3.8.1 Forms of Abuse and Neglect | 3.8.2 Premeditation/Intent | 3.8.3 Severity of Injury | 3.8.4 Location of Injury | 3.8.5 Degree of Violence | 3.8.6 Pattern/Chronicity/Frequency | 3.8.7 **Age of Child | 3.8.8 **Caretaker's Perception of the Problem | 3.8.9 **Caretaker's/Paramour's Ability and Willingness to Protect | 3.8.10 **Child's Fear of the Caretaker | 3.8.11 Child Factors | 3.8.12 Caretaker Factors | 3.8.13 Parenting Factors | 3.8.14 Family Functioning Factors | 3.8.15 Correlation of Risk Factors with Subsequent Reports
The following is a list of the risk factors in the Risk Assessment Protocol that are applicable to abuse or neglect cases, a description of each factors and prompts for effective assessment of the factor. Several risk factors are marked with double asterisks (**). These factors have been identified as high risk. The worker must describe how these factors relate to the family's situation, whether or not they have been identified as contributing to the maltreatment incident.
Historical factors about the incident of maltreatment and the child's relationship with the caretaker (to be described in writing)
This factor describes the form of the maltreatment; for example, abuse or neglect through blatant disregard, failure to protect or direct action. The worker needs to describe the incident in detail here: who, what, where, when and how. Some forms of maltreatment are considered to be higher risk than others.
Key assessment strategies:
Premeditation/intent reflects the state of mind of the perpetrator. "State of mind" is important to assess as it provides a psychological or emotional profile of the perpetrator and guides the determination of treatment needs. A caretaker who appears to be cruel, calculating or unfeeling or who appears to deliberately leave the child home alone (knowing the risk) needs to be treated differently than one who is impulsive or unable to control his/her anger. Both can be dangerous to the child but their treatment needs are different and therefore, different treatment approaches are required.
Key assessment strategies:
All forms of abuse and neglect have the potential to cause serious harm and all incidents need to be taken seriously. Physical abuse can clearly cause severe short-term or long-term injury. Chronic neglect may result in more long-term harmful effects on a child than one incident of physical abuse. Emotional maltreatment may affect a child's capacity for healthy functioning long into adulthood.
Key assessment strategies:
This factor is related to premeditation, intent to harm and severity. Generally an individual knows that a blow to the head will cause more severe harm than a spanking. If the child was injured on the head, neck or other vulnerable place, what does this tell the worker about the perpetrator?
Key assessment strategies:
This factor evaluates the amount of violence used in the maltreatment. Examples of serious violence are choking, severely shaken baby, use of an instrument or object or hitting with one's fists. Clearly the use of a knife or gun suggests a high degree of violence. The degree of violence used in the maltreatment incident provides an insight into the perpetrator's state of mind, intent to harm and predisposition for violence.
Key assessment strategies:
Research indicates that the likelihood of maltreatment increases after each occurrence of maltreatment. Incidents of neglect are more likely to recur, followed by incidents of physical abuse. A child who sustains repeated bruises as a result of negligent care may be at risk due to the parent's lack of supervision. Recurrence of maltreatment is more likely to be reported within six months of the initial report (Fluke, Yuan and Edwards, 1999). It is important to determine how often maltreatment incidents occur in this family. Is this a one-time incident or does this kind of maltreatment occur daily, weekly, monthly?
Key assessment strategies:
The age of the child is associated with his/her level of vulnerability. The younger the child, the more vulnerable he/she is. Research indicates that age of the child is a common indicator of risk of maltreatment (Wells, Fuller and Cotton, in press) and Fuller, 2000). In addition, the age of the child is a strong predictor of recurrence of maltreatment (Fluke, Yuan and Edwards, 1999). Young children are at greater risk for severe child abuse injuries (Zuravin, Orme and Hegar, 1994). The worker needs to consider the child's age in the context of his/her physical, emotional and developmental abilities.
