1. Effects of Sexual Abuse Across the Span

2. Child Who Are Sexually Abused Earlier onset of puberty Depression PTSD Increased rates of obesity Abuse alcohol and drugs Report more medical visits, more major illnesses and hospitalizations Engage in risky sexual behaviors in adolescence Lack of birth control More likely to become teen mothers Place their children at increased risk

3. Child Who Are Sexually Abused Children who have been sexually abused are more likely to experience other forms of abuse, such as physical abuse, emotional abuse and neglect. They are also tended to experience more severe victimizations.

4. Adults Who Experienced Childhood Abuse and Neglect Autoimmune disorders Arthritis Lung Disease Obesity Migraines & Frequent Headaches Hypertension GI Disorders Ulcers Type 2 Diabetes Liver Disease Chronic Pain

5. Adults Who Experienced Childhood Abuse and Neglect Depression Anxiety PTSD Suicide attempts Sleep disorders Panic Disorders Phobias

6. Adults Who Experienced Childhood Abuse and Neglect Alcohol related problems Drug use Eating disorders Poor pre- and post-natal care Anti-social behaviors Sexual risk behaviors Daily cigarette smoking Self-mutilation

7. Adults Who Experienced Childhood Abuse and Neglect Less educational achievement More likely to drop of college Earn less money over their lifespan ~ $5,000 per year More likely to utilize public aid Women who had a history of child sexual abuse were almost twice as likely to be re-victimized sexually and physically as adults

8. Activity!

9. SHIFT HAPPENS!!

10. What if you only knew… Rebecca is a 15 year old female. She has been arrested for possession of pot. She has a long history of skipping school and running away from home. She has failed 9 th grade and is repeating it. She is sexually active. She claims she was raped by a 17 year old classmate at the movie theatre.

11. What are the facts?

12. What are some ideas of what is going on?

13. What do we need to know more about?

14. Where can we get that information?

15. Case Review A formal process in which multidisciplinary discussion and information sharing regarding the investigation, case status, and services needed by the child and family is to occur on a routine basis.

16. Case Review Spirit of the Standard It is intended to monitor current cases and is not meant as a retrospective case study. This is a formal process by which knowledge, experience and expertise of the MDT members is shared so that informed decisions can be made, collaborative efforts are nurtured, formal and informal communication is promoted, mutual support is provided, and protocols/procedures are reviewed.

17. Case Review Process Active cases are discussed All team members actively participate Case Review must occur on a regularly scheduled basis – minimum monthly.

18. Discussions that include: Type and nature of abuse/allegations; Presence of other problems: domestic violence, substance abuse, etc. Developmental, disability, emotional or cultural issues that may be present; Family’s reactions and response to the child’s disclosure and involvement in the criminal justice/child protection systems;

19. Discussions that include: Interview outcomes; Discuss Plan & Monitor the Progress of the investigation; Child protection concerns/safety concerns, Coordinating interventions Emotional support needs of the child and non-offending family members and strategies for meeting those needs; Medical findings;

20. Discussions that include: Treatment needs of the child and non-offending family members and strategies for meeting those needs; Provide input for prosecution and sentencing decisions Provisions for court education and court support Agency dispositions, including a review of criminal and civil (dependency) case dispositions;

21. Discussions should include Case Review should be a forum where complex issues can be raised and discussed which could include: Research Theories Service gaps Parenting styles-child rearing Gender roles Religious beliefs Socioeconomics

22. Discussions that include: Updates and Follow-up recommendations for implementation liaison to absent members Sharing information learned at trainings Protocols and procedures are reviewed