1. Child Abuse & Neglect KRISTEN HORN

2. What is child abuse?  Child abuse is any mistreatment of a child that results in harm or injury.  There are four types of child abuse: physical, sexual, emotional, and neglect.

3. Child Abuse as defined by the Family Code  Sec. 261.001. DEFINITIONS. In this chapter:  (1) "Abuse" includes the following acts or omissions by a person:  (A) mental or emotional injury to a child that results in an observable and material impairment in the child's growth, development, or psychological functioning;  (B) causing or permitting the child to be in a situation in which the child sustains a mental or emotional injury that results in an observable and material impairment in the child's growth, development, or psychological functioning;  (C) physical injury that results in substantial harm to the child, or the genuine threat of substantial harm from physical injury to the child, including an injury that is at variance with the history or explanation given and excluding an accident or reasonable discipline by a parent, guardian, or managing or possessory conservator that does not expose the child to a substantial risk of harm;  (D) failure to make a reasonable effort to prevent an action by another person that results in physical injury that results in substantial harm to the child;

4. Family Code cont.  (E) sexual conduct harmful to a child's mental, emotional, or physical welfare, including conduct that constitutes the offense of continuous sexual abuse of young child or children under Section 21.02, Penal Code, indecency with a child under Section 21.11, Penal Code, sexual assault under Section 22.011, Penal Code, or aggravated sexual assault under Section 22.021, Penal Code;  (F) failure to make a reasonable effort to prevent sexual conduct harmful to a child;  (G) compelling or encouraging the child to engage in sexual conduct as defined by Section 43.01, Penal Code, including conduct that constitutes an offense of trafficking of persons under Section 20A.02(a)(7) or (8), Penal Code, prostitution under Section 43.02(a)(2), Penal Code, or compelling prostitution under Section 43.05(a)(2), Penal Code;  (H) causing, permitting, encouraging, engaging in, or allowing the photographing, filming, or depicting of the child if the person knew or should have known that the resulting photograph, film, or depiction of the child is obscene as defined by Section 43.21, Penal Code, or pornographic;  (I) the current use by a person of a controlled substance as defined by Chapter 481, Health and Safety Code, in a manner or to the extent that the use results in physical, mental, or emotional injury to a child;  (J) causing, expressly permitting, or encouraging a child to use a controlled substance as defined by Chapter 481, Health and Safety Code;

5. Family Code cont.  (K) causing, permitting, encouraging, engaging in, or allowing a sexual performance by a child as defined by Section 43.25, Penal Code; or  (L) knowingly causing, permitting, encouraging, engaging in, or allowing a child to be trafficked in a manner punishable as an offense under Section 20A.02(a)(5), (6), (7), or (8), Penal Code, or the failure to make a reasonable effort to prevent a child from being trafficked in a manner punishable as an offense under any of those sections.  (2) "Department" means the Department of Family and Protective Services.  (3) "Designated agency" means the agency designated by the court as responsible for the protection of children.

6. Family Code cont.  (4) "Neglect" includes:  (A) the leaving of a child in a situation where the child would be exposed to a substantial risk of physical or mental harm, without arranging for necessary care for the child, and the demonstration of an intent not to return by a parent, guardian, or managing or possessory conservator of the child;  (B) the following acts or omissions by a person:  (i) placing a child in or failing to remove a child from a situation that a reasonable person would realize requires judgment or actions beyond the child's level of maturity, physical condition, or mental abilities and that results in bodily injury or a substantial risk of immediate harm to the child;  (ii) failing to seek, obtain, or follow through with medical care for a child, with the failure resulting in or presenting a substantial risk of death, disfigurement, or bodily injury or with the failure resulting in an observable and material impairment to the growth, development, or functioning of the child;  (iii) the failure to provide a child with food, clothing, or shelter necessary to sustain the life or health of the child, excluding failure caused primarily by financial inability unless relief services had been offered and refused;  (iv) placing a child in or failing to remove the child from a situation in which the child would be exposed to a substantial risk of sexual conduct harmful to the child; or  (v) placing a child in or failing to remove the child from a situation in which the child would be exposed to acts or omissions that constitute abuse under Subdivision (1)(E), (F), (G), (H), or (K) committed against another child; or

