PEDIATRIC ABUSE AND NEGLECT

1. PEDIATRIC ABUSE AND NEGLECT Recognizing Child Maltreatment and Working with Families

2. New Views of Child Maltreatment • Societal views of child abuse have expanded. • More individuals are aware of abuse and neglect, and consider them a concern for our society • Barrier: WHAT TO DO ABOUT IT

3. Reporting Is Just One Role True change can only occur when we go beyond just reporting. But let’s begin there

4. Types of Abuse/Neglect Defined KRS 600.020 states: • “Abused or neglected child" means a child whose health or welfare is harmed or threatened with harm when his parent, guardian, or other person exercising custodial control or supervision of the child: (a) Inflicts or allows to be inflicted upon the child physical or emotional injury as defined in this section by other than accidental means; http://162.114.4.13/KRS/TITLES.HTM

5. (b) Creates or allows to be created a risk of physical or emotional injury as defined in this section to the child by other than accidental means; (c) Engages in a pattern of conduct that renders the parent incapable of caring for the immediate and ongoing needs of the child including, but not limited to, parental incapacity due to alcohol and other drug abuse as defined in KRS 222.005(12); (d) Continuously or repeatedly fails or refuses to provide essential parental care and protection for the child, considering the age of the child;

6. Commits or allows to be committed an act of sexual abuse, sexual exploitation, or prostitution upon the child; Creates or allows to be created a risk that an act of sexual abuse, sexual exploitation, or prostitution will be committed upon a child; Abandons or exploits the child;

7. Does not provide the child with adequate care, supervision, food, clothing, shelter, education or medical care necessary for the child's well-being. A parent or other person exercising custodial control or supervision of the child legitimately practicing the person's religious beliefs shall not be considered a negligent parent solely because of failure to provide specified medical treatment for a child for that reason alone. This exception shall not preclude a court from ordering necessary medical services for a child; or

8. Fails to make sufficient progress toward identified goals as set forth in the court approved case plan to allow for the safe return of the child to the parent that results in the child remaining committed to the Cabinet and remaining in foster care for fifteen (15) of the most recent twenty-two (22) months;

9. Dependency KRS 600.020(19): "Dependent child" means any child, other than an abused or neglected child, who is under improper care, custody, control, or guardianship that is not due to an intentional act of the parent, guardian, or person exercising custodial control or supervision of the child.“ This may be referred to as neglect due to dependency. Often child is returned once dependent situation is resolved. • Examples: Caregiver is hospitalized, physically disabled, elderly and impaired, suffering mental illness, or in jail.

10. REAL LIFE EXAMPLES

11. Physical abuse • Use of physical force that leads to danger or injury. The use of spanking is often debated but many concur that spanking with an object, leaving bruises or marks, and on parts of the body other than the buttock is inappropriate. • Witnessing domestic violence is often characterized as physical abuse to a child. The effects are similar to that of being hit themselves.

12. Emotional abuse Cruel or strange punishments: feeding nonfood items, locking or restraining child. Repetitive harassment, scapegoat, threatening. Encouraging unlawful behavior Can occur from chronic family dysfunction and chaos.Emotionally immature parents.Parents with mental illness or character pathology.Can be overt or covert.

13. Sexual abuse • When child is used for sexual purpose of adult or adolescent. Includes exposing child to sexual material, sexual exploitation, or personal pleasure. • Exposing adult genitals to a child. • Sexual harassment. • Allowing child to view adult sex acts. • Children who have a sexually transmitted disease. • Risk of abuse is reportable as well.

14. Neglect: Despite excuses or barriers, if you cannot provide for your child, you are responsible for finding a way to make sure that need is met. Educational neglect • If a parent is unable to control their child and allows child to be truant. • Parent who can’t get child up on time. • Allows medical condition to impede school attendance without exploring alternatives.

15. Environmental neglect • Failure to provide basic necessities of clean home, hygiene, food, clothing, water, safe home. Medical neglect • Medical treatment withheld. • Psychological or therapeutic treatment withheld.

16. Failure to protect • Victim of Domestic violence who does not prevent children from exposure to the DV. • Caregivers who minimize signs and symptoms a child is being sexually, physically, or emotionally abused. • Failure to report known abuse out of fear or any excuse. Emotional neglect • Not providing for love, care, social interaction and stimulation. Extremely difficult to verify.

17. Abuse statistics Rate of abuse decreased from 2001 to 2004, from 12.5 per 1,000 to 11.9 per 1,000 children respectively. 872,000 children were victims of abuse or neglect in 2004. 19,186 children were victims in Kentucky that year. U.S. Department of Health and Human Services, 2006.

