Family of Four: A case study analysis and response.
The following essay examines a suspected neglect case involving a family of four sisters, Megan, nine years old, Madeline, five years old, Emma, two years old, and Katie, one-year-old. It will begin by providing a comprehensive description of Child Neglect to provide a frame of reference for the case material, followed by a case overview. Risk and protective factors will be discussed, and a critical analysis of the potential impacts will be explored. The possible outcomes, should this case remain unaddressed, have far-reaching negative impacts on all four sister’s capacity to function. The information provided in the case material will be guided by relevant legislation, including the Child Protection Act and the United Nations Conventions on the rights of a child. It will then cover the collaboration that will be required to meet the needs of the family, and then suitable prevention and intervention strategies to support the family.
It has been suggested that Child Neglect is the most prevalent type of child abuse globally, yet it is considered to have the least scholarly and public attention (Bryce, Robinson, & Petherick, 2019). Dubowitz (2014) wrote an overarching definition of child neglect, stating it could be the repeated failure to meet a child’s physical or psychological needs that result in severe impairment of child health or development (Bryce et al., 2019). The Child Abuse Prevention and Treatment Act (CAPTA, 2018), states that the term ‘child abuse and neglect’ at a minimum, means,
“Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm” (U.S Department of Health and Human Service, 2018, p. 5).
The Child Welfare Information Gateway (2019), wrote that there are four major recognized types of Child maltreatment, physical abuse, neglect, sexual abuse, and emotional abuse. In addition to identifying abandonment and parental substance use as forms of neglect. Child neglect differs from the other forms of maltreatment like those mentioned above because it infers the omission of care rather than an act of commission of harm (Bryce et al., 2019).
Mennen, Kim, Sang, & Trickett (2010), write about researches attempts to create more explicate categories of child neglect, which include more specificity about the subtype and severity involved. The result was an adoption of five subtypes of neglect, first being Care neglect, which is seen by failing to provide a child with adequate food and sanitation. Medical neglect, which is the failure to provide medical care for injury or illness. Educational neglect is when a child is either not enrolled in school or is not supplied with the necessary tools to strive. Supervisory neglect occurs when a child is not provided adequate supervision, and Environmental neglect is the failure to provide a clean, healthy environment for the child to grow (Bryce et al., 2019).
Case Overview.
In this case, all four sisters have become accustomed to reoccurring relocation, homelessness, lack of education and parental engagement, and exposure to parental substance misuse with mental health and aggressive episodes. There is an apparent dysfunctional family structure, with all supervisor duties being completed by Megan, and all four sisters require severe medical attention. The above acts of omission are indicators for care, medical, educational, supervisory, and environmental neglect and demonstrate the Parent's failure to meet the needs of their children adequately. The context of this case, including there, were four children involved who are all going through different influential developmental stages, the functioning of both parents and mental health concerns, the history of the situation including the previous evasion of intervention with parental agreement (IPA), and the emerging pattern of intergenerational abuse and neglect, informs my professional judgment for intervention. It is imperative to understand the associated risk factors for child neglect to ensure the implementation of effective prevention and intervention strategies.
Case Analysis:
Risk Factors:
Risk Factors are measurable circumstances, conditions, or events that increase the probability that a family will have, or will continue to have poor outcomes, which in turn increases the probability of adverse childhood experiences (ACE). The theoretical model of Belsky (1980), which was based on Bronfenbrenner’s ecological perspective of development, examines the interplay of risk and protective factors that interact across four different levels and influence a child’s development (Mulder, Kuiper, Van der put, Stams, & Assink, 2018).
The first level is the ontogenetic development of the parents, which refers to parents exhibiting signs of negative experiences from their past into their current parenting behavior and actions. The parent’s ontogenetic development is significant in the case of the Family of four, because of the mother’s history of sexual abuse and mental illness, the father’s disclosure of witnessing and experiencing parental substance misuse as a child, and both parents currently engaging in substance misuse. Saraw (2019), writes that parents whom themselves experienced childhood maltreatment have now been identified to be at further risk of maltreating their children, along with identifying parental conflict, parental mental health problems, parental history of abuse, and those already in contact with child protection services, as significant risk factors.
