Poverty, Neglect and Cultural Denial  

(Originally published December 2020)

I began working as a CPS caseworker in Colorado during the early 1970’s only a few years after the creation of the modern child welfare system (i.e., mandatory reporting laws, CPS investigations) in that state. Much of the training CPS caseworkers received was provided by medical experts at the University of Colorado Medical Center famous for their ground-breaking work on battered-child syndrome. That discovery (or revelation) led to the passage of child protection laws in all fifty states within a few years. Training included gory pictures of battered or shaken young children, children with severe inflicted burns, along with the causal explanation that child physical abuse was intergenerationally transmitted, either learned or otherwise inculcated, through childhood experiences.  However, after many hours of training on battered child syndrome, I rarely encountered battered babies or toddlers in my CPS investigations; not more than 1-2 cases annually out of 100-150 assigned cases. Instead, both in Colorado and Washington I received a steady diet of reports of child neglect and, to a lesser extent, reports of excessive punishment of children with minor injuries that did not require medical attention.

During the 1970’s and 1980’s, there was little training on child neglect either in Colorado or Washington State, but a lot of training on physical abuse, still conceptualized as a homogenous phenomenon caused by a history of abuse in childhood; and on sexual abuse, which surfaced as a major child protection issue after 1975. There was one pediatrician in Colorado, Dr. Henrika Cantwell, who did trainings on neglect; otherwise, neglect was hardly mentioned in training programs or by scholars. By the 1990’s, it was common for scholarly articles on neglect to begin with a discussion of the “neglect of neglect.”

This was an odd state of affairs: lots of training and discussion regarding a type of child maltreatment rarely reported to CPS, and little or no attention to the type of maltreatment encountered daily by CPS caseworkers in the U.S.  Initially, I viewed this bizarre behavior as the result of the intense public concern with severely abused children which had led to the swift creation of  legal frameworks and organizational structures in every state and with the federal framework for child protection developed in CAPTA during the 1970’s.  However, after a couple of decades of “same old, same old,” I came to understand that the seeming inability of public agencies to learn from their experience with child maltreatment had a deeper source: the unwillingness to acknowledge (much less come to grips with) the association between poverty and child maltreatment, especially neglect.  Cultural myopia is an effective form of denial when it is virtually unchallenged. It’s impossible to adequately respond to a challenge which policymakers and practitioners do not recognize. What structural racism? What global warming? What pandemic?

Strongly embedded denial is often indifferent to evidence until there is a willingness to admit error and respond to a social challenge that requires big changes and/or sacrifice.  Why respond to critics when it’s easier to ignore them, counterattack with insults or question their motives?  Curiously, evidence from research often seems to have less influence on opinion before people have changed their mind for other reasons (e.g., personal experience, a new social milieu) than afterwards, when a person looks for arguments to support a change in her/his beliefs.      

 

The Myth of Classlessness

Modern child protection systems in the U.S. were created through the myth of classlessness (see Nelson’s, Making an Issue of Child Abuse, 1984), i.e., the idea that child abuse and neglect occur to a similar extent in all social classes, which is sometimes disingenuously conflated with the truism that “child maltreatment occurs in all social classes.” For years, child advocates who discounted the effects of poverty on child abuse and neglect argued that low-income families were more likely than middle class families to be reported to CPS,  despite annual reports of CPS data published by the American Humane Association that found underreporting of suspected maltreatment was strongly associated with age of alleged child victims rather than with parents’ social class.

Outstanding child welfare scholars who persistently pointed out the strong association between poverty and child maltreatment (e.g., David Gil, Isabel Wolock  and Leroy Pelton) were pretty much ignored by most child advocates and many scholars until the publication of the second National Incidence Study (NIS) in the late 1980’s which found a 5-1 difference in the rate of child maltreatment and a 9-1 difference in rates of child neglect for families with annual incomes under $15,000 vs. families with annual incomes greater than $15,000. One main reason the four NIS studies have had great influence on scholarly opinion is that they are not based on CPS reports but rather on  “sentinel” reporters’ knowledge of child maltreatment in multiple communities around the country, a methodology that undercut the claim that the apparent relationship between poverty and child maltreatment was due to greater likelihood of low-income families being reported to CPS. The NIS studies found that “sentinel” reporters were aware of lots of child maltreatment that was never reported to CPS.     

