Child Abuse and Neglect

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  1. Characteristics that Predispose a Child to Abuse
    • Conceived out of wedlock
    • Special child (premature, physical handicap, chronic illness, learning problems)
    • Adolescent striving for autonomy
  2. Physical Symptoms of Abuse
    • Bruises (90% of cases)
    • Fractures
    • Head and internal injuries
    • Burns (10% of cases)
  3. Bruises
    • Critical is pattern and distribution (location; hidden by clothing)
    • Indicative of Abuse:
    • Those prior to becoming ambulatory
    • Those on various parts of body
    • Back of legs, upper arms and chest, neck, head, eyes, genitals
    • Areas covered with clothing
    • Clear pattern (palm print, buckle print, etc.)
    • Color variation (no age on bruises)
    • Adult bite marks
    • Choke marks, pinch or grab marks (indicative of shaking)
    • Nail scratches
  4. Fractures
    • Strong indicator of abuse inchildren under 1 year of age
    • Skull, nose, facial structure
    • Various states healing
    • Multiple or spiral fracture
  5. Head and Internal Injuries
    • Mostly discovered by radiologists
    • Skull factures
    • Subdural hematoma- blood in the brain
    • Retinal detachment, hemorrhages
    • Black eyes (both are especially susupicious)
    • Abdominal injuries
  6. Burns (10% of cases)
    • Cigarette (not accidental on abdomen, genitals, bottom of feet, inaccessible spots)
    • Tap water (most common)
    • -"Gloved hands" or "socked" feet
    • -Patterned (grill, iron, etc)
    • Infected burns, indicating delay in seeking treatment
  7. Unexplained bruises and welts
    • Appear on face, lips, mouth, torso, back, buttocks, thighs
    • Various stages of healing
    • Clustered, forming rectangular patterns, reflecting shape of article used to inflict harm such as electrical cord or belt buckle
    • Appear on several different surface areas
    • Regularly appear after absence, weekend or vacation
  8. Behavioral Indicators of Physical Abuse
    • Unresponsive to environment
    • Developmental lags
    • Impaired capacity to enjoy life
    • Enuresis (unable to control bladder)
    • Encopresis (unable to control waste)
    • Temper tantrums
    • Low self-esteem
    • Withdrawal
    • Passive watchfulness
    • Verbal inhibition
    • Regression
    • Fearful of failure
    • Poor peer relationships
    • Running away
    • Depression
  9. Other Behavioral Indicators of Physical Abuse
    • Feels deserving of punishment
    • Appears wary of adult contact
    • Expresses apprehension when other children cry
    • Expresses behavioral extremes from withdrawal to aggressiveness and/or hyperactivity
    • Appears frightened of parents- afriad to go home
    • Reports injury by parents
    • Expresses vacant or frozen stare, listless and detached
    • Lies very still while surveying surrounding (infant)
    • Responds to questions in monosyllables
    • Expresses inappropriate or precocious maturity
    • Maintains only superficial relationships
    • Expresses manipulative behavior to get attention
    • Indsicriminately seeks affection
    • Expresses poor self-concept
    • Expresses over-compliance
    • Acts consistently irritable
    • Exhibits chronic ailments, stomachaches, vomiting, etc.
