supervision, inadequate hygiene, and failure to
meet a child's educational needs. This suggests that rather than focusing on individual incidents that
may or may not be classified as „neglectful,‰ one should look at an accumulation of incidents that may
together constitute neglect. „If CPS focuses only on the immediate allegation before them and not the
pattern reflected in multiple referrals, then many neglected children will continue to be inappropriately
excluded from the CPS system.‰8 For example, a family exhibiting a pattern of behavior that may
constitute neglect might include frequent reports of not having enough food in the home or keeping
older children home from school to watch younger children. In most CPS systems, however, the
criteria for identifying neglect focuses on recent, discrete, verifiable incidents.
One study found that many children who had been referred to CPS for neglect did not receive services
because their cases did not meet the criteria for „incidents‰ of neglect. It also found, however, that all
of these children had, in fact, suffered severe developmental consequences. In recognition of this issue,
the Missouri Division of Family Services (n.d.) has assigned one of its CPS staff as a „Chronic Neglect
Specialist.‰ This office defines chronic neglect as „. . . a persistent pattern of family functioning in
which the caregiver has not sustained and/or met the basic needs of the children which results in harm
to the child.‰ The focus here is on the „accumulation of harm.‰ CPS and community agencies across
the country are recognizing the importance of early intervention and service provision to support
families so that neglect does not become chronic or lead to other negative consequences.9
Psychological Maltreatment • Isolating (e.g., confining the child, placing

unreasonable limitations on the child's freedom
Psychological maltreatment·also known as of movement, restricting the child from social
emotional abuse and neglect·refers to „a repeated interactions);
pattern of caregiver behavior or extreme incident(s)
• Exploiting or corrupting (e.g., modeling
that convey to children that they are worthless,
antisocial behavior such as criminal activities,
flawed, unloved, unwanted, endangered, or only of
encouraging prostitution, permitting substance
value in meeting another's needs.‰10 Summarizing
abuse);
research and expert opinion, Stuart N. Hart, Ph.D.,
and Marla R. Brassard, Ph.D., present six categories • Denying emotional responsiveness (e.g.,
of psychological maltreatment: ignoring the child's attempts to interact, failing
to express affection);
• Spurning (e.g., belittling, hostile rejecting,
ridiculing); • Mental health, medical, and educational neglect
(e.g., refusing to allow or failing to provide
• Terrorizing (e.g., threatening violence against
treatment for serious mental health or medical
a child, placing a child in a recognizably
problems, ignoring the need for services for
dangerous situation);
serious educational needs).11
To warrant intervention, psychological maltreatment both children who have experienced and those who
must be sustained and repetitive. For less severe have nott experienced maltreatment. Additionally,
acts, such as habitual scapegoating or belittling, the effects of psychological maltreatment may only
demonstrable harm to the child is often required for become evident in later developmental stages of the
CPS to intervene. child's life.
Psychological maltreatment is the most difficult form Although any of the forms of child maltreatment may
of child maltreatment to identify. In part, the difficulty be found alone, they often occur in combination.
in detection occurs because the effects of psychological Psychological maltreatment is almost always present
maltreatment, such as lags in development, learning when other forms are identified.
problems, and speech disorders, are often evident in

Case Examples of Maltreatment
Physical Abuse
During a violent fight between her mother and her mother's boyfriend, 8-year-old Kerry called 911.
She told the operator that her mother's boyfriend always hit her mommy when he came home drunk.
In addition, Kerry said she was worried about her 5-year-old brother, Aaron, because he tried to help
their mom and the boyfriend punched him in the face. As a result, Aaron fell, hit his head on the
coffee table, and had not moved since. The operator heard yelling in the background and the mother
screaming, „Get off the phone!‰ When the police and paramedics arrived, Aaron was unconscious and
the mother had numerous bruises on her face.
Child Neglect
Robert and Carlotta are the parents of a 9-month-old son named Ruiz. Robert and Carlotta used
various drugs together until Robert was arrested and sent to prison for distributing cocaine. Since
Robert's arrest, Carlotta has been living with different relatives and friends. Recently, she left her son
with her sister who also has a history of drug use. Her sister then went to a local bar and left Ruiz
unattended. After hearing the baby boy cry for over an hour, the neighbors called the police. When
Carlotta arrived to pick up Ruiz, the police and the CPS worker were also there. It appeared that she
had been using drugs.
Sexual Abuse
Jody, age 11, said that she was asleep in her bedroom and that her father came in and took off his robe
and underwear. She stated that he got into bed with her and pulled up her nightgown and put his
private part on her private part. She stated that he pushed hard and it hurt. Jody said that the same
thing had happened before while her mother was at work. Jody stated that she told her mother, but
her father insisted that she was telling a lie.
Psychological Abuse
Jackie is a 7-year-old girl who lives with her mother. Jackie's mother often screams at her, calls her
degrading names, and threatens to kill her when Jackie misbehaves. Jackie doesn't talk in class anymore,
doesn't have any friends in her neighborhood, and has lost a lot of weight.
CHAPTER 4
E ach year, hundreds of thousands of children in

the United States are victims of maltreatment.
Knowledge of the scope of the problem is drawn
and agency guidelines. The CPS processes for
screening referrals, conducting investigations, and
substantiating maltreatment are described further in
primarily from data reported by State child protective Chapter 9, „What Does the Child Protection Process
service (CPS) agencies to the National Child Abuse Look Like?‰
and Neglect Data System (NCANDS). Not all
For every 1,000 children in the population in 2000,
maltreatment, however, is known by the authorities.
approximately 12 were victims of maltreatment.13
This chapter summarizes the 2000 NCANDS
Exhibit 4-1 presents NCANDS data on the reported
findings related to the number and characteristics
annual victimization rates over the past 11 years.
of child maltreatment victims and perpetrators
reported to CPS and also discusses estimates of the
actual incidence of abuse and neglect, including Exhibit 4-1
incidents that are not reported to CPS. Trend of Reported Victimization
1990ă2000
REPORTED CHILD MALTREATMENT VICTIMS
The number of children actually maltreated is

unknown. In 2000, there were an estimated 879,000
victims of maltreatment nationwide.12 The term
„victims‰ refers to those children who were found
by CPS to have experienced abuse or neglect (i.e.,
substantiated cases).
During that same year, an estimated 3 million

referrals were made to CPS regarding one or more
children in a family, and nearly two-thirds of those
referrals were „screened in‰ for investigation of
potential maltreatment. „Screened in‰ indicates
that the referral was deemed appropriate for
investigation or assessment based on State statutes
Types of Maltreatment While children of every race and ethnicity were
maltreated, victimization rates varied. Out of all
The following findings describe reported child children reported as maltreated in 2000:
victimization rates by major types of maltreatment
• 50.6 percent of victims were White;
as stated in NCANDS for 2000:
• 24.7 percent of victims were African American;
v Neglect. More than half of all reported victims
(62.8 percent) suffered neglect (including • 14.2 percent of victims were Hispanic;
medical neglect), an estimated rate of 7 per 1,000
children. • 1.6 percent of victims were American Indian-
Alaska Native;
v Physical abuse. Approximately one-fifth of
all known victims (19.3 percent) were physically • 1.4 percent of victims were Asian-Pacific
abused, an estimated rate of 2 per 1,000 Islander.16
children.
It is important to remember that these figures
v Sexual abuse. Of all reported maltreated represent those children who have been referred
children, just over one-tenth (10.1 percent) had to CPS, investigated, and found to have credible
been sexually abused, an estimated rate of 1 per evidence of maltreatment. Other studies suggest
1,000 children. that there are not significant differences in the
actual incidence of maltreatment by race, but rather
v Psychological maltreatment. Less than one- that certain races may receive different attention
tenth (7.7 percent) were identified as victims of during the processes of referral, investigation, and
psychological maltreatment, or less than 1 per service allocation.17
1,000 children.14
Keep in mind that some children are reported as Fatalities

victims of more than one type of maltreatment.
According to NCANDS, an estimated 1,200 children
Characteristics of Victims known to CPS died of abuse and neglect in 2000.
Over two-fifths of these children (43.7 percent) were
less than 1 year old. Child maltreatment fatalities
Overall, in 2000, 52 percent of victims of child
were more frequently associated with neglect (34.9
maltreatment were girls and 48 percent were boys.
percent) than with other types of maltreatment,
While rates of most types of maltreatment were
including physical abuse.
similar for both sexes, more girls than boys were
sexually abused.
CHILD MALTREATMENT PERPETRATORS
The youngest and most vulnerable children·children
under the age of 3·had the highest victimization
rate, approximately 16 per 1,000.15 Overall, rates of The majority of victims reported to NCANDS in
victimization declined as children's age increased. 2000 (78.8 percent) were maltreated by a parent. This
(Victimization patterns by age, however, differ by is not surprising given that child maltreatment is
type of maltreatment.) defined as the abuse or neglect of children by parents
or caregivers. The definition of who is considered a
caregiver (e.g., babysitter, daycare worker, residential
facility staff, relatives, or household members) varies
What Is the Scope of the Problem?

from State to State. Approximately three-fifths of such, the statistics presented above likely under-
perpetrators of maltreatment (59.9 percent) were represent the true scope of child maltreatment. The
women. Nearly 42 percent of that group of women Third National Incidence Study of Child Abuse
perpetrators were younger than 30. While mothers and Neglect (NIS-3) surveyed community-level
were more frequently identified as perpetrators of professionals (e.g., educators, medical professionals,
neglect and physical abuse (the most common forms and mental health care providers) who came into
of maltreatment), fathers were more frequently contact with children in 1993. The study estimated
identified as the perpetrators of sexual abuse.18 that less than one-third of the children who were
identified as having experienced harm from abuse
or neglect had been investigated by CPS.19 General
NONREPORTED CHILD
population surveys also suggest that maltreatment is
ABUSE AND NEGLECT
higher than the official reports. For example, based
on what parents say they did in disciplining their
Not all victims of abuse and neglect are reported children, a 1995 Gallup Poll estimated the number
to CPS and not all reports are verifiable. As of physical abuse victims to be 16 times the official
reported number of victims for that time period.
Key Sources of Child Abuse and Neglect Statistics
The primary sources of national statistics on child abuse and neglect are two reports sponsored by the
Children's Bureau of the U.S. Department of Health and Human Services:
v Child Maltreatment: Reports from the States to the National Child Abuse and Neglect
Data System (NCANDS). NCANDS collects national information on maltreated children
known to State CPS. The annual NCANDS report presents national and State level findings on
the number and sources of child abuse and neglect reports, investigation dispositions, types of
maltreatment, characteristics of children victimized, relationship of perpetrators to victims, and
services provided for child maltreatment victims.
v National Incidence Study of Child Abuse and Neglect (NIS). NIS is designed to estimate
the actual number of abused and neglected children nationwide including both cases reported
and cases not reported to CPS. NIS bases estimates on information provided by a nationally
representative sample of community professionals (e.g., educators, law enforcement personnel,
medical professionals, and other service providers) who come into contact with maltreated
children.
The most recent reports from these studies are available from the National Clearinghouse
on Child Abuse and Neglect Information, 800-FYI-3366, [email protected], or online at
www.calib.com/nccanch.
CHAPTER 5
T here is no single known cause of child

maltreatment. Nor is there any single
description that captures all families in which
Risk factors associated with child maltreatment can
be grouped in four domains:
children are victims of abuse and neglect. Child • Parent or caregiver factors
maltreatment occurs across socio-economic, religious,
• Family factors
cultural, racial, and ethnic groups. While no specific
causes definitively have been identified that lead a • Child factors
parent or other caregiver to abuse or neglect a child,
research has recognized a number of risk factors or • Environmental factors
attributes commonly associated with maltreatment.
It is increasingly recognized that child maltreatment
Children within families and environments in
arises from the interaction of multiple factors across
which these factors exist have a higher probability of
these four domains.20 The sections that follow
experiencing maltreatment. It must be emphasized,
examine risk factors in each category. Available
however, that while certain factors often are present
research suggests that different factors may play
among families where maltreatment occurs, this
varying roles in accounting for different forms of
does not mean that the presence of these factors will
child maltreatment (physical abuse, sexual abuse,
always result in child abuse and neglect. The factors
neglect, and psychological or emotional abuse).
that may contribute to maltreatment in one family
Some of these differences are highlighted throughout
may not result in child abuse and neglect in another
the chapter.
family. For example, several researchers note the
relation between poverty and maltreatment, yet it A greater understanding of risk factors can
must be noted that most people living in poverty do help professionals working with children and
not harm their children. Professionals who intervene families both to identify maltreatment and high-
in cases of child maltreatment must recognize the risk situations and to intervene appropriately.
multiple, complex causes of the problem and must Assessment of the specific risk factors that affect
tailor their assessment and treatment of children and a family may influence the prioritization of
families to meet the specific needs and circumstances intervention services for that family (e.g., substance
of the family. abuse treatment). Moreover, addressing risk and
protective factors can help to prevent child abuse
and neglect. For example, prevention programs
may focus on increasing social supports for families
(thereby reducing the risk of social isolation) or
providing parent education to improve parent's While the estimated number varies, child
age-appropriate expectations for their children. maltreatment literature commonly supports the
Prevention activities and their link to risk factors are finding that some maltreating parents or caregivers
discussed further in Chapter 7, „What Can Be Done were victims of abuse and neglect themselves as
to Prevent Child Abuse and Neglect?‰ children.23 One review of the relevant research
suggested that about one-third of all individuals
who were maltreated will subject their children to
PARENT OR CAREGIVER FACTORS maltreatment.24 Children who either experienced
maltreatment or witnessed violence between their
Parent or caregiver factors potentially contributing parents or caregivers may learn violent behavior
to maltreatment relate to: and may also learn to justify violent behavior as
appropriate.25
• Personality characteristics and psychological
well-being An incorrect conclusion from this finding, however,
is that a maltreated child will always grow up to
• History of maltreatment become a maltreating parent. There are individuals
who have not been abused as children who become
• Substance abuse
abusive, as well as individuals who have been abused
• Attitudes and knowledge as children and do not subsequently abuse their
own children. In the research review noted above,
• Age approximately two-thirds of all individuals who
were maltreated did not subject their children to
Personality Characteristics and
abuse or neglect.26
Psychological Well-being
It is not known why some parents or caregivers who

were maltreated as children abuse or neglect their own
No consistent set of characteristics or personality children and others with a similar history do not.27
traits has been associated with maltreating parents While every individual is responsible for his or her
or caregivers. Some characteristics frequently actions, research suggests the presence of emotionally
identified in those who are physically abusive or supportive relationships may help lessen the risk of
neglectful include low self-esteem, an external locus the intergenerational cycle of abuse.28
of control (i.e., belief that events are determined
by chance or outside forces beyond one's personal
Substance Abuse
control), poor impulse control, depression, anxiety,
and antisocial behavior.21 While some maltreating
parents or caregivers experience behavioral and Parental substance abuse is reported to be a
emotional difficulties, severe mental disorders are contributing factor for between one- and two-thirds
not common.22 of maltreated children in the child welfare system.29
Research supports the association between substance
abuse and child maltreatment.30 For example:
Parental Histories and the Cycle of Abuse
• A retrospective study of maltreatment experience
A parent's childhood history plays a large part in in Chicago found children whose parents abused
how he or she may behave as a parent. Individuals alcohol and other drugs were almost three times
with poor parental role models or those who did not likelier to be abused and more than four times
have their own needs met may find it very difficult likelier to be neglected than children of parents
to meet the needs of their children. who were not substance abusers.31
What Factors Contribute to Child Abuse and Neglect?

• A Department of Health and Human Services Attitudes and Knowledge
study found all types of maltreatment, and
particularly neglect, to be more likely in alcohol- Negative attitudes and attributions about a child's
abusing families than in nonalcohol-abusing behavior and inaccurate knowledge about child
families.32 development may play a contributing role in child
maltreatment.39 For example, some studies have
Substance abuse can interfere with a parent's mental
found that mothers who physically abuse their
functioning, judgment, inhibitions, and protective
children have both more negative and higher than
capacity. Parents significantly affected by the use
normal expectations of their children, as well as
of drugs and alcohol may neglect the needs of
less understanding of appropriate developmental
their children, spend money on drugs instead of
norms.40 Not all research, however, has found
household expenses, or get involved in criminal
differences in parental expectations.41
activities that jeopardize their children's health or
safety.33 Also, studies suggest that substance abuse A parent's lack of knowledge about normal child
can influence parental discipline choices and child development may result in unrealistic expectations.
rearing styles.34 Unmet expectations can culminate in inappropriate
punishment (e.g., a parent hitting a one-year-old
Over the past decade, prenatal exposure of
for soiling his pants). Other parents may become
children to drugs and alcohol during their
frustrated with not knowing how to manage a
mother's pregnancy and its potentially negative,
child's behavior and may lash out at the child. Still
developmental consequences has been an issue of
others may have attitudes that devalue children or
particular concern. The number of children born
view them as property.
each year exposed to drugs or alcohol is estimated
to be between 550,000 and 750,000.35 While this
issue has received much attention, children who are Age
exposed prenatally represent only a small proportion
of children negatively affected by parental substance Caretaker age may be a risk factor for some forms
abuse.36 of maltreatment, although research findings are
inconsistent.42 Some studies of physical abuse,
The number and complexity of co-occurring in particular, have found that mothers who were
family problems often makes it difficult to younger at the birth of their child exhibited higher
understand the full impact of substance abuse on rates of child abuse than did older mothers.43 Other
child maltreatment.37 Substance abuse and child contributing factors, such as lower economic status,
maltreatment often co-occur with other problems, lack of social support, and high stress levels may
including mental illness, HIV/AIDS or other health influence the link between younger childbirth·
problems, domestic violence, poverty, and prior particularly teenage parenthood·and child abuse.44
child maltreatment. These co-occurring problems
produce extremely complex situations that can be
difficult to resolve.38 Because many of the problems FAMILY FACTORS
may be important and urgent, it can be difficult to
prioritize what services to provide. Additionally,
Specific life situations of some families·such
identifying and obtaining appropriate resources
as marital conflict, domestic violence, single
to address these needs is a challenge in many
parenthood, unemployment, financial stress, and
communities.
social isolation·may increase the likelihood of
maltreatment. While these factors by themselves may
not cause maltreatment, they frequently contribute single mother, and 4 percent lived in households
to negative patterns of family functioning. with a single father.46 A strong, positive relationship
between the child and the father, whether he resides
Family Structure in the home or not, contributes to the child's
development and may lessen the risk of abuse.
Children living with single parents may be at higher In addition, studies have found that compared to
risk of experiencing physical and sexual abuse and similar non-neglecting families, neglectful families
neglect than children living with two biological tend to have more children or greater numbers
parents.45 Single parent households are substantially of people living in the household.47 Chronically
more likely to have incomes below the poverty line. neglecting families often are characterized by a
Lower income, the increased stress associated with chaotic household with changing constellations
the sole burden of family responsibilities, and fewer of adult and child figures (e.g., a mother and her
supports are thought to contribute to the risk of children who live on and off with various others,
single parents maltreating their children. In 1998, such as the mother's mother, the mother's sister, or
23 percent of children lived in households with a a boyfriend).48

