Working with Families At-Risk

1. Working with Families At-Risk OCDC 2009

2. Family Stress Factors: There are usually several stress factors occurring simultaneously in families of child abuse/neglect victims

3. What is Drug & Alcohol Abuse? Drug abuse (substance abuse) = • the repeated and excessive use of chemical substances to achieve a certain affect. • Substances may be “street” or “illicit” drugs, illegal due to their high potential for addiction and abuse or prescription drugs used for pleasure rather than for medical reasons. Effects of drugs = • an intense “rush” and initial feeling of energy or excessive feelings of relaxation and calm (overstimulation of the pleasure center of the brain).

4. What is addiction and how does it happen? Addiction = • Brain chemistry is altered by the drug to the point where not having the drug becomes extremely uncomfortable and even painful resulting in a “compelling urge to use” • Addiction becomes powerful and disrupts work, relationships, and health. • A powerful force in addiction is the inability to self-soothe or get relief from untreated mental (emotional) or physical pain. • Without the self-resilience and support to handle stress, loneliness, or depression, drugs can be a tempting way to deal with the situation.

5. What are physical signs of substance abuse and addiction? • Cycles of increased energy, restlessness, and inability to sleep • Abnormally slow movements, speech or reaction time, confusion and disorientation • Sudden weight loss or weight gain • Cycles of excessive sleep • Unexpected changes in clothing (e.g. long sleeves to hide needle marks) • Drug paraphernalia(pipes, syringes, roach clips) • Chronic troubles with sinusitis or nosebleeds(snorted drugs) • Persistent cough or bronchitis, coughing up excessive mucus or blood(smoked drugs) • Progressive severe dental problems(methamphetamines)

6. What are mental/emotional signs of abuse and addiction? • Cycles of being unusually talkative, “up” and cheerful, with seemingly boundless energy. • Increased irritability, agitation and anger • Unusual calmness, unresponsiveness or looking “spaced out” • Apathy and depression • Paranoia, delusions • Temporary psychosis, hallucinations • Lowered threshold for violence • In teenagers, look for marked changes in behavior, appearance and health.

7. How are the user and the family affected? • Health: neglecting & negatively impacting own health and spreading infectious diseases • Finances and stability: productivity at work suffers, and eventually jobless homeless • Criminal activity for money or drugs • Substance abuse during pregnancy negatively impacts the health and development of the growing fetus • Relationships deteriorate: user lies & isolates self from family and friends • Domestic Violence: lack of impulse control can lead to increased physical and emotional abuse • Child Abuse & Neglect: more common when substance abuse is in the family

8. Symptoms that may indicate a mental illness: Adults: • Confused thinking • Long-lasting sadness or irritability • Extreme highs and lows in mood • Excessive fear, worry, or anxiety • Social withdrawal • Strong feelings of anger • Dramatic changes in eating or sleeping habits • Delusions or hallucinations (seeing or hearing things that are not really there) • Increasing inability to cope with daily problems and activities • Thoughts of suicide • Denial of obvious problems • Many unexplained physical problems • Abuse of drugs and/or alcohol

9. Symptoms that may indicate a mental illness: In older children and pre-teens: • Abuse of drugs and/or alcohol • Inability to cope with daily problems and activities • Changes in sleeping and/or eating habits • Excessive complaints of physical problems • Defying authority, skipping school, stealing, or damaging property • Intense fear of gaining weight • Long-lasting negative mood, often along with poor appetite and thoughts of death • Frequent outbursts of anger

10. Symptoms that may indicate a mental illness: In younger children: • Changes in school performance • Poor grades despite strong efforts • Excessive worry or anxiety • Hyperactivity • Persistent nightmares • Persistent disobedience and/or aggressive behavior • Frequent temper tantrums

11. What are common mental health problems? • Long-term or Chronic Stress can rewire the brain, leaving the person more vulnerable to anxiety and depression • Anxiety • Depression • situational vs. clinical

12. Symptoms of Anxiety Disorders: • Feelings of panic, fear, and uneasiness • Uncontrollable, obsessive thoughts • Repeated thoughts or flashbacks of traumatic experiences • Nightmares • Ritualistic behaviors, such as repeated hand washing • Problems sleeping • Cold or sweaty hands and/or feet • Shortness of breath • Palpitations • An inability to be still and calm • Dry mouth • Numbness or tingling in the hands or feet • Nausea • Muscle tension • Dizziness

