Abuse and Neglect: Implications for Practice and Policy

This information was taken directly from Child Welfare Information Gateway

Implications for Practice and Policy

The knowledge we have gained from research examining the effects of maltreatment on brain development can be helpful in many ways. With this information, we are better able to understand what is happening within the brains of children who have been abused and neglected. In fact, much of this research is providing concrete/scientific evidence for what professionals and caregivers have long been describing in behavioral, emotional, and psychological terms. We can use this information to improve our systems of care and to strengthen our prevention efforts.

The Role of the Child Welfare System

While the goal of the child welfare system is to protect children, many child welfare interventions—such as investigation, appearance in court, removal from home, placement in a foster home, etc.—may actually reinforce the child’s view that the world is unknown, uncontrollable, and frightening. A number of trends in child welfare may help provide a more caring view of the world to an abused or neglected child. These trends include:

• Family-centered practice and case planning
• Individualized services for children and families
• The growth of child advocacy centers, where children can be interviewed and assessed and receive services in a child- friendly environment
• The use of differential response to ensure children’s safety while providing nonadversarial support to families in low- risk cases

Prevention. Child welfare systems that devote significant efforts to prevention may be the most successful in helping children and families and promoting healthy brain development. Prevention efforts should focus on supporting and strengthening children’s families so that children have the best chance of remaining safely in their homes and communities while receiving proper nurturing and care. The Centers for Disease Control and Prevention (CDC) has developed several publications that promote Safe, Stable, and Nurturing Relationships (SSNRs) between children and caregivers and prevent maltreatment.

By the time a child who has been abused or neglected comes to the attention of professionals, it is likely that some damage already has been done. Prevention efforts must reach out to families before this point. These efforts may target the general population (“primary” or “universal” prevention), educating the public and changing policies to promote healthy brain development. Prevention efforts also may target children and families considered to be at-risk of developing problems (“secondary” or “selected” prevention). Brain research underscores the importance of prevention efforts that target the youngest children— efforts such as early childhood home visiting programs for expectant and new mothers who might be at-risk because of their age, income, or other circumstances, and parent education programs that promote protective factors and lead to positive outcomes for both parents and children. Prevention efforts for at-risk families should focus on strengthening the family and building on the family’s positive attributes. Recent prevention resource guides from the U.S. Department of Health and Human Services Children’s Bureau (2009) encourage professionals to promote five “protective factors” that can strengthen families, help prevent abuse and neglect, and promote healthy brain development:

• Nurturing and attachment
• Knowledge of parenting and of child and youth development
• Parental resilience
• Social connections
• Concrete supports for parents

Early Intervention. Intensive, early interventions are key to minimizing the long- term effects of early trauma on children’s brain development (Committee on Early Childhood, Adoption and Dependent Care, 2000). In recognition of this fact, Federal legislation requires States to develop referral procedures for children ages 0-36 months who are involved in a substantiated case of child abuse or neglect. Once a child is identified, States must provide intervention services through Early Intervention Plans funded under Part C of the Individuals with Disabilities Education Improvement Act (IDEA). A number of States have developed innovative programs to meet these requirements and to identify and help the youngest victims of abuse and neglect (Child Welfare Information Gateway, 2007).

In order to heal a damaged or altered brain, interventions must target those portions of the brain that have been altered (Perry, 2000b). Because brain functioning is altered by repeated experiences that strengthen and sensitize neuronal pathways, interventions cannot be limited to weekly therapy appointments. Interventions must address the totality of the child’s life, providing frequent, consistent replacement experiences so that the child’s brain can begin to incorporate a new environment—one that is safe, predictable and nurturing.

Child welfare professionals can play a crucial role in helping children who have experienced abuse or trauma receive appropriate mental health services. Even when the maltreatment occurred in the distant past, there are interventions that can help a child or youth heal. In fact, many types of interventions and therapies have emerged in recent years to help children and adults deal with past abuse and trauma. The Child Trauma Academy (http://www.childtrauma.org) provides some online trainings to help professionals become more familiar with the effects of abuse on brain development and the need for early interventions. The National Child Traumatic Stress Network, funded by the U.S. Department of Health and Human Services, offers resources for parents, caregivers, and professionals on helping children survive and recover from many kinds of trauma, including factsheets on trauma-focused interventions. Other resources are listed at the end of this paper.

The Role of Caregivers

Many children who have suffered abuse and neglect are removed from their homes by the child welfare system for their safety. These children may be temporarily cared for by extended family, foster parents, or group home staff, and some will be adopted. In these cases, educating caregivers about the possible effects of maltreatment on brain development may help them better understand and support the children in their care. Child welfare workers may also want to explore any past abuse or trauma experienced by parents that may influence their parenting skills and behaviors.

It is important for caregivers to have realistic expectations for their children. Children who have been abused or neglected may not be functioning at their chronological age in terms of their physical, social, emotional, and cognitive skills. They may also be displaying unusual and/or difficult coping behaviors. For example, abused or neglected children may:

• Be unable to control their emotions and have frequent outbursts
• Be quiet and submissive
• Have difficulties learning in school
• Have difficulties getting along with siblings or classmates
• Have unusual eating or sleeping behaviors
• Attempt to provoke fights or solicit sexual experiences
• Be socially or emotionally inappropriate for their age
• Be unresponsive to affection

Understanding some basic information about the neurobiology underlying many challenging behaviors may help caregivers shape their responses more effectively. They also need to know as much as possible about the particular circumstances and background of the individual children in their care.

In general, children who have been abused or neglected need nurturance, stability, predictability, understanding, and support (Committee on Early Childhood, Adoption and Dependent Care, 2000). They may need frequent, repeated experiences of these kinds to begin altering their view of the world from one that is uncaring or hostile to one that is caring and supportive. Until that view begins to take hold in a child’s mind, the child may not be able to truly engage in a positive relationship. And the longer a child lived in an abusive or neglectful environment, the harder it will be to convince the child’s brain that the world can change. Consistent nurturing from caregivers who receive training and support may offer the best hope for the children who need it most.

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Resource

Child Welfare Information Gateway. http://www.childwelfare.gov/pubs/issue_briefs/brain_development/

References can be found here