The Child Abuse and Father Absence Connection
• The rate of child abuse in single parent households is 27.3 children per 1,000, which is nearly twice
the rate of child abuse in two parent households (15.5 children per 1,000).
• An analysis of child abuse cases in a nationally representative sample of 42 counties found that
children from single parent families are more likely to be victims of physical and sexual abuse than
children who live with both biological parents. Compared to their peers living with both parents,
children in single parent homes had:
- 77 percent greater risk of being physically abused;
- 87 percent greater risk of being harmed by physical neglect;
- 165 percent greater risk of experiencing notable physical neglect;
- 74 percent greater risk of suffering from emotional neglect;
- 80 percent greater risk of suffering serious injury as a result of abuse;
- 120 percent greater risk of experiencing some type of maltreatment overall.
• A national survey of nearly 1,000 parents found that 7.4 percent of children who lived with one
parent had been sexually abused, compared to only 4.2 percent of children who lived with both
biological parents.
• Using data from 1,000 students tracked from seventh or eighth grade in 1988 through high school
in 1992, researchers determined that only 3.2 percent of the boys and girls who were raised with
both biological parents had a history of maltreatment. However, a full 18.6 percent of those in
other family situations had been maltreated.
• A study of 156 victims of child sexual abuse found that the majority of the children came from
disrupted or single-parent homes; only 31 percent of the children lived with both biological
parents. Although stepfamilies make up only about 10 percent of all families, 27 percent of the
abused children in this study lived with either a stepfather or the mother's boyfriend.49
Marital Conflict and Domestic Violence harmful emotional consequences from witnessing
the parental violence.52
According to published studies, in 30 to 60 percent
of families where spouse abuse takes place, child Stress
maltreatment also occurs.50 Children in violent
homes may witness parental violence, may be victims Stress is also thought to play a significant role in
of physical abuse themselves, and may be neglected family functioning, although its exact relationship
by parents who are focused on their partners or with maltreatment is not fully understood.53 Physical
unresponsive to their children due to their own abuse has been associated with stressful life events,
fears.51 A child who witnesses parental violence is parenting stress, and emotional distress in various
at risk for also being maltreated, but, even if the studies.54 Similarly, some studies have found that
child is not maltreated, he or she may experience neglectful families report more day-to-day stress than
non-neglectful families.55 It is not clear, however, of maltreatment. In 2000, for example, the rate of
whether maltreating parents actually experience more documented maltreatment was highest for children
life stress or, rather, perceive more events and life between birth and 3 years of age (15.7 victims per
experiences as being stressful.56 In addition, specific 1,000 children of this age in the population) and
stressful situations (e.g., losing a job, physical illness, declined as age increased.61 The inverse relationship
marital problems, or the death of a family member) between age and maltreatment is particularly strong
may exacerbate certain characteristics of the family for neglect, but not as evident for other types of
members affected, such as hostility, anxiety, or maltreatment (physical, emotional, or sexual abuse).
depression, and that may also aggravate the level of
family conflict and maltreatment.57 Infants and young children, due to their small
physical size, early developmental status, and need
for constant care, can be particularly vulnerable to
Parent-Child Interaction
child maltreatment. Very young children are more
likely to experience certain forms of maltreatment,
Families involved in child maltreatment seldom such as shaken baby syndrome and nonorganic
recognize or reward their child's positive behaviors, failure to thrive. Teenagers, on the other hand, are
while having strong responses to their child's at greater risk for sexual abuse.62
negative behaviors.58 Maltreating parents have been
found to be less supportive, affectionate, playful, and
Disabilities
responsive with their children than parents who do
not abuse their children.59 Research on maltreating
parents, particularly physically abusive mothers, Children with physical, cognitive, and emotional
found that these parents were more likely to use disabilities appear to experience higher rates of
harsh discipline strategies (e.g., hitting, prolonged maltreatment than do other children.63 A national
isolation) and verbal aggression and less likely to use study, completed in 1993, found that children
positive parenting strategies (e.g., using time outs, with disabilities were 1.7 times more likely to be
reasoning, and recognizing and encouraging the maltreated than children without disabilities.64 To
child's successes).60 date, the full degree to which disabilities precede or
are a result of maltreatment is unclear.
CHILD FACTORS In general, children who are perceived by their

parents as „different‰ or who have special needs·
including children with disabilities, as well as
Children are not responsible for being victims of children with chronic illnesses or children with
maltreatment. Certain factors, however, can make difficult temperaments·may be at greater risk of
some children more vulnerable to maltreating maltreatment.65 The demands of caring for these
behavior. The child's age and development·physical, children may overwhelm their parents. Disruptions
mental, emotional, and social·may increase the may occur in the bonding or attachment processes,
child's vulnerability to maltreatment, depending particularly if children are unresponsive to
on the interactions of these characteristics with the affection or if children are separated by frequent
parental factors previously discussed. hospitalizations.66 Children with disabilities also
may be vulnerable to repeated maltreatment because
Age they may not understand that the abusive behaviors
are inappropriate, and they may be unable to escape
The relationship between a child's age and or defend themselves in abusive situations.67 Some
maltreatment is not clear cut and may differ by type researchers and advocates have suggested that some

societal attitudes, practices, and beliefs that devalue unemployment, social isolation, and community
and depersonalize children with disabilities sanction characteristics. It is important to reiterate that
abusive behavior and contribute to their higher most parents or caregivers who live in these types of
risk of maltreatment.68 For instance, there may be environments are not abusive.
greater tolerance of a caregiver verbally berating or
physically responding to a disabled child's inability Poverty and Unemployment
to accomplish a task or act in an expected way than
there would be if similar behavior was directed at a
Poverty and unemployment show strong associations
normally abled child.
with child maltreatment, particularly neglect.73 The
NIS-3 study, for example, found that children from
Other Child Characteristics families with annual incomes below $15,000 in 1993
were more than 22 times more likely to be harmed
While some studies suggest that infants born by child abuse and neglect as compared to children
prematurely or with low birth-weight may be at from families with annual incomes above $30,000.74
increased risk for maltreatment, other studies do It is important to underscore that most poor
not.69 The relationship between low birth-weight and people do not maltreat their children. However,
maltreatment may be attributable to higher maternal poverty·particularly when interacting with other
stress heightened by high caregiver demands, but it risk factors such as depression, substance abuse,
also may be related to poor parental education about and social isolation·can increase the likelihood
low birth-weight, lack of accessible prenatal care, and of maltreatment. In 1999, 85 percent of States
other factors, such as substance abuse or domestic identified poverty and substance abuse as the top
violence.70 two problems challenging families reported to child
protective service (CPS) agencies.75
Child factors such as aggression, attention deficits,
difficult temperaments, and behavior problems·or Rod Plotnik, emeritus professor, Department of
the parental perceptions of such problems·have Psychology, San Diego State University, describes
been associated with increased risk for all types of several theories related to the association between
child maltreatment.71 These factors may contribute poverty and maltreatment, all of which may hold
indirectly to child maltreatment when interacting some truth. One theory is that low income creates
with certain parental characteristics, such as poor greater family stress, which, in turn, leads to higher
coping skills, poor ability to empathize with the chances of maltreatment. A second theory is that
child, or difficulty controlling emotions. In addition, parents with low incomes, despite good intentions,
these same child characteristics may be reinforced by may be unable to provide adequate care while raising
the maltreatment (e.g., a physically abused child children in high-risk neighborhoods with unsafe or
may develop aggressive behaviors that elicit harsh crowded housing and inadequate daycare. A third
reactions from others) and create conditions that theory is that some other characteristics may make
can lead to recurring maltreatment.72 parents more likely to be both poor and abusive.
For example, a parent may have a substance abuse
problem that impedes the parent's ability to obtain
ENVIRONMENTAL FACTORS and maintain a job, which also may contribute to
abusive behavior. A final theory is that poor families
Environmental factors are often found in may experience maltreatment at rates similar to other
combination with parent, family, and child families, but that maltreatment in poor families is
factors, as highlighted in previous sections of this reported to CPS more frequently, in part because
chapter. Environmental factors include poverty and they have more contact with and are under greater
scrutiny from individuals who are legally mandated Societal attitudes and the promotion of violence in
to report suspected child maltreatment.76 cultural norms and the media have been suggested as
risk factors for physical abuse.81 In addition, while
Social Isolation and Social Support the research is controversial, some studies show a
positive relationship between televised violence and
aggressive behaviors, particularly for individuals
Some studies indicate that compared to other
who watch substantial amounts of television.82
parents, parents who maltreat their children report
experiencing greater isolation, more loneliness,
and less social support.77 Social isolation may PROTECTIVE FACTORS
contribute to maltreatment because parents have
less material and emotional support, do not have
positive parenting role models, and feel less pressure Just as there are factors that place families at risk
to conform to conventional standards of parenting for maltreating their children, there are other factors
behaviors.78 It is not clear, however, whether social that may protect them from vulnerabilities·factors
isolation in some cases precedes and serves as a that promote resilience. In general, research has
contributing factor to maltreatment or whether found that supportive, emotionally satisfying
it is a consequence of the behavioral dynamics of relationships with a network of relatives or friends
maltreatment.79 can help minimize the risk of parents maltreating
children, especially during stressful life events.83 For
example, parents who were abused as children are
Violent Communities less likely to abuse their own children if they have
resolved internal conflicts and pain related to their
Children living in dangerous neighborhoods have history of abuse and if they have an intact, stable,
been found to be at higher risk than children from supportive, and nonabusive relationship with their
safer neighborhoods for severe neglect and physical partner.84 Additionally, programs on marriage
abuse, as well as child sexual victimization.80 Some education and enhancement may provide a roadmap
risk may be associated with the poverty found of expected challenges such as the birth of the first
in dangerous neighborhoods, however, concerns child, parenting adolescents, and common gender
remain that violence may seem an acceptable differences which may act as a protective factor by
response or behavior to individuals who witness it strengthening families.85
more frequently.

CHAPTER 6
T he consequences of child maltreatment can

be profound and may endure long after the
abuse or neglect occurs. The effects can appear in
Despite the above challenges, it is still possible to
identify effects that have been more commonly
associated with individuals who have experienced
childhood, adolescence, or adulthood, and may affect abuse and neglect. These effects are discussed
various aspects of an individual's development (e.g., in the sections that follow as they relate to three
physical, cognitive, psychological, and behavioral). overlapping areas:
These effects range in consequence from minor
physical injuries, low self-esteem, attention disorders, • Health and physical effects
and poor peer relations to severe brain damage,
• Intellectual and cognitive development
extremely violent behavior, and death.86
• Emotional, psychological, and behavioral
While substantial evidence exists for the negative
consequences
consequences of maltreatment, practitioners should
be aware of the limitations of current research. First, While maltreated children have a higher risk of
many research efforts have studied the effects of child certain problems, it cannot be concluded that
maltreatment among individuals from lower socio any given consequence will always occur. Not all
economic backgrounds, prison populations, mental children who have been maltreated will suffer severe
health patients, or other clinical populations who consequences. A number of factors may influence
may exhibit the most serious behavior problems and the effects of maltreatment, including the child's
whose families often have had many other problems age and developmental status at the time of the
(e.g., poverty, parental substance abuse, domestic maltreatment, as well as the type, the frequency, the
violence). Further, many early studies examining duration, and the severity of the maltreatment and
consequences did not compare outcomes among co-occurring problems.87 In addition, research has
maltreated individuals with outcomes among identified certain protective factors that mediate the
individuals who had not experienced maltreatment. effects of maltreatment. These protective factors
In addition, studies often rely on official records or and a child's resilience to negative consequences are
self-reporting of current or past child maltreatment, addressed in the final section of this chapter.
both of which may undercount the true prevalence
of maltreatment. Finally, the nature and extent
of maltreatment are different for each child and
family, and these differences may influence the
consequences.
as well as cognitive and psychological problems.90
HEALTH AND PHYSICAL EFFECTS Even with treatment, the long-term consequences
can include continued growth problems, diminished
Health and physical effects can include the cognitive abilities, retardation, and socio-emotional
immediate effects of bruises, burns, lacerations, and deficits such as poor impulse control.
broken bones and also longer-term effects of brain
damage, hemorrhages, and permanent disabilities. Effects on Brain Development
Negative effects on physical development can result
from physical trauma (e.g., blows to the head or Over the last decade, researchers have enhanced
body, violent shaking, scalding with hot water, or the field's understanding of the adverse effects of
asphyxiation) and from neglect (e.g., inadequate maltreatment on early brain development. Recent
nutrition, lack of adequate motor stimulation, or brain research has established a foundation for
withholding medical treatments). Specific physical the neurobiological explanations for many of the
effects as they relate to the early brain development physical, cognitive, social, and emotional difficulties
of infants are highlighted in the following sections, exhibited by children who experienced maltreatment
along with some general health problems associated in their early years.
with maltreatment. The issue of child fatalities, the
most tragic consequence of child maltreatment, is One explanation begins with the link between chronic
discussed in Chapter 4, „What Is the Scope of the physical abuse, sexual abuse, or neglect and the chronic
Problem?‰ stress it typically causes in a young child. In reaction
to this persistent stress associated with ongoing
Physical Effects on Infants maltreatment, the child's brain may strengthen the
pathways among neurons that are involved in the fear
response. As a result, the brain may become „wired‰
Infants and young children are particularly
to experience the world as hostile and uncaring. This
vulnerable to the physical effects of maltreatment.
negative perspective may influence the child's later
Shaking an infant may result in bruising, bleeding,
interactions, prompting the child to become anxious
and swelling in the brain. The health consequences
and overly aggressive or withdrawn.91
of „shaken baby syndrome‰ can range from
vomiting or irritability to more severe effects, such Research shows that maltreatment also may inhibit
as concussions, respiratory distress, seizures, and the appropriate development of certain regions
death.88 Other possible consequences include partial of the brain. A neglected infant or young child,
loss of vision or blindness, learning disabilities, for example, may not be exposed to stimuli that
mental retardation, cerebral palsy, or paralysis.89 would activate important regions of the brain and
strengthen cognitive pathways. Consequently, the
Infants who have been neglected and malnourished
connections among neurons in these inactivated
may experience a condition known as „nonorganic
regions can literally whither away, hampering
failure to thrive.‰ With this condition, the child's
the individual's later functioning. If the regions
weight, height, and motor development fall
responsible for emotional regulation are not
significantly below age-appropriate ranges with no
activated, the child may have trouble controlling
medical or organic cause. The death of the child is
his or her emotions and behaving or interacting
the end result in extreme cases. Nonorganic failure
appropriately (e.g., impulsive behavior, difficulties
to thrive can result in continued growth retardation
in social interactions, or a lack of empathy).92
What Are the Consequences of Child Abuse and Neglect?

Other Health-related Problems
EMOTIONAL, PSYCHOSOCIAL, AND
Maltreatment may affect an individual's health in BEHAVIORAL DEVELOPMENT
a number of direct and indirect ways. Victims of

sexual abuse, for example, may become infected All types of maltreatment·physical abuse, sexual
with sexually transmitted diseases including syphilis abuse, neglect, and psychological or emotional
and human immunodeficiency virus (HIV). Studies maltreatment·can affect a child's emotional and
have found that women who had experienced sexual psychological well-being and lead to behavioral
abuse were more likely to experience ongoing health problems. These consequences may appear
problems such as chronic pelvic pain and other immediately after the maltreatment or years later.
gynecologic problems, gastrointestinal problems,
headaches, and obesity.93 Recent research suggests
Emotional and Psychological Consequences
that adults who were maltreated as children show
higher levels of many health problems not typically
associated with abuse and neglect·heart disease, While there is no single set of behaviors that is
cancer, chronic lung disease, and liver disease.94 The characteristic of all children who have been abused
link between maltreatment and these diseases may and neglected, the presence of emotional and
be depression, which can influence the immune psychological problems among many maltreated
system and may lead to higher risk behaviors such children is well documented. Clinicians and
as smoking, alcohol and drug use, and overeating.95 researchers report behaviors that range from passive
and withdrawn to active and aggressive.99 Physically
and sexually abused children often exhibit both
COGNITIVE DEVELOPMENT AND
internalizing and externalizing problems.100
ACADEMIC ACHIEVEMENT
Emotional and psychosocial problems identified
among individuals who were maltreated as children
include:
Current research differs on findings related to
the consequences of maltreatment on cognitive • Low self-esteem
development, verbal abilities, and problem-solving
skills. Some studies find evidence of lowered • Depression and anxiety
intellectual and cognitive functioning in abused
• Post-traumatic stress disorder (PTSD)
children as compared to children who had not been
abused,96 and other studies find no differences.97 • Attachment difficulties
Research has consistently found that maltreatment • Eating disorders
increases the risk of lower academic achievement
and problematic school performance.98 Abused • Poor peer relations
and neglected children in these studies received
lower grades and test scores than did nonmaltreated • Self-injurious behavior (e.g., suicide attempts)101
children.
Maltreated children who developed insecure
attachments to caregivers may become more
mistrustful of others and less ready to learn from
adults. They also may experience difficulties in
understanding the emotions of others, regulating
their own emotions, and in forming and maintaining RESILIENCE
relationships with peers.102
Not every child who is maltreated will experience the
Violence, Substance Abuse, negative consequences discussed above. „Protective
and Other Problem Behaviors factors‰ that appear to mediate or serve as a „buffer‰
against the effects of the negative experiences may
Individuals victimized by child maltreatment are include:
more likely than people who were not maltreated
• Personal characteristics, such as optimism,
to engage in juvenile delinquency, adult criminality,
high self-esteem, high intelligence, or a sense of
and violent behavior.103 A study sponsored by the
hopefulness.108
National Institute of Justice followed cases from
childhood through adulthood and compared • Social support and relationships with a
arrest records of a group of substantiated cases of supportive adult(s).109
maltreatment with a comparison group composed
of individuals who were not officially recorded The finding that the seriousness of negative effects
as maltreated. While most members of both experienced by victims can be influenced by the
groups had no juvenile or adult criminal records, availability of support from parents, relatives,
being abused or neglected as a child increased the professionals, and others has important implications
likelihood of arrest as a juvenile by 53 percent and for prevention and early intervention, discussed later
as a young adult by 38 percent.104 Physically abused in this manual.
children were the most likely of maltreated children
Studies have documented the link between abuse
to be arrested later for violent crime, followed closely
and neglect of children and a range of physical,
by neglected children.
emotional, psychological, and behavioral problems.
Other studies also have found maltreated children In addition to the tragic consequences endured by
to be at increased risk (at least 25 percent more the children who have been maltreated, society pays
likely) for a variety of adolescent problem behaviors, a high monetary cost for child maltreatment. The
including delinquency, teen pregnancy, drug use, costs for child maltreatment include both direct
low academic achievement, and mental health costs (i.e., those associated with the immediate
problems.105 It must be underscored, however, that needs of abused and neglected children) and indirect
while the risk is higher, most abused and neglected costs (i.e., those associated with the longer term and
children will not become delinquent, experience secondary effects of child maltreatment). Since
adolescent problem behaviors, or become involved some maltreatment goes unrecognized and it is
in violent crime. difficult to link costs to specific incidents, it is not
possible to determine the actual cost of child abuse
Research also suggests a relationship between child and neglect. As estimated by Prevent Child Abuse
maltreatment and later substance abuse.106 In America, the total annual cost of child abuse and
addition to being a risk factor, child maltreatment, neglect in the United States may be as high as $94
particularly sexual abuse, may be a precursor of billion, as shown in Exhibit 6-1.
substance abuse.107
What Are the Consequences of Child Abuse and Neglect?