7. Reporting of abuse or neglect  REPORT OF ABUSE OR NEGLECT  Sec. 261.101. PERSONS REQUIRED TO REPORT; TIME TO REPORT. (a) A person having cause to believe that a child's physical or mental health or welfare has been adversely affected by abuse or neglect by any person shall immediately make a report as provided by this subchapter.  (b) If a professional has cause to believe that a child has been abused or neglected or may be abused or neglected, or that a child is a victim of an offense under Section 21.11, Penal Code, and the professional has cause to believe that the child has been abused as defined by Section 261.001 or 261.401, the professional shall make a report not later than the 48th hour after the hour the professional first suspects that the child has been or may be abused or neglected or is a victim of an offense under Section 21.11, Penal Code. A professional may not delegate to or rely on another person to make the report. In this subsection, "professional" means an individual who is licensed or certified by the state or who is an employee of a facility licensed, certified, or operated by the state and who, in the normal course of official duties or duties for which a license or certification is required, has direct contact with children. The term includes teachers, nurses, doctors, day-care employees, employees of a clinic or health care facility that provides reproductive services, juvenile probation officers, and juvenile detention or correctional officers.  (c) The requirement to report under this section applies without exception to an individual whose personal communications may otherwise be privileged, including an attorney, a member of the clergy, a medical practitioner, a social worker, a mental health professional, and an employee of a clinic or health care facility that provides reproductive services.  (d) Unless waived in writing by the person making the report, the identity of an individual making a report under this chapter is confidential and may be disclosed only:  (1) as provided by Section 261.201; or  (2) to a law enforcement officer for the purposes of conducting a criminal investigation of the report.

8.  Sec. 261.111. REFUSAL OF PSYCHIATRIC OR PSYCHOLOGICAL TREATMENT OF CHILD. (a) In this section, "psychotropic drug" means a substance that is:  (1) used in the diagnosis, treatment, or prevention of a disease or as a component of a medication; and  (2) intended to have an altering effect on perception, emotion, or behavior.  (b) The refusal of a parent, guardian, or managing or possessory conservator of a child to administer or consent to the administration of a psychotropic drug to the child, or to consent to any other psychiatric or psychological treatment of the child, does not by itself constitute neglect of the child unless the refusal to consent:  (1) presents a substantial risk of death, disfigurement, or bodily injury to the child; or  (2) has resulted in an observable and material impairment to the growth, development, or functioning of the child.

9. Signs of abuse  Abused children might seem:  Nervous around adults or afraid of certain adults.  Reluctant to go home (coming to school early or staying late, for example).  Very passive and withdrawn or aggressive and disruptive.  Tired a lot, or they might complain of nightmares or not sleeping well.  Fearful and anxious.

10. Signs of Neglect Missing school a lot.  Begging for food, stealing food, or stealing money for food.  Lacking needed medical or dental care.  Being frequently dirty.  Using alcohol or other drugs.  Saying there is no one at home to take care of them.

11. Signs of Physical Abuse  Frequent injuries such as bruises, cuts, black eyes, or burns  Frequent complaints of pain without obvious injury  Burns or bruises in unusual patterns that may indicate the use of an instrument or human bite; cigarette burns on any part of the body  Lack of reaction to pain  Aggressive, disruptive, and destructive behavior  Passive, withdrawn, and emotionless behavior  Fear of going home or seeing parents  Injuries that appear after a child has not been seen for several days  Unreasonable clothing that may hide injuries to arms or legs

12. Signs of Sexual Abuse  Physical signs of sexually transmitted diseases  Evidence of injury to the genital area  Pregnancy in a young girl  Difficulty in sitting or walking  Extreme fear of being alone with adults of a certain sex  Sexual comments, behaviors or play  Knowledge of sexual relations beyond what is expected for a child’s age  Sexual victimization of other children

