Black\'s Law Dictionary (1991), Child

¶ … Black's Law Dictionary (1991), child abuse is "any form of cruelty to a child's physical, moral or mental well-being. Also used to describe form of sexual attack which may or may not amount to rape. Such acts are criminal offenses in most states" (p. 239). By contrast, the legal definition of abused and neglected children describes children who "are suffering serious physical or emotional injury inflicted upon them including malnutrition" (p. 11). The first step in providing social service treatment to physically abusive families is therefore to ensure the physical safety of the children involved (Herschell & McNeil, 2005). This response, typically from the law enforcement community, can range along the entire continuum of severity, up to and including incarceration of the offending parents and placement of the abused children in foster care for an undetermined duration (Bryant & Milsom, 2005).

Following this step, a wide array of treatment modalities is available for physically abusive families. Family therapy and parent-child cognitive behavior therapy have been shown to be effective in improving parental discipline and reducing parent-child conflicts. In addition, home visits, therapeutic day treatments, individual child psychotherapy and art therapy have been found useful by some clinicians (Montgomery & Ramchandani, 2009). According to Herschell and McNeil (2005), "Parent-Child Interaction Therapy (PCIT), originally developed for the treatment of externalizing behavior problems in children aged two to seven years, has also been used to treat child physical abuse populations" (p. 15). The PCIT protocol, though, is designed to be a short-term intervention for families (Hershell & McNeil, 2005). Other protocols that have been deemed best practices for the treatment of physical abuse include Abuse-Focused Cognitive Behavior Therapy for child physical abuse (AF-CBT) and Trauma-Focused Cognitive Behavior Therapy for child sexual abuse (Herschell & McNeil, 2005).

It is important to note, though, that there is no "one-size-fits-all" clinical intervention that is equally effective or applicable to all physically abusive family settings. In this regard, Mennen and Trickett (2011) emphasize that, "The etiology of child maltreatment is complex and related to characteristics of the parents and children, the surrounding ecology, the situation in time, and social factors, among other things" (2011, p. 21). Therefore, achieving the desired outcomes of reducing parent-child conflict and eliminating physically abusive behaviors requires a careful assessment of the home environment, the family dynamics that are involved, and what interventions, if any, have been used in the past (Jouriles, McDonald, Slep, Heyman & Garrido, 2008). Because social services resources are scarce (Bryant, 2009), it is important to identify optimal solutions as quickly as possible and evaluate their effectiveness to ensure that these outcomes are achieved. Unfortunately, many agencies lack the manpower needed to visit every family every day, but focusing this level of oversight on specific cases may be needed over the short-term in any event.

Answer 6-2.

In the 19th century and early 20th century, members of the community in the rural American South would visit neglectful fathers at night and "persuade" them that they should take better care of their families if their children were hungry and dressed in rags. Likewise, when signs of child neglect are detected by members of the community today, social services can become involved in meaningful ways that can help parents recognize their responsibilities and help them become better parents in response. Admittedly, parenting is a challenging enterprise by any measure, and some people struggle to provide their children with the basic needs of living every day. Some of these parents may be too proud or otherwise restrained by different cultural values to seek out social service assistance, viewing it as "welfare" or "charity." In the vast majority of cases, though, neglectful parents can be neglectful by other acts of both commission and omission, suggesting that they know their children are going without but simply do not care. In these situations, removing the children to other settings may be appropriate until the responsible parent or parents are able to demonstrate their capacity to respond to the needs of their children.

These interventions will take place after disequilibrium has occurred, and the outcomes thereafter will seek to reestablish equilibrium, a process that also exists along a continuum (Grinker & McGregor, 1991). In this regard, Radosevich, Levine, Sumner, Knight, Arendt and Johnson (2009) report that, "A perceived discrepancy between performance and internal goals is considered an error and creates disequilibrium in the system. Individuals experience negative affect and are motivated to restore equilibrium by reducing the discrepancy either cognitively or behaviorally" (p. 37).

Cognitive therapy seeks to restore as much equilibrium in people's lives as possible, but the process is not one-time or static, but rather is an iterative process that requires time to achieve substantive outcomes in many treatment settings. As Radosevich and his associates point out, "These responses affect individuals' subsequent progress toward the goal, at which time another self-evaluation process occurs. If a discrepancy still remains, individuals are motivated to reduce it again. The process continues until performance matches the goal" (2009, p. 38). Therefore, cognitive therapy focuses on reducing these discrepancies as the primary corrective motive for changing human behavior (Radosevich et al., 2009).