13. Depression Signs and Symptoms: Clinical depression is distinguished from situational depression by length and severity • Feelings of helplessness and hopelessnessA bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation. • Loss of interest in daily activitiesNo interest in or ability to enjoy former hobbies, pastimes, social activities, or sex. • Appetite or weight changesSignificant weight loss or weight gain—a change of more than 5% of body weight in a month. • Sleep changesEither insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia). • Psychomotor agitation or retardationEither feeling “keyed up” and restlessorsluggish and physically slowed down. • Loss of energyFeeling fatigued and physically drained. Even small tasks are exhausting or take longer. • Self-loathing Strong feelings of worthlessness or guilt. Harsh criticism of perceived faults and mistakes. • Concentration problemsTrouble focusing, making decisions, or remembering things

14. More on Depression… • Anger, aggression, reckless behavior and violence, along with substance abuse, can be signs of an underlying depression in men. • Suicidal individuals often give warning signs or signals of their intentions. • Depression can be triggered or aggravated by: • personal and interpersonal events • hormonal changes (e.g. pregnancy, childbirth) • lack of sunlight. • Isolation fuels depression.

15. Pregnancy & Mental Health: • “the baby blues” are strong emotions after birth that are considered normal reactions • Actual “perinatal mood & anxiety disorders” can occur during pregnancy and up to one year after birth and can include: • Prenatal Depression or Anxiety • Complicated Baby Blues • Post Traumatic or Acute Stress Reactions • Psychosis • Major Postpartum Depression • Postpartum Anxiety or Panic Disorder • Postpartum Obsessive-Compulsive Disorder

16. Symptoms of Perinatal Mood & Anxiety Disorders: • Agitation and Anxiety • Anger, Rage • Insomnia • Mania • Intrusive, Obsessive Thoughts and Fears • Protectiveness and Hyper-vigilance • Drug and Alcohol Dependence

17. What is a healthy relationship? In healthy relationships, both partners: • Define the relationship • Have a strong bond characterized by levels of closeness and autonomy • Are interested in each other’s thoughts and feelings and encourage expression of them • Resolve conflicts and solve problems positively • Share most basic values • Deal with change and stress • Interact and spend time together • Show intimacy and emotional support • Communicate effectively • Demonstrate commitment to family

19. What characterizes an unhealthy relationship? • One partner says he or she cannot live without the other. • One partner stops seeing other friends or family, or gives up activities previously enjoyed because the other partner does not like them. • One partner appears to “walk on eggshells” to keep the other partner from getting angry. • One partner does not express opinions if the other partner doesn’t agree with these opinions. • One partner believes he or she is the only one who can help the other and that he or she should try to change him/her. • One partner stays in the relationship because of a belief that the other will kill himself/herself if he/she leaves. • One partner believes the critical things the other says about him or her • One partner is frequently jealous

21. What is Domestic Violence? • A pattern of coercive behavior exerted by one adult or adolescent family member over their intimate partner. • It is a learned behavior. • This behavior is PURPOSEFUL and DELIBERATE, and has the goal of establishing and maintaining POWER and CONTROL. • Domestic Violence involves a range of coercive behaviors that may or may not include physical violence. • Intimate partner abuse is reported in many different kinds of families. • Domestic violence occurs in all socio-economic and cultural/ethnic groups.

22. Types of Domestic Abuse: • Physical • Sexual • Emotional • Economic • ACTIVITY: “House of Abuse” (Handout 1.6)

23. Statistics on Domestic Violence: • Head Start and Early Head Start programs report between 17 and 40% of families they serve are affected by domestic violence. • 17% of pregnant women report abuse during the current pregnancy. • 1,500 women each year are murdered by a current or former partner. • 25% of women and 8% of surveyed men said they were raped and/or physically assaulted by a current or former spouse, cohabiting partner, or date at some time in their lifetime.

