Overloaded: Understanding Neglect

Understanding Neglect

Episode Summary

How do we define neglect? How is neglect interpreted and operationalized by our child welfare system, and how many children and families are separated because of it? What are the underlying root causes of neglect that overload caregivers with stress? In this first episode, host Luke Waldo explores these questions and the complexity of neglect with our research and policy, child welfare and child maltreatment prevention, and lived experience experts.

Episode Notes

Today’s episode included the following speakers (in the order they appear):

Host: Luke Waldo


:31 – Luke Waldo – Introduction to Overloaded: Understanding Neglect podcast and Strong Families, Thriving Children, Connected Communities initiative. 

3:33 – Luke Waldo – Child neglect and abuse statistics. How is child neglect defined?

4:56 – Jennifer Jones – Definitions of neglect differ across the country. Wisconsin’s definition of neglect, which specifically includes “for reasons other than poverty”.

7:51 – Bryan Samuels – Child neglect national and state statistics. Why neglect is the primary reason for family separation in child welfare systems.

10:43 – Dr. Kristi Slack – Child neglect and poverty. Systems’ failures that lead to overloaded families.

12:51 – Luke Waldo – Introduction of Lived Experience and Direct Practice experts.

13:12 – Hannah Kirk – Defining child neglect.

13:40 – Theresa Swiechowski – Defining child neglect.

13:55 – Ashlee Jackson – Poverty and neglect. 

14:22 – Bregetta Wilson - Defining child neglect.

14:31 – Hannah Kirk – Mental health and substance use challenges.

15:44 – Theresa Swiechowski – The gray areas of neglect.

17:54 – Luke Waldo – Complexity of neglect. Introduction of stories about individuals and families that experienced neglect.

18:48 – Bregetta Wilson – Social determinants of health. Story about an 18 year old young man who had been involved with the child welfare system for much of his childhood. Story about a mother who went to the system to ask for help, but then had her children taken from her.

24:00 – Tim Grove – Story about a 3 month old child that experienced neglect. Trauma as an underlying root cause. Trauma statistics in the child welfare system.

30:23 – Luke Waldo – How families become overloaded by stress.

30:54 – Dr. Julie Woodbury – Mental health and stress piling on overloaded families.

32:18 – Bryan Samuels – The intersection of poverty and neglect. 

32:54 – Luke Waldo – 3 Key Takeaways. 

35:21 - Closing Credits and Gratitude.

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Episode Transcription

Luke Waldo  00:02

Welcome to Overloaded: Understanding Neglect, where we explore the complexity of child neglect, its root causes and challenges that families experience that overload them with stress, and the opportunities that we have to improve our communities, organizations and systems that build strong families and thriving children.

Luke Waldo  00:31

Hey, everyone, this is Luke Waldo, your host for this podcast series and the Director of Program Design and Community Engagement for the Institute for Child and Family Well-being, our partnership between Children's Wisconsin and the University of Wisconsin Milwaukee's Helen Bader School of Social Welfare. 

Earlier this year, our Institute for Child and Family Well Being team at Children's launched a new initiative that aspires to reduce the number of family separations for reasons of neglect by building a community focused on collaboratively pursuing policies and practices that support overloaded families and address systemic failings. This initiative is aptly named Strong Families, Thriving Children, Connected Communities. The initiative is a developmental strategy at its core, recognizing that more can be accomplished through shared learning and action to address the drivers of systems change that either hold the conditions that contribute to neglect in place, or provide scaffolding for progress. This strategy includes three core phases: 1. Building shared understanding, 2. Implementing a critical path strategy, and 3. Advancing innovation, systems, and policy solutions. 

Through this podcast, we hope to advance that initial phase of building shared understanding through conversations that explore the definitions and complex conditions of neglect, how families become overloaded by those conditions, such as generational trauma, poverty, and toxic stress, and how our systems failed to meet the needs of overloaded families or, often worse, make conditions more difficult for families. Additionally, we will explore how we may improve outcomes for families through promising and impactful programs, policies and communities, and through systems change and collaboration that center child and family well- being. 

