Exam 1 Flashcards
Historical Timeline: 1875
Society for the Prevention of Cruelty to Children (SPCC) developed
Historical Timeline:
Mid-1940’s
unexplained multiple fractures & subdural hematoma
Historical Timeline:
1962
“The Battered-Child Syndrome” by Dr. C. Henry Kempe
Historical Timeline:
1972
the National Center for the Prevention of Child Abuse and Neglect established
Historical Timeline:
1974
(CAPTA) Child Abuse Prevention andTreatment Act is passed
CAPTA defines child abuse and neglect as:
“Any recent act or failure to act on the part of a parent which results in
death
serious physical or emotional harm,
sexual abuse or exploitation”
or
“An act or failure to act which presents an imminent risk of serious harm.”
Historical Timeline:
1963
First child abuse reporting law in California.
Only for physicians reporting evidence of physical abuse.
Historical Timeline:
1980
The Child Abuse & Neglect Reporting Act (CANRA) is developed.
Expanded definition of abuse & who must report.
CARNA defines abuse and neglect as:
physical abuse,
sexual abuse (including both sexual assault and sexual exploitation),
willful cruelty or unjustified punishment,
unlawful corporal punishment or injury,
and neglect (including both acts and omissions).
Under current law, child abuse does NOT include
1) “A mutual affray between minors.”
2) “Reasonable and necessary force used by a peace officer acting within the course and scope of his or her employment as a peace officer.”
3) “An amount of force that is reasonable and necessary for a person employed by or engaged in a public school to quell a disturbance threatening physical injury to person or damage to property, for purposes of self-defense, or to obtain possession of weapons or other dangerous objects within the control of the pupil.”
4) “A child receiving treatment by spiritual means…or not receiving specified medical treatment for religious reasons, shall not for that reason alone be considered a neglected child. An informed and appropriate medical decision made by parent or guardian after consultation with a physician or physicians who have examined the minor does not constitute neglect.”
When do I report?
As a mandated reporter, all you need is a “reasonable suspicion” that abuse or neglect is occurring.
What is “reasonable suspicion?”
Reasonable suspicion means that it is “objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing, when appropriate, on his or her training and experience, to suspect child abuse or neglect”
Verbal disclosures of abuse should always be reported.
What happens if I am a mandated reporter & I have a reasonable suspicion of abuse or neglect and I don’t report?
A person who fails to make a required report is guilty of a misdemeanor punishable by up to six months in county jail and/or up to a $1000 fine
How trauma impacts a child’s brain:
100 billion ____?
neurons
How trauma impacts a child’s brain:
1,000 trillion ____?
synapses by 8 months
How trauma impacts a child’s brain:
% of core brain structures formed by age 3?
90%
How trauma impacts a child’s brain:
What is used is ____ & what isn’t is ____?
What is used is saved & what isn’t used is lost
• Experiences repeated over & over & over (i.e. - nurture)
How trauma impacts a child’s brain:
Our brain develops from the?
bottom up & inside out
How trauma impacts a child’s brain:
Changes in brain chemistry based on?
experiences
• Cortisol levels are increased when an overactive stress response occurs
3 parts of the brain:
Brain Stem
Limbic system
Cortex
Parts of the brain:
Brain Stem
Basic functions that __?
Regulates __?
• keeps us alive
• temperature, heart rate, respiration, blood
pressure
- The “reptilian” part of our brain – shared with lizards
- Fight, flight, or freeze: The brain stem reacts & bypasses rational thinking for the sake of survival
Parts of the brain:
Limbic system
__ responses that __?
Amygdala stores __?
Emotional responses that guide our behaviors
• Fear, hatred, love, joy
Amygdala store emotional memories through our senses
• Memories can be triggered by certain smells, sounds,
etc.
Mammalian” brain – we share this with other mammals including cats, dogs, elephants, dolphins, etc.
Parts of the brain:
Cortex
• Speech & language • Abstract thinking • Planning -Cause & Effect • Deliberate decision making • Unique to primates
“What fires together wires together”
Which experiences have greater impact?
Early experiences have a far greater impact than later ones
What is attachment?
Involves?