The second level is the microsystem, which has the most direct influence on the child as it involves the interactions between the child’s closest relationships with family, friends, teachers. When looking at the family of four case, the siblings are having limited to no influential social interactions as they are moving every few weeks. The moving is having a significant impact on their school attendance and is taking away the chance for the sisters to have a dependable non-relative to rely on, like a teacher or counselor. The sisters also lack social interactions within their microsystem as both of their parents are regularly under the influence and are unable to engage actively. Although the case notes did not provide specific information about the family’s socio-economic status (SES), it is vital to consider the risk factors associated with low SES. Dubowitz (2007) notes that the “problems and burdens associated with poverty compromise the ability of many parents to meet their children’s needs in an adequate fashion” (p. 205).
The third level is the exosystem, which refers to the characteristics of the child’s living environment, which has influences on the child indirectly. In the Family of Four case, the children’s living environments continue to be a significant risk factor for them, the constant moving, over-crowding, unsafe and unhygienic environments, lack of appropriate supervisory and lack of active engagement will potentially have lifelong negative impacts on all four children. It is also essential to take into consideration that harm has already occurred in the unsafe environments that the siblings have had to reside in. Megan’s burn on her arm, from an unsafe kerosene heater, Madeline getting pricked by a needle, and complaining about severe tooth pain, and Emma being covered in scabies all prove the level of negligence of the parents and that this is a case of accumulative harm.
The macrosystem is the fourth level, which involves the attitude of children in the wider society and child maltreatment. The Child Welfare information gateway (2004) stipulates that factors such as narrow legal definitions of child maltreatment, the social acceptance of violence, and political or religious views that value noninterference in families may be risk factors in the macrosystem that are associated with child maltreatment. Regarding the family of four case, this could explain the attitude relating to the parent’s constant evasion of Child safety Officers, even with an IPA in place.
Mulder et al. (2018, p.199) explained neglect as a “disbalance between risk and protective factors,” so it is equally important to consider the relevant protective factors in this case.
Protective factors
Protective factors are characteristics or circumstances that can occur at the micro, Exo, or macrosystem level. Protective factors work to moderate risk or adversity and promote healthy development and child and family wellbeing (Australian Institute of Family Studies, 2017). Resilience is an important protective factor, which means the child can cope despite exposure to negative experiences. Regarding the case, Megan shows high signs of resilience. However, due to the young age of the other three siblings, it is hard to predict their levels of resilience because of heterogeneity. Another potential protective factor for this case is the social support seen within the siblings, with Megan’s protective and parental-like behavior, potentially positively impacting well-being throughout the neglect, working as a promotive and protective factor for the younger siblings (Folger & Wright, 2013). The case material does indicate that the Family is staying in a back room of a Church, so the community is also helping to provide somewhere safe for the family to reside.
Research indicates that it is the accumulation of, and interactions between, multiple protective and risk factors that either increase or decrease the likelihood of a child being neglected (Mulder et al. 2018). When looking at the case of the Family of four, there is a significant imbalance between the overwhelming risk factors and the limiting protective factors.
Rationale for support and Intervention
Potential Impact.
The potential impact of child neglect can be chronic and debilitating and can affect all interrelated domains of development, including physical, psychological, social, emotional, and behavioral (Bryce, 2019a). Hunter (2014) wrote that chronic, toxic stress experienced by neglected children, and particularly in the absence of consistent, supportive and interactive adult caregivers, as seen in this case, has been found to have an especially toxic effect on young children’s developing brains and can result in persistent psychological problems. Robinson (2019), goes further to list some of the potential problematic effects associated with child neglect. She starts with an increased presentation of internalizing and externalizing behaviors, a lack of ego resilience, delays in cognitive and emotional development, poor school performance, antisocial behavior, insecure attachments, and difficulties with emotional regulation.
Further indicators for neglect include the lack of parental interaction and engagement due to being regularly under the influence of substances. Streeck-Fisher and Van der Kolk (2008) stated that, when caregivers are extraordinarily inconsistent, frustrating, or neglectful, children are likely to become intolerably distressed, without a sense that the external environment nor caregivers will provide relief. Not being able to rely on their caregiver will leave the children with insecure attachments and leave them experiencing excessive anxiety, anger, and desires.
Also, the case notes identified the children as lacking adequate shelter and clothing which has the potential to negatively impact Megan, Madeline, Emma, and Katie’s social interactions. Research states that as a result of the neglect of care for the sibling’s basic needs, they may experience ‘poor peer relationships and rejection’ (Knutson, DeGarmo, Koeppl, & Reid, 2005).