Key assessment strategies:
A key part of assessing risk is the ability to "get inside the perpetrator's head" in order to understand the dynamic underneath the maltreatment. The worker needs to develop insight into how the perpetrator thinks and feels about the child and the incident of maltreatment. Does the caretaker believe there is a problem? What is his/her explanation of the incident? Is the caretaker able to take responsibility for the maltreatment? Is he/she willing to change his/her behavior? While in the midst of crisis and the possibility of having his/her child(ren) removed, it is not unusual for a caretaker to express remorse or contrition for the incident and may be quite genuine in his/her expression. At these times it will be important for the worker to examine the caretaker's response in the context of other interrelated factors: the type of abuse, severity, location of injury, premeditation and intent to harm, pattern of abuse and degree of violence used. Underlying parental conditions must always be borne in mind. For example, if there is domestic violence in the home, is the remorse part of the larger pattern of abuse in the family system?
Key assessment strategies:
The worker needs to assess whether the non-offending caretaker knew or should have known of the occurrence of the maltreatment and took reasonable steps to stop it. If the caretaker knew of the maltreatment but did not take any steps to stop it, why? What does this say about the caretaker? It will be necessary to look at whether the caretaker was unable to protect the child because of some underlying condition that impaired his/her understanding or ability to act. For example, a depressed mother or a mother who is economically and emotionally dependent on her boyfriend may not be able or willing to intervene to protect her child. The capacity to protect her child from sexual abuse may be impaired in a mother with a history of sexual abuse who has never engaged in treatment herself. The assessment process must include a determination of the non-offending caretaker's ability to protect the child over the long-term, not just at this moment in time.
Key assessment strategies:
Key assessment strategies:
The child's physical condition is related to vulnerability and chronological age. Illness or physical problems (such as the physical effects of fetal alcohol syndrome or cerebral palsy) can affect the child's vulnerability and ability to protect him/herself. In addition, physical factors can exacerbate stress in the home, creating a climate more conducive to maltreatment.
Key assessment strategies:
Emotional conditions such as temperament, mood swings, temper tantrums or depression can affect the overall functioning of a family leading to conflict and stress. Many of these factors may be amenable to treatment or can be managed through medication and social supports. The worker needs to assess how the child's emotional or mental health affects his/her relationship to the caretaker and the caretaker's coping strategies in relation to the child. Pertinent to this assessment is information related to the child's treatment history (including medication and any psychiatric hospitalizations) and psychiatric diagnosis. If the worker suspects there may be a mental health issue, he/she needs to refer to the mental illness indicators to determine whether a further assessment needs to be made.
Key assessment strategies:
A developmental disability makes the child more vulnerable and affects his/her ability to protect him/herself. Caring for a child with a developmental disability can create stress and affect a caretaker's perception of his/her own parenting capacities. Moreover, it can affect the parent's perception of the child and overall interaction with the child. Parents may be angry with the child for not being the child they wanted or expected. They may see the child in negative terms because of the additional burdens the child places on them. Parents may have unreasonable expectations of the child and not acknowledge that a developmental disability exists. These factors are significant to explore and assess.
Key assessment strategies:
The child's behavior is a strong predictor of recurrence of maltreatment (Wells, Fuller and Cotton, in press). It is important not only to identify the behavior but also to determine the dynamic underlying the child's problematic behavior. Some questions to consider include:
At risk, too, is the child who is passive or depressed and makes no demands on the parents, and therefore is ignored and left to his/her own self-care. These children may be at greater risk of neglect. The worker should explore the parents' coping strategies in relation to the child's behavior.
Key assessment strategies:
The ability to form healthy attachments is a strength that may mitigate risk. Persons to whom the child is attached can be engaged to assist with protecting and caring for the child. It is therefore important to determine to whom the child is primarily attached. On the other hand, if it appears that the child's attachments are weak or non-existent because of social isolation, mental health, developmental delays or other issues, the risk of maltreatment increases. This may be a factor to earmark for treatment services.
