1. Introduction to Child Abuse and Its Impact on Children: A Workshop for Child Life Professionals Millicent Ongaco May 2008 EDU 596

2. Points to Discuss Define Child Abuse Define Child Abuse Effects of Violence on Children Effects of Violence on Children Warning Signs and Intervention Steps Warning Signs and Intervention Steps Coping Strategies and Children Coping Strategies and Children Role of Child Life Working with Child Abuse Survivors in the Hospital Role of Child Life Working with Child Abuse Survivors in the Hospital Self-care for Child Life Professionals Self-care for Child Life Professionals

3. Fact or Fiction? Exploring common thoughts on Child Abuse. Are they TRUE or FALSE?

4. Scenario 1 What are your initial reactions to James? What are your initial reactions to James? What issues jump out at you about James? What issues jump out at you about James? What is going on with James? What is going on with James?

5. What is Child Abuse? What is your definition? What is your definition? What are characteristics of child abuse? What are characteristics of child abuse?

6. Definition of Child Abuse The Federal Child Abuse Prevention and Treatment Act (CAPTA) (42 U.S.C.A. §5106g), as amended by the Keeping Children and Families Safe Act of 2003, defines child abuse and neglect as, at minimum: Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or Any recent act or failure to act on the part of a parent or caretaker 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. An act or failure to act which presents an imminent risk of serious harm.

7. Types of Child Abuse Physical Abuse Physical Abuse Emotional Abuse Emotional Abuse Neglect Neglect Sexual Abuse Sexual Abuse

8. Physical Abuse Any non-accidental injury to a child: Hitting Hitting Kicking Kicking Slapping Slapping Shaking Shaking Burning Burning Pinching Pinching Biting Biting Choking Choking Throwing Throwing Whipping Whipping Paddling Paddling

9. Emotional Abuse Any behavior that can impact a child’s mental health or social behavior. This also includes withholding affection that impairs a child’s emotional and social development. Yelling Yelling Name calling Name calling Shaming Shaming Negative comparisons to others Negative comparisons to others

10. Neglect Failure to provide for a child’s physical needs: Lack of supervision Lack of supervision Poor or lack of shelter Poor or lack of shelter Lack of food Lack of food Poor hygiene Poor hygiene Poor medical/dental care Poor medical/dental care Inadequate clothing for weather Inadequate clothing for weather Abandonment Abandonment Education Education

11. Sexual Abuse Any sexual act between adult and child Fondling Fondling Penetration Penetration Intercourse Intercourse Exploitation Exploitation Pornography Pornography Exhibitionism Exhibitionism Child prostitution Child prostitution Group sex Group sex Oral sex Oral sex Forced observation of sexual acts Forced observation of sexual acts

12. Pressures of Sharing Abuse Confusion Confusion Fear Fear Shame Shame Disbelief from others Disbelief from others Dissolution of family Dissolution of family

13. Statistics in the U.S. An estimated 906,000 children are victims of abuse & neglect every year. The rate of victimization is 12.3 children per 1,000 children An estimated 906,000 children are victims of abuse & neglect every year. The rate of victimization is 12.3 children per 1,000 children Children ages 0-3 are the most likely to experience abuse. About 1 in 50 U.S. infants are victims of nonfatal child abuse or neglect in a year, according to the first national study of the problem in that age group done by the Centers of Disease Control and Prevention along with The Federal Administration for Children and Families. Children ages 0-3 are the most likely to experience abuse. About 1 in 50 U.S. infants are victims of nonfatal child abuse or neglect in a year, according to the first national study of the problem in that age group done by the Centers of Disease Control and Prevention along with The Federal Administration for Children and Families.

14. Statistics in the U.S. continued… 1,500 children die every year from child abuse and neglect. That is just over 4 fatalities every day. 1,500 children die every year from child abuse and neglect. That is just over 4 fatalities every day. 79% of the children killed are younger than 4. 79% of the children killed are younger than 4. Child Welfare Information Gateway

15. Statistics in the U.S. continued… Child Welfare Information Gateway

16. “Jesse’s Story” What are some of your initial reactions to Jesse’s story? What are some of your initial reactions to Jesse’s story? What factors made Jesse’s family situation violent? What factors made Jesse’s family situation violent? How did his “combat violence with violence” solution impact his outlook? How did his “combat violence with violence” solution impact his outlook?

17. Break!

18. Warning Signs

19. Physical Signs of Abuse Unexplained burns, cuts, bruises, or welts in the shape of an object Unexplained burns, cuts, bruises, or welts in the shape of an object Bite marks Bite marks Anti-social behavior Anti-social behavior Problems in school Problems in school Fear of adults Fear of adults

20. Emotional Signs of Abuse Apathy Apathy Depression Depression Hostility or stress Hostility or stress Lack of concentration Lack of concentration Eating disorders Eating disorders

21. Signs of Neglect Unsuitable clothing for weather Unsuitable clothing for weather Dirty or unbathed Dirty or unbathed Extreme hunger Extreme hunger Apparent lack of supervision Apparent lack of supervision

22. Sexual Signs of Abuse Inappropriate interest or knowledge of sexual acts Inappropriate interest or knowledge of sexual acts Nightmares and bed wetting Nightmares and bed wetting Drastic changes in appetite Drastic changes in appetite Over compliance or excessive aggression Over compliance or excessive aggression Fear of a particular person or family member Fear of a particular person or family member

