• States that there is no one at home to provide care • Is inadequately dressed for the weather • Reports caring for younger siblings • Has poor hygiene or smells of urine or feces • Seems malnourished • Has unattended medical or dental problems Consider the possibility of neglect when the parent or other adult caregiver: 5 • Appears to be indifferent to the child • Seems apathetic or depressed • Behaves irrationally or in a bizarre manner • Is abusing alcohol or other drugs The Clinician’s Role in Cases of Neglect Physicians are in a unique position to recognize neglect and protect victims, especially young children, children with disabilities, and other children who are isolated from regular contact with the public. As challenging and unsettling as such cases may be, prompt identification and reporting of suspected neglect can make a real difference to the health and safety of children. 12 Cases of neglect are usually complex and involve layers of interactions between family members and social, economic, cognitive, and cultural dynamics surrounding the family.
Regardless of the interventions a clinician chooses (e.g., referral for counseling, social services, or economic assistance) the following key steps are recommended to maximize the chances for intervention effectiveness: 26 • Build a relationship with the family—when families believe their feelings and concerns have been heard, respected, and considered, they are more likely to be engaged in the planning and actions needed to change the behaviors that contribute to neglect. • Develop case and safety plans (i.e., identify strategies with the family that address the effects of neglect and provide guides for changing behaviors). • Establish clear, concrete goals and provide continuous positive feedback when goals are met. • Track, analyze, and evaluate family progress with continuous monitoring, frequent check- ins with family members, and the use of quantitative tools for measuring agreed-upon outcomes.
Human Trafficking
Human trafficking is defined by the United Nations as the recruitment, transportation, transfer, harboring or receipt of persons by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. 27 Pennsylvania has a similar, but not identical definition of Human Trafficking, as well as a specific definition of Labor Trafficking: • Human Trafficking: the recruitment, harboring, transportation, provision or obtaining of a child for labor or services through the use of force, fraud, or coercion. Under federal law, sex trafficking (such as prostitution, pornography, exotic dancing, etc.) does not require there be force, fraud, or coercion if the victim is under 18. • Labor Trafficking: labor obtained by use of threat of serious harm, physical restraint, or abuse of legal process. Pennsylvania uses the federal definition of ”severe forms of trafficking in persons”: 28 • Sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age
BEFORE MOVING ONTO THE NEXT SECTION, PLEASE COMPLETE CASE STUDY 3.
Case Study 3 Instructions: Read the scenario below and answer the questions as it relates to the case presented.
A single mother brings her 2-year-old son in for a well-child visit. The child appears physically healthy, although somewhat under-weight for age and height. When asked about how the child is cared for while the mother works, the mother explains that she “only works a few hours at a time,” doing house cleaning for other tenants in her apartment complex and that, while she is working, she leaves her son in the living room to watch television. The mother appears to find this behavior normal and, when questioned about the safety of the situation, assures you that she blocks off access to the kitchen and other rooms of the house and leaves the child cups of soda and snacks so he won’t be hungry.
1. Is this an example of neglect as defined under Pennsylvania law?
2. What steps might a clinician take to address this situation?
Questions for case study:
3. What community services might be called upon to provide support for the mother and her son?
Commentary: Leaving a 2-year-old alone for hours at a time is clearly not ideal since it poses the risk of harm from an unsupervised accident or incident. Although this situation probably does not rise to the level of “serious neglect” as defined in PA law, the physician in this case should still make a report through ChildLine (1-800-932-0313) or through the electronic submission at the Child Welfare portal at www.compass.state.pa.us/cwis. Once the report is filed, GPS can offer services and support for the mother. Additionally, the physician should avoid punitive or condemnatory reactions and, instead, work empathetically with the parent to explore the situation further and provide potential resources that can offer help. The PA Family Support Alliance offers a range of services and family support programs that could potentially be valuable to this single parent struggling to raise a child and earn money at the same time.
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