Over the course of six weeks, I had the tremendous honor of exploring these ideas with 10 experts that have dedicated their life's work to supporting children and families. Through wide ranging conversations with each of them that lasted well over an hour, we have created a narrative from their different yet often complementary perspectives on these complex issues that we hope will begin to tell a more complete story through their lived experiences, in many cases, both as professionals in this field of child and family wellbeing and as individuals who also experienced the child welfare system, neglect or the underlying conditions such as trauma firsthand. We hope to shine a brighter light on the realities of child neglect, the conditions that most adversely impact overloaded families, and the opportunities that we have from a programmatic, organizational and systems level to reduce family separations for reasons of neglect. I hope you'll join us over the coming weeks as we embark on this journey to build a shared understanding.

Luke Waldo  03:15

In the state of Wisconsin, the majority of family separations occurred due to reasons of child neglect. In fact, nearly seven out of every 10 families that are separated by our child welfare system are separated because of child neglect. Whereas around one out of every 10 families is separated because of physical and sexual abuse. If we are to be successful in reducing family separations for reasons of neglect, we believe that we must build a more comprehensive shared understanding of what child neglect is, how it is defined by our system and operationalized by the people that make up that system, and what challenges children and families face that may lead to child neglect if they become overloaded with adversity and stress. 

In the coming segment, you will hear from policy and research experts Jennifer Jones, Bryan Samuels, and Dr. Kristi Slack as they share their answers to the following questions that I posed to them in our conversation. How is child neglect defined? When you think of the term neglect, what situations of the families you work with come to mind?

Jennifer Jones  04:57

We know that child neglect is the leading category of child maltreatment substantiations nationally. Yet we also do not have a uniform definition, or a standard for what constitutes neglect. And as a result, because each state differs in how they actually define neglect, whether a family is reported and substantiated for neglect is entirely based on where they live. And so there's disagreement. And some consensus, I will say about what should be included in child neglect definitions. And so 15 states we know have definitions that exclude reasons of poverty when determining child neglect. And Wisconsin is one of those states and I remember being here working at the Wisconsin Department of Children and Families, when we started working on and talking about changing the definition of child neglect. 

So in Wisconsin, we define neglect here as the failure, refusal, or inability on the part of a caregiver for reasons other than poverty, to provide necessary care, food, clothing, medical or dental care, or shelter so as to seriously endanger the physical health of the child. So that's the definition that Wisconsin uses, again, along with 15 other states, we are specific about for reasons other than poverty. 

I mentioned CAPTA earlier the Child Abuse Prevention and Treatment Act, and they actually require that states define child abuse and neglect to mean any recent act or failure to act on the part of a caregiver, or parent that results in death, serious physical or emotional harm, sexual abuse, or exploitation. And so states frequently define neglect as this idea of the failure of a parent, or other person with responsibility for the child to provide the food, the clothing, the shelter, all of the stuff that we know kids need, right. So failure to provide that or to provide supervision in a degree or to a degree that could actually harm the child's health, their safety, their well being. And so I also just want to note here, and again, I'm sure we'll get into this conversation, as well, but there's this widely held belief among proponents of reforming our nation's child welfare system, that a key element of that transformation is changing the definition of child neglect laws in our country.

Bryan Samuels  07:51

One of the important things to understand about neglect overall, it represents about 60% of the families who come into contact with the child welfare system. But there's a great deal of variability across the country. So there are certain states where the number of children who come into child welfare, specifically on issues of neglect, are as low as 15 to 20%. And there are other states where children come into the system, because of neglect, that are closer to 80, or 90%. So there's wide variation in terms of designating neglect as the issue for which a family comes into the child welfare system. So that's important to understand, because depending on what state you're in, that number varies. 

