Pre natal alcohol and drug exposure

Treatment for FASD and Pre-natal Drug Exposure:Neonatal Intensive Care (NICU

Family education and support Feeding (suck reflex) Sensory stimulation and calming techniques

Describe emotional abuse

- aka mental / psychological - impairs child's emotional development, ↓self worth ex. Constant criticism, threats, rejection, withholding of nurturance - difficult to substantiate; often present with other forms of abuse

How is a child's mental health (psychological) affected by abuse and neglect?

- dependency/withdrawal - meet diagnostic criteria for MH disorder by age 12 (anxiety, ED, ADHD, PTSD, etc.) -cognitive - language, learning - social - anti-social traits, personality disorders

Describe sexual abuse

- engaging a child in sexually explicit conduct - - may include fondling genitals, penetration, indecent exposure, exploitation, production of pornographic materials

Describe physical abuse

- non accidental physical injury from punching, kicking, biting, choking, shaking, hitting (hand or object), burning *spanking is NOT physical abuse as long as it doesn't cause bodily injury

Describe two possible impacts of maltreatment on a child's social skills.

-Lack of friends -Hostility toward others/bullying -Lack of trust in others -Poor communication

What is the difference between child abuse and neglect?

-Neglect- failure to meet child's basic physical, educational, and emotional needs; failure to protect or intervene with abuse *twice as common -Abuse- deliberate action that is harmful to child's physical, sexual or, emotional well-being

In which types of cases are perpetrators likely to be reported to law enforcement/police?

-certain types of abuse: sexual abuse, serious physical abuse -perpetrator may face charges and name may appear on a registry (if confirmed)

How is society affected by child abuse and neglect?

-direct costs - child welfare system costs, judicial, law enforcement, health & MH systems (2001-$24 billion) -indirect costs - long-term economic consequences→ criminal activity, MH problems, substance abuse, domestic violence, loss of productivity, special services, inc. use of health care (2001-$69 billion)

What is the relationship between anti-social behavior and child abuse or neglect?

-more likely in this group -delinquency, teen pregnancy, poor grades, substance abuse, MH problems, STD -increased arrest rates -increased substance abuse rates - 2/3 in drug treatment report maltreatment as children

Fetal Alcohol Spectrum Disorders:

1) Fetal Alcohol Syndrome (FAS) - most serious 2) Alcohol-Related Neurodevelopmental Disorder (ARND) - various neurologic abnormalities 3) Partial Fetal Alcohol Syndrome (pFAS) - deficits in skeletal and major organ systems 4) Alcohol Related Birth Defects (ARBD)* Fetal Alcohol Effect(FAE)* *These terms have fallen out of favor, but you will still see them

Damage to fetus: What happens?

1)Defects in brain, face, eyes, ears, heart, kidney, and bones 2) Alcohol triggers cell death 3) Alcohol disrupts nerve development and function 4) Alcohol constricts blood flow to the placenta (affects nutrient and oxygen delivery) 5)Toxic byproducts of alcohol metabolism concentrate in the brain

Identify two signs in a child of neglect

1. absent from school 2. begs or steals (food/money) 3. lacks medical attention 4. dirty, body odor 5. clothing insufficient for weather 6. substance abuse 7. verbalizes no one at home to provide care

Identify two signs in a child of sexual abuse

1. difference in walking or sitting 2. sudden-won't participate in changing for gym or participate in physical activity 3. nightmares/bedwetting 4. sudden change in appetite 5. knowledge of sex/behavior bizarre, surprising, unusual 6. pregnant, STD 7. runaway 8. reports abuse

Identify two signs in a child of maltreatment (emotional)

1. extreme behavior- compliant, demanding, passive, aggressive 2. adult like or infantile 3. delay physical or emotional development 4. suicide attempt 5. reports lack of judgment

Identify two elements key to effective maltreatment prevention programs

1. involving parents in all aspects 2. providing programs that have an evidence base - have demonstrated effectiveness 3. A continuum of strategies at the individual, relationship, community, and social levels

Identify three general signs in the parent that are indicative of child maltreatment

1. not concerned about child 2. denies problem or blames child 3. requests harsh discipline 4. View of child as bad, worthless, burdensome 5. Extremely demanding 6. Exploits child to meet own needs

In a case of substantiated abuse or neglect, where the child is at moderate to high risk, what actions can a CPS worker take?

1. offer in-home CPS services 2. if refused, seek intervention in juvenile court 3. in case of judicial determination, family might consent to in-home CPS or court order to remove or affirm removal prior to decision for safety reasons

Identify two signs in a child of physical abuse

1. unexplained injuries (bites, scratches, burns, bruises, broken bones) 2. fading marks 3. frightened of parent, reluctant to be in parent's care 4. shies away from adults 5. reports of injury

ARND and pFAS

These do not have all the features of FAS, especially the cranio-facial characteristics. Problems associated with these disorders may not be recognized until school age, depending on the social environment and regularity of health care. Determined by history, which may be unreliable

Early Intervention

Feeding Sensory processing Motor development Play and social skills Co-occupations (child and caregiver)

Treatment for FASD

Be aware that there is likely shame and blame associated with FASD. Coordination of multiple services: Social services (safe environment, parental education) Early intervention and educational support (children)

1)Children with pre-natal drug and/or alcohol exposure may develop 2) They are at greater risk for maltreatment 3) Children being raised in an environment where patients are using and abusing substances are

Children with pre-natal drug and/or alcohol exposure may develop abuse problems themselves They are at greater risk for maltreatment, because they are often considered difficult Children being raised in an environment where patients are using and abusing substances are extremely vulnerable; their parents may lack judgment, support, and resources

Explain what a permanency is for children in foster care.