  10. 5 Tasks Abusive Parents Have Not Learned
    • Getting needs met
    • Separating feelings from actions
    • Determining limits of responsibilty
    • Making decisions
    • Delaying gratification
  11. Casual Factors of Physical Abuse
    • Psychopathological Categories (Primary cause resides within parent)
    • -Psychodynamic
    • -Mental Illness
    • -Character-Trait
    • Interactional Categories
    • -Martin
    • -Zimrin
    • -Family-structure model
    • Environmental Sociological Cultural (stresses in society are primary cause of abuse)
    • -Environment Stress Model
    • -Social Learning Model
    • -Social-Psychological Model
    • -Pscyhosocial Systems Model
  12. Psychodynamic Model
    • Disturbance in nurturing relationship between parent and child
    • Parent has potential to abuse based on his/her reading
    • Role reversal
  13. Mental Illness Model
    • Underlying cause of abuse
    • Borderline, bipolar
  14. Character-Trait Model
    • Traits of Abusive Parent
    • -Self-centered
    • -Impulsive
    • -Rigid
    • -Hostile
    • -Dependent/Passive
  15. Martin
    Child perceived by parent as abnormal or different and becomes target of abuse
  16. Zimrin
    • "Encounter Theory"
    • Traits, characteristics of parents interact with that of children in such a way that abuse occurs)
  17. Family-Structure Model
    Dysfunctionl family pattterns (severe enmeshment or scapegoating)
  18. Environment Stress Model
    • Poverty
    • Unemployment
    • Poor education, etc
  19. Social Learning Model
    • Emphasizes parental inadequacy
    • Not learned effective, nonharmful discipline methods
    • Ignorant of child development
    • Unready for parenthood and become easily frustrated
  20. Social Psychological Model
    • Frustration and Stress
    • Stress + Individual Pathology = Abusive Episode
  21. Psychosocial Systems Model
    • Dysfunctional family patterns
    • Parents have unmet needs which children are expected to meet
    • Environmental stressors
  22. Type of Neglect
    • Medical
    • Safety
    • Educational
    • Physical
    • Emotional
  23. Medical Neglect
    Most likely to come to the attention of medical practitioners
  24. Manifestations of Medical Neglect:
    • Non-compliance with recommended care
    • Delay or failure in getting health care
    • Nonorganic Failure to Thrive
    • Drug exposed newborns
    • Obesity?
  25. Medical Neglect Can Include:
    • Refusal of medical interventions for religious reasons
    • Refusal of childhood immunizations due to erroneous beliefs that they are dangerous
    • Refusal to sign forms for necessary and perhaps life-saving interventions
    • Embarking on bizarre diets that lead to vitamen deficiency and anemia
    • Refusal of proven medical treatment in favor of unproven, unorthodox treatments
  26. Noncompliance is very common
    • Compliance is "the extent to which a patient's behavior coincides with the clinical prescription
    • Short-term medications
    • Preventive Regimens
    • Long-term Regimens
  27. When is it Medical Neglect?
    • Harm due to lack of medical care
    • Harm likely if no medical care
    • Medical care that offers significant net benefit is not received
  28. Etiology of Medical Neglect
    • Context (poverty, culture, religion)
    • Family (disorganized, stressed)
    • Parents (knowledge, understanding, motivation)
    • Child (denial, chronic health problem)
    • Disorder and Treatment (severity, chroncity, cost)
    • Process of Care (relationship, communication)
  29. Managment (Medical Neglect)
    • State the problem
    • Convey interest in helping
    • Begin with the least intrusive measures
    • Address contributory factors
    • -extra support
    • -community resources
    • -CPS
  30. Preventing Medical Neglect
    • Know the family: structure, needs, strengths
    • Address risk factors: support, monitor, refer
    • Address barriers to care
    • Build on strengths
    • Anticpatory guidance
    • Health Education
  31. When to Report to Child Protection Services
    • When actual or potential harm is serious or
    • When less intrusive efforts have failed and actual or potential harm persist
  32. How to Improve Compliance (medial neglect)
    • Make treatment practical
    • --Simplify the regimen
    • --prioritize treatments
    • --provide cues and reminders
    • Follow-up
    • --telephone
    • --in person: office, home
    • Family issues
    • --identify beliefs, skills, motivation
    • --identify supports, stressors, barriers
    • --involve key persons in treatment plan
    • Communication
    • --use appropriate language
    • --give written instructions
  33. Addressing Different Cultural or Religious Beliefs (Medical Neglect)
    • Sensitivity, humility, flexibility
    • Weigh costs and benefits of your treatment
    • Seek reasonable compromise
    • Considre approaching group leaders
    • Court interventions?
