1 / 34

Abuse and Neglect

Abuse and Neglect . Constance H. Fournier Clinical Professor Texas A & M University. Goals & Objectives. The Learner Will (TLW) be able to differentiate between the different types of abuse and neglect. TLW be able to identify risk factors associated with abuse

kordell
Download Presentation

Abuse and Neglect

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Abuse and Neglect Constance H. Fournier Clinical Professor Texas A & M University

  2. Goals & Objectives • The Learner Will (TLW) be able to differentiate between the different types of abuse and neglect. • TLW be able to identify risk factors associated with abuse • TLW be able to identify protective factors associated with abuse

  3. Overview of Abuse • 3.3 million cases reported in 2009 (similar to previous years) • 60% investigated • Half investigated substantiated • About 12.5 per 1000 children • 1460 children died of abuse/neglect in 2005 • 77% were children under age 4 • 1770 children died of abuse/neglect in 2009 • 81% under the age of 4 • http://www.medicinenet.com/child_abuse/article.htm • http://www.acf.hhs.gov/programs/cb/pubs/cm09/cm09.pdf#page=58

  4. Overview of abuse For unique victims (abuse reported; counted once even if reported multiple times) • 78% suffered neglect • 18% physical abuse • 9% sexual abuse • 8% psychological maltreatment • For those who died • About 1/3 died from neglect alone • About 1/3 died from multiple abuses

  5. School Nurses: Initial Reflection • What is your school’s policy for reporting abuse? • What is your role as school nurse? • Share with someone not in your district.

  6. Overview of sexual abuse • Sexual abuse not thought to exist until 1970’s; or thought to be very rare • Greater reporting, but still thought to be underreported • Occurs across rural, urban, suburban settings • Occurs across SES groups • Occurs across racial and ethnic groups

  7. Overview: Sexual Abuse • Most abuse occurs with someone the child knows • Girls more likely inside the family • Boys more likely outside the family, but still in circle of trust • 96% of those under age 12 knew attacker • 20% fathers • 16% relatives • 50% acquaintances or friends

  8. Overview: Sexual Abuse • Those 12 to 18 • 12% Family member • 33% stranger • 55% acquaintance • Most abuse is within a relationship of 4 years • Often months spent getting the child “ready” • Abuse also occurs in successive generations of some families • Abuse occurs in 2/3 abduction cases

  9. Overview: Sexual Abuse • About 50% of abusers are adolescent • About 82% of abusers are a heterosexual partner of close family member • About 96% to 100% of those accused are heterosexual • About 50% of fathers and stepfathers who abuse also abuse children outside of the family* • National Research Council

  10. Risk Factors • Having few friends • Absent or unavailable parents • Step family • Conflict with or between parents • Physical or intellectual disability

  11. Risk Factors • Living separated from parents • Parent who was physically or sexually abused • Homes that are not safe (transient, drugs, prostitution) • Deployed parents* 40% higher than when parent home • *http://www.medicalnewstoday.com/articles/78421.php

  12. Risk Factors • With those reporting sexual abuse • 6% no risk factors • 9% one risk factor • 26% two risk factors • 68% three risk factors (one study 78%) • Gay, lesbian, and bisexual youth are especially vulnerable because they tend to be more socially isolated (one study estimates 6 to 7 times greater chance of abuse compared with the general population)

  13. Negative effects: psychological • Often have long term psychological or social negative effects • more than half have are fortunate not to have extreme trauma • Higher risk for mental health issues • Powerlessness interferes with coping

  14. Negative effects: Physical • Risk of HIV infection • Risk of STIs • Pregnancy • Physical impact on organs

  15. Factors worsening severity of outcome of sexual abuse • Younger age • Less developmental maturity • Duration of abuse (longer is worse) • Type of abuse • Abuse by parent • Abuse by older person • Lack of support upon disclosure • Absence of caring parent

  16. Overview of Physical abuse/neglect • Tendency to lump these together, or “maltreatment” • 2009 of 3.3 million cases reported by states • about 15% was physical abuse • about 78% was neglect • About 3 million children received preventative services • About 60% of children who were abused received services post-abuse; 26% of nonvictims • About 21% placed in foster care • Court representation assigned to 16% of victims

  17. Physical Consequences: Physical Abuse • Minor • Bruises • Cuts • Burns • Major • Broken bones • Ruptures • Hemorrhage • death

