Precipitating factors in assessment Flashcards
Physical and behavioral indicators of child maltreatment
- Should be used in conjunction with supporting evidence such as info from family members and medical records.
- indicators of physical abuse -
- indicators of sexual abuse
- indicators of emotional maltreatment
- indicators of physical neglect
All taken from the child’s physical condition, behavior and the parent/caregiver behavior
Indicators of physical abuse
physical condition
- unexplained bruises, burns, welts, fractures, cuts
- unexplained abdominal injuries, swelling, localized tenderness, frequently vomits
- unexplained hair loss
- developmental lags in gross or fine motor coordination, language, height weight
- wears clothing to hide injuries
child’s behavior
- wary of physical contact with parents or other adults, displays lack of trust, fears going home
- exhibits extreme behavior (aggressiveness, withdrawal, compliance, negativity, hyperactivity, excessive fears, self-destructive behavior
- clingy and indiscriminate in attachments
- hypervigilant or ‘frozen watchfulness’
- history of acting out behaviors, school related problems, running away, alcohol or other drug use, depression, suicidal behavior
- avoids physical activity
- attributes injuries to an unlikely cause or states injury was inflicted by parent or caregiver
Indicators of sexual abuse
physical condition
- genital or perineal trauma or a venereal disease
- displays sleep disturbances, encopresis or enuresis, abdominal pain, appetite disturbances and corresponding weight change
behavior
- sudden unexplained change in behavior
- fear states, night terrors (especially under age 5)
- regressive behaviors and or withdrawal into a fantasy world; persistently deficates or urinates in clothes
- engages in antisocial behaviors
- overly sophisticated knowledge about sex; is promiscuous or over sexualized; engages in excessive masterbation that has a driven quality; engages in sexual play with other children toys of herself; unusual interest in sexual matters; engages in sexually suggestive behavior with older children or adults
- socially isolated, poor peer relationships
- attempted suicide
- psychosomatic illness
- abuses alcohol or other drugs
- fear of adults
- states that she has been sexually abused
parent behavior
- extremely jealous, protective or disinterested in child
- has distorted perception of the child’s role int eh family
- has extremely low self-esteem
- inadequate coping skills
- marital difficulties that cause one parent to seek physical affection from the child
- describes a home situation where one parent is often alone with the child
- lacks social and emotional contacts outside the family
- abuses alcohol or other drugs
- describes being sexually abused as a child
Indicators of emotional maltreatment
physical condition
- abnormalities in motor, speech, social, or intellectual behavior
behavior
- habit disorder (thumb-sucking, nail biting, enuresis, rocking)
- conduct disorder (antisocial behavior
- displays neurotic traits or psychoneurotic reactions
- exhibits extremes in behavior (extremem aggressiveness or passivity)
- displays pseudomaturity or regressive behaviors
- consistently makes derogatory remarks about her own behavior
- is overly concerned about conforming to the instructions of parents
- has attempted suicide
parent behavior
- blames, ridicules, denigrates child; is cold and rejecting, withholds love
- has inappropriate explanations for child’s behaviors; disinterested in the child’s problems
- treats children in family unequally
- abuses alcohol or other drugs
- describes being abused or neglected as a child
Indicators of physical neglect
physical
- constantly hungry; signs of malnutrition
- unattended physical problems
- poor hygiene
child’s behavior
- steals or begs for food
- often falls asleep during school, therapy, or other activities; infrequent attendance at school
- abuses alcohol or other drugs
- history of delinquent behaviors or suicide attempts
- states that there is no one to care for them
parent behavior
- disinterested in child
- low motivation to make changes in life; expresses futility
- describe chaotic or unsafe conditions at home
- long-term chronic illness
- has signs of mental illness or below average intelligence
- abuses alcohol or other drugs
- describes being neglected as a child
Questions to help determine is a child’s physical injuries are the result of abuse or an accident
1) Do the parents respond to your questions about their child with an attitude of cooperation or of hostility?
2) Are the parents generally concerned or unconcerned about their child’s injuries?
3) Are the injuries consistent with the explanation given by the child and the parents?
4) Are there discrepancies in the explanations given by different family members?
5) Are the injuries consistent with the child’s age, size, and developmental stage?