Child welfare scholars were much quicker to assimilate information from NIS studies than child advocates and policymakers. In a recurring pattern that affects child welfare discussions to this day, once advocates, stakeholders and policymakers have heard mistaken ideas based on research findings (or questionable interpretation of those findings) presented in public forums and then repeated numerous times without being challenged, ideas that most scholars have quietly discarded may be regarded in public policy debates as axiomatic. Scholarly mistakes have a long half-life, especially when those mistakes support strong ideological commitments.   

Poverty, Neglect and Child Welfare

 

At the societal level, child poverty rates have a strong influence on the profile of child maltreatment, i.e., the percentage of child victims in substantiated reports who are victims of neglect vs. physical abuse or sexual abuse, in part because poverty has a stronger association with neglect than with other types of maltreatment.  However, it is not just a child poverty rate that shapes the national profile of child maltreatment; the minimum wage and characteristics of social welfare systems also influence rates of child neglect. Concretely, the level of income from employment or welfare benefits available to low-income parents affects the rate of neglect reports (see Raisson, et al, 2017).

Rates of neglect are also affected by the extent of child-care burden in low-income families.  In the U.S., poverty rates are much higher for single parent families,  41% vs. 8% for married couples in 2017, according to Child Trends.  Child-care burden is affected by the number of children in a family, especially preschool children, and by inadequate or unaffordable child-care resources, as well as parental income.

 

Imagine raising more than one child in an urban area on TANF benefits or a minimum wage under $10 per hour!  Single parents of young children who are employed but lack strong support from extended families or friends are likely to be faced with extreme pressure to compromise supervisory standards to maintain employment. A study of mostly African American women in substance abuse treatment found that “ … assistance with child-care was the one social network variable that appeared to enhance parenting across most domains, including parenting efficacy.”   (Brown, 2012)

States that are willing to allow 6-10% of children (and 15-20% of black and Native American children) to grow up in severe poverty (i.e., incomes of less than 50% of the federal poverty standard ) are unlikely to provide much support to reduce child-care burden, food insecurity, episodic homelessness, lack of medical or dental care, etc. for low-income children and parents. In these circumstances, it is remarkable that any severely poor family raises children to age 18 without being reported to CPS, not because of poverty per se but also due to an inadequate social welfare system and low minimum wage.

Poverty, Trauma Histories and Mood Disorders

Some CPS reports contain allegations of neglect that are “just poverty”, or which can be quickly and humanely ameliorated by poverty related services without a CPS investigation or assessment. CPS caseworkers should be able to bring investigations or assessments to a quick close when it becomes apparent that all a low-income family requires is assistance with meeting their basic needs.  However, a large percentage of neglect cases which receive post-investigation services, or which result in foster placement, involve a combination of economic deprivation and psychological affliction, beginning with mood disorders such as depression and PTSD. Some studies of depression among welfare recipients have found rates based on self-report of 40-50%. Studies of depression based on application of DSM criteria have found rates about half of the self-report rate. One expert has described depression as the “common cold” of mental health disorders, i.e., both widespread and temporary. However, Major Depressive Disorder (MDD) is not like a cold or minor flu. It is a disabling condition that is compounded by histories of childhood trauma and by interpersonal violence in intimate relationships. Prolonged poverty combined with a history of childhood trauma and/or interpersonal violence in romantic relationships creates a vulnerability to MDD, a condition as chronically relapsing as substance abuse. 

Vulnerability to MDD is an extreme condition that is a common precursor to substance abuse. Stimulants such as methamphetamine or cocaine may be used to combat the loss of energy that is a part of severe depression; and opioids assist in pain management and difficulties with emotion regulation, a common outcome of traumatic experiences. In chronic neglect and chronic maltreatment, i.e., combinations of neglect with physical abuse and or sexual abuse, co – occurring mental health and substance abuse disorders are the rule, not the exception. Co-occurring disorders have a powerful negative effect on the capacity of parents to provide warm emotionally responsive parenting (Brown, 2012).  Once situational neglect caused mainly by poverty has become chronic and pervasive, it is too late to prevent further neglect solely through family support services. Nevertheless, poverty related services will remain essential during a recovery process.

Depression, Trauma Histories and Powerlessness

Depression resulting from poverty or trauma, and symptoms of PTSD such as hypervigilance, flashbacks or nightmares, numbing and dissociation have a common characteristic: they feed on a sense of powerlessness, i.e., lack of control over life circumstances and (painfully) over both mind and body. Poverty reduces choice and freedom in multiple ways; and prolonged severe poverty reduces life to a daily struggle for survival.  Severe depression is fed by compulsive critical self-talk, an obsessive habit which is independent of I.Q;  and which digs an ever-deeper hole of emotional pain which is difficult to escape without professional help.