And that may be contrary to this larger number of 60%. I think, when you try to dig into that number, I think there are a couple of things that are really critical to think about. One is it's a lot easier to document neglect than it is to document abuse. So in some respects, that large number may be a reflection of the fact that it's easier to see poverty, it's easier to see economic insecurities, it's easier to see housing problems. And as a result of that, it's easier to document and meet the definition of neglect. 

The second one is is that child welfare systems are really, really busy. They've got large caseload, particularly those that are going out and doing investigations. And so sometimes when a child is at risk, systems try to move quickly as they try to move quickly. They pick up the evidence that's most readily available to them, so on and so forth. So you got some issues of neglect. 

And then last, we know that economic insecurities increase your visibility for those folks that are doing mandated reporting. And so it's often the case that when the report is made, there aren't sufficient details to articulate the abuse is occurring. But that surface level kind of description of what's happening and families tends to rely on descriptions that are more akin to neglect. And as a result of that, those are the reports that go in. And that's how cases get investigated. So so there's a little bit of complexity here, right? That 60% is kind of a hodgepodge of a bunch of things coming together ultimately determine the circumstances that families are in.

Dr. Kristi Slack  10:44

This is a trend at the federal level, as well, that the vast majority of families that have contact with child welfare systems around the country, do so for reasons related to neglect. And that means that over time, as this trend has happened, that it's a shrinking proportion of the caseload that we're seeing, for reasons of physical abuse or sexual abuse. It leads some people to even say that we're really dealing with a system that is in need of addressing child neglect specifically, and while not exclusively, there's definitely a need to, to understand it better and learn how to intervene around it. 

As far as the families that get involved in the system for reasons of neglect, who are then also at risk of having family separation occur, the words that come to mind are family instability. Certainly, poverty, and often chronic poverty, is present. And the chronicity of neglect is also a phenomenon that most child welfare workers and policymakers and others who study child maltreatment are familiar with, it's families that kind of keep coming back to the system, which to me really just suggests that other systems are failing. So those are some of the things I think about. 

And then, you know, poverty being one of the most pronounced risk factors for neglect and for system involvement is also a risk fast factor that sort of interacts with and compounds a lot of other risk factors. And so that's an additional challenge. When you see families that maybe have multiple risks, poverty is usually present or at least a partial root cause of a lot of the things families are dealing with, who get involved for reasons of neglect.

Luke Waldo  12:34

We ask the same questions to our direct practice and lived experience experts. And this is what we learned from Hannah Kirk, Theresa Swiechowski, and Ashlee Jackson from our Children's Wisconsin Child Welfare programs, and Bregetta Wilson, Lived Experience Coordinator at Wisconsin's Department of Children and Families.

Hannah Kirk  13:11

So neglect, it can cover a wide variety, right? It's a very broad spectrum. But when we describe neglect, we are primarily thinking of how that parent is not meeting the needs of the child day in and day out. That could include clothing them, medical needs, food, providing a safe place to live, things like that.

Theresa Swiechowski  13:39

You know, the failure to provide the food, clothing, shelter, medical care, to do to the degree where you know, the families are jeopardized and put in an unhealthy, unsafe environment.

Ashlee Jackson  13:53

It's one of those things, it's so hard to really articulate because I remember when I was in school for this, you know, it's one of those things that we highlighted that children are not removed from a home due to poverty, but a lot of neglect happens because of poverty. So homelessness, lack of food, you know, transportation, being able to go to medical appointments, get kiddos prescriptions, their inhalers, you know, all these things that they need, that stems from financial instability, 

Bregetta Wilson  14:17

The refusal or inability for the caregiver, to not provide the care that one need for reasons other than poverty.

Hannah Kirk  14:31

When we strip away the basic needs, the ins and outs of what might be common for other people, right. I have a home, I take care of my son, I give him breakfast, lunch and dinner. I don't have any underlying mental health or AODA issues. When we strip all that away and we look at the root of what's causing the neglectful situations, more times than not we're finding parents who are struggling with underlying mental health diagnoses, maybe struggling with some substance use or poly substance use. And a lot of times the housing and poverty is playing a huge role for those parents, because parents are adults, and even children who cannot don't understand their mental health or are not getting the services that they need, are probably not being able to do their best at living day in and day out and providing for themselves or for their children. And so those are the roots of the issues that we need to be paying attention to when we talk about neglect, not just the surface level issues that are coming to our case.