Exhibit 6-1
The Estimated Costs of Child Maltreatment110
Source of Costs Estimated Annual Cost
Direct Costs
Hospitalization $6,205,395,000
Chronic health problems $2,987,957,400
Mental health care system $425,110,400
Child welfare system $14,400,000,000
Law enforcement $24,709,800
Judicial system $341,174,702
Total direct costs $24,384,347,302
Indirect Costs
Special education $223,607,803
Mental health and health care $4,627,636,025
Juvenile delinquency $8,805,291,372
Lost productivity to society (due to unemployment) $656,000,000
Adult criminality $55,380,000,000
Total indirect costs $69,692,535,227
Total Cost $94,076,882,529
CHAPTER 7
T he seriousness of the effects of maltreatment,

presented in the previous chapter, underscore the
importance for professionals, along with concerned
deter predictable problems, protect existing states
of health, and promote desired life objectives.112
More specifically, family support services, a major
community members, to help prevent child component of child abuse prevention, are designed
maltreatment. To break the cycle of maltreatment, to strengthen and stabilize families, increase
communities across the country must continue to parental abilities, provide a safe and stable family
develop and implement strategies that prevent abuse environment, and enhance child development.113
or neglect from happening. While experts agree that
the causes of child abuse and neglect are complex, To prevent child abuse and neglect, programs may
it is possible to develop prevention initiatives that focus on one or several risk factors discussed in
address known risk factors. This chapter provides Chapter 5, „What Factors Contribute to Child
an overview of prevention as a strategy, differentiates Abuse and Neglect?‰ For example, prevention
the various types of prevention activities, describes programs may include:
major prevention program models, and presents the
• Substance abuse treatment programs for women
roles of various sectors in prevention efforts.
with children;
• Respite care programs for families with children

PREVENTION AS A STRATEGY
who have disabilities;
Prevention efforts most commonly occur before • Parent education programs and support groups
a problem develops so that the problem itself, or for families affected by domestic violence.
some manifestation of the problem, can be stopped
Many prevention programs also focus efforts on
or lessened.111 Child abuse and neglect prevention
strengthening child and family protective factors
covers a broad spectrum of services·such as public
such as the knowledge and skills children need
awareness, parent education, and home visitation·
to help protect themselves from sexual abuse, the
for audiences ranging from the general public to
promotion of positive interactions between children
individuals who have abused or neglected a child.
and parents, and the knowledge and skills parents
Community groups, social services agencies, schools,
need to raise healthy, happy children.
and other concerned citizens may provide these
services. Typically, prevention activities attempt to
Secondary or Selective Prevention
TYPES OF PREVENTION ACTIVITIES
Secondary prevention activities focus efforts and
Child abuse and neglect prevention activities resources on children and families known to
generally occur at three basic levels: be at higher risk for maltreatment. Several risk
factors such as substance abuse, young maternal
• Primary, or universal, prevention activities are age, developmental disabilities, and poverty are
directed at the general population with the goal associated with child maltreatment. Programs may
of stopping the occurrence of maltreatment direct services to communities or neighborhoods
before it starts. that have a high incidence of one or several risk
factors. Examples of secondary prevention programs
• Secondary, or selective, prevention activities
include the following:
focus on families at high risk of maltreatment
to alleviate conditions associated with the • Parent education programs located in high
problem. schools for teen mothers;
• Tertiary, or indicated, prevention activities direct • Substance abuse treatment programs for parents
services to families where maltreatment has with young children;
occurred to reduce the negative consequences of
the maltreatment and to prevent its recurrence. • Respite care for families who have children with
special needs;
Primary or Universal Prevention • Family resource centers offering information
and referral services to families living in low-
Primary prevention includes activities or services income neighborhoods.
available to the general public. Frequently such
activities aim to raise awareness among community Family support activities that are available to
members, the public, service providers, and decision- individuals identified as at risk or community
makers about the scope and problems associated members in a high-risk neighborhood also are
with child maltreatment. For example: considered secondary prevention. For example,
local hospitals or community organizations may
• Public awareness campaigns informing citizens offer prenatal care and parenting classes to new
how and where to report suspected child abuse or expectant parents. Local agencies may provide
and neglect; home visitation services for at risk families with
infants and young children. Family support services
• Public service announcements on the radio or are intended to assist parents in creating safe home
television encouraging parents to use nonviolent environments and fostering healthy children.
forms of discipline.
These types of programs are particularly popular Tertiary or Indicated Prevention

during April, which is designated by presidential
proclamation as Child Abuse Prevention Month. Tertiary prevention activities focus efforts on families
Other primary prevention efforts focus on support in which maltreatment has already occurred. The goal
services available to the general population, such as of these programs is to prevent maltreatment from
pediatric care for all children, childcare, or parent recurring and to reduce the negative consequences
education classes. associated with maltreatment (e.g., social-emotional
problems in children, lower academic achievement,
What Can Be Done to Prevent Child Abuse and Neglect?

decreased family functioning). These prevention Public Awareness Activities
programs may include services such as:
Public awareness activities are an important part of
• Intensive family preservation services with
an overall approach to addressing child abuse and
trained mental health counselors available to
neglect. The purpose of public awareness activities
families 24 hours per day for several weeks;
is to raise community awareness of child abuse
• Parent mentor programs with stable, nonabusive and neglect as a public issue and to provide the
families acting as „role models‰ and providing public with information about available resources
support to families in crisis; and solutions. Such activities have the potential
to reach diverse community audiences: parents
• Mental health services for children and families and prospective parents, children, and community
affected by maltreatment to improve family members, including professionals, who are critical to
communication and functioning. the identification and reporting of abuse.
A combination of primary, secondary, and tertiary In designing prevention education and public
prevention services are necessary for any community information activities, national, State, and local
to provide a full continuum of services to deter the organizations use a variety of media to promote
devastating effects of child maltreatment. these activities, including:
• Public service announcements

MAJOR PREVENTION PROGRAM MODELS
• Press releases
Many popular prevention programs are patterned • Posters

after one of four models:
• Information kits and brochures
• Public awareness activities
• Television or video documentaries and dramas
• Parent education programs
Through these media, communities are able to
• Skills-based curricula for children promote support for healthy parenting practices,
child safety skills, and protocols for reporting
• Home visitation programs suspected maltreatment.
Organizations Supporting Public Awareness Activities
State ChildrenÊs Trust Funds

State Children's Trust Funds (CTFs) exist in all 50 States and the District of Columbia with the specific goal
of preventing child maltreatment. CTFs coordinate prevention activities throughout their State by promoting
and funding a variety of community-based programs including public awareness campaigns, home visitation
programs, skills-based curricula for children, and parent education and support activities. In addition, many
CTFs develop and distribute posters for community groups, schools, and many other professionals working
with children. The poster may encourage parents to use positive discipline techniques or encourage children
to say „no‰ to touching that makes them uncomfortable.
DonÊt Shake the Baby Campaign
One of the largest public awareness initiatives focuses on the prevention of Shaken Baby Syndrome. A national
network of DonÊt Shake the Babyy State contacts was established to ensure that all professionals involved in the
care of children (e.g., teachers, physicians, nurses, home visitors, parent educators) become aware of the dangers
associated with shaking infants. In addition to professionals, this campaign targets parents to alert them to the
dangers of shaking their baby as well as playing with the baby in certain ways (e.g., throwing the baby in the air,
bouncing the baby on a knee, twisting the baby in the air).
Prevent Child Abuse America
Prevent Child Abuse America, formerly the National Committee to Prevent Child Abuse (NCPCA), is
a leading national organization actively engaged in public awareness activities. Prevent Child Abuse
America, together with Marvel Comics, developed Spider-Man comic books that address child sexual
abuse and child safety issues. This organization also distributes an information packet each year to
assist community groups planning Child Abuse Prevention Month activities. Both the national office
and Prevent Child Abuse America State Chapters throughout the country provide public awareness and
other activities to prevent child abuse and neglect.
Blue Ribbon Campaign
The Blue Ribbon Campaign began as a tribute from a Virginia grandmother to a grandchild whose
battered body was found at the bottom of a canal. By tying a blue ribbon·signifying the pain and
bruises suffered by abused children·around the antennae of her van, Bonnie Finney sought to raise
awareness of the devastating effects of child abuse and neglect. Since those early days in the 1980s, the
Blue Ribbon Campaign has grown into a national effort to raise awareness of the scope and problem
of child maltreatment. The blue ribbon, often worn during April for Child Abuse Prevention Month,
serves as the most recognized symbol for child abuse prevention.

Parent Education Programs help prevent child maltreatment. For example,
Parents Anonymous affiliates work within their
Parent education programs focus on enhancing communities and States to provide support and
parental competencies and promoting healthy resources to overwhelmed families struggling to
parenting practices and typically target teen and cope with everyday stresses and strains.
highly stressed parents. Some of these programs
are led by professionals or paraprofessionals, while Skills-based Curricula for Children
others are facilitated by parents who provide mutual
support and discuss personal experiences. These Many schools and local community social service
programs address issues such as: organizations offer skills-based curricula to teach
children safety and protection skills. Most of
• Developing and practicing positive discipline
these programs focus efforts on preventing child
techniques;
sexual abuse and teaching children to distinguish
• Learning age-appropriate child development appropriate touching from inappropriate touching.
skills and milestones; Many curricula have a parent education component
to give parents and other caregivers the knowledge
• Promoting positive play between parents and and skills necessary to recognize and discuss sexual
children; abuse with their children. Curricula may use various
methods to teach children skills including:
• Locating and accessing community services and
supports. • Workshops and school lessons
Parent education programs are designed and • Puppet shows and role-playing activities
structured differently, usually depending on the
curriculum being used and the target audience. • Films and videos
Programs may be short-term (i.e., those offering
• Workbooks, storybooks, and comics
classes once a week for 6 to 12 weeks) or they may
be more intensive (i.e., those offering services more Examples of skills-based curricula include programs
than once a week and for up to 1 year). Popular such as Talk About Touching, Safe Child, Reach,
parent education programs include: Recovery, Challenge, Good Touch/Bad Touch, Kids
on the Block, and Illusion Theater.
• Parents as Teachers·visit www.patnc.org for
more information;
Home Visitation Programs
• Every Person Influences Children (EPIC)·
visit www.epicforchildren.org for more Home visitation programs that emphasize the health
information; and well-being of children and families have existed
• The Nurturing Parenting Program·visit in the United States since the late 19th century.
www.nurturingparenting.com for more Organizations and agencies in fields as varied as
information. education, maternal and child health, and health
and human services, use home visitation programs
In addition to parent education programs, mutual to help strengthen families. Home visitation
support groups also may strengthen families and programs offer a variety of family-focused services
to pregnant mothers and families with newborns. Recent evaluations suggest that both short- and
Activities encompass structured visits in the family's long-term positive outcomes may occur for mothers
home, informal visits, and telephone calls. Topics and children receiving home visitation services.
addressed through these programs often include: During a two-year period, nurses provided home
visitation services to a group of poor, unmarried,
• Positive parenting practices and nonviolent teen mothers in Elmira, New York. Only 4 percent
discipline techniques; of the nurse-visited families had verified reports of
child abuse and neglect compared to 19 percent of
• Child development;
the families who did not receive home visits by
• Maternal and child health issues; nurses.114 A follow-up study further supported these
positive results: the number of verified reports of
• Accessing available social services; child maltreatment for the nurse-visited group of
mothers was nearly half that of mothers who did not
• Establishing social supports and networks;
receive home visitation services during the next 15
• Learning to advocate for oneself, one's child, years.115 Additional positive outcomes among nurse-
and one's family; visited mothers included lower levels of smoking,
fewer and better-spaced subsequent pregnancies, and
• Preventing accidental childhood injuries through more months working, as well as fewer emergency
the development of a safe home environment. room visits by children for injuries. Several studies
of home visitation programs using nonmedical
professionals also showed a significantly lower
number of verified maltreatment reports for home-
visited mothers.116
Home Visitation Programs
• Home Visitation 2000 provides services to first-time mothers in Denver, Colorado. This program
focuses efforts on improving maternal health, environmental health (home safety), quality of caregiving
for infants and toddlers, maternal life course development (education and employment), and social
support. For more information, visit www.unitedwaydenver.org/IRIS/aa0g6f81.htm.
• HawaiiÊs Healthy Start is a statewide, multisite program that screens, identifies, and provides
services to families at high risk for child abuse and neglect. Most families are enrolled after
the birth of a child, but some enroll during the prenatal period. For more information, visit
www.state.hi.us/doh/legrpts2002/mchs_healthystart.pdf.
• Healthy Families America (HFA) is a national initiative launched by Prevent Child Abuse America
and Ronald McDonald House Charities in 1992. Modeled after Hawaii's Healthy Start, HFA currently
has home visitation programs in more than 3,000 sites across the country. For more information, visit
www.healthyfamiliesamerica.org.

• Support programs that assist parents of
ROLE OF VARIOUS ENTITIES children with special health and developmental
IN PREVENTION EFFORTS problems.
Primary care providers emphasize the prevention of

Prevention programs typically are administered disease and the promotion of health and well-being.
through specific entities, based on an area of interest With this foundation, they have a natural role in the
or professional expertise. Increasingly, health prevention of child abuse and neglect.
care providers, community organizations, social
services agencies, schools, the faith community,
and employers are becoming involved in the well Community-based Organizations
being of children and families. All members of the
community are working together to prevent child Many community organizations offer a wide range
maltreatment and ensure the health and safety of services for children and families. Boys and Girls
of children and families. The following sections Clubs, scouting troops, and local YMCA/YWCAs
describe how these organizations are providing provide social and recreational opportunities for
prevention services to strengthen and support children and families. Community centers, food
families. banks, emergency assistance programs, and shelters
offer various family support services to increase
family resources and decrease stress. Exchange
Health Care Providers
Clubs, fraternal organizations, advocacy groups,
and ethnic, cultural, and religious organizations also
Health care providers are in a unique position to support child maltreatment prevention activities.
assist in the prevention of child maltreatment.
These professionals have routine access to children Specific examples of prevention activities found
and families by providing regular appointments, within community-based organizations include:
immunizations, and interventions to common
• Self-help and mutual aid groups that provide
illnesses. Activities that promote the health of
nonjudgmental support and assistance to
children and their parents and contribute to the
troubled families;
prevention of child maltreatment include:
• Natural support networks that provide
• Prenatal health care that improves pregnancy
families with informal helpers and community
outcomes and health among new mothers and
resources;
infants;
• Child and respite care programs that reduce the
• Early childhood health care that supports
stress parents experience and provide positive
normal development and the health of young
modeling for parents and children.
children;
Many grassroots efforts develop dynamic
• Family-centered birthing and perinatal coaching
partnerships of professionals, businesses, faith-based
that strengthens early attachment between
organizations, concerned citizens, and other groups
parents and their children;
interested in creating prevention efforts that address
• Home health visitation that provides support, the needs of their community.
education, and community linkages for new
parents;
Social Services Agencies Since most children attend public or private schools,
school-based prevention activities have the potential
Increasingly, social service agencies and professionals to reach the majority of U.S. children.
are expanding their focus to include programs
that prevent family problems from escalating to Faith Community
abuse or neglect. Effective social service initiatives
for strengthening families and preventing child Religious institutions are among the most influential
maltreatment include: organizations in many communities. Churches,
temples, synagogues, mosques, and other faith-based
• Parent education services, which help parents to
groups play an important role in reaching out to
develop adequate child-rearing knowledge and
and helping families at risk. Spiritual leaders can
skills;
use their religious messages as a positive force in
• Parent aide programs, which provide supportive, preventing child abuse and neglect and advocating
one-on-one relationships for parents; nonabusive parenting practices. Faith communities
frequently foster and offer important social supports
• Crisis and emergency services, which support to families.117 Empirical studies suggest a significant
parents and children at times of exceptional relationship between an individual's participation in
stress or crisis; faith practices and physical and mental well-being.118
Improved social supports and enhanced well-being
• Treatment for abused children, which prevents
can help strengthen families and act as protective
an intergenerational repetition of family
factors. Faith communities can participate in
violence.
prevention efforts through activities such as:
As State and local social service agencies examine
• Training religious and lay leaders to recognize
new ways of „doing business,‰ many are pooling
the signs and symptoms of child maltreatment;
resources to provide more prevention services.
• Sponsoring or allowing self-help, parent
Schools education, and support groups to meet at their
facilities;
With increased public and professional attention • Offering respite care for congregation members
on the serious social problems affecting children in need of short-term relief from caregiving
and adolescents, schools have become the focus for responsibilities;
many new prevention efforts including:
• Collecting clothes and baby care products (e.g.,
• Comprehensive, integrated prevention diapers, car seats) for new parents;
curricula to provide children with the skills,
knowledge, and information necessary to cope • Sponsoring after school programs and safety
successfully with the challenges of childhood training for latchkey children;
and adolescence;
• Organizing mentoring programs that pair
• Personal safety programs; responsible adults with children;
• Support programs for children with special • Disseminating information on child

needs to help reduce the stress on families with development, parental stress, and community
a child with disabilities. resources for parents;

