development of an information system for the child abuse and neglect service system

Development of an Information System for the Child Abuse and Neglect Service System Michael Bommer, Ph.D. Gilbert Goodgion, M.B.A. Victor Pease, Ph.D. Robert Zmud, Ph.D.

ABSTRACT: A plan for developing an information system that provides a basis for improved decision making and planning at all levels in a child abuse and neglect service system is offered. The goal attainment scaling method (GAS) is suggested as a means for assisting the client and social worker in identifying needs and in developing a treatment plan for meeting these needs. The proposed information system is outlined using the goal attainment scaling instrument as the basic informational unit.

Child abuse and neglect are significant problems confront- ing our society. Estimates of the pervasiveness of these behaviors vary widely. Solomon (1973), on the basis of extrapolated data, conservatively estimates that "200,000 to 250,000 children in the United States annually are in need of protective services, of which 30,000 to 37,500 may have been badly injured." The American Academy of Pediatrics Committee on Infants and Preschool Children estimates that there are 260 cases of child abuse per mil- lion population in urban areas (Alberts, 1972). Preliminary statistics collected and compiled by the St. Lawrence County Department of Social Services (1974) during the first full year of mandatory reporting under New York State's Child Protective Services Act indicate an incident rate of approxi- mately 540 per 100,000 population, making the previously cited estimates seem very conservative indeed.

The economic cost of child abuse is staggering. The imprisonment of child abused childhoods, or both (New York State Select Committee, 1972). Other findings indicated a high correlation between the way in which persons were treated as children and the way in which they treat their own children (Silver, 1969; Helfer & Kempe, 1968). Finally, children who have experienced abused or neglected chidhoods are less apt to lead a satisfactory and productive adult life and are more apt to become dependents of our society (Feshback, 1973; New York State Select Committee, 1972).

The human costs associated with child abuse are also significant. Recent findings seem to indicate that a high proportion of persons who have commit- ted criminal acts against persons and property experienced neglected or

*Drs. Bommer, Goodgion and Pease are members of the faculty of the School of Management, Clarkson College, Potsdam, New York 13676; Dr. Zmud is with the School of Business Ad- ministration, Auburn University, Auburn, Alabama.

Community Mental Health Journal, Vol. 13 (4), 1977 3 3 3

334 Community Mental Health Journal

abused childhoods, or both (New York State Select Committee, 1972). Other findings indicated a high correlation between the way in which persons were treated as children and the way in which they treat their own children (Silver, 1969; Helfer & Kempe, 1968). Finally, children who have experienced abused or neglected childhoods are less apt to lead a satisfactory and productive adult life and are more apt to become dependents of our society (Feshback, 1973; New York State Select Committee, 1972).

The intent of this paper is to outline a plan for developing an information system that provides a basis for improved decision making and planning at all levels in a child abuse and neglect service system. At present there is a dearth of relevant data to provide meaningful feedback for improving the effectiveness of this complex system on the part of the participants: the client family; the social worker; the family court; the social services administration; gov- ernmental policy making agencies; and research teams. Basic social, economic, and emotional needs of the client are identified and the informational needs of the participants in making improved decisions and plans at all levels in the child abuse and neglect service system are discussed. The goal attainment scaling method (GAS) is suggested as a means for assisting the client and social worker in identifying and developing a treatment plan for fulfilling these needs. Finally, an information system is outlined using the goal attainment scaling instrument as the basic informational unit.

CHILD ABUSER NEEDS A review of the literature relating to the emotional and per-

sonality characteristics of child abusers reveals a recurring pattern. Child abusers are often described as immature, self-centered, emotionally starved, and having unmet dependence needs (Holter & Friedman, 1968; Morse, 1970). Deep-seated hostility and anger and an impulsive and rigid nature further characterize abusers (Johnson & Morse, 1968; Laury, 1970). A pro- nounced lack of warmth (Giovannoni, 1971; Birrell & Birrell, 1968) and an inability to show affection and empathy (Morse, 1970; Melnick & Hurley, 1969) are further characteristics of this group. Finally, many abusers feel in- adequate or incompetent in their particular role (Johnson & Morse, 1968; Bennie & Sclare, 1969).

