Child Abuse And Neglect.docx

CHILD ABUSE AND NEGLECT INTRODUCTION Childhood should be a care-free time filled with love, and the joy of discovering new things and experiences. However, it is a dream for many children. Child abuse and neglect is an increasing social problem. The effects of child abuse and neglect are not limited to childhood but cascade throughout life, with significant consequences for victims (on all aspects of human functioning), their families, and society. Child abuse: words or overt actions that cause harm, potential harm, or threat of harm to a child. Child neglect: It can be conceptualized in a broad sense as harmful acts of omission or the failure to provide for a child's basic physical, emotional, or educational needs or to protect a child from harm or potential harm.

DEFINITION Missouri Child Abuse Law definitions: ABUSE : Any physical injury, sexual abuse, or emotional abuse inflicted on a child other than by accidental means by those responsible for the child’s care, custody and control except that discipline including spanking, administered in a reasonable manner shall not be construed to be abuse; NEGLECT: Failure to provide, by those responsible for the care, custody, and control of the child, the proper or necessary support, education as required by law, nutrition or medical, surgical, or any other care necessary for the child’s well-being. According to Journal of Child Abuse and Neglect, child abuse is "any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of serious harm."

TYPES OF CHILD ABUSE AND NEGLECT Child abuse and neglect is divided into many types which are discussed below;    

Physical Abuse Sexual Abuse Emotional Abuse Neglect  Physical  Educational  Medical  Emotional

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a. Physical Abuse Physical abuse is non accidental physical injury (ranging from minor bruises to severe fractures or death) as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or otherwise harming a child, that is inflicted by a parent, caregiver, or other person who has responsibility for the child. Such injury is considered abuse regardless of whether the caregiver intended to hurt the child. Physical discipline, such as spanking or paddling, is not considered abuse as long as it is reasonable and causes no bodily injury to the child. Sexual abuse includes activities by a parent or caregiver such as fondling a child’s genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or the production of pornographic materials. Behavioral Indicators of Physical Abuse          

Behavioral extremes Inappropriate fear of parent or caretaker Unusual shyness wariness of physical contact Antisocial behavior Reluctance to return home Disclosure of abuse Depression Attempt to Hide injuries Unbelievable or inconsistent explanation of injuries Belief that punishment is deserved

b. Sexual Abuse Sexual abuse is defined by CAPTA as “the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children.” Behavioral Indicators of Sexual Abuse       

Victims disclosure Poor relationships Regressive behaviors such as bedwetting, thumb sucking, fear of dark Sudden behavior changes Promiscuity Prostitution Substance abuse 2

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Difficulty walking or sitting

c. Emotional Abuse Emotional abuse (or psychological abuse) is a pattern of behavior that impairs a child’s emotional development or sense of self-worth. This may include constant criticism, threats, or rejection, as well as withholding love, support, or guidance. Emotional abuse is often difficult to prove, and therefore, child protective services may not be able to intervene without evidence of harm or mental injury to the child. Behavioral Indicators of Emotional Abuse           

Withdrawal Suddenly behaves differently Anxious Clingy Depressed Aggressive problems Sleeping or eating disorders Risks misses school Obsessive behavior Nightmares Self-harm thoughts about suicide

CHILD NEGLECT Neglect is the failure of a parent, guardian, or other caregiver to provide for a child’s basic needs. Neglect may be:    

Physical (e.g., failure to provide necessary food or shelter, or lack of appropriate supervision) Medical (e.g., failure to provide necessary medical or mental health treatment) Educational (e.g., failure to educate a child or attend to special education needs) Emotional (e.g., inattention to a child’s emotional needs, failure to provide psychological care, or permitting the child to use alcohol or other drugs)

Sometimes cultural values, the standards of care in the community, and poverty may contribute to maltreatment, indicating the family is in need of information or assistance. When a family fails to use information and resources, and the child’s health or safety is at risk, then child welfare intervention may be required. In addition, many States provide an exception to the definition of neglect for parents who choose not to seek medical care for their children due to religious beliefs. Behavioral Indicators of Neglect 

Problematic school attendance 3

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Chronic hunger or tiredness Begging Substance abuse Assuming adult responsibilities beyond the child’s capabilities Reporting no caretaker at home Child appears to have no limits

ASSESSMENT OF CHILD ABUSE AND NEGLECT An overview of typical child assessment is given by child protective services which is discussed in the following;

OVERVIEW OF CHILD PROTECTIVE SERVICE PROCESS

IDENTIFICATION

REPORTING

INTAKE

INITIAL ASSESSMENT

FAMILY ASSESSMENT

PLANNING

SERVICE PROVISION

EVALUATION OF FAMILY PROGRESS

CASE CLOSURE

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Identification Recognizing signs of child abuse and neglect

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Reporting Provide information on suspected maltreatment Intake Decide whether to investigate Assess urgency of response to require Initial Assessment Contact child and family gather information Determine whether maltreatment occurred Assess safety of child Assess risk for future abuse or neglect Family Assessment Identify family strengths and needs Assess factors contributing to risk for maltreatment Planning Specify outcomes and goals that will reflect reduction or elimination of risk for maltreatment Identify strategies to achieve goals and outcomes Develop case plans, permanency and other plans Set time frames Service Provision Provide in home or out of home services if possible. Evaluating of family progress Assess safety of child and reduction of risks Evaluate achievement of family outcomes, goals and tasks Case Closure Assess levels of safety and risks Determine whether family can protects child

