ASU team helps state address the most vulnerable population of children

When a child dies because of an abusive caregiver, hearts break and headlines blare. Teddy bears pile up at memorials while the public demands action and accountability.

But thousands of Arizona children go hungry or see violence or don’t get their cavities filled due to neglect — by far the most common form of abuse and one that needs more attention. In fact, neglect accounts for 70 percent of all reports to the hotline run by the Arizona Department of Child Safety.

A research team at Arizona State University is trying to address that. A group from the Morrison Institute for Public Policy combed through 800 child-abuse reports to help the experts better understand neglect in the state.

The project, “Spotlight on Arizona's Kids,” was funded by a three-year, $380,000 grant from the Arizona Community Foundation and is in response to an urgent need for information, according to Erica Quintana, the policy analyst who is leading the project.

The result is a series of reports, with the first, "The Neglect of Neglect," released in 2016, and the fifth report released last week.

“Everyone focuses on the severe abuse cases, and neglect gets pushed to the side,” Quintana said.

Neglect often can get progressively worse, increasing the risk that a child will be removed.

“So the idea of this project and a lot of the conversation in Arizona right now is to prevent that from happening, to intervene when that family is drifting and to get them help before they ever get to DCS’s doorstep,” she said.

Right now, the way the state reporting systems are set up, all of neglect is categorized into one large category, although children can experience difference types of neglect — supervisory, medical, educational, etc.

The stakeholders wanted to understand more about the most common types.

So the department provided PDF documents of 800 case reports from 2013–15, which included information from interviews with the child and parents, as well as details from any hotline calls. The 800 reports, each about 10 to 15 pages, were divided evenly between cases in which a child was removed and those that weren’t. That 50/50 division was for data-analysis purposes; in reality, removal happens in about 10 percent of cases.

Then the team created a codebook. They reviewed the research literature and conducted interviews to come up with an industry standard to define and classify different types of neglect.

“There can be multiple neglect types happening in the same family at the same time,” Quintana said. “Abuse can happen one time. Neglect usually is a continuous experience or a pattern of behavior or interaction within a family.

“It’s like a ball of yarn that’s difficult to untangle.”

Training case managers at ASU

While the Morrison research project is in its second year, ASU has been working to address child abuse for decades. The Child Welfare Education Program in the School of Social Work is in its 30th year and this year will send 64 graduates to work in the Department of Child Safety (DCS). In addition, 44 people who already work in the department are part-time students in the master’s of social work program in the School of Social Work.

Through a federal program, the students’ tuition is paid for if they sign a contract to work as case managers for the Department of Child Safety for two years after graduating.

The ASU program, which is created through the partnership with DCS, prepares the students for the intense career, according to Tonia Stott, coordinator of the program.

“We spend a lot of time talking about critical decision making — how you make decisions about other people’s lives and families, and how you take this massive responsibility the very best way you know how,” she said.

“What are the next decisions? What information do you have and what do you need? How will you get that information? When you go to Mom or the group home, how will you ask that question?”

The students practice together, do role playing and work with attorneys during a mock-trial testimony. The school brings in acting majors from the Herberger Institute for Design and the Arts, who improvise clients based on a character profile.

“When the student and actor meet for the first time, the student is literally meeting a stranger, which is different from practicing interview skills with a peer in the classroom,” Stott said.

Afterward, the social work students get to see the profiles.

“There’s a rich discussion about how the clients’ experiences are so much deeper than what they uncovered in the interview and how all of our clients’ lives are deeper and broader than any of us will truly understand," Stott said. “Then there’s an understanding that while the clients may make a decision that we don’t understand, it might have been the best decision they could make in that moment.”

Wanting to do better

Quintana said that reviewing the case files with details of abuse was difficult for the Morrison researchers, but over the four months they were able create a framework of five types of neglect, and then assign each of the cases to a category:

• Supervisory: abandonment, exposing the child to domestic violence, allowing a child to be in an unsafe environment or allowing a child to use drugs or alcohol.
• Physical: providing inadequate or spoiled food, no coat in cold weather, inadequate shelter or poor hygiene, such as untreated lice.
• Medical: denying or delaying medical, dental or mental health care, such as refusing to seek treatment if a child shows self-harm behaviors, such as cutting.
• Emotional: inadequate nurturing, such as isolating a child from family and peers, or having unrealistic developmental expectations, like expecting an infant to be toilet-trained.
• Substance-exposed newborn.

The team found that 81 percent of calls to the agency hotline were about supervisory neglect, 19 percent were physical, 9 percent were substance-exposed newborns, 9 percent were medical neglect and 3 percent were emotional. (Some cases had multiple categories of neglect.)

Of the 400 cases in which a child was removed within 30 days, 85 percent was for supervisory neglect and 20 percent were substance-exposed newborns. The most common supervisory-neglect issues were allowing a child to be exposed to a dangerous situation, such as being in the car with a drunken driver, as well as exposure to domestic violence and incarceration.

Then the team took the information to the professionals who deal with child abuse, visiting six counties to seek feedback.

“We asked them, ‘Does this seem to be in alignment with what you’re experiencing?’ And we had a conversation about their perceived gaps and strengths as a community in responding to child neglect and abuse,” Quintana said.

The report that was released last week is a summary of those conversations, which found issues unique to some areas as well as a lot in common.

“In Sierra Vista there are border-related issues, and in Coconino County there are weather-related issues because they get snow,” she said. “Many face the same issues, such as dealing with affordable housing and transportation. But they all felt their community was tightly knit and cared about each other.”

The next phase of the project will be a geographical analysis of what services are provided and what is needed.

Quintana said this was the first analysis of its kind in Arizona that looks at types of neglect.

“There are only a few regions that have done this type of analysis, and it speaks to Arizona’s wiliness to learn more and do better,” she said.

“People were craving this information.”

Find the "Spotlight on Arizona's Kids" reports here.