In addition, cognitive therapy holds that there are a number of negative feedback loops contained in a hierarchal framework; this framework is organized such that a series of subgoals may need to be established and achieved in order to move on to higher order needs and outcomes (Radosevich et al., 2009). According to these authorities, "The implication is that in order to achieve any given goal, specific subgoals may need to be established and pursued sequentially as attention shifts from one feedback loop to another" (Radosevich et al., 2009, p. 12). This means that social workers can mutually establish a series of subgoals for neglectful parents that can be used to as benchmarks to assess the effectiveness of the interventions used in terms of achieving the desired individual outcomes. Over time, the best case scenario for this approach would be to help formerly neglectful parents achieve the skills and desire to become satisfactorily attentive parents.

Answer 6-3. When shots are being fired on the battlefield, most soldiers agree that keeping low is just common sense, and even very young children intuitively recognize that keeping a low profile when another child is being beaten or abused is also a good idea. Not surprisingly, young people will try to avoid the same types of situations that their abused siblings experience, and may in fact contribute to the incidence of such abusive behaviors on the part of the parent intentionally as a means of retribution for perceived transgressions, or simply for their own amusement. Indeed, children may contribute to the incidence of the abuse of their siblings by "ratting them out" to their parents or framing them to appear to have committed some infraction that is known to evoke abusive parental behaviors. In other cases, though, siblings may contribute to such abusive behaviors unintentionally and will go to great lengths to avoid becoming involved in the parent-abused child dynamic at all (Miller, 2002). In these cases, young people may be highly reluctant to participate in any family therapy in case they might become the focus of the parents' abuse in the future. In any event, in order to be effective, treatment planning should include all of the immediate family members.

Answer 6-4.

Like grisly deaths and violent accidents, many people want to distance themselves as far as possible from the truly bad things in life such as child sexual abuse, even if they recognize that these things exist and that they need to do something about them (Crosson-Tower, 2009). There are also some other popular misperceptions about child abuse and neglect that constrain mobilizing resources at the community, regional, state and national levels. For example, Taylor and Daniel (2005) emphasize that, "Different perceptions of child neglect are determined by cultural agreement and belief systems, social systems and the personal views held by individuals. These views influence both professional and media attitudes towards neglect" (p. 73). A summary of the relevant literature cited by these authorities included the following beliefs concerning child neglect in the United States:

1. Child neglect does not have serious consequences;

2. It is inappropriate to judge parents involved in poverty-related neglect;

3. Child neglect is an insurmountable problem;

4. Other forms of child maltreatment are more compelling;

5. Ambiguity and vagueness make it difficult to define neglect (Taylor & Daniel, 2005, p. 73).

A careful reading of "Jim's story" (http://www.stopitnow.org/story_jim) indicates that Jim was sexually abused by his own father beginning when he was "two or three years old," but he does not say how long this abuse lasted, if the abuse persisted at all, nor does he elaborate otherwise. Nevertheless, he does cite his status as a victim of such abuse to help place his actions into context, but these assertions somehow ring hollow when combined with his recurring references to his "painful reexaminations" of his life and how his actions have adversely affected his own children.

Moreover, it is unclear whether Jim has attempted to reestablish any meaningful contact with his children; rather, his entire focus has been on becoming a better person. While there is certainly nothing wrong with that goal in and of itself (it is, after all, a universal human quality), he appears to have pursued this goal to the total exclusion of making any substantive reparations to his family. Finally, it is interesting that Jim somehow feels compelled to tell others -- including potential employers -- about his criminal past and his current status in treatment, as if this ongoing commitment to all-out honesty somehow absolves him from a deceptive and duplicitous history, or at least helps to explain it (which it does if one is interested). According to Jim, "Entering into society again was very difficult. I had lost my business, my friends and was now divorced. After leaving jail, I sent out 86 job applications before I found my first position (as a night manager at a fast food restaurant). I was happy to find any work and to be honest about where I was in my recovery and treatment" (para. 2). Good grief! It is little wonder that Jim had trouble finding a job. Employers want to know if applicants can do the job and most will certainly not inquire about the applicants' sexual abuse history or their current status in treatment unless this information is volunteered. After reading this story, the main feeling that emerged was that unless this is a condition is Jim's release from prison, he should shut up about his "special status" as a recovering sex abuser and alcoholic, actively participate in his therapy and try to make some money to support his children. If appropriate, this individual's treatment plan could include contact with his children provided they are amenable to such contact. After all, he could certainly have stopped the sexual abuse before he was forced to and sought therapy, and it was only after being prosecuted and incarcerated that he had this epiphany (this was the feeling that emerged, anyway and it is likely that Jim is required to divulge his status as a sex offender in most jurisdictions (O'Malley, 2002), but perhaps not on initial mailed applications for an interview).