• Offering special outreach and education • Parental leave policies that reduce stress on new
programs for parents and students associated parents and help facilitate positive attachments
with parochial schools. between parents and their infants;
• Employer-supported child care;

Employers
• Family-oriented policies that support healthy
As the number of parents working outside the and humane working conditions and ensure
home continues to grow, the need increases for adequate family income;
workplace policies that support family functioning
• Employee assistance programs that can provide
and promote the prevention of child maltreatment.
information on reducing stress.
Family-focused initiatives for the workplace
include: For all working parents, a supportive work
environment can help ease the stress of the dual
• Flexible work schedules and other „family
responsibilities of work and family. For some
friendly‰ policies that help employees to
already vulnerable parents, a supportive work
balance the demands of their work and parental
climate may prevent family dysfunction, breakdown,
commitments;
abuse, and neglect.119
Working together, the various sectors of the community·health care providers, community-based
organizations, social services agencies, schools, the faith community, employers, other community
practitioners and concerned citizens·can help strengthen families, foster healthy child development,
and reduce child maltreatment.
For more information on child abuse and neglect prevention, contact one of the organizations listed
in Appendix B.
CHAPTER 8
M ost Americans believe, and professionals

agree, that parents are in the best position
to nurture, protect, and care for the needs of their
were already in place, the child welfare policy of the
SSA layered Federal funds over existing State-level
foundations. These child welfare programs, thus,
children. Although most parents are usually capable were new only to the extent that they established
of meeting these needs, the State has the authority to a uniform framework for administration.120
intervene in the parent-child relationship if a parent Congress has amended the Act several times and
is unable or fails to protect his or her child from changed the Act significantly with the passage of
preventable and significant harm. The purpose the Personal Responsibility and Work Opportunity
of this chapter is to present basic information Reconciliation Act of 1996. Within the Federal
about the Federal and State governments' power government, the Children's Bureau and its Office
and authority to intervene into the private lives of on Child Abuse and Neglect (OCAN) serve as a
families when child maltreatment is alleged. The focal point for efforts to respond to the problem of
first section reviews the Federal role in addressing child maltreatment.
child maltreatment, while the second section
discusses the basis for State intervention in family Parens Patriae
life, highlights State child maltreatment reporting
statutes, and describes the functions of civil and
The basis for intervention in child maltreatment is
criminal courts.
grounded in the concept of parens patriae·a legal
term that asserts the government's role in protecting
THE FEDERAL ROLE IN ADDRESSING
the interests of children and intervening when parents
CHILD ABUSE AND NEGLECT
fail to provide proper care. The legal framework
regarding the parent-child relationship balances
the rights and responsibilities among parent, child,
States initiated mechanisms to assist and protect and State, as guided by Federal statutes. It has long
children prior to any Federal-level activity. In 1912, been recognized that parents have a fundamental
the Federal government established the Children's liberty interest, protected by the Constitution, to
Bureau to address these issues. Federal programs raise their children as they choose. This parent-
designed to support child welfare services and to child relationship grants certain rights, duties, and
direct Federal aid to families date from 1935, with obligations to both parent and child, including the
the passage of the Social Security Act (SSA). Since responsibility of the parent to protect the child's
State-supervised and State-administered programs safety and well-being. If a parent, however, is unable
or unwilling to meet this responsibility, the State has v The Adoption Assistance and Child Welfare
the power and authority to take action to protect a Act of 1980 (P.L. 96-272) requires States to
child from significant harm. establish programs and implement procedures
to support maltreated children and their
A series of U.S. Supreme Court cases have defined families, in their own homes, and facilitate
when it is constitutional for the State to intervene family reunification following out-of-home
in family life.121 Although the Court has given placements.
parents great latitude in the upbringing and
education of their children, it has held that the v Family Preservation and Support Services
rights of parenthood and the family have limits Program enacted as part of the Omnibus
and can be regulated in the interest of the public. Budget Reconciliation Act of 1993 (P.L. 103
The Court has further concluded that the State, as 66) provides funding for prevention and support
parens patriae, may restrict the parent's control by services for families at risk of maltreatment
regulating or prohibiting the child's labor, requiring and family preservation services for families
school attendance, and intervening in other ways experiencing crises that might lead to out-of
to promote the child's well-being.122 This doctrine home placement.
has evolved into the principle that the community,
in addition to the parent, has a strong interest in v The Adoption and Safe Families Act (ASFA)
the care and nurturing of children, who represent of 1997 (P.L. 105-89) was built on earlier laws
the future of the community. When basic needs and reforms in the field to promote the safety,
of children are not met or when their rights have permanency, and well-being of maltreated
been violated, as with cases of child maltreatment, children. A component of ASFA is the
the State has an obligation to intervene to assist the Promoting Safe and Stable Families (PSSF)
affected individuals. Program, which was developed from and
expanded upon the Family Preservation and
Support Services Program mentioned above.
Federal Legislation and Programs
While the legislation reaffirms the importance
of making reasonable efforts to preserve and
Over the past several decades, Congress also has reunify families, it also specifies instances
passed significant pieces of child welfare legislation where reunification efforts do not have to be
that support the States' duty and power to act made (e.g., when a child is not safe with his or
on behalf of a child when parents are unable or her family), establishes tighter time frames for
unwilling. Key Federal legislation that addresses the termination of parental rights, and promotes
protection of maltreated children are highlighted adoption initiatives.
below:
v Child Abuse Prevention and Enforcement
v The Child Abuse Prevention and Treatment Act of 2000 (P.L. 106-177) focuses on improving
Act (CAPTA) of 1974 (P.L. 93-247) was the criminal justice system's ability to provide
established to ensure that victimized children timely, accurate criminal-record information
are identified and reported to appropriate to agencies engaged in child protection, and
authorities. The Act was most recently amended enhancing prevention and law enforcement
in 1996 (P.L. 104-235) and continues to provide activities.
minimum standards for definitions and reports
of child maltreatment.
Which Laws and Policies Guide Public Intervention in Child Maltreatment?

v Strengthening Abuse and Neglect Courts the Children's Justice Act. Also, OCAN is the
Act of 2000 (P.L.106-314) was designed to focal point for interagency collaborative efforts,
improve the administrative efficiency and national conferences, and special initiatives
effectiveness of the courts' handling of abuse related to child abuse and neglect.
and neglect cases.
• The Division of Child Welfare Capacity Building
v Promoting Safe and Stable Families provides leadership and direction in the areas of
Program Reauthorization of 2002 (P.L.107 training, technical assistance, and information
133) continued to build upon ASFA by dissemination as directed by Titles IV-B and IV
extending the PSSF for an additional 5 years E of the Social Security Act (SSA) and CAPTA.
and increasing discretionary funding. It also
created several new programs including a new • The Division of Policy provides leadership
state grant program that provides education and and direction in policy development and
training vouchers for youth aging out of foster interpretation as directed by Titles IV-B and
care and a mentoring program for children with IV-E of SSA, the Basic State Grant (BSG), and
incarcerated parents. CAPTA.
These and other pieces of legislation also provide for • The Division of Program Implementation
a variety of funding streams·particularly State grant provides leadership and direction in the
and discretionary grant programs·which support operation and review of programs as directed by
prevention and treatment services for children and Titles IV-B and IV-E of SSA, CAPTA, and BSG.
families.
• The Division of Data, Research, and Innovation
provides leadership and direction in program
Federal Agencies development, innovation, research, and
management of the Bureau's information
The Children's Bureau, an agency within the systems as directed by Titles IV-B and IV-E of
Administration for Children and Families (ACF), SSA and CAPTA.
Administration on Children, Youth and Families,
• The Division of State Systems provides leadership
U.S. Department of Health and Human Services,
and direction to States in the development and
is the focal point for Federal efforts to address the
operation of automated systems, including all
problem of child abuse and neglect. The Children's
Statewide Automated Child Welfare Information
Bureau's mission is to provide for the safety,
System (SACWIS), to support welfare programs
permanency, and well-being of children and families
under Titles IV-B and IV-E of SSA.
through leadership, support for necessary services,
and productive partnerships with States, Tribes, and While this discussion focuses primarily on activities
communities. The Children's Bureau fulfills this related to child protection and the „front end‰ of the
mission through its Office on Child Abuse and child welfare system (e.g., prevention, investigation,
Neglect (OCAN) and its five divisions: assessment, and service planning), the Children's
Bureau also oversees activities and programs related
• OCAN provides leadership and direction on the
to foster care, permanency planning, adoption, and
issues of child maltreatment and the prevention
other „back end‰ child welfare issues.
of abuse and neglect as directed by CAPTA and
Selected Child Maltreatment State Grant Programs
The following are selected, legislatively mandated child maltreatment or child welfare grant programs
available to State entities that meet certain eligibility requirements:
v Basic State Grants provide funds for States to enhance their child protective services (CPS)
systems and to develop and strengthen child maltreatment prevention, treatment, and research
programs.
v The Community-based Family Resource and Support (CBFRS) Program supports the
development of comprehensive networks of community-based, prevention-focused family resource
and support programs.
v ChildrenÊs Justice Act (CJA) Grants help States to develop, establish, and operate programs
designed to improve the investigation and prosecution of child abuse and neglect cases, particularly
cases of child sexual abuse and exploitation, and fatality cases.
v Child Welfare Services assist State public welfare agencies in delivering child welfare services
(including preventive interventions, alternative placements, and reunification services) with the
goal of keeping families together.
v Promoting Safe and Stable Families Program (formerly called the Family Preservation and
Support Services Program) supplies funds to States to provide family support, family preservation,
time-limited family reunification services, and services to promote and support adoptions. These
services are aimed at preventing the risk of abuse as well as promoting nurturing families, assisting
families at risk of having a child removed from the home, promoting the timely return of a child
to his or her home, and, if returning home is not an option, placing a child in a permanent setting
with services that support the family.
The Office on Child Abuse and Neglect convenes child maltreatment and child protection. For
a Federal Interagency Work Group (FEDIAWG) example, the Child Protection Division within
on Child Abuse and Neglect that provides a forum the Office on Juvenile Justice and Delinquency
for collaboration among Federal agencies with an Prevention (OJJDP), U.S. Department of Justice,
interest in child maltreatment. The FEDIAWG conducts research, provides training and technical
shares information, makes policy and programmatic assistance, and supports demonstration programs
recommendations, implements joint activities, and that address child victimization and missing and
works toward establishing complementary agendas exploited children. Several agencies within the
in the areas of training, research, legislation, U.S. Department of Health and Human Services·
information dissemination, and delivery of services including the National Institutes for Health (NIH),
as they relate to the prevention, intervention, and Centers for Disease Control and Prevention,
treatment of child abuse and neglect. Maternal and Child Health Bureau (MCHB),
Health Resources and Services Administration
In addition to the Children's Bureau, several (HRSA), and the Substance Abuse and Mental
other Federal agencies support programs and Health Service Administration (SAMHSA), to name
research and demonstration initiatives related to a few·conduct research and support service delivery

on the identification, prevention, and treatment statutes requiring that the maltreatment of children
of child maltreatment as well as risk factors and be reported to a designated agency or official.
consequences. Reporting laws generally specify the conditions
under which the State may intervene in family life.
(See Chapter 9, „What Does the Child Protection
BASIS FOR STATE INTERVENTION Process Look Like?‰, for more information about
reporting of maltreatment and child protection
States must comply with the child abuse and procedures after a report has been made.)
neglect guidelines mandated under CAPTA in order
to receive Federal funds. Beyond that, however, Child Protective Service Agency
States generally have autonomy in how services are
provided to maltreated children and their families. State legislation mandates that CPS agencies
All States have enacted child maltreatment laws that respond to reports of alleged child maltreatment
play a significant role in reporting and intervening and children at risk of maltreatment, determine
in cases of child abuse and neglect. In order to the safety of the children who are the subject of the
enforce these laws, civil and criminal courts often report, and decide what initial response is needed.
must intervene in the lives of families when parents Intervention into family life on behalf of children
are unable or unwilling to provide for the safety and must be guided by the legal basis for action and
well-being of their children. sound family-centered practice.123 While CPS
agencies are at the center of the child protection
State Reporting Statutes system, an array of service providers and community
professionals collaborate to protect children and
Many States define the parent-child legal relationship support families. (See Chapter 10, „Who Should
in their State statutes. These statutes define who is Be Involved in Child Protection at the Community
considered a „parent‰ (birth or adoptive parent) or Level?‰, for further information about the roles and
other caregiver and indicate that the law imposes responsibilities of various community practitioners
rights, privileges, duties, and obligations on this in child protection.)
relationship. As noted above, the State has the
authority to intervene in this relationship if the Civil Court Intervention
parent fails to provide for or protect the child. The
State's intervention into family life is often triggered Family and juvenile courts have the authority to
by a report of child maltreatment by a voluntary or make decisions about what happens to a child after
mandated reporter as defined by State law under the he or she has been identified as needing the court's
CAPTA requirements. protection. The courts' involvement is initiated by
Through mandated reporting statutes, the State the filing of a petition, usually by CPS, containing
requires certain individuals, typically defined the allegations of abuse or neglect. The primary
by profession (e.g., health care professionals), to purpose of these courts is to resolve conflict and
identify and help protect children from harm. otherwise intervene in the lives of families in a
These statutes also include definitions of the acts manner that promotes the best interest of the
and omissions considered abuse and neglect in a child. The court is responsible for making the final
particular State. Reports of suspected maltreatment, determination about whether a child ought to be
which are required under such laws, activate the child removed from his or her home, where a child is to
protection process. Currently, all States, the District be placed, or whether to terminate parental rights.
of Columbia, and U.S. territories have enacted
In cases of child maltreatment, family and juvenile thus making the child eligible for temporary or
court intervention may be required when: permanent placement or adoption, when a parent:
• Families refuse to cooperate after an initial • Abandons the child;

assessment has determined that an incident of
abuse or neglect has occurred; • Has a long-term mental illness or deficiency;
• The child is determined to be in imminent • Severely or chronically abuses or neglects the

danger of harm and the child's safety cannot be child or other children in the household;
assured in the home through services provided
• Has a long-term alcohol or drug abuse
to the family;
problem;
• Families are unwilling to accept needed services,
• Fails to support or maintain contact with the
yet maltreatment exists and the safety of the
child.
child is a concern.
Parental rights are not terminated simply because a
There are four types of court hearings held in
person is not a model parent. In all States, parental
family or juvenile courts when abused and neglected
rights can be terminated only if the State can prove
children are involved:
by clear and convincing evidence that a parent has
• Emergency hearings are convened to determine failed to provide for or protect the child in one of the
the need for intervention on behalf of, or ways defined in a State's statutes. Most State statutes
emergency protection of, a child who may have also contain provisions for parents to voluntarily
been a victim of maltreatment. relinquish their rights. In addition to temporarily
placing children in out-of-home care, the State has
• Adjudicatory hearings are held to determine the authority to return a child to his or her parents.
whether a child has been maltreated or whether Children may return home once a determination is
some other legal basis exists for the State to made that they will be safe and that their parents will
intervene to protect the child. be able to provide the appropriate care.
• Dispositional hearings are convened to

Criminal Court Intervention
determine the action to be taken on the case
after adjudication, for example, whether State
custody and out-of-home placement is necessary Depending on State law, behavior that constitutes
and what services the children and family will child abuse and neglect in the civil court process may
need to reduce the risk of maltreatment and to also be considered a crime. Each State has enacted
address the effects of maltreatment. criminal statutes that define those forms of child
abuse and neglect that are criminally punishable. In
• Review hearings are held to review the most jurisdictions, child maltreatment is criminally
dispositions and to determine the need to punishable when one or more of the following
continue out-of-home placement, services, or statutory crimes have been committed:
court jurisdiction of a child.
• Homicide, murder, or manslaughter
One of the most drastic options available to a
juvenile or family court judge is the termination of • False imprisonment
parental rights. Parental behaviors that may lead to
• Assault or battery
such action are usually defined in State statutes. The
parent-child relationship may be limited or ended, • Criminal neglect and abandonment

