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Child Victims of Violence: Forging Multidisciplinary Approaches

Child Victims of Violence: Forging Multidisciplinary Approaches. A preconference of the San Diego International Conference on Child and Family Maltreatment. Disclaimer.

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Child Victims of Violence: Forging Multidisciplinary Approaches

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  1. Child Victims of Violence: Forging Multidisciplinary Approaches A preconference of the San Diego International Conference on Child and Family Maltreatment

  2. Disclaimer This presentation was produced by the American Academy of Pediatrics under award #2012-VF-GX-K011, awarded by the Office for Victims of Crime, Office of Justice Programs, US Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this brochure are those of the contributors and do not necessarily represent the official position nor policies of the US Department of Justice.

  3. Today’s Objectives • Introduction to Medical Home for Children Exposed to Violence Project • Who are the children suffering polyvictimization? • Biology of toxic Stress • Identifying child victims of violence • Caring for child victims of violence: interprofessional approach • Review strategies to help providers assist children

  4. Today’s Discussion • Strategy and Advocacy • Key messages • What do we want providers to do? • Knocking down silos • Putting It Into Practice • What are the barriers? • What do providers need? • How do we share success?

  5. Medical Home for Children Exposed to Violence Understanding the Prevalence and Impact of Violence on Children and How to Respond Denise Dowd, MD, MPH, FAAP Chair, Medical Home for Children Exposed to Violence Project Advisory Committee

  6. About the Medical Home for Children Exposed to Violence Project • Funded by grants from DOJ • Educating pediatricians • Identifying children exposed to violence (CEV) • Responding to CEV in the medical home setting • Making needed referrals to effective services • All types of violence • Bullying • Child abuse and neglect • Sexual abuse • Community violence

  7. Our dedicated staff • Heather Fitzpatrick • Tammy Hurley

  8. The Project Advisory Committee • Members represent a variety of areas of expertise: • Denise Dowd, MD, MPH, FAAP – Chair – Emergency Medicine, translation and dissemination. • Nadine Burke Harris, MD, MPH, FAAP – Primary care, incorporating ACEs screening in practice • RJ Gillespie, MD, MHPE, FAAP – Medical home, developmental pediatrics • Betsy McAlister Groves, LICSW – Landmark treatment of children exposed to violence, founder of Child Witness to Violence Project

  9. The Project Advisory Committee, cont • Members represent a variety of areas of expertise: • Suzanne Haney, MD, FAAP – Child abuse and neglect • Colleen Kraft, MD, FAAP – Primary care, medical home, community pediatrics • David Schonfeld, MD, FAAP – Developmental/behavioral pediatrics, responding to in-school violence (grief and loss) • Karen Sheehan, MD, MPH, FAAP – community based injury and violence prevention, youth development • Alison Kirby, MD, FAAP – Co-founder and medical director of The Health Center at Lincoln.

  10. Project activities • Overall goal: Equip pediatricians and medical home teams with knowledge, tools, and resources to more effectively identify children exposed to violence and ensure they receive appropriate services • Raise awareness of prevalence and impact through articles, brochures, etc • Develop a Web-based portal to tools, resources, including interactive clinical vignettes • Provide Webinar series to educate pediatricians and medical home teams • Develop a social marketing campaign to raise awareness • Visiting professor scholarship program

  11. Who were these kids with GSW’s? • The baby evaluated for bruises and called CPS • The toddler who missed well child care appointments • The 7 year old with chronic stomach aches who won’t go to school • The 9 year old with ADHD and oppositional defiant disorder • The 12 year old with a boxers’ fracture • The 14 year beat up at school • The 16 year old shot in a drive by. • The homicide story on the back page.

  12. National Survey of Children’s Exposure to Violence (NATSCEV) • Survey conducted January 2008- May 2008 • National RDD sample of 4549 children age 0-17 • Interviews with 2454 caregivers of children age 0-9 • Interviews with 2095 youth age 10-17 • Oversample of minorities and low income • Interviews completed with 71% of eligible respondents contacted (63% with oversample of minorities and low income)

  13. National Survey of Children’s Exposure to Violence (NATSCEV) • Conventional Crime • Child Maltreatment • Peer & Sibling Victimization • Sexual Victimization • Witnessing & Indirect Victimization • Trauma Symptom Checklists • Community Crime Exposure • Family Abuse Exposure • School Violence Threat • Internet Victimization

  14. Exposure to Violence (NATSCEV) • 60% of children are exposed to violence in a year* • Nearly half (46%) experienced a physical assault • 6% experienced sexual victimization • 20% witnessed an assault in their family • 30% witnessed an assault in their community • 38.7% were victimized two or more times. • 10.9% were victimized five or more times. *Finkelhor , et al. Pediatrics 2009;124:1411-1423

  15. Characteristics of Polyvictims

  16. Past Year Victimizations and Trauma Symptoms Poly-victims  NATSCEV PY weighted ANOVA includes sex, age, race/ethnicity, family structure and SES.

  17. Seriousness of Poly-victims’Victimization Experiences

  18. Summary of Findings Poly-victims: Often come from disadvantaged groups Comprise a large portion of all children who experience individual types of victimization Are often exposed to victimization from multiple contexts or sources

  19. Summary of Findings, cont Poly-victimization is more highly related to trauma symptoms than experiencing repeated victimizations of a single type Lifetime poly-victimization accounts for most of the effect of individual victimization types

  20. Discussion Why the powerful effect of poly-victimization? Represents a condition of victimization rather than a set of events Threats to safety, stability, nurturance in multiple life domains (home, school, community) Damages resources (social support, coping, self concept) that help buffer the impact of victimization

  21. More understanding is needed Need to assess a broader range of victimizations Important to identify the most highly victimized youth Early vs. later onset Need to understand impact of resilience and protective factors

  22. Why Now?: ACE Studies* • The Adverse Childhood Events (ACEs) study demonstrates the impact exposure to violence can have • Increased risk for physical health issues: obesity, heart disease • Increased risk for addiction • Increased risk for mental health issues • The impact of violence in childhood is manifest throughout the entire life course. • Intervention is most effective when issues are identified and treated in early childhood *Felliti V, Anda R, Nordenberg D, et al. Am J Prev Med 1998:14(4):245-258

  23. An Ecobiodevelopmental Response

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