The importance of substance abuse as a contributing factor to Jim's behaviors, though, was also noted in "Edward's story" (http://www.stopitnow.org/story_ edward). Edward's story differs somewhat from Jim's in the type and frequency (apparently an isolated incident that did not involve physical contact) and the ongoing contact with his children that defines the successful outcome in his treatment plan.

Answer 7-1.

The research to date suggests that foster mothers demonstrate more empathy than the physically abusive mothers from which children had been removed and that one of the best predictors of child abuse was the birth mother's perception of her child's behavior as being problematic (Mennen & Trickett, 2011). Increasingly, though, social service agencies are electing to keep natural parents and their children together to the maximum extent possible, even in those cases where abuse or neglect may still occur. This type of cost-benefit analysis is driven in part by the scarcity of social services resources, but this tendency also takes place in jurisdictions where adequate foster homes are available (Mennen & Trickett, 2011). In this regard, Norman (2000) emphasizes that, "Agencies today are faced with a sustained demand for their services in a world of rising insistence on accountability, increasing fiscal austerity, and heightened competition for scarce resources" (p. 127).

Many of the young people in the Kid's Count video likewise made it clear that being separated from their mother and siblings was one of the hardest parts of going through "the system." From the perspective of social services agencies, a foster home placement might be successful if there were no reports of additional abuse or signs of neglect. By very sharp contrast, the children placed in these foster homes consistently emphasized that they were subjected to far different treatment compared to foster parents' natural children and this distinction was further reinforced in various ways, including how they were introduced to others and what chores were assigned compared to the natural children of the family. (These foster children might be interested to know that all parents tell their own children that they should be grateful for what they receive while they live under their roofs, but these admonitions usually also falls on deaf ears in these cases as well.)

The effectiveness of foster care for many of the young people interviewed in this video related to a desperate need to be accepted, nurtured and loved without qualification or the fear of being removed at a moment's notice. Indeed, besides love, all of these young people yearned for stability in their lives and adults who treated them like members of their own family. People treat their pets like members of their own family, and those who would volunteer for foster care services should recognize that these troubled children need all of the reassurances they can get, and when they are treated differently from other birth children of the family, they internalize these behaviors in ways that makes it difficult for them to respond affectionately or to become overly friendly with their foster parents' natural children. These empirical observations are congruent with the clinical research that has been conducted in this area. Although the research in this area is limited, studies have shown that "families with children by both birth and adoption were at greater risk of difficulties than families with children only by birth" (Horner, 2000, p. 82), but there were few differences otherwise in responses to foster place with or without siblings. These clinical findings, though, appear to fly in the face of the importance these young people placed on staying with their brothers and sisters whenever possible.

One of the overriding issues that emerged from these stories of foster care was that despite its drawbacks and potentially harmful effects, these young people were all physically fit, articulate and downright bubbling with enthusiasm about the future. In fact, they all seemed intent and of a like mind on changing the way their families operated and being the beginning of a new chapter in their family history that avoided the pitfalls that destroyed their families in the past -- including drug and alcohol abuse. If nothing else, their parents provided a model of what to avoid. The resiliency demonstrated by these foster care charges may not be entirely typical of "the system," but it is hard not to like their odds for the future. In fact, most of the interviewees were able to point to at least one foster parent who provided the type of loving and secure home that they wanted, but these children were physically and emotionally "normal" rather than special needs as discussed further below.