- Special enduring form of emotional relationship with a specific person
- Involves soothing, comfort, and pleasure
- Loss or threat of loss of the specific person evokes distress
- The child finds security and safety in the context of this relationship
Two main jobs of an attuned, securely attached caregiver
1) Increase pleasure
2) Decrease distress
4 kinds of attachment
1) Secure
2) Insecure: Ambivalent
3) Insecure: Avoidant
4) Insecure: Disorganized
1) Secure
Parent meeting most needs
Parent consistently and reliably provides adequate care
Child seeks comfort from caregiver, easily consolable
2) Insecure: Ambivalent
Parent meeting some needs
Parent goes between being attentive & preoccupied
Child has difficulty regulating – transitions are hard
3) Insecure: Avoidant
Parent meeting minimal to no needs
Parent is neglectful or dismissive of child’s needs
Child appears overly independent or autonomous
4) Insecure: Disorganized
Pathogenic care Traumatic Reactive
Parent is the source of comfort and fear
Child shows lack of consistent behavioral responses
Internal Working Model
Based on all of our interactions with others, we begin to develop a view and belief system about ourselves, others, and the world
4 Basic Needs Parents need to support
- Care
- Stimulation
- Continuity
- Reciprocity
• Care
– physical safety, food, clothing, shelter, to be clean & dry
• Stimulation
– emotional & physical interaction to learn about the world
• Continuity
– care provided consistently by the same caregivers
• Reciprocity
– interaction teaches a child s/he is valued
Erik Erikson Stages of Psychosocial Development
add here
Current society holds parents responsible for giving their children:
(7 things)
Food Shelter Clothing Medical care Education Supervision & protection Moral & social guidance
Neglect
- Act of omission rather than an assault of act of commission
- Many types of behaviors/omissions that can be considered neglect:
1. Physical
2. Educational
3. Emotional
Physical Neglect
Failure to thrive Inadequate supervision Abandonment Failure to meet a child’s basic physical needs: -Food -Shelter -Clothing
Educational Neglect
Permitting truancy Failure to send a child to school/enroll child in school Inattention to special education needs & Language neglect
Language neglect
Part of educational neglect
-Parents may communicate only in commands
-Do not read to children
-Do not talk to children at length
30,000,000 word gap by 18 months to 3 years
3 T’s
Emotional Neglect
-Inattention to child’s emotional needs
-Refusal to tend to serious emotional or behavioral
disorder (mental health neglect)
-Stimulation neglect (Cantwell) – inability to provide stimulation to offspring, endangers emotional/neurological development
i.e. – bottle propping (loss of touch/interaction & hand-eye coordination)
Assessing for Neglect
-Have the parents or caregivers failed to provide the child with needed care for a physical injury,
acute illness, physical disability, or chronic condition?
-Have the parents or caregivers failed to provide the child with regular and ample meals that meet basic nutritional requirements or have the parents or caregivers failed to provide the necessary, rehabilitative diet to a child with particular health problems?
-Have the parents or caregivers failed to attend to the cleanliness of the child’s hair, skin, teeth, and clothes?
-It is difficult to determine the difference between marginal hygiene & neglect. Caseworkers should consider the chronicity, extent, and nature of the condition as well as the impact on the child.
-Does the child have inappropriate clothing for the weather?
-Caseworkers should consider the nature and extent of the conditions and the potential consequences to
the child. They must also take into account diverse cultural values regarding clothing.
-Does the home have obviously hazardous physical conditions (exposed wiring or easily accessible toxic substances) or unsanitary conditions (feces- or trash-covered flooring or furniture)?
-Does the child experience unstable living conditions (frequent changes of residence of evictions due to the caretaker’s mental illness, substance abuse, or extreme poverty)?
-Do the parents or caregivers fail to arrange for a safe substitute caregiver for the child?