The adverse childhood experiences identified in the family of four case, including emotional neglect, physical neglect, household substance abuse, household mental illness, lack of supervision, failure to provide basic needs, and homelessness are all signs of chronic neglect (Bryce, 2017). Bryce (2017), characterized chronic neglect by acts of enduring and reoccurring unmet basic needs, by parents or caregivers, that result in the child experiencing cumulative harm.
Cumulative Harm.
Cumulative harm is an essential consideration in this case, due to the recurrent and multiple nature of the risk factors listed above. Miller (2007), defined cumulative harm as “a series or pattern of harmful events and experiences that may be historical, or ongoing, with the strong possibility of the risk factors being multiple, interrelated and coexisting over critical developmental periods” (as cited by Bryce et al., 2019, p. 153).
The fact that the family of four has been actively evading Child safety offices, the previous IPA, Megan’s clear exhibit of parental-like behaviors, and the medical issues all four siblings currently have, suggest and prove the prolonged and chronic nature of their circumstances. Based on the particularities of this case, it is easy to assume that all four sisters have experienced these circumstances of neglect during a critical period of development. Bryce et al. (2019), indicates that the experience neglect of from a young age, especially birth to five years old, has dire negative implications for learning, behavior, physical and mental health and attachment processes.
Possible Outcomes.
The possible adverse outcomes of continued neglect in Megan, Madeline, Emma, and Katie’s case would be detrimental to all their development and wellbeing. Streek-Fischer & Van der Kolk (2000) write that Children's responses largely mimic those of their parents, and therefore the more disorganized and inconsistent the parent, the more disorganized and inconsistent the child. The more time the family of four are in the care of their parents, the more neglectful and harmful learned behavior, the children will be accustomed to through observation, modeling, and reinforcement. Bryce (2019b) writes about how, due to the theory of social learning, children can learn neglectful behaviors which are then repeated in intergenerational cycles.
Poor mental health outcomes, including anxiety disorders, depression, dissociated disorders, and psychosis, are considered a common consequence of child neglect (Bryce, 2019c). Felitti, Anda, Nordenberg, Williamson, Spitz, Edwards & Marks (1998) wrote that the Adverse Childhood Experience study confirmed links between childhood maltreatment and mental health, highlighting that an individual experiencing four or more ACE’s are twelve times more likely to attempt suicide than their non-abused peers (as cited in Bryce, 2019c p.3).
There is also a continued potential for harm and injury due to a lack of supervision.
Later life adverse outcomes for the family of four are, physical health issues, including increased risk of headaches, chronic disease, stroke, or heart disease. There is a body of evidence supporting links of child maltreatment and substance misuse in adulthood (Bryce, 2019c). Complex trauma and violence and criminality are also frequently identified as later life outcomes of neglect. A national Justice study in the United States predicted that neglected children were eleven times more likely to be arrested for criminal behaviors (Hunter, 2014).
Based on the case material, including the multiple risk factors, lack of protective factors, and suspected cumulative harm, the potential impact and possible outcomes for Megan, Madeline, Emma and Katie provide strong justification for support and intervention.
Response Outline and Justification.
As a Counsellor, the decision to provide support and intervention for the case of the Family of four is based on the risks of harm, the truthfulness of allegations, and the sufficiency of safety for Megan, Madeline, Emma, and Katie. Further investigation is required for Emma and Katie due to their young age to determine the nature of any learning or developmental difficulties. However, based on the case material provided, and the extensive analysis and rationale, all lead to support, and intervention is justified.
Legislation.
The Child Protection Act (1999, p. 24) published that the central belief of child protection is to “ensure the safety, wellbeing and best interests of the child, both through childhood and for the rest of the child’s life.” The child protection Act (1999) also stipulates that a child in need of protection is a child who has either suffered significant harm, or is at unacceptable risk of suffering harm, or if the child does not have a parent able and willing to protect them from harm, which is a prominent factor for this specific case.
Under the United Nations conventions on the right of a Child (1990), Article 24 states, that children have the right to good quality health care, clean water, nutritional food, and a clean environment so that they will stay healthy, which is currently unavailable to the family of four. Article 27 states that children have the right to a standard of living that is good enough to meet their physical and mental needs. Article 28 also states that children have the right to an education, which is another need of the family of four that is not being met.