Theresa Swiechowski  15:43

But I can say when you're working one on one with families, like neglect, you wouldn't think would have a gray area. You know, by definition, this is what it is, right? So when you go in as a family support worker, you're like, okay, the social worker already gave me the definition of what neglect is for this family. You know, I've worked with families that have by definition been homeless, so they aren't providing safe housing. Neglect might be an extended family member living with them, that has substance issues and has a warrant out for their arrest. This is an unsafe situation. It could be educational neglect, COVID hit, we kind of ran across some cases that families were fearful to send their kids to school, but yet they weren't schooling them at home. So the definition does become gray, which I don't know why it surprises me. But it does.

 And, and I've had many conversations with co workers about this. And it's also gray with our, with our families, because they come from generation after generation of technically this term of neglect, but have lived through it and are just fine. So they're you come in there and they're questioning, I don't get this. I'm not, how am I neglecting? You know, my kids are fine. So it's an interesting conversation to have with with many people. And I wish that I had like the perfect answer. But I feel like sometimes I'm just in this gray area of what neglect is. And I know that working in the field, maybe I shouldn't be in a gray area. But it I kinda am sometimes, if that makes sense.

Luke Waldo  17:54

As we've just heard, neglect, while clearly defined by statute in Wisconsin, is both complex in how it's understood, translated into practice and experienced by families. I hope that we have provided a foundation from which we will build over the remainder of this episode and series.

In this coming segment, I want to turn it over to Bregetta Wilson and Tim Grove, Senior Consultant at WellPoint Care Network, formerly St. A, as they share stories about a young man that had lived most of his childhood in the child welfare system, a mother who looked to the system for support, but instead ended up having her children removed from her care, and a three month old child who was left alone. These stories help us understand the complexity of their lives, the systems around them, and some of the underlying root causes that bring them together.

Bregetta Wilson  18:48

Well, you know, I think you talked about my role earlier a little bit as Community Health Navigator with Children's and you mentioned social determinants of health. But what does that really mean? When you think about working with families, it was a really, really eye opening space to be in when I think about the broader level of systems. And when you think about neglect, one of my very first encounters with someone in that role as a Community Health Navigator was with an 18 year old, young African American man, you know. I met him knocking on doors, you know, out here, and I think Children's was so innovative with just having me knock on doors in a neighborhood to really say, hey, what do you really need? How do we address this? And so, this young man was 18 years old. He was living with his aunt. He had just aged out of foster care. And he hadn't graduated from high school. He hadn't even been to high school and he had been in foster care his entire life and so for me, I was like floored, because when you think about neglect, and you say, when families are neglecting their children, and you think about the ability, or their inability to provide, so to speak, you know, I think about, you know, that doesn't neglect constitute poverty, or does poverty constitute neglect. But just because I'm impoverished does not mean that I will neglect my child. it can be, I don't have this need. And so I am not just neglecting my child, but I'm neglecting myself as well, because I can't obtain this need. 

So this young man, you know, he wants to go back, he wants to go to school, he wants to get his GED. And for me, I just couldn't understand how he could have been in foster care that entire time most of his life, and had not been to school. So when you say, you know, like, what is really neglect mean, when you think about families, sometimes children are taken away because of neglect. I think that it's more so how do we address the needs? And we know this like, this is this is not, it's not trigonometry. I wish, I don't, you know, I'm good with algebra and geometry, but it's not trig. Or it's not, you know, but I think you know, so he struggled with developing a healthy relationship with those that he loved, he loved his aunt, but he still had his own mental challenges, because here he is this 18 year old young man who has never been to school hardly, but was involved in the system, whether it was youth justice, or child welfare, and he aged out, and now he's just out here, with no support, with no resources. But our system was responsible for him for that time. 

