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CHILD NEGLECT * What is Neglect? Types of Neglect What constitutes neglect: Behavior of Parent or Harm to child? * How Many Children Are Neglected? Vast Differences between estimates Difficulty in defining and measuring Cultural criterion Where to draw the line Is failure to protect from observing violence neglect? * Is there any way to measure neglect aside from the number of injured children discovered? * Most prevalent and least researched form of child maltreatment * Ways of measuring neglect: CPS, CTS scale, MNS-A and MNS-C * Consequences of Neglect: IDV study, Maine-NH study CA NEGLECT 1 TYPES OF NEGLECT U.S. Department of Health and Human Services as cited in Barnett: 1. Health care neglect (the refusal to provide physical and mental health care) 2. Personal hygiene neglect (personal care and cleanliness standards are failed to be met) 3. Nutritional neglect (failure to provide a nutritious and quality diet) 4. Neglect of household safety (safety hazards either within the house or surrounding area pose danger to the child) 5. Neglect of household sanitation (housekeeping and cleanliness standards are not met) 6. Inadequate shelter (lack of stable home) 7. Abandonment (physical abandonment) 8. Supervisory neglect (parental supervision lacks to the extent that injury is possible) 9. Educational neglect (parents don’t provide the necessary care and supervision to promote education) 10. Emotional neglect (security, support, and encouragement aren’t provided) 11. Fostering delinquency (the encouragement of illegal behaviors) CA NEGLECT 2 DEFINITION OF NEGLECT Neglect is behavior by a caregiver that constitutes a failure to act in ways that are presumed by the culture of a society to be necessary to meet the developmental needs of a child and which are the responsibility of a caregiver to provide. CA NEGLECT 3 CONTROVERSIAL ELEMENTS IN THE DEFINITION “Behavior by a caregiver” * Essential to avoid confounding the definition and measurement of neglect with either the causes of neglect (such as poverty or motive) or with the effects of neglect such as physical or psychological damage to the child. * Crucial to measure causes or effects. For example, service providers may often also need data on injury, as this is often prescribed by statute * Causes and effects must be measured separately from the caregiver behavior that constitutes neglect. CA NEGLECT 4 HARM TO THE CHILD IS NOT IGNORED BY A DEFINITION THAT EXCLUDES HARM •Actualy facilitates research to investigate the degree of harm associated with deviation from culturally established standards of care. • Studies of this type • First identifytype and frequency of neglectful behavior, defined as deviation from cultural standards. • Next investigate the probability and degree of harm associated with those deviations from cultural standards Example: standards for appropriate levels of supervision, such as leaving a seven year-old under the daily supervision of a 10 year-old sibling after school until a parent returns from work. * What percent of such children are harmed? * If harm is included in the definition, there is no way of measuring that. CA NEGLECT 5 “PRESUMED BY THE CULTURE” * Except possibly at the extremes when a child is seriously injured or dies, neglect is a culturally constructed phenomenon * Cultural norms concerning neglect vary from society to society. Within a given society they change