INSTRUMENTS The instruments use for assessing child abuse and neglect are; 

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Childhood Trauma Questionnaire o 28 items o Multiple validation studies including studies on sensitivity and specificity o Retrospective/lifetime o Physical, emotional and sexual abuse and emotional and physical neglect Parent Child Conflict Tactics Scale o 27 items o Multiple validation studies in multiple contexts o Current self-report (past year) o Used with children and parents o Used in intervention studies o Non-violent discipline, psychological aggression, physical assault 5

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o Additional questions on weekly discipline, neglect and sexual abuse ISPCAN Child Abuse Screening Tool o 36-77 items o Child (home & institution), parent and retrospective version available o Current (past-year) and lifetime o Used in intervention studies o Physical, emotional and sexual abuse, neglect, domestic violence, crime, peer violence Childhood Experiences of Care and Abuse o 29 items o Adolescent retrospective self-report (often used by social workers) o Young adult self-report o Physical abuse, emotional abuse sexual abuse, neglect and loss of parents

ASSESSMENT INFORMATION FROM CHILDREN  

Behavioral Report and/or Observation Casual Observations

PROJECTIVE ASSESSMENTS   

Projective Drawings Projective Storytelling/Apperception Tests Rorschach

COGNITIVE ASSESSMENTS   

Bayley Scales of Infant Development (BSID) Wechsler Series of Intelligence Tests for Children Kaufman Assessment Battery for Children (K-ABC)

CLINICAL INTERVIEWS  

Nondirective Play Sessions Structured Psychiatric Diagnostic Interviews

ASSESSMENT INFORMATION FROM PARENTS  

The Child Behavior Checklist (CBCL) The Vineland Adaptive Behavior Scales (VABS)

FAMILY ASSESSMENT   

The Purpose/Intent of Family Assessment Standardized Measures of Family Assessment Clinical interviews

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TREATMENT OF CHILD ABUSE AND NEGLECT A thorough assessment enables the clinician to determine which method will best meet the child’s needs. Sometimes children participate in more than one modality, either in incremental steps or concurrently. For example, some children benefit from concurrent individual and group therapy. They have the opportunity to work on interpersonal skills in individual therapy and reap the rewards of appropriate interaction during group. Psychoeducational groups that present information about the causes and effects of abuse and neglect and offer the opportunity to explore one’s experience can be an effective means of educating parents and introducing topics for them to explore in individual or group therapy. The following modalities are effective in helping children and their parents learn about the effects of abuse and neglect.    

Play Therapy Individual Therapy Group Therapy Family Therapy

PLAY THERAPY Play therapy is an effective modality that helps the child express feelings, act out behaviors, and gain mastery and control over memories and feelings generated by the abusive or neglectful experience. A child uses play to manage his/her fears and anxieties about the abuse, express his/her feelings about what happened to him/her, and demonstrate their knowledge and understanding about relationships. Play therapy allows the child to represent symbolically those events that generate fear and anxiety and helps the child move toward resolution and integration of the frightening experience. INDIVIDUAL THERAPY Usually, individual therapy is the child’s first introduction to treatment. It is an opportunity for the child to interact with a supportive and knowledgeable adult and develop a relationship that models appropriate adult/child relationships. Individual therapy also allows the therapist time to assess and evaluate the child’s interpersonal skills and help the child learn age-appropriate and engaging behaviors to interact with peers. The goal of individual therapy is understanding, integration, and resolution of those experiences that affect development, interaction, and safety. Individual therapy is most beneficial in helping children address developmental issues of trust, mastery and control, and identity. Individual

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therapy generally is helpful in supporting disclosure of abuse and neglect, helping the child identify issues related to their experience, and in resolving intrapersonal issues. GROUP THERPAY Group therapy is especially helpful for decreasing isolation, improving social skills, and monitoring and intervening in problematic interactional patterns of behavior. Group therapy also allows the child to identify and learn from peers and group leaders and helps the child learn new and possibly more effective ways of interacting and communicating about his/her circumstances. Group therapy can facilitate participation with a supportive and understanding peer group and allow the child to practice many of the skills that will improve his/her ability to affiliate and evaluate relationships. FAMILY THERAPY Family therapy is most helpful when the family is willing and able to view the abuse or neglect as an issue that needs to be addressed by all the members in the family. Family therapy is an opportunity to explore roles and relationships, help family members recognize the impact that their behavior has on each other, and increase family cohesion and belonging. Family therapy can facilitate problem solving and improve communication between members. Family therapy seems most helpful after the individual family members have addressed their intrapersonal and developmental issues in individual or group therapy.

CONCLUSION Assessment and treatment is one of many important strategies to help abused and neglected children move beyond the role of victim and continue their progress toward positive and productive adulthood. Therapy with abused and neglected children is often demanding and challenging. However, it offers the immediate reward to the therapist of knowing that he/she is making every effort to help the child and the family who are struggling to overcome the effects of abuse and neglect. For this reason, therapy is a valuable service and a major contributor to the well-being of maltreated children and their families.

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REFERENCES Retrieved from; A journal of treatment for abused and neglect children by Anthony J. Urquiza and Cynthia www.gbcnv.edu www.slideshare.net www.nspcc.org.uk www.childwelfare.gov www.pitt.edu www.kinderschutzhotline.com On 26-12-2017

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