Child Neglect Index (CNI)
Nico Trocmé
- Supervision
- Physical Care
- Food/Nutrition
- Clothing & Hygiene - Provision of Health Care
- Physical Health Care
- Mental Health Care
- Developmental & Educational Care
Causes of Neglect
- Economical
(neglect is a response to stress & poverty is an all-pervasive stress) - Ecological
(the individual as part of & interacting with the environment)
-Neighborhood, culture & society - Personalistic Individual
(development of the individual parent & how s/he has learned to process information)
-How we process information we receive from the world influences how we relate to the world & how we behave
Symptoms & Effects of Neglect
Infancy & Early Childhood
- Nonorganic Failure to Thrive
- Below 5th percentile in weight
- Baby was once at expected weight
- Delays in psychomotor development
- Poor ability to suck
- Little interest in food
- “Unlovable”/unwilling to be held - Poor muscle tone
- Hair rubbed off back of
head/back of head flattened - Unwilling to make eye contact 5. Do not smile, babble, or squeal
Symptoms & Effects of Neglect
Young Children
Poor motor skills Language development delays Flat affect Extreme passivity Lice Short attention span Impaired socialization Inability to delay gratification
ADOLESCENTS: Early emancipation
Neglectful Parents
Characteristics
- Isolated
- Impossible to recognize/meet needs of child
- Indifferent
- Discipline out of need for quiet/convenience rather than concern for teaching child
- Poor capacity to problem solve or set goals for the future
- Less involved with others, less able to control impulses, less verbally accessible, less able to organize or plan, less equipped with pride in accomplishments or workmanship
- Lack of knowledge, lack of judgment, lack of motivation (Cantwell)
Personalities of Neglectful Mothers (Polansky & colleagues)
Apathetic-Futile – seem to have given up on living
Impulse Ridden – low frustration tolerance, inability to delay gratification, uses poor judgment in actions
Developmentally Disabled – supervision/education may be needed
Reactive-Depressive – inability to adjust to life changes & resultant depression
Psychotic – delusional thinking/hallucination à inconsistent caregiving
Issues in treatment
- Pervasive, generational histories
- Depression
- Antisocial behavior
- Denial
- Families are difficult to engage
- Families do not always follow through
- Families are not always eligible for treatment by appropriate agencies
- Resources to treat may be limited
- Treatment methods are not sufficiently refined to ensure success
What can help? (Treatments)
- Offer something tangible the client wants
- Attachment to case worker/therapeutic
relationship (difficulty trusting) - Model appropriate behavior
- Visiting nurse/”lay” therapists/parent aides & partners/anyone who can coach the parent – give support, guidance & advocacy
- Shows the parent that someone cares!
- “Parent” the parent - You can only give what you’ve received
Two treatment models
Equilibrium Maintenance
Disequilibrium Techniques
Equilibrium Maintenance
- Remind of “normal”
- Challenge parenting
Disequilibrium Techniques
- Help assist in reestablishing
- Removal from home
Bruce on 4yo Laura & Mom Virginia
Children who don’t get
consistent, physical affection
or the chance to build loving bonds don’t receive
the patterned, repetitive stimulation
necessary to properly build the systems in the brain that connect reward, pleasure and human-to-human interactions
Bruce on Peter’s brain
Adjust how you treat him based on the level he’s at
Developmentally, he is a moving target
Bruce on Leon’s brain
But because he’d been neglected when key social circuitry of the brain was developing
he couldn’t really appreciate the pleasure of pleasing someone else or receiving their praise,
nor did he suffer particularly from the rejection that followed if his behavior displeased teachers or peers having failed to develop an association between people and pleasure,
he saw no need to do as they wished, felt no joy in making them happy, and didn’t care whether or not they got hurt
“Theory of Mind”
-Other people are distinct from oneself
-Other people have different
knowledge about the world
-Other people have different desires and interests
Sociopaths
- Inability to empathize
- Difficulty mirroring the feelings of others
- Lack of compassion for them
~ They don’t recognize what others feel & don’t care if they hurt them (may even desire to do so).
Cortisol - the stress hormone
Early trauma + genetic variability = dysregulated stress systems
(no longer responsive to anything except extreme stimulation)
The Golden Ticket
Patterned, repetitive experience in a safe and predictable environment
(plus Mama P’s physical affection & stimulation)
What is the Neurosequential Model of Therapeutics? (NMT)
Primary assumption of NMT: The human brain is the organ that mediates all emotional, behavioral, social, motor, and neuro-physiological functioning (All of these areas can be impacted)
Trauma/neglect cause abnormal organization & function of important parts of the brain & compromise the functional capacities of these systems throughout life
NMT: Impacts of early abuse:
- Extreme anxiety,
- Hyper-vigilance,
- Persistently activated threat response
The brain heals from…
NMT
- The brain stem up
The number of repetitions required to change the brainstem is far greater than the number required to change the cortex – it is easier to change beliefs than feelings
Any clinical effort to treat symptoms related to higher parts of the brain without first regulating the brains stem will be insufficient or unsuccessful
Neurosequential Model of Therapeutics (NMT)
Ultimate goal
= matching biological age and developmental age
- Match the developmental period at which the damage first started
- Use enrichment experiences and targeted therapies to help the brain areas which were affected by neglect and trauma
- After improved functioning, move on to next brain region & developmental stage