The Education (provisions) Act 2006, and the Child Protection Act 1999 both provide clean mandatory reporting obligations for suspected or at-risk cases of physical or sexual abuse. However, in cases of neglect, reporting is guided by Section 13A of the Child Protection Act 1999, Stating that non-mandatory reporting can occur when it is reasonably suspected that “a child may require protection because the child has suffered, is suffering, or is at risk of suffering significant harm and may not have a parent able and willing to protect the child from harm” (Department of Education, 2019, p.5)
The Australian Association of social workers (2010), wrote that social workers will seek to safeguard the rights, interests, and safety of clients who have limited or impaired decision-making capacity when working on their behalf and that they will collaborate with other professionals and service providers in the interest of the client.
The emotional neglect, physical neglect, household substance abuse, household mental illness, lack of supervision, failure to provide basic needs, and homelessness identified in the case notes provide reasonable suspicion of both existing and future harm.
Guided by this Legislation, complementary decision-making tools, and professional procedures and conferral, the suspicion of harm to Megan, Madeline, Emma, and Catie reach the threshold for reporting to OPS or Child Safety. As a guidance officer, a report should be provided to the principal via the OneSchool Student Protection Reporting Module (Department of Education, 2019). Following this report, further collaboration will be required to meet the needs of the family of four.
Collaboration.
Throughout the justification process, it is essential to continue collaboration with colleagues. However, it is also required to continue collaboration with systems of child protection to continue responding to the children’s needs. Once the initial report is submitted, further communication with the Department of Child Safety may be required to determine whether notification, investigation, and assessment is required. However, due to the family having a previous IPA in place and actively evading Child Services offices, this case may require a short term order, of one to two years out of home care for the children so that the parents can have appropriate time to access help, support, and resources.
Collaboration with police, child protection investigation units, or suspected child abuse and neglect (SCAN) team may be required (Department of Education, 2019).
It is also imperative to work with both parents to assess their functioning capacity, assess what was and was not working with the IPA, because parental cooperation and intention or capacity to change are crucial to ensuring appropriate intervention and support is provided.
Prevention and Intervention.
Bryce (2017, p. 43) says that intervening in what is current and immediate is imperative, but so too is the prevention of reoccurring harm and ongoing exposures to maltreatment. Yang & Maguire-Jack (2018) stated that prevention and intervention approaches must comprehensively address the complex and multiple risk factors that define neglect.
According to Frederico, Jackson, & Black (2008), they believed that, from a therapeutic perspective, understanding parents’ experiences of trauma and deprivation informs us as to what types of intervention are most active (as cited by Bryce et al., 2019). They go on to explain that parents that have experienced cumulative harm in their lifetime need repetitive positive experiences in order to provide those experiences for their children. External agencies such as Family and Child Connect or Intensive Family Support would be useful as they assess needs, plan service strategies, and connect clients in a collaborative process.
Intensive Family Support (IFS) programs provide case management and support to families at risk of entering the child protection system. IFS could be particularly suited to this case at the services specialize in mental health and substance abuse, parenting support, and strategies to build positive family relationships, providing child health and wellness resources, and linking the parents into services that support the child’s development (Act for kids, 2015).
When looking at tertiary responses aimed at children, Bryce (2019d) recommends that trauma-focused therapy is helpful to address specific symptoms. Resilience building programs and relational/behavioral programs would also help. The father could also find help with referrals for anger management programs.
The Collaborative Assessment and Planning Framework is another that could work, along with programs such as IFS. This framework is a collaborative tool for working with family’s who have come to the attention of Child Safety (Bryce, 2019d). It aims to determine what is the concern, what seems to work well, what is not working well, and what needs to happen.
Conclusion
The case of the family of Four demonstrates the pervasive and ongoing nature of neglect. The above research articulates the severely adverse short and long-term effects of neglect and cumulative harm. The multiple and extensive risk factors and lack of protective factors, in this case, provide a strong motivation for support and intervention. Intervention strategies must address parental risk factors to ensure long-lasting outcomes. Protecting children and mitigating the risk of harm is key to ensuring Megan, Madeline, Emma, and Katie are provided with every opportunity to function and live a positive and fulfilling life.
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