13. Signs of Emotional abuse  Over compliance  Low self-esteem  Severe depression, anxiety, or aggression  Difficulty making friends or doing things with other children  Lagging in physical, emotional, and intellectual development  Caregiver who belittles the child, withholds love, and seems unconcerned about the child’s problems

14. Signs of Neglect  Obvious malnourishment  Lack of personal cleanliness  Torn or dirty clothing  Stealing or begging for food  Child unattended for long periods of time  Need for glasses, dental care, or other medical attention  Frequent tardiness or absence from school

15.  Statistics FY 2009  Texas State Child Population 6,510,210  Children, Alleged Victims 283,922  Children in Confirmed Investigations 100,762  Children Removed 12,107

16.  Statistics FY 2010  Texas State Child Population 6,584,709  Children, Alleged Victims 288,080  Children in Confirmed Investigations 97,890  Children Removed 16,347

17.  Statistics FY 2011  Texas State Child Population 6,663,942  Children, Alleged Victims 297,971  Children in Confirmed Investigations 98,435  Children Removed 17,108

18.  Statistics FY 2012  Texas State Child Population 7,054,634  Children, Alleged Victims 275,961  Children in Confirmed Investigations 97,688  Children Removed 16,972

19. Secondary Traumatic Stress  Secondary traumatic stress is more commonly known as compassion fatigue.  refers to the experience of people, usually professionals, who are exposed to others’ traumatic stories and as a result can develop their own traumatic symptoms and reactions.

20.  Eric Gentry, Ph.D. researched and outlines 5 phases of compassion fatigue. He teaches professionals how to identify the symptoms and to help take care of oneself who may suffer from compassion fatigue.

21. Phases of Compassion Fatigue  Zealot Phase A. Motivated by idealism B. Ready to serve & problem solve C. Desires to contribute & make a difference D. Volunteers to help & assist E. Full of energy & enthusiasm

22. Phases of Compassion Fatigue cont.  Irritability Phase A. Cuts corners B. Avoid client contact C. Mock peers & clients D. Underestimate own efforts at wellness E. Lose concentration & focus F. Distance oneself from others

23. Phases of Compassion Fatigue cont.  Withdrawal Phase A. Loses patience with clients B. Becomes defensive C. Neglects self & others D. Chronically fatigued E. Loses hope F. Views oneself as a victim & isolates oneself

24. Phases of Compassion Fatigue cont.  Zombie Phase A. Views others as ignorant or incompetent B. Loses, patience, sense of humor & zest for life C. Dislikes others D. Becomes easily enraged

25. Phases of Compassion Fatigue cont.  Pathology & Victimization or Maturation & Renewal Choice Phase A. P & V choice usually results when no action is taken and the worker becomes overwhelmed, considers leaving or leaves the profession and/or develops somatic illness. B. M & R choice is only possible when the worker acknowledges the symptoms of compassion fatigue & takes direct action to overcome it which will make them strong, resilient and transformed.

26. Risks of compassion fatigue  Diminished job performance  Increased tardiness & absenteeism  Declining physical health  poor morale  low energy  stressed personal relationships  Increased substance abuse  Depression  Irritability

27. What is your risk?

28. References  http://www.childwelfare.gov http://www.childwelfare.gov  http://www.dfps.state.tx.us http://www.dfps.state.tx.us  http://www.helpandhope.org/recognizing-abuse-neglect.html http://www.helpandhope.org/recognizing-abuse-neglect.html  http://www.statutes.legis.state.tx.us/Docs/FA/htm/FA.261.htm http://www.statutes.legis.state.tx.us/Docs/FA/htm/FA.261.htm  http://www.chinstreetcounseling.com  Lookabill, Debra C., Burn Out or Compassion Fatigue Syndrome, retrieved from aphsa.org.  Compassion Fatigue Prevention and Resiliency: Fitness for the Frontline; Training Manual by Eric Gentry Ph.D., and Anna Baranowsky, Ph.D.: A continuing education training.  Compassion Fatigue Self Test was obtained from: Florida State University Psychosocial Stress Research Program. http://www.ptsdsupport.net