24. Domestic Violence and Migrant Farm worker Women: In a study on the incidence of domestic violence in the migrant farm worker population (1994-1997): • Over 80% of the women experiencing abuse were in their child-bearing years and 50% of battered women were pregnant at the time of the abuse. • 73% of abused women reported that their partner used drugs or alcohol. • 91% of women who expressed fear of their partners were also battered. • Approximately 70% of women reporting abuse were living with their partners

25. Complications of Domestic Violence: • Sometimes, it can be difficult to figure out who is being abused. • Violence in the home affects the whole community. • There are messages that we receive in our culture that support the continuation of domestic violence.

26. “Why don’t you just leave?” Barriers to leaving: • Perpetrator’s violence and control • Economic barriers • Community barriers • Individual barriers • Cultural barriers • ACTIVITY: Examples of these barriers. (“House of Abuse” Handout 1.6 Continued)

27. Violence Against Women Act: • The Violence Against Women Act (VAWA) became effective in 1994 and is the first example of legislation specifically protecting battered women and children. • Protection during the immigration process is only one of the aspects of this Act. • VAWA requires that civil orders of protection issued in one state be recognized and enforced in all states and counties within the U.S. • However, this benefit can be missed for farm worker women because there is no system to monitor the orders of protection that is responsive to their level of mobility.

28. How does Domestic Violence impact the adult victims? Many people who have experienced or are experiencing intimate partner abuse may display symptoms typical of response to trauma, including: • Substance abuse • Numbing • Hyper-vigilance • Low-self esteem • Depression • Anxiety • Disruption in sleeping patterns

29. MYTHS about Domestic Violence: • Domestic violence is caused by mental illness, alcohol or drug use, out-of-control anger, or stress. • Children are too young to be affected. • People who are abused ask for the abuse or get something out of it. • Victims of domestic violence who stay are weak and have no willpower. • Violence is a women’s issue. • Some cultures and religions approve of domestic violence.

30. What is the role of all HS staff? • Be aware and alert to the signs/symptoms • Promote positive messages of health, safety, relationships • Do not place blame • Recognize our own biases and ensure they do not interfere with services • Fulfill mandatory reporting responsibilities • Talk to others when we have concerns • The family (the adult victim) • Co-workers (Child’s Teacher or Family Advocate) • Supervisor (seek support) • Mental Health Consultant (ask for consultation on the situation) • Know community resources or know how/who to refer to • Take care of self

31. Resources: • Alcoholics Anonymous (AA) http://www.aa.org • Narcotics Anonymous (NA) http://www.na.org/ • National Alliance on Mental Illness (NAMI) http://www.nami.org • Oregon Department of Human Services Office of Mental Health and Addiction Services http://www.oregon.gov/DHS/mentalhealth/index.shtml • US National Mental Health Information Center (Substance Abuse & Mental Health Services Administration) http://www.mentalhealth.samhsa.gov/ • Domestic Violence Resource Network • National Resource Center on Domestic Violence 1-800-537-2238 • Resource Center on Domestic Violence: Child Protection and Custody 1-800-52-PEACE (527-3223) http://www.nationalcouncilfvd.org • National Health Resource Center on Domestic 1-800-Rx-ABUSE (729-2873) http://www.fvpf.org/health/ • Violence National Domestic Violence Hotline 1-800-799-SAFE (7233) • National Coalition Against Domestic Violence http://www.ncadv.org/ • National Latino Alliance for the Elimination of Domestic Violence www.dvalianza.org • National Network to End Violence Against Immigrant Women www.immigrantwomennetwork.org • WomensLaw.org www.womenslaw.org

32. References: • The Migrant Clinician Network, Inc., Domestic Violence in the Farmworker Population, (1997). • Marsh, Elizabeth, Safe Futures: Supporting Children and Families Impacted By Domestic Violence, (2005). • http://www.helpguide.org/mental/drug_substance_addiction_signs_effects_treatment • http://www.addictions.org/signs.htm • http://www.webmd.com/anxiety-panic/mental-health-warning-signs • http://www.helpguide.org/mental/depression_signs_types_diagnosis_treatment.html • http://www.helpguide.org/mental/stress_signs.html • Davis, Wendy, PhD, Maternal Mental Health During and After Pregnancy: Clinical and Public Health Approaches, (2009) • Gustin, Fawn, Domestic Violence Overview: Increasing Safety for Children and Families (Adapted from Helping Young Children and Families Cope with Trauma, Miami Safe Start Initiative), (2002). • http://www.theduluthmodel.org/wheelgallery.php