The Dynamics of Abuse and Neglect on Family and Children Module 5 The Dynamics of Abuse and Neglect on Family and Children 5.0.1

Learning Objectives 5.0.2

Agenda 5.0.3 Substances and their Effects Why People Use Drugs Risk and Protective Factors Spectrum of Addiction- Use & Abuse Characteristics of a Disease. Criteria for Substance Abuse & Dependence Implications for Child Welfare and Examples of Risks to Children B. Substance Abuse and the User Physical and Psychological Effects Brain Chemistry of Addiction Prescription Drugs Effect on Parenting C. Substance Abuse and the Family Impact on the Child Family Disease Family Roles

The Dynamics of Substance Abuse Unit 5.1 The Dynamics of Substance Abuse 5.1.4

Learning Objectives 5.1.5

Prevalence of Substance Use Disorders Substance Dependence or Abuse, 2004 15.2 million Millions 3.9 million 3.4 million 5.1.6

Children Living with Substance Dependent or Substance Abusing Parents 5.1.7 Source 2002-2007 SAMHSA National Surveys on Drug Use and Health (NSDUH)

Substances and their Effects Why People use Drugs The Spectrum of Addiction Physical and Psychological Effects of Substance Use 5.1.8

Why People Use Alcohol and Drugs Behavioral Social Environmental Risk vs. Protective Biological Risk and Protective Unique Combinations 5.1.9

Risk Factors vs. Protective Factors Child School and Peer Parenting Contextual and Family Community 5.1.10

Spectrum of Addiction Experiment 5.1.11 Use Abuse Dependence

Addiction A disease Progressive Potentially fatal Incurable 5.1.12

Personal-Professional Dimensions of Substance Use Views and experiences Your viewpoint affects others Unique Discuss your issues 5.1.13

Criteria for Substance Dependence Tolerance Withdrawal Longer period Desire or unsuccessful efforts Excessive time spent Giving up or reducing Despite 5.1.14

Effects of Substance Abuse on the User Physical and Psychological Effects Brain Chemistry of Addiction Prescription Drugs Ability to Parent 5.1.15

Physical and Psychological Effects of Substance Use http://fadaa.org/resource_center/just_the_facts/PSYCHO1.pdf Alcohol Methamphetamine Cocaine Hallucinogens Marijuana 5.1.16 http://www.fadaa.org/resource_center/justFacts.php

Prescription Drug Abuse “The use of a prescription medication in a way not intended by the prescribing doctor. Prescription drug abuse includes everything from taking a friend's prescription painkiller for your backache to snorting ground-up pills to get high.” -The Mayo Clinic (2011) 5.1.17

Florida10 Year Trend Upward in Prescription Drug Abuse 40 % 35 % 30 % 25 % 20 % 15 % 10 % 00 % Alcohol Marijuana Crack/Cocaine Heroin Other Opiates Meth Prescription Other Drugs % of Total Admissions 5.1.18 FY 01-02 FY 02-03 FY 03-04 FY 04-05 FY 05-06 FY 06-07 FY 07-08 FY 08-09 FY 09-10 FY 10-11

Key Questions “How is the substance use affecting the parent’s ability to make sound judgments regarding the welfare of the child?” ”What behaviors are resulting or have resulted from the parent’s substance use that may put the child at risk?” 5.1.19

Different substances effect parenting differently 5.1.20

Effects of Prenatal Exposure Neurological and behavioral differences Cognitive and communication/language difficulties 5.1.21

Effects of Substance Use on the Family Impact on the Child Family Disease Family Roles 5.1.22

Substance Abuse Does Not Occur in a Bubble 5.1.23

Impact on the Child 5.1.24 When parents become preoccupied with drugs, or any other activity which dominates and monopolizes their time and energy, the children become emotional and sometimes physical cripples as a result of deprivation. Though the children are innocent they still become partners locked into this problem. Their coping skills become frustrated and their needs are invariably short-circuited. Such children carry these inappropriate adaptive behaviors with them into adulthood and create an inter-generational cycle of maladaptive coping techniques,‖ (Briggs, 1970). Briggs, D.C. (1970). Your child's self-esteem. New York: Doubleday.  At the same time that the ACE Study was being done, parallel research on kids’ brains found that toxic stress physically damages a child’s developing brain.  When children are overloaded with stress hormones, they’re in flight, fright or freeze mode. They can’t learn in school. They often have difficulty trusting adults or developing healthy relationships with peers (i.e., they become loners). To relieve their anxiety, depression, guilt, shame, and/or inability to focus, they turn to easily available biochemical solutions — nicotine, alcohol, marijuana, methamphetamine — or activities in which they can escape their problems — high-risk sports, proliferation of sex partners, and work/over-achievement. (e.g. Nicotine reduces anger, increases focus and relieves depression. Alcohol relieves stress.) ACE STUDY’ http://acestoohigh.com/got-your-ace-score/