Key assessment strategies:
A key part of assessing risk is examining how the child interacts with the caretaker. Through observation and interviews with the child and caretaker, the worker may note that the child is defiant or disrespectful toward the caretaker. There may be a high degree of conflict between child and caretaker, perhaps leading to physical assault of the caretaker. On the other hand, the child may be passive, fearful and overly compliant. The worker needs to observe the role of the child vis-à-vis the caretaker and other household members; for example, the child may have assumed a caretaking role toward the parent or other children in the household. Conflict, disruption, passivity or role diffusion increases risk when the child's physical, emotional or developmental condition is significantly impacted.
Key assessment strategies:
When a caretaker has low impulse control, risk of maltreatment increases. A caretaker may lash out or beat a child seriously without considering the impact of what he/she is doing. Or a caretaker may leave a young child at home alone as he/she decides on the spur of the moment to go out partying. Impulsive acts can be as risky to children's safety as premeditated acts.
Key assessment strategies:
In Illinois, the number of child abuse cases where the mother's paramour is the perpetrator has increased dramatically in the past few years, as has the severity of the abuse. A paramour is defined in the Department's paramour-involved families as:
...A significant other (e.g.,
who is involved in an intimate/romantic relationship with one of the custodial parents of the child who come to the official attention of the Department through a child abuse or neglect investigation and/or open case; does not have a legally recognized and/or significant, continuous and stable relationship with all of the children; and may or may not live in the same household as the custodial parent of the involved children. (Policy Transmittal 2000.18, Procedural Guidelines for Intake, Investigation and Delivery of Services to Paramour Involved Families; italics in original).
Stepparents are not included in the definition of paramour. However, the procedural guidelines should also be applied to any stepparent named as a perpetrator of physical abuse to a stepchild if the stepparent has not had a significant, continuous and stable relationship with the custodial parent and involved stepchildren. Given the Department's policy on paramours, it is imperative that the worker pay attention to a paramour living in or frequenting the home and assess his/her role in the maltreatment.
Key assessment strategies:
When a family has a strong support system, there are others available to protect and care for the child. However, when the family is isolated, the stress and lack of support may increase the risk of maltreatment. Families are isolated for a variety of reasons; for example, lack of transportation, poor social skills, mental illness, geographic or language barriers. It is important to determine the cause of the isolation so that services can be geared to mitigating this factor.
Key assessment strategies:
A caretaker's physical well-being affects the level of stress in the home and the caretaker's capacity to provide adequate care and protection for the child. Acute or chronic illness or disability can impact roles within the family (e.g., the child taking care of the parent) and contribute to impaired family functioning.
Key assessment strategies:
Mental illness can impair a caretaker's capacity to parent in a variety of ways. When a worker notices indicators for mental illness, he/she must make a referral for a further assessment. It will be important to assess whether the caretaker has a history of psychiatric hospitalizations. If so, details about past hospitalizations should be obtained. In addition, the worker should determine if the caretaker has a psychiatric diagnosis by contacting the caretaker's treatment providers or through further assessment. Although mental illness (an Axis I diagnosis) cannot be "cured", it often can be adequately managed or treated through proper medication, structure and therapy. After further assessments are obtained, or through interviews with the caretaker's treatment providers, the worker will be able to assess whether the caretaker's mental illness is manageable, thereby mitigating this risk factor.
Key assessment strategies:
A developmental disability is another factor that can seriously impact parenting capacity. A developmental disability is defined as a "condition that produces functional impairment as a result of disease, genetic disorder or impaired growth pattern before adulthood." (Barker Robert L., The Social Work Dictionary, 2nd ed., Washington D.C.: National Association of Social Workers, 1991, p. 61) Some examples of a developmental disability include cerebral palsy, Down's syndrome, epilepsy, mental retardation and autism. A developmentally disabled caretaker may be able to care for and protect his/her child through adequate supports or through a co-parenting relationship with a relative (i.e., this condition may be managed). If the worker notices indicators of a developmental disability, a referral for a further assessment must be made. After adequate information is obtained, the worker will need to assess whether community or familial support will enable the caregiver to care for his/her children safely.
