3. Child Maltreatment: A Public Health Issue

What are the circumstances in which someone ought report? To whom must that information be reported?

- "If a reporter, in their professional capacity, has received information WHICH GIVES THEM REASON TO BELIEVE that an act or commission was committed by a parent, guardian, or other caretaker, a report MUST BE MADE to DSS - "If a report, in their professional capacity, has receives information WHICH GIVES THEM REASON TO BELIEVE that someone OTHER than those responsible for the child's welfare has committed an act or commission a report MUST be made to the appropriate LAW ENFORCEMENT AGENCY - DO NOT INVESTIGATE YOURSELF!!! - DO NOT WAIT FOR PROOF!!!

What is the prevalence of Child Abuse/Maltreatment in the nation? How does that break down into the subtypes discussed?

- 9.2/1000 children were found to be victims of child abuse in the year 2011, and of those 681,000 children: 78% - suffered Neglect 18% - suffered Physical Abuse 9% - suffered Sexual Abuse - Estimates put 1/4 children in the US as experiencing some form of child maltreatment over the course of the entire childhood

Define Emotional Abuse

- A pattern of behavior that impairs a child's emotional development or sense of self worth - This may include constant criticism, threats, rejection, withholding love, support, or guidance

Define Abuse

- Abuse is defined variably from state to state but all legal definitions at least match the minimum federal standards which defines Abuse as: 1. "Any recent act or failure to act on the part of the parent or caretake which results in death, physical harm, emotional harm, sexual harm, or exploitation." 2. "An act or failure to act which present an imminent risk of serious harm."

Define Sexual Abuse

- Activities performed by a parent, caretaker, or other individual such as fondling, penetration, incest, rape, sodomy, indecent exposure, and exploitation of a sexual manner which involves force, threats, age difference, or a lack of consent

What is the prevalence of Sexual Abuse?

- An estimated 1/10 of children will experience Sexual Abuse before their 18th birthday - 1/7 girls experience Sexual Abuse - 1/25 boys experience Sexual Abuse

Who are the perpetrators of Child Maltreatment?

- By relation to the child: Parents - 78.5% Relatives - 6.5% Unmarried Partners of Parents - 4.1% - By sex of perpetrator: Sexual Abuse - 95% male All Other Kinds - 50/50 Split

When in doubt with respect to reportability, what do you do?

- Cal NCVC, they will talk it out and help make a decision

Describe the effects of Child Maltreatment on children

- Effects are best categorized into, "Short Term," and ," Long Term," as they manifest in different ways. - Short Term effects are often considered problems and while they demand attention, these can be overcome as many children are resilient in the face of such treatment. Treatment is also not as extensive as for those with Long Term effects Short Term effects do NOT mean that Long Term issues will be experienced - Long Term effects are frequent results of Maltreatment but not necessarily. Maltreatment is a risk factor for many psychiatric disorders and medical conditions

How does mandated reporting work?

- Every state has statutes governing mandatory reporting - In SC the following is the reportable: 1. PA - Physical injury of any kind, including those sustained as a result of excessive corporal punishment. Witnessing of domestic violence 2. Neglect - Failure to supply basic needs appropriate to child's age and development 3. Sexual Abuse - Commits, or allows to be committed, against a child 4. Abandonment

How does cultural competence relate to this issue?

- Given the complicated nature of this issue and the fact that more often than not it affects minorities, it is essential that we understand the values of our patients with respect to religion, ethnicity, and culture when it comes to intervention on this front - It has been shown that cultural modifications to interventions can enhance their success - In particular it is found most often the highest barrier is the initiation of treatment protocols for minorities; once begun they have equivalent success rates as compared to other groups

Who are mandated reporters?

- It varies from state to state, but in SC the following are: 1. Physicians, Nurses, Hospital Employees, etc 2. Coroners 3. ME's 4. Mental Health Providers 5. Social Workers 6. School Personnel 7. Law Enforcement Officers 8. Child Care Providers 9. Film Processors/IT

How do confidentiality and mandated reporting interplay?

- Mandated Reporting trumps Confidentiality for Minors - Confidentiality trumps Mandated Reporting for Adults

Define Physical Abuse

- Physical injury as a result of hitting, punching, beating, kicking, biting, shaking, throwing, stabbing, choking, burning, or otherwise harming a child, regardless of intention

Define Neglect

- The failure to provide for a child's basic needs, including: 1. Physical 2. Medical 3. Educational 4. Emotional

What's the takeaway about perpetrators of Child Maltreatment?

- The most common perpetrators are KNOWN ADULTS - Stranger Danger is a myth

What is the public health impact of child maltreatment?

- Those who experience it have higher incidences of chronic health problems and mental health disorders - Costs are estimated to be over 80 Billion Dollars annually

List the common short term effects of child maltreatment

1. Behavior Problems 2. Cognitive Difficulties 3. Social Difficulties 4. Juvenile Delinquency 5. Alcohol & Other Drug Use 6. PTSD 7. Depression 8. Disruptive Behavior Disorders

List the major risk factors for child maltreatment

1. Caregiver history of abuse 2. Parental/Caregiver Substance Abuse 3. Corporal Punishment 4. Teenaged Parents 5. Single Parents 6. Domestic Violence History 7. Familial Instability

What children are most vulnerable/statistically most likely to be maltreated?

1. Children aged from Birth to 3 years 2. Children with disabilities 3. Impoverished Children 4. Children with limited social support 5. Children enmeshed in community violence

List the objectives for this lecture

1. Define physical abuse, sexual abuse, and neglect 2. Describe the prevalence of neglect and abuse 3. List the most common perpetrators of abuse 4. List risk factors for maltreatment 5. Describe the psychological and behavioral long and short term effects of child maltreatment 6. Explain differences in prevalence, expression, and service use by race, ethnicity, and culture 7. Explain mandatory reporting requirements and how to make a report 8. Identify common interventions to be used with families who present following maltreatment

What information should a report contain?

1. Name, Age, & DOB 2. Home Address 3. Nature & Extent of Injury 4. Behavioral Observation, School Performance, and Attendance if applicable and known 5. Familial background information

List the 4 types of Child Maltreatment

1. Neglect 2. Physical Abuse 3. Sexual Abuse 4. Emotional Abuse

List the common long term effects of child maltreatment

1. Relationship Difficulties 2. Issues with Sexual Intimacy* 3. Occupational Difficulty 4. Increased risk of smoking 5. Increased Incidence of Heart Disease 6. Increased risk of Liver Disease 7. Increased risk of Suicide