  18. Physical abuse/Neglect • Shaken baby • Bleeding in eyes, brain • Spinal cord and neck injuries • Rib and bone fractures • Abuse and neglect in young children • Impaired brain development • On-going poor physical health • Poor nutrition and related problems • Dirty; inappropriate clothing

  19. Physical/neglect: Psychological • Infancy-depression and withdrawn; lack of trust; fear • Poorer mental health overall • 80% met criteria for psychiatric disorder by age 21 • Depression, anxiety, suicide attempts seen in high numbers • Lower cognitive functioning; poorer academic performance • Social issues: antisocial traits

  20. Physical/neglect: Behavioral • Adolescence: more problems with delinquency; pregnancy; low academic functioning; risk taking • Increased juvenile delinquency (11 times more likely than general population) • Adult crime 2.7 times more likely; 3.1 times for violent crime • Increased drug and alcohol abuse; as many as 2/3 of those in drug treatment were abused as children • Can increase abusive behavior with own children

  21. Factitious Disorder by Proxy • Factitious disorder in general- faking” symptoms for gain • Get something: attention, special services • Not Malingering—faking for money or other goods; or to get out of personal responsibility like work or jail

  22. Factitious Disorder by Proxy • Factitious disorder with mostly psychological symptoms • Confusion • Auditory hallucinations • Bizarre behavior • Was called GanserSymdrome (prison psychosis)

  23. Factitious Disorder by Proxy • Factitious disorder with physical symptoms • Vague pain, fever, unusual constellation of symptoms • Can be induced (e.g., injecting self with substances) • Also called Munchausen after the Baron who “embellished” stories of his life • Can be combined physical and psychological symptoms

  24. Factitious Disorder by Proxy • In children, the symptoms are induced or concluded by the parent (typically mothers) to meet the psychological needs of the mother • Parent appears to be • very concerned • eager to talk with medical professionals • often very knowledgeable about procedures • seems very compliant with protocols

  25. Factitious Disorder by Proxy • Warning signs • Dramatic but inconsistent medical history • Unclear symptoms that get worse • Relapse following improvement • Extensive knowledge • Hospitals • Procedures • “Text book” Symptoms

  26. Factitious Disorder by Proxy • Many surgical scars • New or additional symptoms after negative test results • No symptoms when child is alone or not being observed • Parent willingness to subject child to multiple medical tests or procedures • History with seeking treatment with many providers or at many hospitals • Reluctance to allow child to talk with personal alone

  27. Factitious Disorder by Proxy • How diagnosed? • Do symptoms make sense? • Is there collateral confirmation (school nurse?) • Parent willing to subject child to multiple tests • Treatments not working in predictable way

  28. Factitious Disorder by Proxy • Role of child-may be stages of collusion • Unaware • Passively colluding • Actively colluding • Self production of symptomology • Outcomes • Medical issues • PTSD • Other (lack of bonding)

  29. Factitious Disorder by Proxy • Treatment • Diagnosis – typically a team approach • Examining all records • Recording parent • Information from other sources • Child Protective Services • Child taken away from perpetrator • In some states, perpetrator jailed • Treatment • Individual therapy for child; parent • Family therapy

  30. School Nurse: Reflection #2 • What changes need to be made in school policies for reporting abuse? • What changes need to be made for the role of the school nurse? • How can these changes be made? • Be prepared to share changes with each other, and the group.

  31. Protective factors for Abuse • Nurturing and attachment • Health in general is better (more stress seen with families with children who are sick) • Trust in caregivers • Development is appropriate (more stress seen with families with children who are developmentally delayed) • Knowledge of child development • Realistic expectations for age of child • Fosters adjustment, success, motivation

  32. Protective Factors • Parental resilience • Models of coping that are positive and helpful • Utilizes resources effectively • More effective in day-to-day activities • Utilizes resources effectively • Good problem solving • More effective in dealing with stress • Can control self • Other family members can control selves

  33. Protective Factors: School • Success at school • Positive relationships with one or more teachers • Positive relationships with peers • Strong bond with positive others (School nurse?) • Nurturing and supportive school climate • Conditions that foster feelings of competence, self-determination, and connectedness • http://smhp.psych.ucla.edu/pdfdocs/Sampler/Resiliency/resilien.pdf

  34. Resources • www.childwelfare.gov • http://www.advocatesforyouth.org/ • http://my.clevelandclinic.org/disorders/Factitious_Disorders/hic_Munchausen_Syndrome.aspx • http://my.clevelandclinic.org/disorders/Factitious_Disorders/hic_An_Overview_of_Factitious_Disorders.aspx

More Related