over time. * Laotia, Cambodian, and many other societies: leaving an infant in the daylong care of 7 or 8 year old siblings expected rather than be considered neglect (Korbin & Spilsbury, 1999). * Contemporary USA: both the infant and the 7 or 8 year-old caregiver child would be judged as neglected. * For example, learning to read and write was at one time a privilege of a small minority of children rather than a developmental need that, if not met, constitutes neglect. CA NEGLECT 6 “RESPONSIBILITY OF A CAREGIVER” • Allows for a division of labor between caregivers. • If there are two caregivers and only one is expected to provide food, and only one does, the other caregiver has not been neglectful. • If both are expected to provide food and one does not, that is neglect by the caregiver who fails to provide food. • This is the case even if the child gets enough to eat from the other caregiver because a primary caregiver has failed to meet the standards of the culture. CA NEGLECT 7 PREVALENCE OF NEGLECT DIFFERENCES IN RATES FROM THREE SOURCES Cases reported to Child Protective Services, 1998 53% of all cases reported to CPS RATE PER 1,000 7.2 NUMBER OF CHILDREN 504,000 National Incidence Study of cases known to human service professionals (random sample of 28 counties) 15.9 1,004,00 National Survey of 1,000 parents, 1995 270.0 18,865,000 Cases known to professionals is double Cases uncovered by 1995 survey of parents is 37 times greater WHAT COULD EXPLAIN THESE DIFFERENCES? CA NEGLECT 8 WHAT COULD EXPLAIN THESE DIFFERENCES? MOST CASES NOT REPORTED Even human service professionals do not report all (perhaps half of cases they know about) DIFFERENT CRITERIA FOR JUDGING A CASE TO BE NEGLECT National Survey of parents used parents behavior CPS and human service professionals tend to use injury to the child Most neglect does not result in a visible injury. The most frequent injury is psychological and it is rarely observable CA NEGLECT 9 HOW CAN NEGLECT BE MEASURED ASIDE FROM REPORTS TO CPS? Surveys Of Service Providers – the least useful approach Epidemiological Surveys = studies of a general population The CTS Neglect Scale The Multimensional Neglect Scale Form A – Adolescent Report and Adult Recall Form AS – Short form as part of the PRP Form CR – Computer Administered For children 6-12 Form PR – Parent Self Report CA NEGLECT 10 WHY HAVING OTHER MEASURES IS MPORTANT Cases known to CPS are the tip of the iceberg Provides more complete estimate of prevalence But the criteria are not necessarily the same A means of testing the effectiveness of prevention and treatment programs More adequate data on CPS cases, especially cases with other presenting problems Research that will provide the better understanding of the causes neglect needed to develop "primary prevention" programs CA NEGLECT 11 NATIONAL SURVEY OF 1,000 PARENTS (Straus et al, 1995) THE CTS NEGLECT Prevalence Past Yr SCALE Scale and Items Year Ever Chron NA. Had to leave your child home alone, even 195 213 6.0 when you thought some adult should be with him/her NC. Were not able to make sure your child got 110 137 5.5 the food he/she needed NE. Were so drunk or high that you had a 33 5.9 2.3 Problem taking care of your child ND. Were not able to make sure your child got to 4 12 2.0 a doctor or hospital when he/she needed it. NB. Were so caught up with problems that you 2 11 4.6 were not able to show or tell your child that you loved him/her Neglect Scale (= sum of the 5 items) 270 306 6.9__________ Chronicity is the mean number of times each act was reported among the subset of parents who reported at least one occurrence. CA NEGLECT 12 MULTIDIMENSIONAL NEGLECT SCALE SHORT FORM (Form MNS-AS) Cognitive needs My parents helped me with homework if I needed help (R) My parents did not help me to do my best in school Educational Needs My parents made sure I went to school (R) My parents did not care if I got into trouble in school Emotional needs My parents helped me when I had problems (R) My parents did not comfort me when I was upset Physical needs My parents gave me enough clothes to keep me warm (R) My parents did not keep me clean (R) = REVERSED ITEMS RELIABILITY COEFFICIENT (ALPHA = .71) CA NEGLECT 13 Table 3: Percent Reporting One or More Forms of Each Type of Neglect, by Gender 7,500 Students in 14 Countries Neglect Scale Total Cognitive Emotional Educational Physical CA NEGLECT Total Males Females 1+ forms 50.50% 56.20% 47.80% 2+ forms 24.50% 28.70% 22.60% 1+ forms 29.80% 34.40% 27.70% 2+ forms 5.30% 5.60% 5.10% 1+ forms 22.30% 25.50% 20.90% 2+ forms 5.60% 5.20% 5.70% 1+ forms 19.80% 23.20% 18.30% 2+ forms 1.20% 1.40% 1.10% 1+ forms 11.80% 14.40% 10.70% 2+ forms 0.70% 1.30% 0.50% Chi Square 55.27*** 34.66*** 29.90*** 23.42*** 27.93*** 14 Table 3. Number of Neglectful Behaviors Experienced by Students Who Were Neglected, By Gender* Number of Behaviors 1 2 3 4 5 6 7 8 Mean SD CA NEGLECT Total 51.4% 24.3% 12.8% 6.8% 2.9% 1.2% 0.5% 0.0% 1.91 1.22 Males 49.0% 24.1% 14.2% 7.8% 3.3% 1.4% 0.2% 0.0% 1.97 1.23 Females 52.7% 24.4% 12.0% 6.3% 2.8% 1.1% 0.6% 0.0% 1.88 1.22 15 Table 5a: Neglect Total Scores in Rank Order by Site, by Gender NHT1 (% 1 or more) Rank Male NHT1 (% 3 or more) Female Male Female 1 KOR-PUSAN 93.9 KOR-PUSAN 95.0 KOR-PUSAN 28.1 KOR-PUSAN 41.2 2 HKG-HONGKONG 86.2 HKG-HONGKONG 78.9 HKG-HONGKONG 25.3 HKG-HONGKONG 30.8 3 BEL-LEUVEN 73.3 BEL-LEUVEN 64.0 USA-TX NCDCHS 24.3 CAN-LONDON 20.3 4 MEX-JUAREZ 70.2 MEX-JUAREZ 61.8 CAN-WINNIPEG 23.5 USA-MISSISSP 16.3 5 NDL-AMSTRDAM 69.4 ISR-EMEKZYRL 59.3 CAN-LONDON 22.7 USA-TX-MEX 15.5 6 PRT-BRAGA 69.1 CHE-GERMAN 56.9 MEX-JUAREZ 21.3 USA-LOUISIAN 13.9 7 IND-PUNE 65.6 PRT-BRAGA 54.5 USA-TX-N MEX 20.2 MEX-JUAREZ 13.5 8 BRA-SAOPAULO 65.1 NDL-AMSTRDAM 53.6 BRA-SAOPAULO 19.1 ISR-EMEKZYRL 12.9 9 ISR-EMEKZYRL 64.0 BRA-SAOPAULO 53.2 USA-MISSISSP 17.9 CAN-HAMILTON 12.0 10 CAN-HAMILTON 61.9 USA-MISSISSP 52.9 USA-LOUISIAN 17.6 CAN-WINNIPEG 11.2 11 USA-TX-N MEX 58.1 USA-TX-MEX 52.2 USA-CINCINN 17.5 USA-TX-N MEX 10.5 12 USA-UTAH 56.9 CAN-HAMILTON 49.6 ISR-EMEKZYRL 17.4 BRA-SAOPAULO 10.4 13 USA-LOUISIAN 56.8 USA-TX NCDCHS 48.4 USA-UTAH 16.7 IND-PUNE 9.8 14 USA-TX-MEX 56.3 USA-LOUISIAN 48.1 BEL-LEUVEN 16.4 NDL-AMSTRDAM 9.6 15 CAN-MONTREAL 54.8 IND-PUNE 48.1 AUS-MAGILL 14.6 CHE-GERMAN 9.5 16 USA-TX NCDCHS 54.1 CHE-FRENCH 46.6 CHE-FRENCH 13.7 USA-TX NCDCHS 9.5 17 USA-MISSISSP 53.6 CAN-MONTREAL 45.7 USA-NH 2 12.8 AUS-MAGILL 9.4 18 CAN-WINNIPEG 52.9 CAN-LONDON 45.6 CAN-MONTREAL 12.3 CAN-MONTREAL 9.4 19 USA-CINCINN 52.6 CAN-WINNIPEG 42.2 NDL-AMSTRDAM 12.2 PRT-BRAGA 9.1 20 CAN-LONDON 51.5 USA-UTAH 42.0 PRT-BRAGA 12.2 BEL-LEUVEN 8.8 21 CHE-FRENCH 50.5 USA-TX-N MEX 42.0 CAN-HAMILTON 11.9 NZL-CHRISTCH 8.7 22 CHE-GERMAN 48.4 AUS-MAGILL 41.4 IND-PUNE 11.5 USA-CINCINN 7.7 23 AUS-MAGILL 42.7 USA-CINCINN 40.5 USA-TX-MEX 10.1 USA-UTAH 7.6 24 USA-NH 2 40.4 NZL-CHRISTCH 33.7 NZL-CHRISTCH 10.0 CHE-FRENCH 6.2 25 NZL-CHRISTCH 40.0 USA-NH 2 