• Emotional, physical, or sexual abuse Responsibility for investigation of crimes related to
child abuse and neglect rests with law enforcement
• Pornography or child prostitution agencies and the district attorney or local
prosecutor. They are vested with the responsibility
• Rape or deviant sexual assault
for deciding under what circumstances prosecution
• Indecent exposure of perpetrators of child abuse and neglect will occur.
Criminal courts serve to protect victims and the
• Child endangerment or reckless endangerment public from offenders and to rehabilitate those who
break the law.
The same family may be simultaneously involved in
both a criminal and civil case. Criminal prosecution, The defendant in a criminal case is entitled to
however, is directed at deterring future incidents and full protection guaranteed by the Fourth, Fifth,
rehabilitating the defendant rather than ensuring the and Sixth amendments to the U.S. Constitution.
safety of the child. In a criminal case, the burden These protections include the right to a jury, the
of proof·beyond a reasonable doubt·is higher than right to cross-examination, the right to appointed
in a civil case and the rules of evidence are more counsel, and the right to a public and speedy trial.
stringent. Criminal prosecution may result in such penalties as
probation or incarceration.
CHAPTER 9
T his chapter traces the child protection process

beginning with the identification and reporting
of suspected child maltreatment. As previously
IDENTIFICATION
discussed, every State has enacted reporting laws. The first step in any child protection response
These laws provide guidance to individuals required system is the identification of possible incidents of
to identify and report suspected maltreatment, child maltreatment. Medical personnel, educators,
require investigations by specified agencies to child care providers, mental health professionals,
determine if a child was abused, and provide for law enforcement personnel, the clergy, and other
the delivery of protective services and treatment to professionals are often in a position to observe
maltreated children and their families. Reports of families and children on an ongoing basis and
maltreatment required under such laws activate the identify abuse or neglect when they occur. Private
child protection process, which includes: citizens, such as family members, friends, and
neighbors, also may identify suspected incidents of
• Intake
child maltreatment.
• Initial assessment and investigation
To ensure that community professionals working
• Family assessment with children and families recognize possible
indicators of child maltreatment, preservice and
• Case planning inservice training must be provided on an ongoing
basis. In addition, public awareness campaigns
• Service provision
should be planned and implemented to promote
• Evaluation of family progress understanding of the problem in the community.
• Case closure
Exhibit 9-1 presents an overview of the typical child

protection process for most locales and is described
further below.
Exhibit 9-1
Overview of Child Protection Process
Mandatory Reporters
REPORTING
Every State has statutes identifying mandatory
The next step in responding to child maltreatment is reporters of child maltreatment and the circumstances
to report the suspected incident. Although there is under which they are required to report. This
tremendous variation in the requirements described designation creates a legal responsibility to report,
in State reporting laws, they typically: which can result in criminal and civil liability for
failure to report as required. In approximately
• Specify selected individuals mandated to report 18 States, any person who suspects child abuse or
suspected child maltreatment; neglect is required to report.124 Most States, however,
limit mandatory reporting to professionals working
• Define reportable conditions;
with children. Individuals typically designated as
• Explain how, when, and to whom reports are to mandatory reporters include:
be filed and the information to be contained in
• Physicians, nurses, hospital personnel, and
the report;
dentists
• Describe the agencies designated to receive and
• Medical examiners
investigate reports;
• Coroners
• Describe the abrogation of certain privileged
communication rights (e.g., doctorăpatient); • Mental health professionals
• Provide immunity from legal liability for • Social workers
reporters;
• School personnel
• Provide penalties for failure to report and false
reporting. • Child care providers
Key aspects of reporting laws are described in the • Law enforcement officers
sections that follow.
In addition, any person in any State may report
incidents of suspected abuse or neglect.
The legal standards used to determine when a

mandatory reporter is required to notify authorities
of abuse or neglect also vary slightly from State to
State. Typically, a report must be made when a
reporter has reasonable cause to know, suspect, or
believe that a child has been abused or neglected.
State Statutes
To review a summary of reporting laws, visit the State Statutes section of the National Clearinghouse on
Child Abuse and Neglect Web site at www.calib.com/nccanch/statutes.
Exhibit 9-2
Sources of Child Abuse and Neglect Reports in 2000125
Reporter Percent
Education personnel 16.1
Legal, law enforcement, criminal justice personnel 15.2
Social services and mental health personnel 14.4
Medical personnel 8.3
Child daycare and substitute care providers 2.0
Anonymous or unknown reporters 13.6
Other relatives 8.3
Friends and neighbors 5.9
Parents 5.9
Alleged victims 0.9
Alleged perpetrators 0.1
Other 9.2
Based only on sources of „screened-in‰ referrals in 2000
Reporting Procedures Who Receives the Reports

Each State designates specific agencies to receive
Every State has reporting laws specifying procedures reports of child abuse and neglect. In most States,
that a mandatory reporter must follow when making child protective services (CPS) has the primary
a report of suspected child abuse and neglect. responsibility for receiving reports. Other States
Generally, these procedures specify how, where, allow reports to be made to either CPS or law
when, and what to report. enforcement. Some State laws require that certain
forms of maltreatment·such as sexual abuse, child
How and When to Report pornography, or severe physical abuse·be reported
to law enforcement in addition to CPS. The nature
The majority of States require that reports of child
of the relationship of the alleged perpetrator may
maltreatment be made orally·either by telephone or
also affect where reports are made. Most alleged
in person·to the specified authorities. Some States
cases of child maltreatment within the family are
require that a written report follow the oral report,
reportable to CPS. Depending on the State, reports
while in other States written reports are filed only
of allegations of abuse or neglect by other caregivers,
upon request, and still other States require written
such as foster parents, daycare providers, teachers or
reports only from mandated reporters.
residential care providers, may need to be filed with
Reports of suspected maltreatment are required by a law enforcement office. Additionally, in some
statute to be made immediately to protect children States, allegations of abuse in out-of-home care are
from potentially serious consequences that may be reported to a centralized investigative body within
caused by a delay in reporting. While an individual CPS at the State or regional level.
may want to collect additional information before
In most States, statutes also include requirements for
reporting, waiting for proof may place the child in
cross-system reporting procedures or information
danger.
What Does the Child Protection Process Look Like?

Reporting Child Abuse and Neglect
See Appendix C for a list of State toll-free telephone numbers for reporting suspected child abuse or
call the Childhelp USA National Child Abuse Hotline at 1-800-4-A-CHILD. This hotline is available
24 hours a day, 7 days a week.
sharing among professional entities. Typically, If the alleged maltreatment occurred in an out-
reports are shared among social services agencies, of-home care setting, reporters should provide
law enforcement, and prosecutors' offices. information about the setting, such as hours of
operation; number of other children in the facility,
Contents of the Report if known; and identification of any others in the
facility who may have information about the
Reporting laws also describe the information that alleged maltreatment. The more comprehensive
must be contained in the report. Typically, reports the information provided by the reporter, the better
contain the following information: able CPS staff will be to evaluate the appropriateness
of the report for CPS intervention, determine the
• The name, age, sex, and address of the child;
urgency of the response needed, and prepare for an
• The nature and extent of the child's injuries or initial assessment and investigation, if warranted.
condition;
While most States allow anonymous reporting, it
• The name and address of the parent or other is preferred that reporters provide their name and
person(s) responsible for the child's care; contact information. This information will enable
a caseworker to ask follow-up questions or obtain
• Any other information relevant to the clarification. At intake, caseworkers should discuss
investigation. immunity for reporters, issues of confidentiality,
and the extent and nature of follow up with the
It is essential that reporters provide as much detailed
reporter upon completion of the initial assessment
information as possible about:
or investigation.
• The child, the child's condition, and the child's
whereabouts; Special Issues, Exceptions, and
Penalties Related to Reporting
• The parents and their whereabouts;
• The person alleged to have caused the child's To encourage reporting of child maltreatment and
condition and his or her current location; provide protection for reporters, State statutes include
provisions related to privileged communications,
• The family, including other children in the immunity for reporters, and penalties for failure to
home; report. The laws also discourage intentionally false
reporting through specified penalties.
• The type and nature of the maltreatment, such
as the length of time it has been occurring,
Privileged Communications
whether the maltreatment has increased in
severity or frequency, and whether objects or The law provides special protection to
weapons were used. communications in certain relationships. For
example, the content of communications between
an attorney and client, physician and patient, typically classified as a misdemeanor. Sanctions
and clergy and congregant often is protected by specified in the statutes are generally in the form of
a privilege. This means that professionals in a fine or imprisonment.
such relationships are prohibited from disclosing
confidential information communicated to them by Penalties for False Reporting
their client, patient, or penitent to any unauthorized
person. Mandatory child abuse reporting statutes In order to prevent malicious or intentional false
specify when communications are confidential. reporting, the majority of States impose penalties for
The attorney-client privilege is most frequently false reporting of abuse. Most of these jurisdictions
maintained by States. The privilege pertaining to impose penalties on mandatory reporters who
clergy-congregant also is frequently recognized by knowingly or willfully file a false report of abuse or
States. Most States, however, void the physician- neglect. False reporting is typically classified as a
patient, mental health professional-patient, and misdemeanor. Sanctions specified in the statutes are
husband-wife privileges in instances of child generally in the form of a fine or imprisonment.
maltreatment. When a privileged communication
is voided, a mandated reporter must report instances Problems in Reporting
of child maltreatment and cooperate in the ensuing
investigation. Paradoxically, both underreporting and
overreporting have been cited as problems in the
Immunity to Reporters identification of child abuse and neglect.
Every State provides immunity from civil or
criminal liability for individuals making reports Underreporting
of suspected or known instances of child abuse Numerous professionals admit that during their
or neglect. Immunity provisions typically apply careers, they have failed to report suspected
both to mandatory reporters and permissive maltreatment to the appropriate agencies.126 One
reporters (i.e., individuals not required under law possible reason is that professionals still lack
to report). These provisions may not prevent the training and knowledge about legal obligations and
filing of civil lawsuits, but they help prevent, within procedures for reporting. The issue of subjectivity
limitations, an outcome unfavorable to the reporter. also may account for some of the underreporting
Immunity provisions, like other aspects of reporting of abuse. Many laws defining child maltreatment
statutes, vary from State to State. The majority of are broadly written with ambiguous requirements,
jurisdictions require that reports be made in good which may result in professionals lacking guidance
faith. A number of States include a presumption and clarity regarding when intervention is required.
in their statutes that the reporter is acting in good
faith. Immunity, therefore, does not extend to One of the biggest obstacles to reporting is personal
reports made maliciously or in bad faith. feelings. Some people do not want to get involved.
Others have difficulty reporting a person they
Penalties for Failure to Report suspect is an abuser, especially if they know that
person well. Still others may think they can help
To encourage reporting, the majority of States the family more by working with the child or family
now provide in their reporting statutes a specific themselves. Mandated reporters may believe that
penalty for failure to report suspected cases of their professional relationship with the child will
abuse. Most of these jurisdictions impose penalties be strained if they report their suspicions of abuse.
on mandatory reporters who knowingly or willfully When a professional has established a relationship
fail to report suspected abuse. Failure to report is

with a parent or family prior to recognizing increase in the number of reports of suspected
maltreatment, reporting becomes a delicate issue. child maltreatment made during such times, in
part because the community's awareness has been
Some reporters also may be reluctant to report heightened.
because they have had negative experiences with CPS
or they view social services agencies as overburdened,
understaffed, or incompetent. At times, professionals INTAKE
become concerned that nothing will be done if they
report or that the investigation and service provision
Intake is the point at which reports of suspected
will do more harm than good. Consequently, they
child maltreatment are received by the agency
choose not to report. This reluctance to report,
designated by the State (typically the CPS agency
which can have serious consequences for a child in
and sometimes the police department). The
an unsafe situation, underscores the critical need for
agency receiving the report must make two primary
ongoing communication and feedback between CPS
decisions at intake:
and mandated reporters. It also underscores the need
for CPS to function sensitively and competently in • Does the reported information meet the statutory
the best interests of the child while creating as little and agency guidelines for child maltreatment?
disruption as possible.
• How urgent is the required response?
Professionals must report regardless of their concerns
or previous experiences. The law requires it, and no The first decision consists of three essential steps:
exemptions are granted to those who have had a
1. Gathering sufficient information from the
bad experience. In addition, while reporting does
reporter to allow accurate decision-making;
not guarantee that the situation will improve, not
reporting guarantees that, if abuse and neglect exists, 2. Evaluating the information to determine if it
the child will continue to be at risk of further and meets the statutory and agency guidelines for
perhaps more serious harm. child maltreatment;
Overreporting 3. Assessing the credibility of the reporter based on

the relationship of the alleged victim and family,
Only a portion of reports received and investigated knowledge of the family and circumstances, and
by CPS reflect children who are found to be victims apparent motives for reporting.
of, or at risk for, maltreatment. While the children
and families in these reports may be in need of There will be a check of agency records and State
help or services, they frequently do not meet the central registries to determine if the family is
legal definition of maltreatment in that family's currently involved in an open case or has a history
jurisdiction. This apparent pattern of over-reporting of involvement in a maltreatment case. (A central
raises several concerns. First, children and families registry is a database containing information
who will not receive child welfare services may be on all previously substantiated reports of child
subjected to an intrusive public agency investigation. maltreatment.)
Second, these reports may divert CPS resources from
higher risk cases. When the agency determines that an initial
assessment or investigation is warranted, the report
Overreporting may occur in a community following is „screened in‰; cases closed without further
a serious case of child maltreatment that receives a investigation are referred to as „screened out.‰ While
lot of media attention. There is often a significant screening rates vary substantially across States, CPS
agencies screened in and investigated approximately Primary Initial Assessment
62 percent of the nearly 3 million report referrals or Investigation Decisions
received nationwide in 2000.127 In some instances,
screened out cases will receive referrals to other The purpose of the initial assessment or investigation
community services (e.g., substance abuse treatment, of cases of child abuse and neglect is to determine
mental health services, child care, domestic violence the following:
shelters, or income support agencies).
• Is child maltreatment substantiated as defined
Once the CPS agency determines that an initial by State statute?
assessment is warranted, the immediacy of the
response is evaluated. The decision regarding the • Is the child at risk of maltreatment and what is
urgency of the response is based on an analysis of the level of risk?
the information gathered to determine if the child is
• Is the child safe, and if not, what type of agency
at imminent risk of serious harm. This decision will
or community response will ensure the child's
be based upon a number of factors including:
safety in the least intrusive manner?
• The nature of the act or omission;
• If the child's safety cannot be assured within the
• The severity of harm to the child; family, what type and level of care does the child
need?
• The relationship of the child to the person
responsible for the maltreatment; • Does the family have emergency needs that must
be met?
• The access of the perpetrator to the child;
• Should ongoing agency services be offered to
• The child's vulnerability (e.g., due to age, illness, the family to reduce the risk or address the
or disability); treatment needs of the child?
• The other known cases of maltreatment by the CPS agencies and law enforcement are each
parent or caregiver; responsible for conducting initial assessments or
investigations in cases of child abuse and neglect.
• The availability of persons who can protect the
Exhibit 9-3 presents the primary decisions or issues
child.
considered at this stage according to the agency that
Some CPS agencies provide guidelines for initial typically considers the decision.
assessment response times, although it is difficult
to generalize. Caseworkers are required to respond Involvement of Other Professionals
to reports within a specified time, typically ranging
from 24 to 72 hours on more serious cases. If it is In addition to CPS and law enforcement, other
determined that the child in a report may not be disciplines have a role to play in the initial
safe, caseworkers must respond immediately. assessment process:
v Medical personnel may be involved in

INITIAL ASSESSMENT OR INVESTIGATION assessing and responding to the medical needs
of a child or parent and perhaps in documenting
The initial assessment or investigation follows the the nature and extent of maltreatment. It is
intake process for those reports that are screened in. helpful to have medical practitioners in each
community who have had specific training in

Exhibit 9-3
Primary Decisions Considered During Initial Assessment or Investigation
CPS Law Enforcement CPS and Law Enforcement
Is the child safe? If not, what Did a crime occur? Do sources of corroboration
measures are necessary to ensure or witnesses exist?
the child's safety? Who is the alleged
offender? Has all physical evidence
Did the child suffer maltreatment been obtained or preserved?
or is he or she threatened by harm Is there evidence to arrest
as defined by the State reporting the alleged offender? Are there any other victims
law? (e.g., siblings)?
Has all physical evidence
Is maltreatment likely to occur in been obtained, preserved, Should the child be taken
the future? If so, what is the level
and/or photographed? into protective custody?
of risk of maltreatment?
Have all witnesses been
Are there emergency needs in the
interviewed?
family that must be met?
Are continuing agency services

necessary to protect the child and
reduce the risk of maltreatment
occurring in the future?
child maltreatment because they will provide v Teachers and child care providers may be
a more complete and accurate evaluation than involved in providing direct information about
will an examiner without specific training. the effects of maltreatment and in describing
information pertinent to risk assessment.
v Mental health personnel may be involved in In addition, during the investigative stage,
assessing the effects of any alleged maltreatment educators provide support for the efforts
and in determining the validity of specific of CPS and law enforcement. For example,
allegations. At this stage of the CPS process, if the CPS caseworker or law enforcement
referrals to mental health providers are primarily needs to interview the child in the school, the
for help in determining whether abuse occurred, school should provide a private place for the
whether there is sufficient information to file interview.
charges related to child maltreatment, and
whether the child is capable of providing valid v Foster care, residential, or child care
and reliable information. In addition, referrals licensing personnel may participate in
to mental health practitioners may be made for the initial assessment if abuse is allegedly
assistance in assessing the safety of the child. committed by an out-of-home caregiver. Each
For example, parents or caregivers may be State differs with respect to who is responsible
referred for an evaluation of their mental status, for initially assessing or investigating allegations
the presence of psychiatric problems, personality of child abuse and neglect in out-of-home
disorders, or substance abuse. care. In some States, local CPS staffs have
Major Types of Investigation Dispositions
v Substantiated is an investigation disposition that concludes that the allegation of maltreatment

or risk of maltreatment was supported or founded by State law or State policy. This is the highest
level of finding by a State Agency.
v Indicated or Reason to Suspect is an investigation disposition that concludes that maltreatment

cannot be substantiated under State law or policy, but there is reason to suspect that the child
may have been maltreated or was at risk of maltreatment. This is applicable only to States that
distinguish between substantiated and indicated dispositions.
v Not Substantiated is an investigation disposition that determines that there is not sufficient
evidence under State law or policy to conclude that the child has been maltreated or is at risk of
being maltreated.128
responsibility for investigating certain types of • What responsibility do others in the facility
allegations, for example, those in foster care have for any incident of maltreatment, and is
and daycare. Frequently, the investigation of a corrective action plan needed to prevent the
alleged maltreatment in institutional settings is likelihood of future incidents?
handled by central or regional CPS or licensing
staff, rather than by local CPS agencies. • Can the problem, if validated, be addressed
Depending on the nature of the allegations, law administratively?
enforcement agencies also will assume a primary
• Is the administrative authority responsible and,
role in investigating these types of cases.
if so, in what manner?
Other community service providers also may have
• Should the facility's or foster care or other child
past experience with the child or family and may
care provider's license be revoked?
be used as a resource in addressing any emergency
needs that the child or family may have. These decisions are made by thoroughly gathering
and analyzing information from and about the child,
Investigation in Out-of-Home Care Settings family, or in some cases, the out-of-home provider.
Typically, a protocol is employed for interviewing
In cases of child maltreatment in out-of-home the child victim, family members, the person alleged
care (e.g., residential facilities, foster homes), an to have maltreated the child, and others possessing
investigation must be completed by an independent information about the child and the family.
authority designated by the State. For cases
involving out-of-home care abuse, there are other FAMILY ASSESSMENT
decisions and issues to consider:
• Did the reported event occur? The family assessment is a comprehensive process for
identifying, considering, and weighing factors that
• Are personnel actions indicated and, if so, are affect the child's safety, permanency, and well-being.
they being initiated appropriately by the child The family assessment is a process designed to gain
care facility? a greater understanding about the strengths, needs,