  34. Safety Neglect
    • Lack of supervision and careful monitoring
    • Failure to remove hazards and avoid dangerous situations
  35. Educational Neglect
    • Kept from school to do work or babysitting
    • Exaggerated illness
  36. Physical Neglect
    • Failure to provide regular, ample meals
    • Failure to keep child clean
    • Basic needs for clothing and shelter not met
  37. Emotional Neglect
    • Failure to provide affection, attention
    • Withdrawal
    • Developmental delays
    • Self-stimulating behaviors
    • Insecure in play
  38. Cause of Neglect
    • Economic
    • Ecological
    • Societal
  39. Economic Causes of Neglect
    • Is 44% higher in lower socioeconomic families
    • A potential error is overzelousness in the detection of neglect, leading to the confusion of neglect with poverty or ignorance
    • Only if improvished families refuse reasonable services to children should neglect be considered
  40. Ecological Causes of Neglect
    • Poorly kept, unfriendly neighborhood
    • Feel unsupported by their surroundings and develop low morale
    • Social isolation
    • Lack good knowledge about child rearing
  41. Societal Values and Institutions Stimulate Neglectful Situations:
    • Welfare reform that decreases eligibility categories
    • Lack of quality, affordable daycare services for working moms
    • Lack of affordable housing
    • Lack of health care insurance
    • Journal of Pediatrics study found that neglectful moms were less likely to have completed high school; had more children younger than 6 years of age; scored poorer on parenting skills and support system scales
    • Neglected children were lower in birth weight; rate more difficult tempermentally; poorer mental, motor, and developmental scores
  42. Characterisitcs of Nonorganic Failure to Thrive Infants
    • Fussier, more demanding, unsociable
    • Less adaptive, more inconsolable
    • Developmental lags (oral-motor skills, etc)
  43. Family Characteristcs Associated with Nonorganic Failure to Thrive Infatnts
    • Unusual beliefs about normal diet
    • Distorted mother-child relationship
    • Multiple problems
    • Emotional deprivation
  44. Types of Emotional Abuse
    • Rejecting
    • Terrorizing
    • Ignoring
    • Isolating
    • Corrupting
    • Exploiting
  45. Rejecting
    Refusing to show the child's worth; name calling, ignoring, etc
  46. Terrorizing
    Threaten the child with a punishment; fear
  47. Ignoring
    Refuse to provide stimulation and praise that the child needs
  48. Isolating
    Preventing them from opportunities of experiencing social needs
  49. Corrupting
    Teach the child anti-social, deviant behaviors
  50. Exploiting
    Using the child to satisfy adult needs; the child takes care of the adult
  51. James Garbarino (5 types of Emotional Abuse)
    • Rejecting
    • Terrorizing
    • Ignoring
    • Isolating
    • Corrupting
  52. Characteristics of Emotionally Abusive Parents
    • Do not know enough about child development to cope with the normal demands resulting from their child's behavior at different developmental stages
    • Lower socioeconomic stauts that generates a sense of powerlessness and frustration
    • Middle class families where there is stress, tension, and aggression coupled with inadequate parenting skills and unrealistic expectations
    • Poorere coping skills, child management techniques, and more difficulty in forming relationships (don't know how to handle bumps in the road)
  53. Characteristics of the Emotionally Abused Child
    • Suffer feelings of being inadequate, isolated, unwanted, and unloved
    • Low self-esteem
    • May fight back with aggression or behavior problems
    • May trun anger inward (self-destructive behaviors)
    • Somatic complaints (can never focus on where the hurt is)
    • Sleep disturbances
    • Frightened, distressed, anxious
  54. 4 Preconditions for Child Sexual Abuse
    • Motivation to sexually abuse a child
    • --emotional congruence
    • --sexual arousal
    • --blockage
    • Overcoming internal inhibitors (this is a requirement for sexual abuse)
    • Overcoming external inhibitors (supervision, family, peers, etc)
    • Overcoming the resistance of the child
  55. Disinhibition
    Why is a person not deterred by conventional social inhibitions from having a sexual relationships with a child?
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Child Abuse and Neglect
2011-10-20 18:09:13
Unit Two

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