Key assessment strategies:
A caretaker's use or misuse of alcohol and/or other drugs can seriously impact his/her ability to provide for a child's needs. The worker will need to determine the extent to which the caretaker's substance use impairs his/her capacity to care for and protect the child. It will be important to explore with the caretaker whether he/she has ever participated in substance abuse treatment and, if so, the outcome of the treatment. When child is born positive for drugs or diagnosed with fetal alcohol syndrome or fetal alcohol effects, the caretaker must be evaluated for current substance misuse. The worker must refer to the substance abuse indicators whenever substance misuse is suspected and make a referral for a further assessment if necessary.
Key assessment strategies:
Denial, the effects of past trauma and other conditions may cloud a non-offending caretaker's awareness that sexual abuse has occurred to his/her child. A non-offending caretaker may have doubts about the child's credibility regarding the abuse or may blame the child for the abuse. In reports of sexual abuse, the worker must be able to assess the non-offending caretaker's capacity to protect the child by determining how the caretaker perceives the child and the allegation. The worker should be aware that a caretaker who has suffered sexual abuse and who has not engaged in treatment might have difficulty recognizing that their child has been sexually abused.
Key assessment strategies:
A past history of sexual perpetration by the caretaker - especially if he/she has never been treated - presents a serious risk of future maltreatment to a child. The worker will need to look at several factors: whether the caretaker ever engaged in treatment and whether he/she made progress, the caretaker's access to the child, the caretaker's relationship with the child, the child's ability to self-protect, whether there have been any recent sexual offences on the part of the caretaker and other factors depending on the facts of the case. It is important that the worker understand the caretaker's past history and how the caretaker perceives him/herself as a sexual perpetrator: does he/she acknowledge this history, take responsibility for it, understand the seriousness of it, etc.
Key assessment strategies:
If a caretaker is in and out of prison, he/she cannot adequately care for a child. If a caretaker has a background of committing violent crimes, his/her ability to protect the child is called into question. Even a history of "petty offenses" or misdemeanors reflects on a caretaker's judgment and impulse control, thereby affecting his/her capacity to parent. On the other hand, LEADS information itself doesn't present the whole picture. The worker needs to look beyond the LEADS information and make an assessment of the caretaker's character and capacity to parent this child at this time.
Key assessment strategies:
One of the commonly found indicators of risk is the perpetrator's access to the child (Wells, Fuller and Cotton, in press). It is important for the worker to assess the capacity of the non-offending parent to protect. In situations where the risk of re-abuse is high, the risk of severe abuse is high and the non-offending parent is unable or unwilling to protect, the worker may need to develop a safety plan or take protective custody.
Key assessment strategies:
This factor assesses the parent's capacity to provide adequate care and protection and assesses the presence of disabling conditions that impair this capacity. Disabling conditions include mental illness, developmental disabilities, a history of sex abuse, substance abuse and domestic violence.
Key assessment strategies:
Unrealistic expectations and negative interactions are indications of high risk of maltreatment (Wells, Fuller and Cotton, in press). In assessing this factor, the worker should observe the caretaker's interactions with the child to look for indicators of attachment in the parent-child relationship and determine whether the parent's expectations of the child are age and developmentally appropriate. The worker needs to understand how the caretaker perceives the child. If there are indications of conflict and negativity, the worker will need to explore with the family the dynamics that created this situation.
Key assessment strategies:
Prior history of abuse or neglect is a commonly found indicator of risk (Wells, Fuller, and Cotton, in press). It will be important to assess how this factor affects the caretaker's current ability to provide care and protect the child.
Key assessment strategies:
Financial instability - inability to meet present expenses, unemployment, inability to manage finances, etc. - can negatively impact a child's well-being; i.e., health care needs may go unmet, housing may be deteriorating due to lack of funds or the family may move frequently due to evictions. Chronic unemployment or underemployment is often associated with depression, substance abuse and high levels of stress. Partners may argue and fight over finances. Of course, mental illness, substance abuse, domestic violence or other conditions may contribute to financial instability. Thus, in assessing this factor, the worker will need to be aware of the interrelationships between financial stability and other risk factors.