One of the alarming discoveries of victims of chronic or complex trauma  is that their conscious self has lost control of their brain function and bodily reactions to stress; and (in effect) parts of themselves are operating as independent entities in peculiar ways. Trauma victims may experience panic attacks for reasons they don’t understand and have somatic symptoms they can’t even name, much less control or reduce through medical treatment (see Herman, Trauma and Recovery). Recovery from chronic or complex trauma is a lengthy process which is far from completed when a few major PTSD symptoms vanish or become less frequent due to effective treatment, or when a trauma victim becomes clean and sober. 

Restoring Self-Efficacy 

Parents who have lost control of their circumstances, intrapsychic processes, and bodily reactions due to combinations of poverty, mood disorders, substance abuse and/or interpersonal violence are likely to have difficulty providing nurturing parenting for extended periods of time. Some (but not all) chronically neglected children need to be placed  in kinship care or in non-kin foster care. Social justice/racial justice agendas are not served by denying or minimizing this reality. Nevertheless, trauma studies and studies of resilience have some important lessons for child welfare policy and practice:

  • Use of coercion undermines recovery from trauma (again, see Herman, 1992) because coercion reenacts the powerlessness that is integral to traumatic events.

  • Ensuring the safety of victims (both adults and children) is  a necessary first step in treatment; this principle has obvious implications for the child welfare response to domestic violence.   

  • Trauma victims must be allowed to mourn their losses without the expectation that they should “get over it;” this principle is  fundamental to healing from historical trauma for racial/ethnic groups’ with lengthy histories of oppression.     

  • Recovery can only occur in the context of supportive relationships.

Sobriety and symptom relief from mental health conditions are means to an end, i.e., restored self-efficacy, i.e., the confidence in one’s  motivation and skills to do ordinary things (such as self-care and care of children).  Recovery is likely to be a rocky road with periodic reversals such as relapse and self-sabotage, which child welfare staff must be able to recognize and confront in skillful ways, i.e., no avoidance, no aggression in the voice, and without minimizing their significance or overreacting.     

The capacity to exert control in the social environment is a critical part of trauma treatment. Restoring self-efficacy requires giving trauma victims (even young children) choices whenever possible; and rewarding small instances of initiative and courage. It is also necessary to develop the skills of children and adults to calm down without engaging in dangerous practices that endanger their health such as smoking or substance abuse.

There is also a lesson for prevention programs: experiences of power and control over life circumstances are a means of preventing  the sense of powerlessness that in its extreme form undermines the capacity for nurturing parenting.  To this end, philanthropic investments in child welfare reform should build the collective efficacy of low- income neighborhoods and communities, as well as support the empowerment of Native American tribes. The idea that child welfare reform can be effectively driven top-down by the federal government and state governments is false. Governments can and must provide funding and guidelines for innovation; and then allow local communities and affected populations a much greater voice in policy development and implementation planning. This is trauma informed policy development. 

References 

Brown, S., “The Impact of Bonding and Social Networks on Parental Competence Among Mothers with Substance Dependence and Co-Occurring Disorders,” (2012) P.H.D. Dissertation, Mandel School of Applied Social Sciences, Case Western University.   

Herman, J., Trauma and Recovery (1992), Basic Books, New York City.

Nelson, B., Making an Issue of Child Abuse (1984), University of Chicago Press, Chicago, Illinois.   

Raission, K. & Bullinger, L., “Money matters: Does the minimum wage affect child maltreatment rates?” (2017), Children and Youth Services Review, vol. 72, issue C, pp. 60-70.   

Sedlak, A., National Incidence and Prevalence of Child Abuse and Neglect: 1988, Revised report, Westat, Inc., Rockville, Md.    

 

Sounding Board 2020

January - Causes and Consequences of a Drug Epidemic                     

February - How to Stop and Prevent Drug Epidemics                          

March - How to Reduce Tort Claims in Child Welfare                              

April  - Child Welfare During a Pandemic                                                   

May - Repurposing Foster Care to Support Birth Families                        

June - A Social Justice Agenda for Child Welfare: Poverty, Race and Power in Child Welfare                                                                                    

July - Reunification Policy and Practice in the Light of Social Justice  

August -  Permanent Planning Policy and Practice in the Light of Social Justice                                                                                                             

September - Mistaken Ideas in Social Justice Agendas                           

October - Advancing Social Justice in Child Welfare Reform               

November - What Is Chronic Neglect?                                                  

December - Poverty, Neglect and Cultural Denial (this page)               

                    

For past Sounding Board commentaries click here    

 

©Dee Wilson     

  

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