Answer 7-2. Children with severe physical or emotional or other developmental disabilities may present too much of a challenge for many adoptive parents (Shannon & Tappen, 2011). Unfortunately, children with developmental disabilities are more likely to be abused or neglected than are children who do not have developmental disabilities (Shannon & Tappen, 2011). The research to date shows that children with disabilities are almost four times (3.8) more at risk for neglect, more than three times (3.1) more at risk for sexual abuse, almost four times (3.8) more at risk for physical abuse and emotional abuse (3.9) compared to other children, and severely disabled children being three times more likely to be abused by a parent (Shannon & Tappen, 2011). It is not surprising, then, that fully 66% of children in foster care are experiencing developmental delays and many children enter child protective service systems have developmental needs that are not being met (Shannon & Tappen, 2001). Moreover, children with disabilities routinely receive more serious physical and sexual offenses, are more likely to report repeated sexual abuse and to report more injuries related to physical abuse compared to other children (Shannon & Tappen, 2011)

Outcomes for these special needs children can be improved through early screening and intervention (Shannon & Tappen, 2011). In addition, follow-up support following place in child services settings is an important component for successful outcomes. In this regard, Powers (1999) emphasizes that, "Thousands of children with special needs await adoption and the number is rising rapidly. States have taken steps to facilitate and encourage adoption, but few states provide support for families after adoption" (p. 37).

Answer 7-3.

The adults interviewed in the Kids Count video were shown to be the type of people that define exemplary parenting. Everyone should be as lucky as the children placed in the care of these extraordinary foster parents and the same themes of unconditional love and stability were mentioned over and over. Clearly, when young people receive the level of attention and support these interviewees experienced, they can thrive and overcome the challenges and obstacles that were constraining their development to become healthy and caring adults themselves.

It is also clear, though, that foster parents that truly have the best interests of these children in mind will consider the type of cooperative parenting approaches that were described in the Kids Count video, all on a case-by-case basis. Every situation is different, and the potential for harm always exists when reintroductions are attempted. Children, especially very young children, desperately want and need their parents and they may not understand how anything can keep them apart and foster parents may be regarded as poor substitutes even if there was abuse involved in the home.

Unfortunately, Solomon is not around anymore and wise decisions and optimal solutions are difficult to find, especially when there are many of the additional factors that contribute to child abuse and neglect present, such as substance abuse and mental health disorders. In reality, if everyone involved remains focused on what is best for the child that is involved, though, then the type and extent of different responses by foster and birth parents that are most appropriate can be identified and these interventions evaluated over time for their effectiveness. In the final analysis, many young people will be fortunate to find a single birth or foster parent with the qualities needed to satisfy all of their developmental needs, and if more than one is available for this purpose then it just makes good sense to take advantage of these additional resources. The key to success would involve the same type of cost-benefit analysis that constraints any intervention involved the welfare of children and the fundamental rights of parents -- irrespective of how bad they may be at the task.

Answer 7-4.

Anyone who has submitted a suggestion as part of a human resource program expecting everyone to see the obvious advantages of their solution only to find that bureaucrats rejected it for spurious reasons can readily testify that working in a bureaucracy is a soul-numbing experience that can sap the enthusiasm from the most well intentioned practitioner over time. Indeed, it is easy enough for all professional who routinely experience failure to become jaded and simply give up on their clients and themselves and even leave the field as a result. Likewise, the frustrations that are associated with an inability to make a substantive difference within a bureaucratic framework can result in stress and/or diminished effectiveness and productivity in the social service workplace. In this regard, Lombardo and Eyre (2011) emphasize that even "empathic and caring" practitioners "can become victims of the continuing stress of meeting the often overwhelming needs of clients and their families, resulting in compassion fatigue" (p. 19).

Certainly, everyone -- especially social workers -- experience failures all the time in their struggle to help others, but the defining characteristic of the compassion fatigue experience is the adverse effect these repeated failures can have on future job effectiveness, and even the choice of career field. These issues are compounded by the widespread depiction of social services as being failed enterprises in many settings across the country. For example, Norman (2000) emphasizes that, "The media portrayal of social workers tends to be of failed practice with clients, for example in the area of child abuse or neglect" (p. 180).