Differential Response Systems
Over the past decade, States have begun to enhance CPS practice and build community partnerships
in responding to cases of child maltreatment. One area of CPS reform emphasizes greater flexibility
in responding to allegations of abuse and neglect. A „dual track‰ or „multiple track‰ response permits
CPS agencies to respond differentially according to the children's safety, the degree of risk present, and
the family's needs for support services. Implementation models vary across States piloting differential
response systems. Typically, in cases where abuse and neglect are severe or serious criminal offenses
against children have occurred, an investigation will commence. The investigation focuses on evidence
gathering and may include a referral to law enforcement. In less serious cases of child maltreatment,
where the family may benefit from community services, an assessment will be conducted. In these
cases the facts regarding what happened will be obtained, but the intervention will emphasize the
comprehensive assessment of family strengths and needs and an appropriate match with community
services.
The assessment is designed to be a process where parents or caregivers are partners with CPS, and that
partnership begins with the very first contact. In addition, the family's support network is frequently
brought into the process. States that have implemented the differential response strategy have shown
that a majority of cases now coming to CPS can be handled safely through an approach that emphasizes
service delivery and voluntary family participation as well as the fact finding of „traditional‰ CPS
investigations.129
and resources of the family so that children can be and capacity to assure safety, permanency, and
safe and the risk of maltreatment can be reduced. well-being?
The family assessment is initiated immediately
after the decision is made that ongoing services are Family assessment should be strengths-based,
needed. The following are the key decisions made as culturally sensitive, and developed with the family.
a result of the family assessment: In addition to gathering information regarding
problems, risks, and needs, strengths should be
• What are the risks and needs of this family that identified that may mitigate the identified concern(s)
affect safety, permanency, or well-being? and the family's stated goals as they relate to each
problem. The strengths identified will provide the
• What are the effects of maltreatment that affect foundation upon which the family can change.
safety, permanency, and well-being?
Assessments should be conducted in a partnership
• What are the individual and family strengths? with the family to help parents or caregivers
recognize and remedy conditions so children can
• How do the family members perceive their
safely remain in their own home. Family assessments
conditions, problems, and strengths?
must be individualized and tailored to the unique
• What must change in order for the effects of strengths and needs of each family. When possible,
maltreatment to be addressed and for the risk of this assessment also should be undertaken in
maltreatment to be reduced or eliminated? conjunction with the extended family and support
network through family decision-making meetings
• What is the parent's or caregiver's level of and other processes designed to involve this network
readiness for change? What is their motivation in the process.130
Concurrent Planning
The passage of the Adoption and Safe Families Act (ASFA) in 1997 has resulted in time limits for
permanency for children and termination of parental rights so that children are provided safe, stable,
and permanent placements more quickly. Concurrent planning works toward reunification of children
in care with their birth families while at the same time establishing a „back-up‰ permanency plan that
will be implemented if the children cannot be reunified with their birth family. The concurrent plan
provides a safeguard to assure secure childhood attachments by developing a stronger bond to the birth
families and simultaneously supporting ties between the child and other possible permanent families,
for example, kin or foster parents. Concurrent permanency plans provide a structured approach to
move children quickly from temporary foster care to the stability of a safe and continuous family
home.131
• What intervention approaches or services will

PLANNING facilitate the successful goal achievement and
the accomplishment of outcomes?
The comprehensive assessment of the family's • How and when will progress toward achievement
circumstances and conditions is the foundation of these outcomes and goals be evaluated?
on which the case plan is built. Armed with this
knowledge, CPS caseworkers, other service providers In order to achieve the client outcomes, the case
or community professionals, and the family plan must be developed with, not for, the family.
and its support network will determine the best Involving the family in planning serves several
possible strategies for reducing or eliminating the purposes. It facilitates the family's investment in
behaviors and conditions contributing to the risk and commitment to the plan, it empowers parents
of maltreatment of the child. The purposes of case or caregivers to take the necessary action to change
planning are to identify the strategies with clients behavior, and ensures that the agency and the family
that will help address the effects of maltreatment are working toward the same end. Some CPS
and lessen the risk of further abuse and neglect; to agencies use models that optimize family strengths
provide a clear and specific guide for the professional in the planning process. These models bring
and the family for changing the behaviors and together the family, the extended family, and others
conditions that impact risk; to provide a benchmark important in the family's life·for example, friends,
for measuring client progress toward achieving clergy, neighbors·to make decisions regarding how
outcomes; and to provide a framework for case best to ensure the safety of the family members.
decision-making.
The key decisions made at the case planning stage SERVICE PROVISION
are:
• What are the client outcomes that, when Once the case plan has been developed, the CPS
achieved, will indicate that risk has been caseworker must provide or arrange for services
reduced and the effects of maltreatment have identified in the plan to help family members achieve
been successfully addressed? the outcomes, goals, and tasks outlined in the case
plan. Selecting and matching interventions that will
• What goals must be accomplished to achieve the support the family in achieving outcomes and goals
outcomes? is a major responsibility in child protection.

The needs of families are often complex. As discussed • Identifying family strengths;
in Chapter 5, child abuse and neglect is caused by
multiple and interacting intrapersonal, interpersonal, • Targeting outcomes for change;
and environmental factors. Interventions need
• Identifying treatment approaches best suited
to address as many of these contributing issues as
to the desired outcome, based on any available
possible.132 Research on the effectiveness of child
research evidence;
abuse and neglect treatment suggests that successful
intervention with maltreating families requires • Listing resources available and accessible in the
addressing both the interpersonal and concrete needs community.
(e.g., housing, child care) of all family members.
Evaluation projects found that programs that rely The CPS caseworker serves as the case manager,
solely upon professional therapy, without augmenting articulating the needs of the family, coordinating
the service strategies with other supportive or services provided to them, and advocating on their
remedial services to children and families, will offer behalf.134 The case management functions include:
less opportunity for maximizing client gains.133 collecting and analyzing information, reaching
decisions at all stages of the case process, coordinating
Therefore, each community must provide a broad services provided by others, and directly providing
range of services to meet the multidimensional supportive services. This critical case-management
needs of abused and neglected children and their function requires open and continuous communication
families. These may include: among CPS, the family, and other service providers;
developing a teamwork relationship; clarifying roles
• Services provided to the entire family (e.g., family
and responsibilities in delivering and monitoring
preservation services, multisystemic therapy for
services; and reaching consensus on goals and methods
children and families, or family strengthening
for monitoring progress toward goal achievement.
programs);
• Services provided specifically to parents or EVALUATION OF FAMILY PROGRESS

caregivers (e.g., sex offender treatment, parent
education, substance abuse treatment, or mutual
support programs); Evaluating whether risk behaviors and conditions
have changed is central to case decisions. Monitoring
• Services provided to children (e.g., counseling, change should begin as soon as an intervention is
therapeutic preschool, peer-based training, or implemented and should continue throughout the
mentoring programs). life of a case until appropriate outcomes have been
achieved.135
Depending on the assessed needs, strengths, and
safety issues, services may be provided either in or The importance of evaluating family progress is to
out of the family's home. When a child is unsafe help answer the following questions:
because the risk of imminent harm is great or when
the child's behavioral and emotional needs cannot • Is the child safe? Have the protective factors,
be addressed at home, out-of-home placement strengths, or the safety factors changed,
services, such as foster care, should be considered. warranting a change or elimination of the safety
plan or the development of a safety plan?
Selection of services in a particular case is based on:
• What changes, if any, have occurred with respect
• Assessing factors that contribute to the risk of to the conditions and behaviors contributing to
maltreatment; the risk of maltreatment?
• What outcomes have been accomplished and some cases, it may be appropriate to convene a team
how does the caseworker know that they have meeting to review the progress in relation to the
been accomplished? family assessment and the case plan.
• What progress has been made toward achieving The process of evaluating family progress is a
case goals? continual case management function. Once the
case plan is established, each client contact will be
• Have the services been effective in helping focused on assessing the progress being made to
clients achieve outcomes and goals and, if not, achieve established outcomes, goals, and tasks, and
what adjustments need to be made to improve to reassess safety. Formal case evaluations should
outcomes? occur at regular intervals. Good practice suggests
evaluation of progress at least every 3 months.
• What is the current level of risk in the family?
• Have the risk factors been reduced sufficiently

CASE CLOSURE
so that parents or caregivers can protect their
children and meet their developmental needs so
the case can be closed? Closure is the point at which the agency no longer
maintains an active relationship with the family.
• Has it been determined that reunification is not The decision to end the agency's involvement must
likely in the ASFA-required time frames and there be based on the monitoring and evaluation of the
is no significant progress toward outcomes? If so, case. ASFA requires decisions regarding case closure
is an alternative permanent plan goal needed? to be made in conjunction with the family and
individuals important to the family. The preeminent
Since intervention and service provision to families at
concerns that inform case closure decisions are
risk of maltreatment is a collaborative effort between
based on safety and permanency outcomes. The
CPS and other agencies or individual providers, the
agency should support the family's right to self-
evaluation of family progress must be a collaborative
determination by ending services when the risks to
venture. It is the CPS caseworker's responsibility to
child safety have been reduced significantly and the
manage the comparison of client progress based on
family believes they no longer need services.136
information reported from all service providers. In
For more detailed information on the child protection process, check other manuals in the series at
www.calib.com/nccanch/pubs/usermanual.cfm.

CHAPTER 10
C hild protective services (CPS) is typically the

central agency in each community's child
protection system. It usually plays the lead role in
• Conducting assessments of family strengths,
resources, and needs;
coordinating communication and services among • Developing individualized case plans;

the various disciplines responsible for addressing
• Providing direct services to support families
child maltreatment. In addition to CPS, law
in addressing the problems that led to
enforcement, educators, child care providers, health
maltreatment and reducing the risk of
care providers, mental health care providers, legal
subsequent maltreatment;
and judicial system professionals, substitute care
providers, support service providers, domestic • Coordinating services provided by other
violence victim advocates, substance abuse treatment professionals;
providers, and concerned community members all
play important roles in keeping children safe. All • Completing case management functions such
relevant professionals must be aware of their role as maintaining case records, systematically
in child protection and the unique knowledge and reviewing case plans, and developing court
skills they bring to their community's prevention reports.
and intervention efforts. They must also understand
CPS also helps educate the community about child
the roles, responsibilities, and expertise of other
abuse and neglect and seeks to enhance community
professionals.
prevention and treatment resources.
CHILD PROTECTIVE SERVICES

LAW ENFORCEMENT
CPS is the agency mandated in most States to

In the initial stages of the child protection response,
respond to reports of child abuse and neglect.
law enforcement and CPS often have similar
CPS is responsible for: responsibilities. Law enforcement's involvement
in the initial assessment and investigation of
• Receiving reports of child abuse and neglect; child abuse and neglect varies across States and
communities. For example, in many States, sexual
• Conducting initial assessments and investigations
abuse or severe physical abuse must be investigated
regarding suspected maltreatment;
by law enforcement. In a few States, abuse
allegations are reported initially to law enforcement
rather than to CPS.137 Whether the community has EDUCATORS AND
a protocol for joint or separate initial assessments EARLY CHILD CARE PROVIDERS
and investigations, a high degree of coordination

between CPS and law enforcement is necessary to Principals, teachers, school social workers, and
minimize the confusion and trauma to the child as counselors, as well as early childhood education
a result of system intervention. and child care providers, play a critical role in the
The primary responsibilities of law enforcement community child protection system. Key functions
include: of educators include:
• Identifying and reporting suspected child • Developing and implementing prevention

maltreatment; programs for children and parents;
• Receiving reports of child abuse and neglect; • Identifying and reporting suspected child abuse
and neglect;
• Conducting investigations of reports of child
maltreatment when there is a suspicion that a • Recognizing and reporting child abuse and
crime has been committed; neglect occurring in the school system or child
care program;
• Gathering physical evidence;
• Developing a school or program policy for
• Determining whether sufficient evidence exists reporting instances of child abuse and neglect
to prosecute alleged offenders; and cooperating with CPS investigations;
• Assisting with any need to secure the protection • Keeping CPS informed of the changes or
of the child; improvements in the child's behavior and
condition following the investigation;
• Providing protection to CPS staff when a
caseworker's personal safety may be in jeopardy • Providing input in diagnostic and treatment
if confrontation occurs with alleged offenders; services for the child;
• Supporting the victim through the criminal • Supporting the child through potentially
court process. traumatic events, for example, court hearings
and out-of-home placement;
In several States, law enforcement plays a key role in
multidisciplinary teams or Child Advocacy Centers • Providing support services for parents such as
(CACs). These teams and centers aim to reduce the school-sponsored self-help groups;
trauma to the child caused by multiple interviewing.
They also work to improve the prosecution of cases, • Serving on child maltreatment multidisciplinary
particularly in sexual abuse cases.138 (For more teams.
information on multidisciplinary teams and CACs,
see Chapter 11, „How Can Organizations Work
Together to Protect Children?‰)
Who Should Be Involved in Child Protection at the Community Level?

HEALTH CARE PROVIDERS MENTAL HEALTH PROFESSIONALS
Physicians, nurses, emergency medical technicians, Mental health services are a prerequisite for any
and other medical personnel play a major role in the community system designed to prevent and
child protection system in every community. Key treat child abuse and neglect. Key functions of
functions of health care providers include: psychiatrists, psychologists, social workers, and
other mental health professionals include:
• Identifying and reporting suspected cases of
child abuse and neglect; • Identifying and reporting suspected cases of
child abuse and neglect;
• Providing diagnostic and treatment services
(medical and psychiatric) for maltreated • Conducting necessary evaluations of abused and
children and their families; neglected children and their families;
• Providing consultation to CPS regarding • Providing treatment for abused and neglected
medical aspects of child abuse and neglect; children and their families;
• Participating on the multidisciplinary case- • Providing clinical consultation to CPS;

consultation team;
• Providing expert testimony in child protection
• Providing expert testimony in child protection judicial proceedings;
judicial proceedings;
• Providing self-help groups for parents who have
• Providing information to parents regarding the maltreated or are at risk of maltreating their
needs, care, and treatment of children; children;
• Identifying and providing support for families • Developing and implementing prevention
at risk of child maltreatment; programs;
• Developing and conducting primary prevention • Participating on community multidisciplinary

programs; teams.
• Providing training for medical and nonmedical

professionals regarding the medical aspects of LEGAL AND JUDICIAL SYSTEM PROFESSIONALS
child abuse and neglect;
• Participating on community multidisciplinary Responsibilities of legal professionals vary depending

teams. upon who the attorney's client is and the stage of a
judicial proceeding.
Attorneys representing the CPS agency who are

responsible for presenting child maltreatment cases
in court:
• Assure that CPS personnel are given appropriate • Determine the child's educational, psychological,
legal advice and consultation, for example, and other treatment needs and help assure that
on decisions regarding emergency removal of the judicial intervention leads to appropriate
children; treatment;
• Prepare necessary legal pleadings when court • Facilitate a speedy, nonadversarial resolution of
intervention becomes necessary; the case whenever possible and appropriate.
• Participate in multidisciplinary team meetings Defense attorneys for the parents or other
when potential legal actions on behalf of the maltreating caregiver:
child may be explored;
• Assure that the parents' or caregivers' statutory
• Prepare CPS caseworkers, expert witnesses, and and constitutional rights are fully protected in
other witnesses, especially children, for testifying any judicial proceeding;
in court.
• Assure that the parents or caregivers understand
Criminal prosecutors: the judicial process and the potential impact of
the process.
• Assure that any criminal action is coordinated
with a civil child protection proceeding Juvenile or family court judges:
involving the same child;
• Provide emergency protective orders when
• Assure that the child is adequately prepared for necessary, 24 hours a day, 7 days a week;
testifying;
• Resolve speedily all court cases of alleged child
• Provide the child with victim advocacy services maltreatment;
when necessary;
• Apply relevant case law and adjust the court
• Assist the court in arriving at a sentence that process, as appropriate, to deal sensitively with
serves the interest of justice and assures that child victims;
proper treatment is provided;
• Encourage the development of greater
• Participate in multidisciplinary team meetings community resources for maltreated children
when potential legal actions on behalf of the and their families.
child may be explored.
Court personnel help assure that children and
Guardians ad Litem, legal counsel for children, families are dealt with sensitively throughout the
and court-appointed special advocates judicial process. It is important for all family
(CASAs): members to feel respected by the legal system as they
go through a process that may feel intimidating and
• Assure that the needs and interests of a child in overwhelming. They also identify possible child
child protection judicial proceedings are fully maltreatment in cases before the court for other
protected; reasons, for example, delinquency.
• Conduct an independent investigation into
background and facts of the case;

Kinship Care
In recent decades, increasing numbers of substitute care providers are relatives of the maltreated children.
„Kinship care‰ often involves formal child placement by the child welfare agency and juvenile court in
the home of a child's relative·most frequently the child's grandmother.139 Kinship care offers several
benefits including greater familiarity between the caregiver and the child, potentially less traumatic
placements, more visitation and contact with birth parents, and fewer placement changes.140
• Organizing self-help or mutual support groups

SUBSTITUTE CARE PROVIDERS at their facilities for parents who have maltreated
a child or are at risk for doing so;
When children are removed from their parents'
• Participating in community multidisciplinary
care and placed in foster care or residential care to
teams.
ensure their safety, foster parents and residential care
providers become part of the treatment team, which
is focused on the objective of family reunification. COMMUNITY ORGANIZATIONS
Substitute care providers help ensure that the basic AND SUPPORT SERVICES PROVIDERS
needs of maltreated children are met in safe, stable,

and nurturing environments. Foster families
typically become a part of their child's extended There are many other individuals who support the
family and help negotiate relationships that support community intervention efforts, including youth
the birth parents and case plan goals. service workers, community-based organizations,
housing and job assistance agencies, civic groups,
volunteers, and parent aides. These individuals
FAITH COMMUNITY offer prevention, support, and treatment services
to abused and neglected children and their families.
Support services frequently address the reduction of
Clergy and spiritual leaders can play important roles
risk factors and enhancement of protective factors
in supporting families and protecting children by:
discussed in Chapter 5, „What Factors Contribute
• Providing counseling, support, and spiritual to Child Abuse and Neglect?‰ Involvement may
leadership to their congregation; occur prior to CPS involvement (e.g., supporting
families at risk), concurrent with CPS involvement
• Developing and implementing prevention (e.g., attending family team meetings to help make
programs to help stop child maltreatment; decisions about case plans), or following CPS
involvement (e.g., providing ongoing support and
• Identifying and reporting suspected child abuse
services).
and neglect;
Some examples of the diverse community support
• Supporting the child and family through
provided to maltreated children and their families
potentially traumatic events, for example, court
include:
hearings and out-of-home placement;
• Home visitors supporting new parents and
• Attending family team meetings to help make
modeling appropriate parenting practices;
decisions about case plans;
• Substance abuse treatment providers offering As part of ongoing CPS reform movements across
services to parents who are addicted to drugs; the country, community organizations and support
service providers increasingly are playing more active
• Big Brother/Big Sister Organizations providing roles in collaborative child protection efforts.
mentoring and social opportunities for
maltreated children;
CONCERNED CITIZENS
• Domestic violence shelters offering safe housing
arrangements for abused spouses and their
children; In addition to the various practitioners described
above, concerned citizens, particularly friends and
• Neighborhood centers helping to build family neighbors, play an important role in responding
skills and providing networking opportunities; to child maltreatment. All individuals in the
community can contribute to the protection of
• Homeless shelter staff providing homemaking children by providing social and emotional support
and advocacy services for families in a shelter; to fellow community members, reporting suspected
maltreatment, modeling good parenting behaviors,
• Child care programs offering respite care to
advocating for needed resources, and helping educate
stressed parents;
others about the problems of maltreatment.
• Family service agencies lending support to teen
parents.