The Substance Abuser’s Child May: Appear unkempt. Be frequently sleepy Be late to school Have unexplained bruises Know too much about drinking Appear withdrawn/depressed Display behavioral problems. Be frequently absent Complain of stomachaches.. 5.1.25

increasing stress levels arguing and hostility overall chaos Family Disease a constant strain unemployment. increasing stress levels arguing and hostility overall chaos anxiety, confusion, and conflict in the children 5.1.26

Communication in the Home Inconsistency and unpredictability Open and honest communication declines Silence and secrets prevail 5.1.27

Reassignment of Roles and Responsibilities Overburdened Re-assigned Responsibilities Increased Responsibilities Less Support 5.1.28

Family Roles in Substance Abusing Families Rescuer/Enabler Hero/Caretaker Adjuster/Lost Child Scapegoat/Rebel Mascots/Pleasers 5.1.29

Activity Family Sculpture 5.1.30

Substance Abuse and Family Violence 5.1.31

The Dynamics of Domestic Violence Unit 5.2 The Dynamics of Domestic Violence 5.2.32

Learning Objectives 5.2.33

What is Domestic Violence? 5.2.34

Activity Domestic Violence, According to Florida Statutes 5.2.35

The Cycle of Domestic Violence 5.2.36

The Dynamics of Domestic Violence and the Family 5.2.37

Who Is the Batterer? 5.2.38

Wheel of Power and Control 5.2.39

Domestic Violence, Child Abuse, and the Wheel of Child Abuse 5.2.40

The Likelihood that a Batterer Will Kill 5.2.41

If the Woman Is Able to Leave…& Your Responsibility Chapter 39 FS - Injunctions Florida Coalition Against Domestic Violence (FCADV) Toll-free number, 1-800-500-1119 Connect to the domestic violence center nearest you www.fcadv.org/centers for your local certified domestic violence center 5.2.42

What If She Cannot or Will Not Leave? 5.2.43

Activity Dynamics of Domestic Violence in the Andersen Family 5.2.44

Why It Matters 5.2.45

The Dynamics of Sexual Abuse Unit 5.3 The Dynamics of Sexual Abuse 5.3.46

Learning Objectives 5.3.47

Sexual Abuse – Other Child What is Sexual Abuse? Sexual Battery Sexual Molestation Sexual Exploitation Sexual Abuse – Other Child 5.3.48

Signs of Child Sexual Abuse in Family Dynamics 5.3.49

Five Phases of Sexual Abuse Engagement Sexual Interactions Secrecy Disclosure Suppression 5.3.50

Activity: Eve’s Family 5.3.51

Trauma-genic Dynamics of Child Sexual Abuse Traumatic Sexualization Stigmatization Betrayal Powerlessness Impact on Child 5.3.52

The Family Response to Disclosed Sexual Abuse 5.3.53

Recanting 5.3.54

The Dynamics of Mental Illness Unit 5.4 The Dynamics of Mental Illness 5.4.55

Learning Objectives 5.4.56

Mental Illness/Mental Disorder What’s in a Name? Mental Health Behavior Health Mental Illness/Mental Disorder 5.4.57 Key Points Mental Health: Is the state of emotional and psychological well-being. Behavior Health: focuses on the reciprocal relationship between the holistic view of human behavior and the well-being of the body as a whole entity. Mental Illness is the medical condition that disrupts a person's thinking, feeling, mood, ability to relate to others and daily functioning. Characteristics of a person with mental illness can include: Sustained and abnormal alterations in thinking, in mood, or in behavior. Disruptions and impairment in a person’s daily functioning.