27.8 CHE-GERMAN 6.3 USA-NH 2 4.7 26 USA-NH 1 24.7 USA-NH 1 17.8 USA-NH 1 5.2 USA-NH 1 CA NEGLECT 2.4 16 Figure 1: Interaction Effect of Gender and Site for Total Neglect 2.30 2.10 1.90 1.70 1.50 1.30 1.10 0.90 0.70 Male CA NEGLECT Female 17 Multidimensional Neglect Scale-Child Report (MNS-CR) Glenda Kaufman Kantor, Ph.D., Murray A. Straus, Ph.D., & Melissa Holt, Ph.D, Family Research Laboratory, University of New Hampshire Lawrence Ricci, M.D. & Kerry Drach, Psy.D. Spurwink Clinic, Portland Maine •FOR CHILDREN 6-9 AND 10-15 •COMPUTER ADMINISTERD -- SOUND AND TOUCH SCREEN •WARM-UP PICTURES DONE WITH RESEARCER •COMPUTER GAME HALF WAY THROUGH CA NEGLECT 18 Emotional Neglect Sample Item Which girl is most like you? This girl’s father doesn’t make her feel better when she is sad or scared CA NEGLECT This girl’s father makes her feel better when she is sad or scared 19 Emotional Neglect Sample Item Cont. Is this… A little Sort of A lot Really a lot like you like you like you like you CA NEGLECT 20 Cognitive Neglect Sample Item Which girl is most like you? This girl’s mother talks to her about what she is learning in school CA NEGLECT This girl’s mother does not talk to her about what she is learning in school 21 Supervision Neglect Sample Item (age 6-9) Which boy is most like you? This boy’s mother knows where he’s playing outdoors CA NEGLECT This boy’s mother doesn’t know where he’s playing outdoors 22 Supervision Neglect Sample Item (age 10-15) Which boy is most like you? This boy’s father does not find out where he is going after school CA NEGLECT This boy’s father finds out where he is going after school 23 Hasn’t left alone for a couple of days without grown-ups CA NEGLECT 24 Physical Neglect Sample Item Which boy is most like you? This boy’s mother makes sure he takes a bath CA NEGLECT This boy’s mother does not make sure he takes a bath 25 Sees grown-ups in the house hitting each other CA NEGLECT 26 Depression Sample Item Which girl is most like you? Some girls are unhappy a lot of the time CA NEGLECT Other girls are pretty happy a lot of the time 27 Depression Sample Item Cont. Is this… A little Sort of A lot Really a lot like you like you like you like you CA NEGLECT 28 Sample Characteristics • Clinical Sample • • • • • • N = 143 57% 6-9 years of age 43% 10-15 yrs. of age 59% female 41% male 6% non-white CA NEGLECT • Community Sample • • • • • • N = 45 67% 6-9 years of age 33% 10-15 yrs. of age 53% female 47% male 38% non-white 29 % Child Behavioral Problems by MNS-CR Median Split Scores 40% 37% 35% 30% 30% 25% 20% 25% 19% 15% Below Median Above Median 10% 5% 0% 6-9 year olds CA NEGLECT 10-15 year olds 30 Relations of Neglect to Depression and PPVT Standard Scores: Age 6-9 • Child Depression • • • • • • • Neglect Total (r = .54**) Emotional Neglect (r = .40**) Cognitive Neglect (r = .40**) Supervision Neglect (r = .41**) Physical Neglect (r = .45**) Parental Alcohol Use (r = .50**) Child’s Appraisal of Neglect (r = .53**) • PPVT Standard Scores • MNS-CR Total Score (r = -.26*) • Physical Neglect (r = -.36**) • Neglect Maltreatment Group (r = -.38**) *p= CA NEGLECT .05, ** p = .01 31 Relations of Neglect to Depression and PPVT Standard Scores: Age 10-15 • Child Depression • • • • • • Neglect Total (r = .35*) Emotional Neglect (r = .37**) Cognitive Neglect (r = .33*) Supervision Neglect (r = .49**) Failure to Protect (r = .58**) Parental Alcohol Use (r = .32**) • PPVT Standard Scores • Child’s Appraisal of