Most child abuse incidents occur under conditions of accumulated stress in which the abuser feels overwhelmed and unable to cope with his or her problems (Elmer, 1967; Giovannoni & Billingsley, 1970). Some of these problems originate from within the family, such as marital discord or a rapid succession of pregnancies (Bennie & Sclare, 1969; Fergusson, 1972), and oth- ers relate to the abuser's relationship to the outside environment, including employment and financial difficulties (Giovannoni, 1971; Birrell & Birrell, 1968). The abuser out of frustration explodes with violence which is directed toward a child in a futile attempt to cope with his or her stressful situation (Silver, 1969; Brown & Daniels, 1968). Any child is a target under these cir- cumstances. However, those that were born prematurely, deformed, or il-

Michael Bommer, Gilbert Goodgion, Victor Pease, Robert Zmud 335

legitimate (Bishop, 1971; Caffney, 1972), or are foster or step children (Caffney, 1972) are more apt to become targets of such misplaced frustrations.

Research also indicates that a primary factor in determining whether a parent becomes a child abuser is the amount of resources and support available to the parent in dealing with a crisis or stressful situation (Elmer, 1967; with the most desirable outcome, and 0 is assigned to the most likely outcome. This scale then becomes the basis for evaluating the progress of each client family in achieving their goals.

An example of a Goal Attainment Scale for an individual dient based on four separate identified areas of need, a goal associated with each area of Giovannoni & Billingsley, 1970). The literature suggests that providing support services that defuse the crisis or stress-producing situation will decrease the probability of the occurrence of child abuse (Elmer, 1967; Callaghan & Fotheringham, 1970).

Conclusions drawn from these research findings suggest that child abuse and neglect are performed by persons who have unmet emotional needs and who are living under conditions of stress. By providing appropriate support services to help the abuser deal with his or her stress-producing conditions, including both extra family problems as well as interaction patterns within the family, the incidence of child abuse will decrease. Thus the provision and management of support services become major considerations in both the design of treatment plans and in the development of an information system.

A useful identification and categorization of the basic major need areas of clients in the child abuse and neglect service system, adapted from work performed on general social service systems (Bloedorn, 1970; United Way of America, 1972), is as follows: education, housing, child care, health, transpor- tation, legal services, socialization, home management, financial, employment. This represents a comprehensive listing of the major areas of client need under whcih virtually any particular need can be classified. This listing provides a basis for the construction of treatment plans and for the development of the information system.

GOAL ATTAINMENT SCALING TREATMENT PLAN The goal attainment scaling method (Kiresuk & Sherman,

1968; Wilson, 1973) consists of the development of an individualized treatment plan with a number of specific goals for the client. Using the major areas of client need as a guide, the client and the social worker jointly idnetify the client's needs and develop a goal-oriented treatment plan for satisfying these needs. These goals are designed to support the overall objective of decreasing behavior that leads to physical or mental neglect as well as supporting behvaior that leads to an increase in positive feelings and a reintegration of the family. The philosophical basis of the approach is that it is explicitly cognitive and leads to self-determination for the participants, given the con- straints and resources of society.


TABLE 1 Sample Goal Attainment Scale

i Needs Employment Education Home Management ] Socialization

Resource Vocational Tutorial Housemaker Service Parent Class Agencies Training Center Volunteers

Goals Learn Skill Raise Reading Make the House a Meet my child's Level Home needs

Goal Weights .40 .lO .20 .30

Best Expecta- Get orders for Get H.S. equi- Learn to budget See what children tions cabinet work valency diploma time and money need and do it for

+2 them or help them do it

More than Find talent Attend night Learn to clean Have children ask Expected for carpentry-- high school house so it looks me for things

+I pass journey- program clean man's exam

Expected Complete Basic Pass 8th grade Learn to cook Watch children at Level of Skill Aptitude reader exam school and try to Success Program get them to ask for