18. Percent by type U.S. Department of Health and Human Services, 2006.

19. Victim rates by age group U.S. Department of Health and Human Services, 2006.

20. Statutes defining obligation to report: KRS 620.030 (1) Any personwho knows or has reasonable cause to believe that a child is dependent, neglected or abused shall immediately cause an oral or written report to be made to a local law enforcement agency or the Kentucky State Police; the Department for Social Services; the Commonwealth's Attorney; or the County Attorney. Unless requested by law enforcement, the Department for Social Services investigates only those cases of abuse or neglect alleged to have been committed by a parent, guardian, or other person in care, custody or control of the child. http://162.114.4.13/KRS/620-00/030.PDF

21. (2) Any person, including but not limited to a physician, osteopathic physician, nurse, teacher, school personnel, social worker, coroner, medical examiner, child-caring personnel, resident, intern, chiropractor, dentist, optometrist, emergency medical technician, paramedic, health professional, mental health professional, peace officer or any organization or agency for any of the above, who knows or has reasonable cause to believe that a child is dependent, neglected or abused, regardless of whether the person believed to have caused the dependency, neglect or abuse is a parent, guardian, person exercising custodial control or supervision or another person, or who has attended such child as a part of his professional duties shall, if requested, in addition to the report required in subsection (1) of this section, file with the local law enforcement agency or the Kentucky State Police or the Commonwealth's or county attorney, the cabinet or its designated representative within forty-eight (48) hours of the original report a written report containing: http://162.114.4.13/KRS/620-00/030.PDF

22. (a) The names and addresses of the child and his parents or other persons exercising custodial control or supervision; (b) The child's age; (c) The nature and extent of the child's alleged dependency, neglect or abuse (including any previous charges of dependency, neglect or abuse) to this child or his siblings; (d) The name and address of the person allegedly responsible for the abuse or neglect; and (e) Any other information that the person making the report believes may be helpful in the furtherance of the purpose of this section. http://162.114.4.13/KRS/620-00/030.PDF

23. How to respond • Be neutral, supportive, do not react with crisis mentality • Validate the child, demonstrate belief • It is not your job to investigate, or find the truth, just report What might happen • It is common for victims of valid abuse to recant. • If imminent danger is assessed, child may be removed. If not, services may simply put in place to assist the family.

24. Efficacy of early intervention Case example

25. Effects of child maltreatment • Understanding lasting effects to the brain • Weakening of the brain architecture • Need for interaction in early child development • Stress related neurochemical reactions. • Early intervention and prevention is paramount • Effects both behavior and emotional development • Physical abuse can lead to permanent damage or death. • Higher occurrence of depression, anxiety, violence, delinquent, socialization difficulties, emotional lability. All of which are made more extreme if emotional maltreatment is present.

26. Recognize families at risk for child maltreatment Signs and Symptoms • See handout. When children do not tell • Patterns of family secrecy • Fear of abandonment is deep • Fear of getting loved ones in trouble. • Feel great sense of blame or responsibility.

27. Predictive factors of maltreatment • Poverty • Divorce • Addiction • Stress • Limited education • Isolation • History of childhood maltreatment • Family systems • History of abuse and the victim/aggressor dynamic • The permissive parent who becomes fed up • Control oriented

28. Protective factors that lower abuse and neglect • Nurturing and attachment • Knowledge of parenting and of child and youth development • Parental resilience • Social connections • Concrete supports for parents - Promoting Healthy Families in Your Community, 2007 Resource Packet

29. Need for broader approach to prevention and intervention WORKING IN PARTNERSHIP

30. Consider opportunities in the “Village” • Multiple Players: Pediatricians, Home visitors, Schools and Teachers, Community Centers, Faith Communities, Coaches, Librarians, Extended family, Respite, Support groups • Integrated community facilities: develop opportunities for many services to be provided in clinic settings. • Outside consultants • Multidisciplinary on-site staff • Resources and workshops available • Linkages with other organizations.

31. Opportunities to strengthen child development and prevent maltreatment • Interventions for families at risk for child maltreatment • Support programs • Resources • Education Screenings • Professional interventions • Societal support of social services

32. Social Services and Programs are currently grossly under supported and under funded. However, you can foster resources within your community: • Local faith communities. • Men and fathers. • Local schools. • Honor community cultures. • Celebrate community heroes. • Community agencies. • Offer workshops on the 5 protective factors. - Promoting Healthy Families in Your Community, 2007 Resource Packet

33. Parent Education • Parenting as a learned skill. • Parenting is influenced and impacted by the society. • Context of the family situation impacts intervention. • New information on the cognitive development of the brain supports need for positive parenting. Education for children: • Go beyond ‘stranger danger’ approach Medical Professionals with parents • Have opportunities to answer questions and address frustrations about child behaviors, provide developmental norms, and hub a network of resources.

34. Resources/References • (800) CHILDREN an information, support and referral line. • Child Protection Hot Line at (800) 752-6200 • Healthy Families America: Site Development Guide,http://www.healthyfamiliesamerica.org/downloads/sdg.pdf • Kentucky Legislature: Kentucky Revised Statues List by Section. http://162.114.4.13/KRS/209A00/CHAPTER.HTM • Prevent Child Abuse America. www.preventchildabuse.org • Promoting Healthy Families in Your Community, 2007 Resource Packet. http://www.childwelfare.gov/ • U.S. Department of Health and Human Services, Administration on Children, Youth and Families. Child Maltreatment 2004 (Washington, DC: U.S. Government Printing Office, 2006). http://www.acf.dhhs.gov/programs/cb/pubs/cm04/index.htm

35. Which of the ideas we have talked about make sense for you? • What can you do within your community? How can you help make that happen? Adapted from Promoting Healthy Families in Your Community, 2007 Resource Packet

36. Questions