Over time, these complex but powerful factors can combine to frustrate even the most zealous social worker. In fact, Lombardo and Eyre conclude that, "Compassion fatigue affects not only the practitioner in terms of job satisfaction and emotional and physical health, but also the workplace environment by decreasing productivity and increasing turnover" (p. 19). There may be little room for false starts or experimentation when it comes to immediately protecting young people, and there is a glaring need for using the best evidence-based practices available for these purposes (Norman, 2000). Indeed, there is an ongoing need for all social services to determine what works best in their unique situations and then to do more of that -- just as in the business world. Many social workers, though, should be prepared to face a rigid hierarchy of authority that will defy their efforts to change it so they should chose their battles carefully to avoid developing compassion fatigue.

Answer 8-1. According to Norman (2000), resiliency refers to the ability of people to respond in healthy ways to adverse situations, and it appears to be a universal human quality that extends to much of the rest of the natural world as well. In this regard, Norman advises that, "Resiliency is the ability to bounce back in the face of adversity. It is a term borrowed from the physical sciences that connotes a self-righting process that allows a body to spring back to its original shape and level of functioning after external stressors have been applied" (p. 157). This relentless quest for stasis, then, is a recurring feature of the human condition and serves to motivate people to meet challenges head-on and overcome them. For instance, Norman notes that, "Resiliency is achieved when, after experiencing stress, one returns to functioning" (p. 157).

For young people caught up in "the system," resiliency can play an important role in mediating the otherwise deleterious factors that they may encounter, including the instability and fear that characterize many of their experiences. Therefore, practitioners can help these young people by identifying their strengths and drawing on these rather than focusing on what the major weaknesses in their relationships with their parents or caregivers may be. In this regard, Norman cites the work of Nan Henderson and other resiliency model therapists and explains, "Resiliency is enhanced through the development and use of protective factors. Such protective factors, therefore, become the mediators between a person or group and their stressful environment; they are the means, while resiliency is the sought after result" (p. 157). The fact that the resiliency model has worked as well as its proponents (especially Henderson) claim may be attributable to other factors, though, including the degree and quality of the social services that are otherwise being provided. Nevertheless, it just makes good sense to use whatever strengths are available in a family unit to their maximum advantage, and focusing on what is wrong can produce negative results rather than the desired outcome.

Answer 8-2.

While much of the research to date in the area of child abuse has focused on individual resiliency, the resiliency model has been extended to include broader systems such as families and schools (Henderson, 1996; Henderson & Milstein, 1996). Teachers can help young people understand that child abuse is not their fault and that the adults responsible for these actions are accountable to society (Gullart & Stockton, 2000). While innovation may not be appropriate in every setting, it can play an important role in helping identify alternatives to existing interventions that are not providing the desired outcomes and school-based clinicians are in an excellent position to participate in formulating more efficacious protocols by virtue of the frequency of their contact and their ability to observe students over time. In this regard, the U.S. Department of Health & Human Services' Administration for Children and Families (2012) reports that, "Teachers and other school staff are in an optimal position to prevent, identify, and assist victims of child abuse and neglect because of their frequent contact with students" (School-based prevention programs, 2012, para. 2). A collaborative initiative between RAND Corporation, RAND Health and school-based mental health practitioners resulted in a school-based program that has been found to be highly effective in reaching marginalized students in socioeconomically depressed communities (Helping children cope with violence and trauma, 2011). The key findings that emerged from this study included the following:

1. Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) significantly reduced symptoms of post-traumatic stress and depression in students exposed to violence.

2. School mental health clinicians successfully delivered the program.

3. The program produced consistent results and was well accepted by students, parents, and teachers.

4. A version of the intervention has been adapted for delivery by regular school staff with no mental health training.

5. A new website that provides online training and support for mental health professionals to deliver CBITS is now accessible, free of charge: http://cbitsprogram.org (Helping children cope with violence and trauma, 2012).

Answer 8-3.

One of the major strengths of child protective services is the fact they are staffed by people who care about children in the first place, which is the reason for the choice of career fields. These people form the front lines of the battle against child abuse and neglect, but they are few compared to the numbers of young people who need them. Indeed, when it comes to trying to replace the love and nurturing environment of traditional homes, even the best operated facilities and loving foster homes will likely pale in comparison in the eyes of children who really just want their moms and dads, and their brothers and sisters, in as normal a family unit as possible.