So did we neglect him? Is what I think was that a neglect, can our system neglect someone who was in our care? You know, when I think about the struggles our families face, is it's about how do we support them in a way that puts them in front of their own lives to create, to understand, you know, what opportunities they may want to walk into? How do we nurture them? How do we address some of the historical trauma and generational cycles that we see, when we have one family whose child was taken away? Then that person has a kid and then their children are taken away. So I think about, I think about this young man. 

And I think about a young family that a young mom that she used to come and do supervised visits with us at the organization I worked at. And you know, I listened to her story. She had five children. And she said, You know, I went to the system for help, and they took my kids away. And so when you think about like neglect, was she neglectful in asking for help? Or do we judge her because her inability to care for five children in the way that we thought she should have, but we didn't look at the fact that she came to us for help. Instead, there was a decision made, that said, Hey, you're not able to care for your kids. But I'm coming to you for help. But I think that at the end of the day, how do we balance providing, or giving families the tools that they need, as well as understanding that, if they are neglectful, it's not because they don't want to, but sometimes it's because they can't or don't have the opportunity to, you know.

Tim Grove  24:00

I have been involved with our Child and Family Well Being program for all of 2021 basically staffing kids and family needs at the 45 day mark of entry into the system. And what we always ask in those discussions is what brought the family to the system. And just to sort of paint maybe a more child welfare-specific picture of neglect, what I heard quite a bit of was a three month old kid was left alone for a day and a half. There might have been a myriad of reasons why the parent struggles led to that outcome, but that's more typical of the kind of neglect we get worried about. And to your point, Gabe, when you're talking about a parent being gone, depending on the age, for 10 minutes or 20 minutes or 30 minutes, from a stress point of view, that's a whole different scenario than being gone and a young and sort of vulnerable age for a day or a day and a half. And the risk of the stress related outcomes we get very worried about starts to go up exponentially. And it starts to sort of engender a system response that says, now we're getting to a threshold where we have to consider a very serious thing, which is, does the system need to get involved? In what capacity? Can we support and help your family? And if not, do we have to get to a point where we make a serious decision to remove that child from the family temporarily, hopefully, and then work like crazy to reunite them. 

So let me stick with my three month old kid who was left in the home for an extended period of time. One of the questions I suspect might come up for people is how does that happen? How does a parent get to a place where that is the outcome that we hear about and see? And if we sort of follow the dots, it's actually in many cases, a pretty clear path. So for many parents, there is an addiction problem, substance misuse problem that is contributing to that process. So maybe they are strung out or high, or struggling in some way, shape, or form with their addiction, that is prohibiting them from getting home and taking care of their kids, or maybe sort of forcing them to make a non-developmentally wise decision for their kids to go seek a drug. Because their addictive process is driving that behavior. What we get a little worried about is the root cause of some of that for many of our parents is trauma. 

So that requires a little unpacking, as well, some of the data we see, there was just a really good meta analysis done, that's technical term for people taking a look at recent articles and kind of summarizing them. That sort of suggests about 25% of child welfare involved parents have a diagnosis of PTSD or some form of complex trauma process. That's probably a very conservative number. But that's about five times the number in the general public. So when you're talking about five times the number, that's a really big deal. So then we've got to start thinking about well, what does that mean? And how does trauma connect the dots back to that addictive process? 

One of the best ways to think about trauma is basically when overwhelming toxic, fearful events happen to an individual, and they don't generally get the support or help they need to sort through it, process through it, manage it, et cetera. One of the symptoms that we see is what the clinical community would call re-experiencing. And I want to be again really explicit around what we mean by a flashback. Survivors of trauma often say, even though it might have been two years ago, five years ago, 20 years ago, when they have a flashback or reminder or memory of what happened to them, it's like being in the original incident. If 25% of our population is struggling with sort of reminders and memories that are similar, if not sort of just like being involved in the original traumatic incident, it's a pretty quick connection to start to say, "Where do they go to try to manage that?". And one of the truths about drugs of abuse is even though they've got lots of other harmful sort of side effects, they're often very effective at helping manage that. 