Neglect (r = -.30*) • Neglect Maltreatment Group (r = -.50**) * p = .05, ** p = .01 CA NEGLECT 32 SUMMARY ESTIMATES OF NEGLECT VARY WIDELY Mainly because they measure different phenomena Parent behavior versus injury INFORMATION ABOUT NEGLECT THAT DOES NOT COME TO THE ATTENTION OF CPS IS NEEDED BECAUSE CPS CASES ARE A SMALL FRACTION OF THE ACTUAL NUMBER OF CASES THE ABOVE STATEMENT IS TRUE ONLY IF ONE MEASURES NEGLECT BY PARENT BEHAVIOR IT IS POSSIBLE TO MEASURE NEGLECT IN THE GENERAL POPULATION USE OF ONE OF THESE MEASURES IN THE INTERNATIONAL DATING VIOLENCE STUDY SHOWS THAT NEGLECT OCCURS WORLD-WIDE CA NEGLECT 33 End for Soc 697 CA NEGLECT 34 CA NEGLECT 35 30% 25% 20% 15% 10% 5% 0% 0 5 10 15 20 25 30 35 40 45 50 Neglect History Total INDA%>2TOTAL CA NEGLECT 36 50% 40% 30% 20% 10% 0 5 10 15 20 25 30 35 40 45 Neglect History Total INDA%>2TOTAL CA NEGLECT 37 Central Aims of the Study • Develop a standardized instrument to measure neglect • Estimate the prevalence of different types of neglect in a community sample • Describe characteristics of neglectful families in community and clinical samples • Describe the relationship of neglect to child behavior problems & family characteristics CA NEGLECT 38 ACASI • Audio enhanced version of the Computer Assisted Self-Administered Interview • Uses an audio system and touch screen to interview child • Scale version adapted by age and gender of the child and gender of the primary caretaker CA NEGLECT 39 Child Self Report Neglect Scale • Measures cognitive, emotional, supervision, and physical neglect • Includes subscales on: Child Endangerment: exposure to parental conflict & violence, abandonment, and parental alcohol abuse; • Includes subscale on child’s general feelings or appraisals of each domain CA NEGLECT 40 Eligibility • Inclusionary Criteria- 6-15 yrs old • Lived in foster care < 6 months (age 6-9) • Lived in foster care < 1 year (age 10-15) • Exclusionary Criteria• Visually impaired • Hearing impaired • No spoken language ability • Non-English speaking • Formal diagnosis of mental retardation • Deemed “not interviewable” by clinician CA NEGLECT 41 Maltreatment Types in Clinical Sample Number & % in Group (Total N = 143) Overall Types Neglect Physical abuse Sexual abuse Emotional/Psychological abuse “Pure” Categories (Participants with only one designated abuse type) Neglect Physical abuse Sexual abuse Emotional/Psychological abuse Multiple CA NEGLECTAbuse Types 41 (29%) 39 (27%) 104 (73%) 44 (31%) 86 (60%) 8 (5.6%) 2 (1.4 %) 74 (51.7%) 2 (1.4%) 57 (40%) 42 Total MNS-CR Scores by Sample: Age 6-9 Neglect Total 10 * 8.35 8 6 4.56 4 2 0 Community Sample Clinical Sample Significance, * p = <.01 CA NEGLECT 43 MNS-CR Scores by Sample: Age 6-9 Neglect Domain Clinical Sample (N = 81) Cmty. Sample (N = 30) Emotional 1.83 1.07 Cognitive 1.65 1.17 Supervision 1.88 0.69** Physical 2.83 1.63 Abandonment 0.16 0* Failure to Protect 0.88 0.73 Alcohol 0.23 0* Child’s Appraisal 2.74 3.15 Depression 2.86 2.31 CA NEGLECT ** p < .01, * p < .05 44 Total MNS-CR Scores by Sample: Age 10-15 Neglect Total 8 6 7.62 5.26 4 2 0 Community Sample CA NEGLECT Clinical Sample 45 MNS-CR Scores by Sample: Age 10-15 Neglect Domain Clinical Sample (N = 81) Cmty. Sample (N = 30) Emotional 2.26 1.94 Cognitive 1.58 0.80 Supervision 2.04 1.18 Physical 1.58 1.20 Abandonment 0.16 0.13 Failure to Protect 0.66 0.69 Alcohol 0.09 0.0 Child’s Appraisal 1.94 1.91 Depression 2.61 2.43 CA NEGLECT 46 MNS-CR