CHAPTER 11
N ational, State, and local movements to

integrate services and improve collaboration
have been among the most significant trends in
contributor, and value the uniqueness of their
colleagues. Collaborators can build trust by:
- Reaching agreement regarding norms for
human services over the last decade.141 Catalysts
behavior for working together;
supporting this trend toward increased collaboration

include changes in Federal funding programs - Developing mutual respect, which enables
that now encourage collaborative efforts and them to be creative, take risks, and openly
the desire to enhance service delivery to clients explore difficult issues;
who exhibit multifaceted problems.142 Likewise, - Correcting common misconceptions and

many communities are experimenting with a new learning up-to-date information regarding
approach to child protection and family well-being other agencies;
by broadening the commitment and responsibility
- Developing an informal, relaxed atmosphere,
from a single public agency to the community.143
for example, by getting to know team
This chapter examines the essential elements of a members outside of the work setting;
well-coordinated child protection system. Other - Viewing all participants as equal members
manuals in the series include more detailed in designing and implementing the
information regarding community collaboration collaborative efforts.144
and integrated service systems.
v Reach agreement on core values. All the
parties must reach consensus on a core set of
PRINCIPLES TO GUIDE COLLABORATION values for the collaborative effort. Each of the
parties must honor the importance of the values
and their implementation in practice.
Collaboration is grounded in interdependent
relationships. There are several basic guidelines to v Reach agreement and stay focused on
foster collaborative efforts: common goals. A well-coordinated system is
based on agreement between all of the parties
v Build and maintain trust. Trust enables
on common goals, such as the prevention of
people to share information, perceptions, and
child abuse, the safety of children, and the
feedback. Professionals and nonprofessionals
permanency for children. In spite of the fact
working together must trust each other, respect
that the professionals or agencies involved in
each other, view each other as an important
child welfare have differences in philosophy,
focus, mission, and perceptions, which may v Recognize the strengths, needs, and
sometimes come into conflict with one another, limitations of all of the parties. Each person
it is possible to agree on common goals. This and agency comes to the collaborative process
requires that all parties: with strengths, needs, and limitations. For
example, community agencies bring with them
- Set aside or merge their vested interests;
specific resources needed to build an effective
- Believe that by developing and maintaining community response to child maltreatment.
common goals children and families will They also bring with them limitations, such
attain more positive outcomes. as differing missions, goals, policies, and
v Develop a common language. Each procedures. Capitalizing on the strengths and
profession and agency has its own terminology, being aware of and addressing any barriers
jargon, and acronyms. It is important to help to participation are essential. It may require
the parties overcome language barriers. Each of being open to and exploring alternative ways
the parties should: individuals can contribute to the collaborative
effort.
- Explain the technical language, words, and
phrases they use;
v Work through conflict. Conflict is healthy
- Refrain from using acronyms and
and inevitable when people work together
professional jargon;
collaboratively. The extent to which people feel
comfortable with conflict and airing differences
- Achieve a common understanding of what affects reaching consensus or an acceptable
terms mean, for example, „strengths-based‰ conclusion. Since communication is a
or „family involvement.‰ significant part of one's culture, great care must
v Demonstrate respect for the knowledge be taken to encourage the equal participation of
and experience of each person. Respect is all members.
a fundamental starting point for understanding
v Share decision-making, risk taking, and
and action. Effective collaboration requires
accountability. A true collaborative effort means
the expertise and knowledge of all parties,
that decisions are made and risks are taken as a team.
who should listen to and be respectful of
Members participate in planning and decision-
each person's opinions and ideas. Any
making and openly collaborate with others. All
misunderstandings, unreasonable expectations,
members feel a professional responsibility for
myths, previous problems, or other issues must
the performance of the partnership. This means
be worked through.
the entire team is accountable for achieving the
v Assume positive intentions of the parties. outcomes and goals.145
When a variety of professionals, as well as
nonprofessionals, comes together to develop
EFFECTIVE LEADERSHIP·
and implement a collaborative effort, they bring

AN ESSENTIAL COMPONENT OF
with them different ideas, perspectives, and

approaches. It is important to believe that each SUCCESSFUL COLLABORATION
of the parties is genuinely interested in working

toward the agreed upon goals and positive Leadership is key to successful collaboration. The
outcomes for children and families. leader:
• Assures that all of the stakeholders are

represented on the team;
How Can Organizations Work Together to Protect Children?

• Is able to search for and discover opportunities, The outcomes achieved through child fatality review
benefits, and resources; teams include: the improvement of child protection
through better coordination and collection of
• Can build trust across agencies, professionals, information; the protection of siblings in at-risk
and nonprofessionals; families; a decrease in the number of child deaths;
and an enhanced collection of evidence, which
• Is responsive to the needs of the group;
improves the prosecution of abusers.147
• Is flexible and can flow with the dynamics of the
group; Child Advocacy Centers
• Understands the dynamics of power, authority,

and influence and uses this knowledge to Child advocacy centers (CAC) are community-based
facilitate collaboration; facilities designed to coordinate services to victims
of nonfatal abuse and neglect, especially in cases of
• Is able to manage conflict effectively; child sexual abuse and severe physical abuse. The
key goal of these centers is to reduce the trauma to
• Does not promote his or her own agenda to the victims that may result from agency intervention.
exclusion of others; CACs seek to improve the handling of cases at key
points in the child protection process·investigation,
• Understands and responds appropriately to
prosecution, and treatment·by assuring the
people from diverse cultures;
collaboration of the key professionals and agencies
• Treats all members with respect; involved.148
• Facilitates group discussions effectively; The Child Advocacy Center is a child-friendly

facility where all of the key professionals·child
• Frames needs, problems, and opportunities for protective services (CPS), law enforcement,
the group.146 prosecutors, mental health professionals, and child
advocates·are co-located. Also, CACs typically
work closely with medical personnel who specialize
COLLABORATIVE MODELS in child sexual abuse. CACs enhance coordination
and achievement of positive outcomes by the close
The following models demonstrate the effectiveness proximity of professionals, the assignment of a child
of collaboration. advocate who monitors the case through the various
systems, and the case review, which promotes formal
and informal discussion of cases.
Fatality Review Team
In the event of a child's death due to abuse or CONCLUSION

neglect, a child fatality review team provides a
systemic and multidisciplinary means to identify
Every child deserves to grow up in a safe and
discrepancies between policy and practice and
nurturing environment. Unfortunately, hundreds
gaps in communication systems. Child fatality
of thousands of children are reported to be victims
review teams typically consist of representatives
of child abuse and neglect each year.150 An untold
from pertinent agencies or offices, such as CPS, law
number of other children are maltreated but not
enforcement, and the coroner or medical examiner.
reported to responding agencies. As outlined in this parenting, fostering families' support networks, and
manual, a number of practitioners and professionals providing comprehensive services customized to
assume different roles and responsibilities in meet the circumstances, strengths, and needs of each
identifying and responding to reported cases of child family.
abuse and neglect. Child maltreatment, however, is
so widespread and, thus, such a significant issue This manual is intended as a foundation for
that every citizen and organization shares in the understanding child maltreatment issues and
responsibility for responding to this problem. responses. Interested parties are encouraged to read
the accompanying profession-specific and special-
Interventions are designed to strengthen families as issue publications contained in the User Manual
an integral part of ensuring child safety, permanency, Series.
and well-being. This includes promoting responsible
Integrated Service Delivery Systems
Many communities throughout the United States are attempting to create integrated service delivery
systems that honor the unique strengths, needs, and culture of each child and family. One example is
the six sites implementing „Partnerships in Action,‰ which brings together families and child welfare,
mental health, and other related systems.
• The program in Branch County, Michigan, assessed and redesigned community-based services to
develop a seamless, integrated system of care for pregnant women and their families with newborn
children (up to 6 years of age).
• The program in the Pueblo of Zuni, New Mexico, created a single point of entry among tribal
agencies for families experiencing domestic violence and child abuse. Also, the program
strengthened domestic violence codes and created a state-of-the-art shelter for female victims of
domestic violence and their children.
• The program in Lorain County, Ohio, developed an infrastructure to provide the strongest possible
community safety net for adolescents who „fell through the cracks‰ because their needs were not
severe enough to require immediate, crisis, or intensive services from child welfare or mental
health agencies. An essential part of the program was the development of a written operational
interagency agreement.
• The Rhode Island program provided seed money to communities to develop a specialized team
approach for transition planning for youth with multiple agency needs who are incarcerated in a
training school.
• The program in Sedgwick County, Kansas, collaborated with a private contractor providing
foster care to develop individualized plans of care for children diagnosed with serious emotional
disturbances in need of mental health services. They also provided training to staff regarding
family involvement.
• The program in Maryland identified the individual and collective effects of multiple reform efforts
in the State and identified ways the efforts could reinforce each other.149
How Can Organizations Work Together to Protect Children?

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APPENDIX A
Adjudicatory Hearings ă held by the juvenile and Caseworker Competency ă demonstrated

family court to determine whether a child has been professional behaviors based on the knowledge,
maltreated or whether another legal basis exists for skills, personal qualities, and values a person holds.
the State to intervene to protect the child.
Central Registry ă a centralized database containing
Adoption and Safe Families Act (ASFA) ă signed information on all substantiated/founded reports of
into law November 1997 and designed to improve child maltreatment in a selected area (typically a
the safety of children, to promote adoption and State).
other permanent homes for children who need
them, and to support families. The law requires Child Abuse Prevention and Treatment Act
CPS agencies to provide more timely and focused (CAPTA) ă the law (P.L. 93-247) that provides a
assessment and intervention services to the children foundation for a national definition of child abuse
and families that are served within the CPS system. and neglect. Reauthorized in October 1996 (P.L.
104-235), it was up for reauthorization at the time of
CASA ă court-appointed special advocates (usually publication. CAPTA defines child abuse and neglect
volunteers) who serve to ensure that the needs and as „at a minimum, any recent act or failure to act
interests of a child in child protection judicial on the part of a parent or caretaker, which results
proceedings are fully protected. in death, serious physical or emotional harm, sexual
abuse or exploitation, or an act or failure to act
Case Closure ă the process of ending the which presents an imminent risk of serious harm.‰
relationship between the CPS worker and the family
that often involves a mutual assessment of progress. Child Protective Services (CPS) ă the designated
Optimally, cases are closed when families have social services agency (in most States) to receive
achieved their goals and the risk of maltreatment reports, investigate, and provide intervention and
has been reduced or eliminated. treatment services to children and families in which
child maltreatment has occurred. Frequently, this
Case Plan ă the casework document that outlines the agency is located within larger public social service
outcomes, goals, and tasks necessary to be achieved agencies, such as Departments of Social Services.
in order to reduce the risk of maltreatment.
Concurrent Planning ă identifies alternative forms
Case Planning ă the stage of the CPS case process of permanency by addressing both reunification or
where the CPS caseworker develops a case plan with legal permanency with a new parent or caregiver if
the family members. reunification efforts fail.
Cultural Competence ă a set of attitudes, strengths in the planning process. This model brings
behaviors, and policies that integrates knowledge the family, extended family, and others important
about groups of people into practices and standards in the family's life (e.g., friends, clergy, neighbors)
to enhance the quality of services to all cultural together to make decisions regarding how best to
groups being served. ensure safety of the family members.
Differential Response ă an area of CPS reform that Family Unity Model ă a family meeting model
offers greater flexibility in responding to allegations used by CPS agencies to optimize family strengths in
of abuse and neglect. Also referred to as „dual track‰ the planning process. This model is similar to the
or „multi-track‰ response, it permits CPS agencies to Family Group Conferencing model.
respond differentially to children's needs for safety,
the degree of risk present, and the family's needs for Full Disclosure ă CPS information to the family
services and support. See „dual track.‰ regarding the steps in the intervention process, the
requirements of CPS, the expectations of the family,
Dispositional Hearings ă held by the juvenile the consequences if the family does not fulfill the
and family court to determine the disposition of expectations, and the rights of the parents to ensure
children after cases have been adjudicated, such that the family completely understands the process.
as whether placement of the child in out-of-home
care is necessary and what services the children and Guardian ad Litem ă a lawyer or lay person who
family will need to reduce the risk of maltreatment represents a child in juvenile or family court. Usually
and to address the effects of maltreatment. this person considers the „best interest‰ of the child
and may perform a variety of roles, including those
Dual Track ă term reflecting new CPS response of independent investigator, advocate, advisor, and
systems that typically combine a nonadversarial guardian for the child. A lay person who serves in
service-based assessment track for cases where this role is sometimes known as a court-appointed
children are not at immediate risk with a traditional special advocate or CASA.
CPS investigative track for cases where children
are unsafe or at greater risk for maltreatment. See Home Visitation Programs ă prevention
„differential response.‰ programs that offer a variety of family-focused
services to pregnant mothers and families with new
Evaluation of Family Progress ă the stage of the babies. Activities frequently encompass structured
CPS case process where the CPS caseworker measures visits to the family's home and may address
changes in family behaviors and conditions (risk positive parenting practices, nonviolent discipline
factors), monitors risk elimination or reduction, techniques, child development, maternal and child
assesses strengths, and determines case closure. health, available services, and advocacy.
Family Assessment ă the stage of the child Immunity ă established in all child abuse laws to
protection process when the CPS caseworker, protect reporters from civil law suits and criminal
community treatment provider, and the family reach prosecution resulting from filing a report of child
a mutual understanding regarding the behaviors and abuse and neglect.
conditions that must change to reduce or eliminate
the risk of maltreatment, the most critical treatment Initial Assessment or Investigation ă the stage of the
needs that must be addressed, and the strengths on CPS case process where the CPS caseworker determines
which to build. the validity of the child maltreatment report, assesses
the risk of maltreatment, determines if the child is safe,
Family Group Conferencing ă a family meeting develops a safety plan if needed to assure the child's
model used by CPS agencies to optimize family protection, and determines services needed.
Appendix A—Glossary of Terms