So if we're following my sort of connecting of dots, it's a pretty, I think, clear pathway where again, if 25% of folks are struggling with that process, many of them are discovering that drugs of abuse are very helpful in managing that process. That becomes a habitual or addictive process and it's easy to see, tragic as it might be, how that three month old gets left alone for an extended period of time.

Luke Waldo  30:23

In the final segment of this initial episode, we begin to explore the complex challenges that families experience and how they can pile on, as our expert Julie Woodbury from our Children's Wisconsin Family Preservation and Support Program in Black River Falls illustrates, often overloading families with stress and making them more vulnerable than they already were. Then Bryan Samuels from Chapin Hall will close out today's episode with final thoughts about poverty and our child welfare system.

Dr. Julie Woodbury  30:53

I think the the biggest underlying core issue in western Wisconsin is there's many, but the mental health piece of it is huge. And again, it's a lot of it is just stress. It can be any any type of stress, environmental stress, just family stress, loss, loss of job, loss of family members, I mean, any type of stress that's adding on to any type of trauma, adding on to it just, it just keeps getting piled on. And when we think about the system, the system is protective of the child. So which is a strength of the system, it's going to protect the child, which is great. But the challenge is, that just adds more stress to the parent, or the caregiver. So you're just piling more on what's already a stressed out parent. So we're just continuing to add to the overload.

Bryan Samuels  32:18

Now, it's quite clear that a large driver of neglect is in fact, poverty is in fact, economic insecurity, is in fact, material hardship. And so child welfare systems are increasingly aware that by beginning to disaggregate some of those characteristics, they can begin to be more specific around the solutions that they are developing and addressing the needs of families.

Luke Waldo  32:50

I hope that today's episode and insights from our experts have you thinking more about overloaded families, and how we might support them to reduce family separations for reasons of neglect. Before we go, I wanted to highlight three key takeaways to reflect on as we move into our next episodes. 

First, defining and understanding neglect is hard. Neglect is a constellation of complex challenges, ranging from deeply rooted challenges such as generational trauma to systemic oppression, to compounding factors such as financial instability to homelessness, mental health to addiction.

Second, while our state's definition of neglect excludes poverty, it is difficult to deny poverty's underlying role in a caregivers ability to provide food, a safe and stable home, clothing, transportation to medical care and the like for their child's safety and well being. If we are to reduce family separation for reasons of neglect, we will need to address poverty and financial instability. 

And third, as neglect is a constellation of complex challenges, our system's response to and view of overloaded families may be even more complex. If we were to imagine and, better yet, create a more comprehensive child maltreatment prevention system, we would need to involve our anti-poverty, housing, mental health and child care systems just to name a few, as well as shift mindsets to center on equity, trauma- informed care, and personal- and community-centered care that sees families and caregivers as overloaded rather than as neglectful. 

Thank you for joining us for this first episode. We hope that you will come back and listen to our second episode next week as we go deeper into these core underlying root causes of neglect. If you enjoyed today's episode, please share with friends, family and colleagues. Also, if you rate us on whatever podcast platform you listen to us on, it makes it easier for others to find us. To learn more about the experts that you heard today, visit the show notes which is where you will also find links to sources or information that were mentioned in today's episode. Thank you again for joining us. See you next week.

Luke Waldo 34:30

This podcast would not have been possible without the support and talents of Carrie Wade, who is responsible for our technical production and original music composition. I can't express my gratitude enough to Carrie for all she gave to this project. I'm also grateful to Gabe McGaughey, our Co-Director here at the Institute for Child and Family Well-being, who contributed to the ideas behind this podcast and interviewed some of our experts. Finally, I would like to thank all of our speakers that you have heard today and throughout the podcast for their partnership, their willingness to share their stories and expertise with me and all of you, and their commitment to improving the lives of children and families. I'm Luke Waldo, your Host and Executive Editor. Thanks again for listening and see you next time.