6) Is the pattern of injury suggestive of physical abuse?
7) What are the parents’ expectations regarding the child’s behavior and development? Appropriate?
8) What are the parent’ attitudes toward the use of physical punishment? Do they use excessive or inappropriate forms of punishment?
9) How do the parents ordinarily cope with stress? Do they loose control easily?
Questions to help determine is a child’s emotional maltreatment
1) What are the parents’ personal capacities? What is the status of each parent’s physical health, emotional health, and intellectual functioning?
2) What are the parent’s beliefs about the parent-child relationship (e.g. about methods of punishment)
3) Do the parents ignore the child’s problems or blame the child?
4) Are the parents concerned or unconcerned about the child’s problems and solutions to the problems?
Distinguish emotional maltreatment from ineffective parenting or other non-maltreatment
1) Emotional maltreatment consists of a pattern of behavior by the parents that has an adverse effect on the child
2) When there is emotional maltreatment, its effects can be clearly observed in the child’s behavior or performance
3) the effects of emotional maltreatment are longstanding
4) the effects of emotional maltreatment represent a handicap in the child
Questions to distinguish physical neglect
1) What are the prevailing cultural expectations and values with regard to child care and child-rearing techniques? Are the parents child-rearing practices considered normal by the culture to which they belong?
2) Is the lack of care for the child die to poverty or a lack of other resources or it is due to intentional deprivation?
3) Is the lack of care episodic or chronic? Does neglect occur only when a family member is absent or ill or is it consistent over time?
Special assessment issues when dealing with child abuse
1) confidentiality and reporting - you should inform family members of your legal responsibility to report.
2) involuntary participation - these families are frequently involuntary clients and therefore may be defensive or hostile
3) characteristics that interfere with assessment - these characteristics may include difficulties in forming interpersonal relationshops, poor social skills, distrust of authorities, low self esteem, difficulties in seeking and accepting help from others, lack of interest in helping their child, and inability to recognize their behaviors are inacceptable
4) difficulties in obtaining information about behaviors of interest - private, usually unobservable
5) assessment of factors of interest to a child protective agency or court - include the factors of interest by the requesting agency or court (i.e. risk of leaving the child at home with the family and potential negative effects of separating the child from the family)
Assessment of spousal abuse - types
1) physical
2) sexual
3) psychological
Indicators of spousal abuse in the battered woman
- injuries at various stages of healing
- obviously false explanations for injuries
- chronic depression, anxiety, insomnia, or nightmares
- request for sleeping pills. tranquilizers, or pain medication
- vague psychosomatic complaints
- complaints of marital problems (spouse drinks too much or is promiscuous)
- over-dependence on the spouse
- history of abuse as a child
- problems with the couples children
Assessment procedure for suspected spousal abuse
1) If both come, interview separately. Be aware that the batterer may try to prevent this
2) Explain confidentiality issues
3) identify current level of danger - legal duty to report to authority, ethical duty to prevent client from future harm by telling her about resources available and develop plan of escape
- additional abuse
- suicide
- homicide
- children in danger
4) Address minimization by
- explaining cycle of violence - tension building, acute battering incident, loving contrition
- if the client is out of danger, allow her to move past the minimization at own pace
- if client clearly in danger but insists she isn’t you can label her as battered to offset her minimization and encourage her to consider taking steps to better protect herself from further abuse.
5) Ask specific questions to gather details regarding the most recent battering incident and carefully document the information, including evidence of physical injuries.
6) Assess the batterer for substance abuse and dependence
7) The batterer is likely to focus on what his partner did to deserve the abuse. if so, confront his rationalization by emphasizing that, no matter what his partner did, his violent response had severe consequences.
Causes of Elder abuse
1) caregiver stress
2) caregiver impairment
Assessment issues with elderly abuse
- use sustainment procedures to alleviate anxiety, guilt, and tension
- focus on what has been said and what is directly observable
- use open-ended questions
- pay attention to non verbal signs of anxiety, hostility, withdrawal, etc.
- maintain a neutral attitude
- avoid condoning abusive behaviors
- clarify events that precipitated most recent crisis
- advocate specific action and mobilize support systems for the family
- obtain medical attention for the abused or neglected elder if necessary