0 what they want

Less than Drop out of Read more than Have my husband Have children cry Expected Basic Program half the words continue to com- when I talk with

-l in an 8th grade plain them reader

Most Un- favorable Outcome

-2

Find I have skills but not interested in using them

Make no improve- ment--still at 4th grade level

i

Have home break up

Get angry and h i t somebody

Goal attainment scaling provides a basis for the measurement and con- sequent evaluation of a therapeutic treatment plan. Each goal is related to a graded series of likely outcomes and a specific identifiable action or indicator is associated with each outcome. The outcomes for each goal are rated on a -2, -1, 0, +1, +2 scale with -2 corresponding to the least desirable outcome, +2 need, and the resources provided to assist the client in attaining his or her goals is illustrated as Table I. This instrument is a slight modification of the one proposed by Kiresuk and Sherman (1968) in that the previously identified major need areas serve as the basic dimension and the resources provided for assisting the client in meeting his or her needs are designated.

Goals may be assigned weights to reflect differing relative importance. For example, for the sample Goal Attainment Scale appearing as Table 1, the goal of "learning a skill" was deemed to be a key goal in the overall treatment plan and was assigned a weight of .40, whereas the goal of "raising reading level" was considered to be of lesser importance and assigned a weight of.10.

The selection and weighting of a realistic and meaningful set of goals would be decided on by the two most significant participants in the child abuse and neglect system: the client family and the social worker. The overall objective is to devise a set of goals that will lead to a long-term reduction in the intensity and pervasiveness of child abuse and neglect. These goals, correspondingly, should concentrate on the solution of the fundamental stress-producing problems that seem to precipitate abuse and neglect behavior as well as to point a direction for transforming negative into positive behavior patterns for the entire family.


The relationships between the goal attainment scaling plan and the various participants in the child abuse and neglect service system is depicted as Table 2. In this table activities correspond to interactions between the various com- ponents of the system arranged in chronological sequence stages. As indicated by the table, the goal attainment treatment plan is developed jointly by the client and social worker in stage 5, reviewed for conformance to guidelines in stage 6, and the final plan is agreed on by both the client and social worker in stage 7. In stage 9 the treatment plan is initiated by the client who works on the agreed on goals and by the social worker who coordinates the resources that are identified in the plan. In stage 11 the progress of the client in attaining the agreed on goals is reviewed by both the client and the social worker. This stage provides a basis for revising and updating the plan in stage 13. Finally, stages 7 through 13 are repeated as necessary until the client has progressed to the point where services are no longer necessary.

This process of jointly determining the relevant goals for the client, by the client and social worker, yields many benefits. First, the goal selection process enables the client and social worker to arrive at a treatment program that is meaningful and conforms to the unique needs of the client. Second, a realistic time period for attaining goals can be jointly determined. Caution should be exercised, however, in the setting of deadlines for goal attainment, even if agreed on by both parties, as this might cause a further stress-producing situation--a condition with which many child abusers are unable to cope. Third, through the attainment of goals by the client and family and sub- sequent joint formulation of new goals, a process of positive reinforcement and growth of positive family behaviors becomes a natural and continuing process. Fourth, the goal attainment scaling process provides a basis for an information system that supports the decision making and planning efforts of all participants in the child abuse and neglect service system.

INFORMATION SYSTEM The information system, in addition to collecting, process-

ing, and summarizing data, acts as a major force in supporting and coordinat- ing the decision making and planning efforts. Briefly, the objectives of such an information system include the following:

1. Assisting the client family and socail worker in assessing their current needs and developing a treatment plan.

2. Providing an objective basis for monitoring client progress, assessing the effectivenss of treatment plans, and allocating human service resources.

3. Assisting the administrators of child abuse and neglect service systems in formulating policies, plans, and budgets, and in evaluating the services being provided.

4. Providing a data base relevant to researchers in the field of child abuse and neglect in inves- tigating and testing theories in an attempt to understand better and deal with the etiology of child abuse and neglect.