Scores by Neglect: Age 6-9 Yes (N = 20) No (N = 54) Neglect Total 8.14 8.24 Emotional 1.66 2.00 Cognitive 1.40 1.56 Supervision 1.76 1.99 Physical 3.22 2.56* Abandonment 0.10 0.13 Alcohol 0.25 0.23 Failure to Protect 0.45 1.05 General Appraisal 2.77 2.77 Depression 3.44 2.63* CA NEGLECT 47 MNS-CR Scores by Psych. Abuse: Age 6-9 Yes (N = 20) No (N = 54) Neglect Total 6.07 9.00 Emotional 1.05 2.22 Cognitive 1.16 1.65 Supervision 1.60 2.05 Physical 2.21 2.94 Abandonment 0.05 0.15 Alcohol 0.30 0.21 Failure to Protect 0.61 0.99 General Appraisal 2.61 2.82 Depression 2.07 3.10 CA NEGLECT 48 MNS-CR Scores by Neglect: Age 10-15 Yes (N = 17) No (N = 47) Neglect Total 8.20 6.15 Emotional 2.52 1.80 Cognitive 1.73 1.28 Supervision 1.94 1.98 Physical 1.89 1.09 Abandonment 0.12 0.0 Alcohol 0.06 0.10 Failure to Protect 0.49 0.55 General Appraisal 2.26 1.72 Depression 2.40 2.69 CA NEGLECT 49 MNS-CR Scores by Psych. Abuse: Age 10-15 Yes (N = 21) No (N = 37) 10.12 4.84 Emotional 3.11 1.39 Cognitive 2.13 1.00 Supervision 3.16 1.16 Physical 1.63 1.16 Abandonment 0.10 0.0 Alcohol 0.24 0.0 Failure to Protect 0.97 0.28 General Appraisal 1.81 1.92 Depression 3.35 2.13 Neglect Total CA NEGLECT 50 MNS-CR Scores by Past CPS Involvement 9 8.8 8 7 6 5 6.74 5.76 Never Involved Ever Involved 4 3 2.54 2 1 0 6-9 year olds CA NEGLECT 10-15 year olds 51 MNS-CR Scores by Current CPS Involvement (Open Case) 12 10 10.51 8 6.82 6 6.49 5.16 4 Currently No Open Case Current Open Case 2 0 6-9 year olds CA NEGLECT 10-15 year olds 52 PPVT Standard Scores by Presenting Maltreatment Type PPVT Standard Score Age 6-9 Age 10-15 Yes 88.37** 87.87** No 100.31 100.74 Yes 92.17 95.33 No 98.79 98.00 Yes 99.64** 99.58* No 89.67 90.80 Yes 94.80 95.43 No 98.02 98.19 Neglect Concerns Physical Abuse Concerns Sexual Abuse Concerns Psych. Abuse Concerns CA NEGLECT * p < .05, ** p < .01 53 Table 1: Comparison of Neglect Estimated Authors Sample Randomly Gallup selected US Organization, 1995 households Randomly selected 18-24 Cawson, P., et al., year old UK 2000 residents Christensen, E., 1996 Health Nurses in Denmark Department of Families in Department of Queensland, Families, 2002 Australia U.S. Department of Child Protective Health and Human Services and Services, 1999 DHHS in US National Clearinghouse on Child Abuse and Child Protective Neglect, 1999 Services in US Sedlak, A. J., et al., 1996 CA NEGLECT Case Source Neglect Type Perpetrators interviewed Total Neglect Victims interviewed Total known cases of victimization Human Service Total known Professionals in cases of US victimization 27.00% Physical Neglect 6.00% Passive Neglect 4.00% Officially reported cases of victimization Total Neglect Officially reported cases of victimization Passive Neglect Total known cases of victimization Prevalence Rate Total Neglect Total Neglect Educational Physical Emotional 3.00% 0.60% 0.60% 1.30% 0.60% 0.50% 0.30% 54 Table 2: Reliability of Neglect File Version Individual level file Original 0.71 0.71 Individual level file DA 0.58 0.58 Aggregate file DA 0.63 0.76 Aggregate file D 0.90 0.91 Aggregate file Pooled 0.59 0.70 CA NEGLECT Alpha Standardized 55 Reliability Summary for MNS-CR Scores Scale Number of Items Alpha Age 6-9 Age 10-15 Neglect Total 36 .78 .91 Emotional 7 .55 .79 Cognitive 5 .30 .59 Supervision 8 .29 .73 Physical 13 .45 .72 Abandonment 2 -.02 N/A Alcohol Use 2 -.07 N/A Failure to Protect 3 -.04 .35 General Appraisal 6 .50 .45 Depression 6 .68 .78 CA NEGLECT 56