What You Need to Know 5.4.58 Key Points: Children whose parents have mental health needs are at far greater risk of developing emotional and behavioral difficulties than children of parents who do not have mental health diagnoses

What We Do Know About Mental Illness Definition Impact of mental illness on individuals 5.4.59 Key Points Mental illness is associated with increased occurrence of chronic diseases such as cardiovascular disease, diabetes, obesity, asthma, epilepsy, and cancer. It is also associated with the following: Lower use of medical care. Reduced adherence to treatment therapies for chronic diseases. Higher risks of adverse health outcomes. The use of tobacco products. The abuse of alcohol. Co-occurring Disorder (Dual Diagnosis): 8.9 million in the United States 7.4 percent of individuals receive treatment for both conditions, and 55.8 percent receiving no treatment at all

Overview to Module Content 5.4.60

Anxiety Disorders 5.4.61 Key Points Anxiety disorders are among the most common mental disorders experienced by Americans. There are a wide variety of anxiety disorders, including post-traumatic stress disorder, obsessive-compulsive disorder, and specific phobias to name a few.

Post-Traumatic Stress Disorder (PTSD) Definition 5.4.62

Major Depressive Disorder Post-Partum Depression (PPD) Mood Disorders Bipolar Disorder Major Depressive Disorder Post-Partum Depression (PPD) 5.4.63

Bipolar Disorder 5.4.64

Major depressive disorder Post-partum depression 5.4.65

Post-Partum Depression 5.4.66

Schizophrenia 5.4.67

Dual Diagnosis Definition Prevalence Implications 5.4.68

Other Impacts on Children 5.4.69

Chapter 394 –Florida Mental Health Act Provisions Baker Act Chapter 394 –Florida Mental Health Act Provisions Involuntary Exam Criteria 5.4.70 Key Points The Baker Act is found in Florida Statutes Chapter 394, Part 1. It is also known as the Florida Mental Health Act.   The Baker Act provides legal procedures for mental health examination and treatment, including: Voluntary admission Involuntary examination Involuntary inpatient placement (IIP) Involuntary outpatient placement( IOP)

Activity: What Are Your Concerns as a Child Welfare Professional? 5.4.71

The Dynamics of Poverty Unit 5.5 The Dynamics of Poverty 5.5.72

Learning Objectives 5.5.73 Learning Objectives Define the terms “poverty,” “the culture of poverty,” conditions of poverty and “intergenerational poverty.” Describe the impact of poverty on families. Identify how children are impacted physically, emotionally and educationally from living in poverty. Describe how poverty impacts child development

5.5.74

Activity Could You Survive Poverty? 5.5.75

Definitions and Distinctions Poverty Conditions of Poverty Situational Poverty Generational Poverty 2014 the poverty line in the U.S. is $23,850 for a family of four. 5.5.76

Hard Times Generation https://www.youtube.com/watch?v=vK4PvcVAbes 5.5.77 https://www.youtube.com/watch?v=vK4PvcVAbes https://www.youtube.com/watch?v=vK4PvcVAbes

Impact of Poverty on Children? Florida’s Statistics Environmental Deprivation/Stress Relationship to Neglect Brain Development 5.5.78

What can you do to help the children and families you work with? 5.5.79

The Effects of Limited Cognitive Functioning on Family Dynamics Unit 5.6 The Effects of Limited Cognitive Functioning on Family Dynamics   5.6.80

Learning Objectives 5.6.81

Definitions and Distinctions Cognitive Disorder Limited Cognitive Functioning Intellectual Disability Cognitive Impairment Developmental Disability 5.6.82

Weschler Adult Intelligence Scale-IV (WAIS-IV) IQ Score Definition >130 Very Superior 120–129 Superior 110–119 High Average 90–109 Average 80–89 Low Average 70–79 Borderline 55–69 Mild Retardation 40–54 Moderate Retardation 25–39 Severe Retardation <24 Profound Retardation 5.6.83

What Causes Limited Cognitive Functioning? Genetic Conditions Prenatal Problems Problems at Birth Health Problems Post-birth problems Environmental Factors 5.6.84

Working with Individuals with Limited Cognitive Functioning 5.6.85

Intellectual disability is not mental illness 5.6.86

Do intellectual and developmental disabilities affect parenting ability? 5.6.87

Implications for children with limited cognitive functioning Cause Parental capacity Availability of services Age delay occurred Challenges 5.6.88