An information system is normally comprised of three interrelated parts: a data base, a reporting system, and some means of data storing and handling.

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This analysis will focus primarily on the first two, as the latter depends largely upon the activity levels and resources, both technical and financial, of the specific agency.

The data base is comprised of two basic data types: background information and treatment information. A description of the data base, termed the "'Client Information and Goal File" (CIGF), appears as Table 3. In order to ease the data collection task and to insure the applicability of the data base, this file was desgined to conform with a sample of intake forms currently utilized by child abuse and neglect agencies. The "nontypical" data included in this file pertain to a more in-depth description of the client family, a description of the treatment plan, and data on the resources utilized in serving a client family. For the most part these data are objective, either quantifiable or codable, and easily collected.

The relationship between the various participants of the child abuse and neglect service system with regard to the information system can be seen in Table 2. As indicated in the table, data are entered into the data base of the information system regarding the client's background in stage 3, the client's goal attainment treatment plan in stage 8, the resources and services provided the client in stage 10 and the progress of a client in attaining specific goals in stage 12. This process is repeated as necessary to track the progress of the client. Although the client's background, the client's goal attainment plan, the resource services provided, and soon, are unique to the client, the information is entered into and available from the data base in standardized form. By and large, the process of collecting and entering the information to establish the data base for each client places no extra requirements on the social worker. Most of the data included in the client information and goal file should be or is currently being collected by social service agencies or will be a by-product of the goal attainment plan. However, instead of having the information embedded in a lengthy narrative or case history file, the relevant information will be readily available in a standardized format in the goal file.

Probably the greatest benefits provided by an information system are the reports that can be generated to facilitate decision making and planning at all levels in the child abuse and neglect service system. The greater the degree of automation of the data storing and handling subsystem, the faster the re- sponse time and the greater the flexibility with regard to the type and quantity of reports generated.

As treatment plans are adopted and implemented, reports can be generated that allow an assessment to be made regarding the viability of a treatment plan and the progress of a client family in achieving the goals outlined in the plan. The structure of the attainment scale model allows for such assessments to be made. This information would assist the client and social worker in periodically reviewing and revising the treatment plan as the client pro- gresses. This report could also serve as a basis for making disposition decisions regarding the client family on the part of the family court. A report comparing the effectiveness of various treatment plans and service provided


TABLE 3 Client Information and Goal File

I. Client Fami ly Case Number

2. Client Family Name

3. Client Family Address

4. Social Worker Number

5, Date Contact Initiated

6. Date Contact Terminated

7. Accumulated Social Worker Hours

8. Number of Family Members

9. For Each Family Member:

a. Name

b, Relation Code

c, Age

d. Current Family Status Code

e. Education Code

f . Employment Code

g. Number of Ident i f ied Social, Economic, Emotional, or Medical Needs

h. For Each Need:

] ) Need Code

2) Treatment Status Code

I0. Number of Abused or Neglected Children

l I . For Each Abused or Neglected Child:

a. Name

b. S ta te R e g i s t r y Number

c . S ta te Case Number

d. Local R e g i s t r y Number

e . Loca] Case Number

f . Ca~e D i s p o s i t i o n Code

g. Legal Status Code

for clients with similar needs would prove to be extremely beneficial to both the client and social worker in devising an individual plan.

Past and current resources demands in the servicing of client families could be reported to administrators of the child abuse and neglect service system, thus enabling them to use this information in forumlating policies, plans, and budgets. Useful information that would appear in such reports might include, man-hours on a per-client basis, social worker case loads, and interagency service commitments. In addition, periodic summaries of resource demands across clients, services, and time could be provided.

Finally, the data contained in the client information and goal file would be extremely useful to researchers in the field of child abuse and neglect. The background data appear relevant to studies attempting to characterize either the abused or neglected child or the child abuser or neglecter. Such data also provide for studies that attempt to identify family situations that are prone to child abuse or neglect. In addition, by maintaining data on treatment plans and treatment progress, the client information and goal file should provide a suitable data base for research on child abuse and neglect treatment.