Key assessment strategies:
Environmental conditions of the home are often symptoms of a deeper condition within the caretaker or the family system. To assess this factor adequately, it will be necessary to look at the underlying cause or condition that resulted in, for example, the dirty house or the homelessness. Why is the house dirty or the family homeless? If the caretaker lost his job, why? This may point to the presence of a mental illness or a substance abuse problem. Poor housekeeping may be indicative of a mental illness or developmental disability.
Key assessment strategies:
Domestic violence between adults in the home can place children at risk. The worker must spend enough time with the family to gain an understanding of how the family functions. If the worker notices any signs of domestic violence using the domestic violence indicators, a referral for further assessment must be made. At times, children may try to intervene and get hurt in the process. Or one caretaker may use the child as a "shield" in order to protect him/herself from the other. Contributing factors, such as alcohol use, may be involved and need to be assessed.
Key assessment strategies:
The level of crisis and stress in the home and the family's coping strategies are important indicators of risk. High levels of stress are correlated with many other risk factors such as substance abuse, mental illness, domestic violence, sex abuse, the existence of a support system and the environment in which one lives. How the family copes with stress is determined by the family's communication patterns, attachment to each other, role expectations, boundaries, the presence of underlying conditions (substance abuse, mental illness, etc.) that impair healthy coping--to name just a few. The worker must assess whether the level of crisis or stress in the home and whether the family's coping strategies place a child at risk of maltreatment. Again, the worker will need to be aware of a multiplicity of factors that have a bearing on how a family copes with stress and why some families are always in crisis.
Key assessment strategies:
Research has shown that single parent households are at greater risk of multiple referrals (i.e., child abuse or neglect reports) to the child welfare system (Wells, Fuller and Cotton, in press). The number of cases in which a mother's paramour was found to be a perpetrator of abuse or neglect has increased. A two-parent family where both caretakers work, with no family or community support and limited financial resources will difficulty providing for their child `s care while they work. These examples illustrate that family structure has a bearing on how children's needs are met. However, they also point out that family structure cannot be assessed in isolation. The household structure must be examined in conjunction with other factors that may mitigate or exacerbate this factor.
Key assessment strategies:
The worker needs to develop a picture of the family and how it functions as a system. Family dysfunction includes such subjects as:
Key assessment strategies:
Research indicates that certain families with identified characteristics are associated with the likelihood of multiple referrals (reports). Commonly found characteristics associated with risk are:
The type of maltreatment is an indicator of recurring reports. Compared to sex abuse reports, child abuse/neglect and substance exposed infants are 27 times more likely to be re-reported. Child behavior is also very predictive of repeated reports. Additional allegations that are more likely to be re-reported are: caretaker acts negatively toward the child, caretaker has unrealistic expectations of the child, and the child is fearful of others in the home.
Case disposition also influences recurrence. Cases referred out to community agencies are 4.8 times more likely to be re-referred compared to cases referred for assessment, family preservation or other child welfare services. The latter cases are 2.7 times more likely to be re-reported than those cases that received no services. (Source: Wells, Fuller and Cotton, in press)
3.8.1 Forms of Abuse and Neglect | 3.8.2 Premeditation/Intent | 3.8.3 Severity of Injury | 3.8.4 Location of Injury | 3.8.5 Degree of Violence | 3.8.6 Pattern/Chronicity/Frequency | 3.8.7 **Age of Child | 3.8.8 **Caretaker's Perception of the Problem | 3.8.9 **Caretaker's/Paramour's Ability and Willingness to Protect | 3.8.10 **Child's Fear of the Caretaker | 3.8.11 Child Factors | 3.8.12 Caretaker Factors | 3.8.13 Parenting Factors | 3.8.14 Family Functioning Factors | 3.8.15 Correlation of Risk Factors with Subsequent Reports