The Tragedy Of Child Ne­glect

Par­ents Need So­ci­ety’s Help

The Washington Post Sunday - - Close To Home - — Howard Dubowitz

T he March 15 edi­to­rial “Cru­elty to Chil­dren; Mary­land needs to up­date its abuse law” fo­cused on a mother who left her five young sons unat­tended in a squalid base­ment apart­ment in Prince Ge­orge’s County. It sug­gested tougher penal­ties for child ne­glect. No one should con­done such cir­cum­stances. But, in urg­ing pun­ish­ment of ne­glect­ful par­ents, the edi­to­rial re­flected a lim­ited un­der­stand­ing of ne­glect and of what chil­dren truly need.

Child ne­glect is a se­ri­ous prob­lem. It does not evoke the strong re­ac­tion that abuse does. But it should.

Ne­glect ac­counts for two-thirds of the 3 mil­lion re­ports made to child pro­tec­tive ser­vices an­nu­ally in the United States. That’s the tip of the ice­berg. There are se­vere short­and long-term harms of ne­glect. Ne­glect oc­curs in half the 1,500 child deaths at­trib­uted to mal­treat­ment an­nu­ally. Ne­glected chil­dren suf­fer many men­tal and phys­i­cal health prob­lems, such as de­pres­sion and heart dis­ease, decades later. Ne­glect con­trib­utes to ju­ve­nile delin­quency and adult crim­i­nal­ity. The fis­cal costs are enor­mous. We are pay­ing dearly.

Our re­sponse to ne­glect should be guided by an un­der­stand­ing of what con­trib­utes to this prob­lem.

Af­ter 25 years as a pe­di­a­tri­cian and re­searcher in this field, I still be­lieve that most par­ents care about their chil­dren. Most do not in­ten­tion­ally ne­glect them. In­stead, there are usu­ally sev­eral prob­lems that com­pro­mise par­ents’ abil­i­ties to care for their chil­dren. Some re­side within par­ents, such as de­pres­sion. Some re­late to the child, such as se­vere dis­abil­i­ties. Oth­ers per­tain to the fam­ily, such as do­mes­tic vi­o­lence. Some are within the com­mu­nity, such as the bur­dens of poverty. A study found ne­glect to be 44 times more fre­quent in fam­i­lies earn­ing less than $15,000 a year than among those earn­ing more than $30,000.

Pe­di­a­tri­cians get up­set when chil­dren are not brought in for med­i­cal care, but what if the fam­ily lacks health in­sur­ance? More than 9 mil­lion Amer­i­can chil­dren have none. This does not let par­ents off the hook; they are pri­mar­ily re­spon­si­ble for en­sur­ing that their chil­dren’s needs are met. But ne­glect is not sim­ply a re­sult of par­ents who don’t care.

What’s our cur­rent re­sponse? Some­times ne­glect is re­ported to child pro­tec­tive ser­vices. About half of those cases get in­ves­ti­gated, per­haps lead­ing to help­ful in­ter­ven­tions. Too of­ten, lit­tle hap­pens. Case­work­ers are of­ten un­der­trained and over­whelmed, strug­gling in “a poor sys­tem for poor peo­ple.” Child pro­tec­tive ser­vices, man­dated by law to pro­tect chil­dren, of­ten lack the funds to pro­vide what chil­dren and fam­i­lies need. Still, re­peat­edly, there’s me­dia and pub­lic out­rage when dis­as­ter strikes on such agen­cies’ watch.

An­other re­sponse is to con­ve­niently wag a fin­ger at the re­spon­si­ble par­ent and seek pun­ish­ment. In­deed, some cir­cum­stances war­rant a puni­tive approach. But in most in­stances, sup­port and ser­vices are what chil­dren and fam­i­lies need. About 20 states are mod­i­fy­ing their approach to ne­glect, re­plac­ing foren­sic in­ves­ti­ga­tions with eval­u­a­tions of what’s needed. Their suc­cess hinges on com­mu­nity re­sources, such as af­ford­able day care, ac­ces­si­ble med­i­cal and men­tal health care, and low-in­come hous­ing.

Those who fa­vor pros­e­cut­ing ne­glect­ful par­ents need to con­sider who will care for the chil­dren of par­ents in prison. We don’t have good al­ter­na­tives. Fos­ter homes are in short sup­ply. Sep­a­rat­ing chil­dren from par­ents is trau­matic; it should be the last re­sort. Most ne­glect sit­u­a­tions are less egre­gious than those mak­ing hor­ri­ble head­lines. Most ne­glected chil­dren ap­pro­pri­ately re­main in their par­ents’ care. We need ways to im­prove their lot while mon­i­tor­ing their safety and well-be­ing.

There are poli­cies and pro­grams that pro­vide fam­i­lies valu­able sup­port and ser­vices. We know much about what works and what’s needed. Tack­ling poverty is crit­i­cal; ex­pand­ing the earned-in­come tax credit pro­gram and rais­ing the min­i­mum wage would help. Pros­e­cut­ing par­ents is not a so­lu­tion to this com­plex prob­lem. We need to muster pub­lic sup­port and the po­lit­i­cal will to de­velop the de­cent, child-friendly and com­pas­sion­ate so­ci­ety to which we as­pire. If not, with all our re­sources, are we not be­ing ne­glect­ful our­selves?

clos­e­to­home@wash­post.com.

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