Describes where child will live after foster care - most focus on reunification with parents; could be adoption or custody with relative

Fetal Alcohol Spectrum Disorders FASD:

FASD describes a range of disorders It is a group of conditions with a range of physical, mental, behavioral and learning effects with lifelong implications not considered a diagnosis Fetal Alcohol Syndrome (FAS) is a clinical diagnosis

Fetal Alcohol Spectrum Disorders (FASD)

FASD is a pre-natal to grave public health issue Blood alcohol level (BAC) of fetus becomes equal to or greater than that in the mother Fetus cannot effectively metabolize alcohol, consequently the BAC remains high longer

General outcomes of pre-natal exposure (cont'd):

Irritability Disrupted eating and sleeping Atypical muscle tone (often hypertonic) Atypical social interaction May have withdrawal symptoms (all but cocaine)

Fetal Alcohol Syndrome Signs obvious at birth

Low birth weight Height and weight below 10th percentile for age and race Cranio-facial characteristics a. microcephaly b. widely spaced eyes c. short, upturned nose d. thin upper lip e. flattened philtrum (space between upper lip and nose)

Fetal Alcohol Syndrome (cont'd)

Lower IQ Hypotonia Emotional and behavioral problems interfere with role performance Lifetime costs for one person with FAS is approximately $3 million

Explain the ratio of 3:1 for reported and substantiated cases of maltreatment.

Multiple reports for each child Need for proof ↑ awareness, ↑ reporting Mistaken or misleading reporting

Food for Thought

No amount of alcohol use during pregnancy is considered safe. FASDs are not caused by the father's alcohol use - BUT studies are being conducted to determine the effect of alcohol on sperm. FASDs are not intentional - can be attributed to a lack of education and awareness.

Alcohol

One of the most dangerous pre-natal teratogens When pregnant woman drinks, developing fetus does as well Alcohol easily passes from bloodstream to placenta, putting fetus at risk for Fetal Alcohol Spectrum Disorder (FASD)

Why is having a primary medical practitioner a protective factor for a child?

One practitioner sees child over time, can more readily detect changes, monitor deviations, can develop relationship with child and parent, can offer resources, make referrals

4) Pattern of binge drinking, especially during critical period - 5) Leading cause of birth defects

Pattern of binge drinking, especially during critical period - very dangerous (heaviest drinkers most likely to under-report) Leading cause of birth defects and developmental disability 100% preventable

General outcomes of pre-natal exposure:

Premature birth Low birth weight Microcephaly Lowered height and weight percentiles Delayed language development

Epidemiology of FASD:

Prevalence of FASD - approximately 40,000 newborns annually Annual cost to the nation is up to $6 billion Costs are related to: - treatment services to age 21 - home and residential care for moderate to severe intellectual disability to age 65 - special ed services - lost productivity

School

Sensory processing Fine and gross motor Classroom participation Social skills

What are three physical health consequences of abuse or neglect?

Shaken baby - damage to spinal cord, bleeding in brain/eye, fractures Impaired brain development - cognitive, language and academic problems Poor physical health - especially later in life - chronic conditions like arthritis, high BP, ulcers, asthma

Pre-natal Drug Exposure

Women who use or abuse drugs may also consume alcohol and smoke tobacco, have poor eating habits, and may lack pre-natal care Consequently, causation is almost always multi-factorial

Can a CPS worker remove a child from the home before a full investigation is completed?

Yes - children in immediate danger can be moved while court proceedings are pending CPS worker needs to determine if child is safe, if maltreatment occurred, and if risk of re-occurrence

Briefly define each level of prevention and identify one idea for each in regard to child abuse and neglect. Look at the internet reading "preventing child abuse and neglect" for ideas.

a. primary - prevent injury, disease or abuse before it happens/ decrease impact. ex. Stabilize neighborhoods and families; ↓ teen parent; economic security b. secondary - intervene as soon as possible after identification of problem to ↓or eliminate effects, avert harm in high risk situations. ex. Home visits; prev. medical Rx; effective parenting c. tertiary - reduce impact of a problem after it has occurred, prevent secondary complications. ex. Remove child or perpetrator; provide stable, caring environment

There are various diagnostic criteria

and guidelines University of Washington published the "4-Digit Diagnostic Code" that measures four key features of FASD on a scale of 1-4 1. Growth deficiency 2. Facial Features 3. CNS damage 4. Alcohol Exposure

FASD continued 1) Exposure is dose 2) Some groups have higher incidence 3)Any consumption of alcohol during pregnancy

dependent, but threshold is not easy to determine - the threshold effect than others (some Native-American groups; African-Americans) is dangerous, as brain continues to develop throughout

Identify the four types of neglect

physical medical educational emotional

Explain what it means for a child protective services (CPS) worker to "screen in" or "screen out" a report of maltreatment

screen in - sufficient evidence to suggest investigation screen out - not enough evidence to follow up on situation -doesn't meet state definitions - other referral might be made