~2,

13.

I~ .

15.

TABLE 3 (continued) h , N~mber a f Substant ia ted Perpe tra t ions

i , For Each Substant ia ted P e r p e t r a t i o n :

l ) Perpe t ra t ion Code

2) Ef fec t o f Pe rpe t ra t i on on Chi ld Code

3) Perpetrator Name

~) Perpetrator's Rel~tion to Chl]d Code

5) Perpetrator's Attitude Toward Perp~tratlon Code

6) Perpetrator's Attitude Toward Child Code

7) Perpetratorls Attitude Toward Change Code

Number of Soclal Services Received by Client Family Not Directly Related to

Treatment Plan

For Each Soclal Service:

ao Agency Code

b, S e r v i c e Code

c, Date Initiated

d. Date Terminated

Number of Goals in Treatment Plan

For Each Goal:

a, Need Area Treated

b, Textual Statement of Goa|

c. Provided Resources Code

d. Number of Outcomes

e. For Each Outcome:

l ) Textual Statement

2) Score

f , Current Goal Status

g. Date Treatment I n i t i a t e d

h. Date Treatment Terminated

REFERENCES

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975-979. Birrell, R., & Birrell, J. The maltreatment syndrome in children: A hospital survey. Medical Journal

of Australia (Sydney), 1968, 2, 1023-1029. Bishop, F. Children at risk. Medical Journal of Australia (Sydney), 1971, 1, 632-638. Bloedorn, J. Designing social service systems. Chicago: American Public Welfare Association, 1970. Brown, J., & Daniels, R. Some observations on abusive parents. Child Welfare, 1968, 47, 89-94. Caffey, J. The parent-infant traumatic stress syndrome (Caffey-Kempe syndrome), (battered babe

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Cal~aghan, K. & Fothering~,am, B. Practical management of the battered baby syndrome. Medical Journal of Australia (Sydney), 1970, 1, 1282-1284.

Elmer, E. Child abuse: The family's cry for help. Journal of Psychiatric Nursing, 1967, 5, 332-341. Fanshel, D., & Shinn, E. Dollars and cents in the foster care of children: A look at cost factors. Chicago:

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28-31.


Giovannoni, J. Parental mistreatment: Perpetrators and victims. Journal of Marriage and the Family, 1971, 33, 649-657.

Giovannoni, J., & Billingsley, A. Child neglect among the poor: A study of parental adequacy in families of three ethnic groups. Child Welfare, 1970, 49, 196-204.

Helfer, R., & Kempe, H. The battered child. Chicago: University of Chicago Press, 1968. Holter, J., & Friedman, S. Principles of management in child abuse cases. American Journal of

Orthopsychiatry, 1968, 38, 127. Johnson, B., & Morse, H. Injured children and their parents. Children, 1968, 15, 147-152. Kiresuk, T., & Sherman, R. Goal attainment scaling: A general method for evaluating com-

prehensive community mental health programs. Community Mental Health Journal, 1968, 4, 443-453.

Laury, G. The battered child syndrome: Parental motivation, clinical aspects. Bulletin of the New York Academy of Medicine, 1970, 46, 676-685.

Melnick, B., & Hurley, J. Distinctive personality attributes of child-abusing mothers. Journal of Consulting Clinical Psychology, 1969, 33, 746-749.

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New York State Select Committee. Report of the select committee on child abuse. Albany, N.Y.: New York State Assembly, 1972.

St. Lawrence County Department of Social Services. Plan for child protective services. Albany, N.Y.: State of New York, 1974.

Silver, L. Does violence breed violence? Contributions from a study of the child abuse syndrome. American Journal of Psychiatry, 1969, 126, 404-407.

Solomon, R. History and demography of child abuse. Pediatrics, 1973, 51, 773-776. United Way of America. United Way of America services identification system. United Way, 1972. Wilson, N. The automated tri-informant goal-oriented progress note. Journal of Community Psy-

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