Intake ă the stage of the CPS case process where the or emotional. Physical neglect can include not
CPS caseworker screens and accepts reports of child providing adequate food or clothing, appropriate
maltreatment. medical care, supervision, or proper weather
protection (heat or coats). Educational neglect
Interview Protocol ă a structured format to ensure includes failure to provide appropriate schooling,
that all family members are seen in a planned special educational needs, or allowing excessive
strategy, that community providers collaborate, and truancies. Psychological neglect includes the lack of
that information gathering is thorough. any emotional support and love, chronic inattention
to the child, exposure to spouse abuse, or drug and
Juvenile and Family Courts ă established in most
alcohol abuse.
States to resolve conflict and to otherwise intervene
in the lives of families in a manner that promotes the Out-of-Home Care ă child care, foster care, or
best interest of children. These courts specialize in residential care provided by persons, organizations,
areas such as child maltreatment, domestic violence, and institutions to children who are placed outside
juvenile delinquency, divorce, child custody, and their families, usually under the jurisdiction of
child support. juvenile or family court.
Kinship Care ă formal child placement by the Parent or caretaker ă person responsible for the
juvenile court and child welfare agency in the home care of the child.
of a child's relative.
Parens Patriae Doctrine - originating in feudal
Liaison ă the designation of a person within an England, a doctrine that vests in the State a right of
organization who has responsibility for facilitating guardianship of minors. This concept has gradually
communication, collaboration, and coordination evolved into the principle that the community, in
between agencies involved in the child protection addition to the parent, has a strong interest in the
system. care and nurturing of children. Schools, juvenile
courts, and social service agencies all derive their
Mandated Reporter ă groups of professionals
authority from the State's power to ensure the
required by State statutes to report suspected child
protection and rights of children as a unique class.
abuse and neglect to the proper authorities (usually
CPS or law enforcement agencies). Mandated Physical Abuse ă the inflicting of a nonaccidental
reporters typically include: educators and other physical injury upon a child. This may include,
school personnel, health care and mental health burning, hitting, punching, shaking, kicking,
professionals, social workers, childcare providers, beating, or otherwise harming a child. It may,
and law enforcement officers. however, have been the result of over-discipline or
physical punishment that is inappropriate to the
Multidisciplinary Team ă established between
child's age.
agencies and professionals within the child
protection system to discuss cases of child abuse Primary Prevention ă activities geared to a sample
and neglect and to aid in decisions at various stages of the general population to prevent child abuse
of the CPS case process. These terms may also be and neglect from occurring. Also referred to as
designated by different names, including child „universal prevention.‰
protection teams, interdisciplinary teams, or case
consultation teams. Protocol ă an interagency agreement that delineates
joint roles and responsibilities by establishing
Neglect ă the failure to provide for the child's criteria and procedures for working together on
basic needs. Neglect can be physical, educational, cases of child abuse and neglect.
Protective Factors ă strengths and resources that Safety Plan ă a casework document developed when
appear to mediate or serve as a „buffer‰ against it is determined that the child is in imminent risk
risk factors that contribute to vulnerability to of serious harm. In the safety plan, the caseworker
maltreatment or against the negative effects of targets the factors that are causing or contributing to
maltreatment experiences. the risk of imminent serious harm to the child, and
identifies, along with the family, the interventions
Psychological Maltreatment ă a pattern of that will control the safety factors and assure the
caregiver behavior or extreme incidents that child's protection.
convey to children that they are worthless, flawed,
unloved, unwanted, endangered, or only of value to Secondary Prevention ă activities targeted to
meeting another's needs. This can include parents prevent breakdowns and dysfunctions among
or caretakers using extreme or bizarre forms of families who have been identified as at risk for abuse
punishment or threatening or terrorizing a child. and neglect.
The term „psychological maltreatment‰ is also
known as emotional abuse or neglect, verbal abuse, Service Agreement ă the casework document
or mental abuse. developed between the CPS caseworker and the
family that outlines the tasks necessary to achieve
Response Time ă a determination made by CPS goals and outcomes necessary for risk reduction.
and law enforcement regarding the immediacy of
the response needed to a report of child abuse or Service Provision ă the stage of the CPS casework
neglect. process when CPS and other service providers
provide specific services geared toward the reduction
Review Hearings ă held by the juvenile and family of risk of maltreatment.
court to review dispositions (usually every 6 months)
and to determine the need to maintain placement in Sexual Abuse ă inappropriate adolescent or adult
out-of-home care or court jurisdiction of a child. sexual behavior with a child. It includes fondling
a child's genitals, making the child fondle the
Risk ă the likelihood that a child will be maltreated adult's genitals, intercourse, incest, rape, sodomy,
in the future. exhibitionism, sexual exploitation, or exposure to
pornography. To be considered child abuse, these
Risk Assessment ă to assess and measure the acts have to be committed by a person responsible
likelihood that a child will be maltreated in the future, for the care of a child (for example a baby-sitter,
frequently through the use of checklists, matrices, a parent, or a daycare provider) or related to the
scales, and other methods of measurement. child. If a stranger commits these acts, it would be
considered sexual assault and handled solely be the
Risk Factors ă behaviors and conditions present in
police and criminal courts.
the child, parent, or family that will likely contribute
to child maltreatment occurring in the future. Substantiated ă an investigation disposition
concluding that the allegation of maltreatment or
Safety ă absence of an imminent or immediate
risk of maltreatment was supported or founded
threat of moderate-to-serious harm to the child.
by State law or State policy. A CPS determination
Safety Assessment ă a part of the CPS case process means that credible evidence exists that child abuse
in which available information is analyzed to or neglect has occurred.
identify whether a child is in immediate danger of
Tertiary Prevention ă treatment efforts geared to
moderate or serious harm.
address situations where child maltreatment has
already occurred with the goals of preventing child
Appendix A—Glossary of Terms

maltreatment from occurring in the future and of stopping the occurrence of maltreatment before it
avoiding the harmful effects of child maltreatment. starts. Also referred to as „primary prevention.‰
Treatment ă the stage of the child protection Unsubstantiated (not substantiated) ă an

case process when specific services are provided investigation disposition that determines that there
by CPS and other providers to reduce the risk of is not sufficient evidence under State law or policy
maltreatment, support families in meeting case to conclude that the child has been maltreated or at
goals, and address the effects of maltreatment. risk of maltreatment. A CPS determination means
that credible evidence does not exist that child abuse
Universal Prevention ă activities and services or neglect has occurred.
directed at the general public with the goal of
APPENDIX B
L isted below are several representatives of the many national organizations and groups that deal with various
aspects of child maltreatment. Please visit www.calib.com/nccanch to view a more comprehensive
list of resources and visit www.calib.com/nccanch/database/index.cfm to view an organization database.
Inclusion on this list is for information purposes and does not constitute an endorsement by the Office on
Child Abuse and Neglect or the Children's Bureau.
Childhelp USA
FOR THE GENERAL PUBLIC
address: 15757 North 78th St.
Scottsdale, AZ 85260
American Bar Association Center on Children
and the Law phone: (800) 4-A-CHILD
(800) 2-A-CHILD (TDD line)
address: 740 15th St., NW (480) 922-8212
fax: (480) 922-7061
phone: (202) 662-1720
e-mail: [email protected]
fax: (202) 662-1755
Web site: www.childhelpusa.org
Provides crisis counseling to adult survivors and
Web site: www.abanet.org/child child victims of child abuse, offenders, and parents
and operates a national hotline.
Promotes improvement of laws and policies affecting
children and provides education in child-related law
topics.
National Center for Missing and Exploited homeless youth, independent living, child care,
Children (NCMEC) child support enforcement, and child welfare.
address: Charles B. Wang International Family Support America

Children's Building (formerly Family Resource Coalition of America)
699 Prince St.
Alexandria, VA 22314-3175 address: 20 N. Wacker Dr., Suite 1100
Chicago, IL 60606
phone: (800) 843-5678
(703) 274-3900 phone: (312) 338-0900
fax: (703) 274-2220 fax: (312) 338-1522
Web site: www.missingkids.com e-mail: [email protected]
Provides assistance to parents, children, law Web site: www.familysupportamerica.org

enforcement, schools, and the community in
Works to strengthen and empower families and
recovering missing children and raising public
communities so that they can foster the optimal
awareness about ways to help prevent child
development of children, youth, and adult family
abduction, molestation, and sexual exploitation.
members.
Parents Anonymous
National ChildrenÊs Alliance
address: 675 West Foothill Blvd., Suite 220
address: 1612 K St., NW, Suite 500
Claremont, CA 91711
phone: (909) 621-6184
phone: (800) 239-9950
fax: (909) 625-6304 (202) 452-6001
e-mail: [email protected] fax: (202) 452-6002
Web site: www.parentsanonymous.org e-mail: [email protected]
Leads mutual support groups to help parents provide Web site: www.nca-online.org
nurturing environments for their families. Provides training, technical assistance, and
networking opportunities to communities seeking
COMMUNITY PARTNERS to plan, establish, and improve Children's Advocacy
Centers.
The Center for Faith-based and Community National Exchange Club Foundation for the
Initiatives Prevention of Child Abuse
e-mail: [email protected] address: 3050 Central Ave.

Toledo, OH 43606-1700
Web site: www.hhs.gov/faith
phone: (800) 924-2643
Welcomes the participation of faith-based and
community-based organizations as valued and (419) 535-3232
essential partners with the U.S. Department of fax: (419) 535-1989
Health and Human Services. Funding goes to
faith-based organizations through Head Start and e-mail: [email protected]
to programs for refugee resettlement, runaway and Web site: www.nationalexchangeclub.com
Appendix B—Resource Listings

Conducts local campaigns in the fight against child Conducts prevention activities such as public
abuse by providing education, intervention, and awareness campaigns, advocacy, networking, research,
support to families affected by child maltreatment. and publishing. Also, provides information and
statistics on child abuse.
National Fatherhood Initiative
Shaken Baby Syndrome Prevention Plus
address: 101 Lake Forest Blvd., Suite 360
Gaithersburg, MD 20877 address: 649 Main St., Suite B Groveport, OH
43125
phone: (301) 948-0599
phone: (800) 858-5222
fax: (301) 948-4325
(614) 836-8360
Web site: www.fatherhood.org
fax: (614) 836-8359
Works to improve the well-being of children by e-mail: [email protected]
increasing the proportion of children growing up
with involved, responsible, and committed fathers. Web site: www.sbsplus.com
Develops, studies, and disseminates information and
PREVENTION ORGANIZATIONS materials designed to prevent shaken baby syndrome
and other forms of physical child abuse and to
increase positive parenting and child care.
National Alliance of ChildrenÊs Trust and
Prevention Funds (ACT)
CHILD WELFARE ORGANIZATIONS
address: Michigan State University
Department of Psychology
East Lansing, MI 48824-1117 American Humane Association ChildrenÊs
Division
phone: (517) 432-5096
address: 63 Inverness Dr., East
fax: (517) 432-2476
Englewood, CO 80112-5117
phone: (800) 227-4645
Web site: www.ctfalliance.org (303) 792-9900
Assists State children's trust and prevention funds to fax: (303) 792-5333
strengthen families and protect children from harm. e-mail: [email protected]
Prevent Child Abuse America Web site: www.americanhumane.org
address: 200 South Michigan Ave., 17th Floor Conducts research, analysis, and training to help
Chicago, IL 60604-2404 public and private agencies respond to child
phone: (800) 835-2671 (orders) maltreatment.
(312) 663-3520
fax: (312) 939-8962
Web site: www.preventchildabuse.org
American Public Human Services Association Child Welfare League of America
address: 810 First St., NE, Suite 500 address: 440 First St., NW, Third Floor
Washington, DC 20002-4267 Washington, DC 20001-2085
phone: (202) 682-0100 phone: (202) 638-2952
fax: (202) 289-6555 fax: (202) 638-4004
Web site: www.aphsa.org Web site: www.cwla.org
Addresses program and policy issues related Provides training, consultation, and technical
to the administration and delivery of publicly assistance to child welfare professionals and agencies
funded human services. Professional membership while also educating the public about emerging
organization. issues affecting children.
American Professional Society on the Abuse of ChildrenÊs Defense Fund

Children
address: 25 E St., NW
address: 940 N.E. 13th St. Washington, DC 20001
CHO 3B-3406
phone: (202) 628-8787
Oklahoma City, OK 73104
fax: (202) 662-3540
phone: (405) 271-8202
fax: (405) 271-2931
Web site: www.childrensdefense.org
Provides technical assistance to State and local
Web site: www.apsac.org
child advocates, gathers and disseminates data on
Provides professional education, promotes research to children, and advocates for children's issues.
inform effective practice, and addresses public policy
issues. Professional membership organization. National Black Child Development Institute
AVANCE Family Support and Education address: 1023 15th St., NW, Suite 600
Program
phone: (202) 387-1281
address: 301 South Frio, Suite 380
San Antonio, TX 78207 fax: (202) 234-1738
phone: (210) 270-4630 e-mail: [email protected]
fax: (210) 270-4612 Web site: www.nbcdi.org
Web site: www.avance.org Operates programs and sponsors a national training
conference through Howard University to improve
Operates a national training center to share and
and protect the well-being of African-American
disseminate information, material, and curricula
children.
to service providers and policy makers interested in
supporting high-risk Hispanic families.
Appendix B—Resource Listings

National ChildrenÊs Advocacy Center National Resource Center on Child
Maltreatment
address: 200 Westside Sq., Suite 700
Huntsville AL 35801 address: Child Welfare Institute
3950 Shackleford Rd., Suite 175
phone: (256) 533-0531
Duluth, GA 30096
fax: (256) 534-6883
phone: (770) 935-8484
fax: (770) 935-0344
Web site: www.ncac-hsv.org
Provides prevention, intervention, and treatment
Web site: www.gocwi.org
services to physically and sexually abused children
and their families within a child-focused team Helps States, local agencies, and Tribes develop
approach. effective and efficient child protective services systems.
Jointly operated by the Child Welfare Institute and
National Indian Child Welfare Association ACTION for Child Protection, it responds to needs
related to prevention, identification, intervention,
address: 5100 SW Macadam Ave., Suite 300
Portland, OR 97201 and treatment of child abuse and neglect.
phone: (503) 222-4044

FOR MORE INFORMATION
fax: (503) 222-4007
National Clearinghouse on Child Abuse and
Web site: www.nicwa.org Neglect Information
Disseminates information and provides technical address: 330 C St., SW

assistance on Indian child welfare issues. Supports Washington, DC 20447
community development and advocacy efforts to
phone: (800) 394-3366
facilitate tribal responses to the needs of families (703) 385-7565
and children.
fax: (703) 385-3206
Web site: www.calib.com/nccanch
Collects, stores, catalogs, and disseminates
information on all aspects of child maltreatment
and child welfare to help build the capacity of
professionals in the field. A service of the Children's
Bureau.
APPENDIX C
E ach State designates specific agencies to receive and investigate reports of suspected child abuse and
neglect. Typically, this responsibility is carried out by child protective services (CPS) within a Department
of Social Services, Department of Human Resources, or Division of Family and Children Services. In some
States, police departments also may receive reports of child abuse or neglect.
Many States have an in-State toll-free telephone number, listed below, for reporting suspected abuse. The
reporting party must be calling from the same State where the child is allegedly being abused for
most of the following numbers to be valid.
For States not listed or when the reporting party resides in a different State than the child, please call
Childhelp, 800-4-A-Child (800-422-4453), or your local CPS agency.
Alaska (AK) Illinois (IL) Massachusetts (MA)

800-478-4444 800-252-2873 800-792-5200
Arizona (AZ) Indiana (IN) Michigan (MI)

888-SOS-CHILD 800-800-5556 800-942-4357
(888-767-2445)
Iowa (IA) Mississippi (MS)
Arkansas (AR) 800-362-2178 800-222-8000
800-482-5964
Kansas (KS) Missouri (MO)
Connecticut (CT) 800-922-5330 800-392-3738
800-842-2288
800-624-5518 (TDD) Kentucky (KY) Montana (MT)
800-752-6200 800-332-6100
Delaware (DE)
800-292-9582 Maine (ME) Nebraska (NE)
800-452-1999 800-652-1999
Florida (FL)
800-96-ABUSE Maryland (MD) Nevada (NV)
(800-962-2873) 800-332-6347 800-992-5757
New Hampshire (NH) Oklahoma (OK) Utah (UT)
800-894-5533 800-522-3511 800-678-9399
800-852-3388 (after hours)
Oregon (OR) Vermont (VT)
800-649-5285
New Jersey (NJ) 800-854-3508, ext. 2402
800-792-8610 Virginia (VA)
800-835-5510 (TDD) Pennsylvania (PA) 800-552-7096
800-932-0313
New Mexico (NM) Washington (WA)
Rhode Island (RI) 866-END-HARM
800-797-3260 (866-363-4276)
800-RI-CHILD
New York (NY) (800-742-4453) West Virginia (WV)
800-342-3720 800-352-6513
Texas (TX)
Wyoming (WY)
North Dakota (ND) 800-252-5400
800-457-3659
800-245-3736
Appendix C—State Toll-free Telephone Numbers for Reporting Child Abuse

To view or obtain copies of other manuals in this series, contact the
National Clearinghouse on Child Abuse and Neglect Information at:
800-FYI-3366
[email protected]
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CHILD ABUSE AND NEGLECT

USER MANUAL SERIES

U.S. Department of Health and Human Services

to Child Abuse and Neglect:

The Foundation for Practice

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Office on Child Abuse and Neglect

1. PURPOSE AND OVERVIEW .......................................................................................................................... 7

2. WHAT ARE THE PHILOSOPHICAL TENETS OF CHILD PROTECTION? .............................. 9

Key Principles of Child Protection ...............................................................................................................9

Philosophical Tenets ...................................................................................................................................... 10

3. WHAT IS CHILD MALTREATMENT? ..................................................................................................... 13

Definitions in Federal Law .......................................................................................................................... 13

Sources of Definitions in State Law ........................................................................................................... 15

General Definitions by Type of Maltreatment ......................................................................................... 16

4. WHAT IS THE SCOPE OF THE PROBLEM?......................................................................................... 23

Reported Child Maltreatment Victims ...................................................................................................... 23

Child Maltreatment Perpetrators................................................................................................................ 24

Nonreported Child Abuse and Neglect..................................................................................................... 25

5. WHAT FACTORS CONTRIBUTE TO CHILD ABUSE AND NEGLECT?.................................. 27

Parent or Caregiver Factors.......................................................................................................................... 28

Family Factors ................................................................................................................................................ 29

Child Factors .................................................................................................................................................. 32

Environmental Factors ................................................................................................................................. 33

Protective Factors ........................................................................................................................................... 34

6. WHAT ARE THE CONSEQUENCES OF CHILD ABUSE AND NEGLECT? ........................... 35

Health and Physical Effects ......................................................................................................................... 36

Cognitive Development and Academic Achievement ............................................................................ 37

Emotional, Psychosocial, and Behavioral Development........................................................................ 37

Prevention as a Strategy ................................................................................................................................ 41

Types of Prevention Activities ..................................................................................................................... 42

Major Prevention Program Models ............................................................................................................ 43

Role of Various Entities in Prevention Efforts......................................................................................... 47

8. WHICH LAWS AND POLICIES GUIDE PUBLIC INTERVENTION

IN CHILD MALTREATMENT? ................................................................................................................... 51

The Federal Role in Addressing Child Abuse and Neglect ................................................................... 51

Basis for State Intervention.......................................................................................................................... 55

9. WHAT DOES THE CHILD PROTECTION PROCESS LOOK LIKE?.......................................... 59

Initial Assessment or Investigation ............................................................................................................ 66

Service Provision ............................................................................................................................................ 70

Evaluation of Family Progress..................................................................................................................... 71

Case Closure ................................................................................................................................................... 72

10. WHO SHOULD BE INVOLVED IN CHILD PROTECTION

AT THE COMMUNITY LEVEL? ................................................................................................................. 73

Child Protective Services .............................................................................................................................. 73

Law Enforcement ........................................................................................................................................... 73

Educators and Early Child Care Providers............................................................................................... 74

Health Care Providers................................................................................................................................... 75

Mental Health Professionals........................................................................................................................ 75

Legal and Judicial System Professionals .................................................................................................... 75

Substitute Care Providers ............................................................................................................................. 77

Community Organizations and Support Services Providers................................................................. 77

Concerned Citizens ....................................................................................................................................... 78

11. HOW CAN ORGANIZATIONS WORK TOGETHER TO PROTECT CHILDREN? .............. 79

Principles to Guide Collaboraton .............................................................................................................. 79

Effective Leadership·An Essential Component of Successful Collaboration ................................... 80

APPENDIX A·GLOSSARY OF TERMS .................................................................................................... 91