23. Intervention

24. How to Talk to a Child in the Case of Child Abuse DO… Believe the child Believe the child Do try to remain calm Do try to remain calm Do praise the child for telling Do praise the child for telling Do reassure the child Do reassure the child Do listen to the child Do listen to the child Do respect the child’s privacy Do respect the child’s privacy Do get help, be responsible Do get help, be responsible

25. How to Talk to a Child in the Case of Child Abuse continued… DON’T… Don’t panic or overreact Don’t panic or overreact Don’t blame the child Don’t blame the child

26. Coping Strategies in Children How child survivors cope: How child survivors cope: - Numbing emotions - Fantasizing - Physical avoidance - Drugs/alcohol - Becoming “parent” - Self infliction (cutting, suicidal, etc.) - Continuing cycle of violence

27. Long Term Effects 80% of young adults who had been abused met the diagnostic criteria for at least 1 psychiatric disorder at the age of 21 (including depression, anxiety, eating disorders, & post-traumatic stress disorder) 80% of young adults who had been abused met the diagnostic criteria for at least 1 psychiatric disorder at the age of 21 (including depression, anxiety, eating disorders, & post-traumatic stress disorder) Abused children are 25% more likely to experience teen pregnancy Abused children are 25% more likely to experience teen pregnancy Abused teens are 3 times less likely to practice safe sex, putting them at greater risk for STDs Abused teens are 3 times less likely to practice safe sex, putting them at greater risk for STDs National Clearinghouse on Child Abuse & Neglect Information. Long-term Consequences of Child Abuse & Neglect 2005

28. Long Term Effects continued… Nearly 2/3’s of the people in treatment for drug abuse reported being abused as children Nearly 2/3’s of the people in treatment for drug abuse reported being abused as children Children who experience child abuse & neglect are 59% more likely to be arrested as a juvenile, 28% more likely to be arrested as an adult, and 30% more likely to commit violent crime. Children who experience child abuse & neglect are 59% more likely to be arrested as a juvenile, 28% more likely to be arrested as an adult, and 30% more likely to commit violent crime. National Clearinghouse on Child Abuse & Neglect Information. Long-term Consequences of Child Abuse & Neglect 2005 and U.S. Department of Justice Reports

29. Child Life and Child Abuse Survivors

30. Importance of Identifying Child Abuse Hospital is a foreign environment Hospital is a foreign environment Re-traumatizing for child Re-traumatizing for child Abuse may not be identified Abuse may not be identified Confusion/fear regarding violent, traumatic, or abusive experiences Confusion/fear regarding violent, traumatic, or abusive experiences Education regarding abuse Education regarding abuse Healing opportunities and healthy coping Healing opportunities and healthy coping Work with multi-disciplinary team in the hospital Work with multi-disciplinary team in the hospital

31. Tools for Working with Child/Family Patient/family information Patient/family information First contact: First contact: - Safety - Security - Trust Assessing individual needs Assessing individual needs Speak with parents and siblings Speak with parents and siblings

32. Tools for Working with Child/Family continued… Be aware of underlying issues Be aware of underlying issues Safety of patient and family Safety of patient and family Hospital policies regarding reporting child abuse Hospital policies regarding reporting child abuse - Mandated reporting Multi-disciplinary team Multi-disciplinary team - Social Work (CPS) - Psychology consult Cultural sensitivity and awareness Cultural sensitivity and awareness

33. Support and Healing Identify feelings Identify feelings Promote self expression Promote self expression Educate patient about abuse Educate patient about abuse

34. Art Non-verbal self expression Non-verbal self expression Empowerment Empowerment Personal Personal Renewal Renewal Hope Hope Survival Survival

35. Music Self expression Self expression Empowerment Empowerment Anxiety/stress reduction Anxiety/stress reduction Self awareness Self awareness Social interaction Social interaction

36. Dance and Movement Self expression Self expression Self esteem Self esteem Empowerment Empowerment Identify emotions Identify emotions Creativity Creativity

37. Scenario 2 What are the underlying issues? What are the underlying issues? How would you address these issues? How would you address these issues? What activities should be used? What activities should be used?

38. Stressors for Child Life Professionals Working with Child Abuse Survivors Counter transference/ Counter transference/ General Psychological Distress Secondary Traumatic Stress or Compassion Fatigue Secondary Traumatic Stress or Compassion Fatigue Vicarious Traumatization Vicarious Traumatization

39. Ways to Relieve Stress and Find Support Seeking support from peers Seeking support from peers Talking with someone outside the situation Talking with someone outside the situation Speak with a clinician/therapist Speak with a clinician/therapist Create boundaries Create boundaries Creative arts Creative arts Spending time with family and friends Spending time with family and friends

40. Agent of Change “I, as a Child Life professional, strive to be an ‘Agent of Change’ in the movement against Child Abuse with patients in the hospital by…”

41. References Child Abuse and Neglect Fatalities: Statistics and Interventions. Child Welfare Child Abuse and Neglect Fatalities: Statistics and Interventions. Child Welfare Information Gateway. (2006). Retrieved on April 13, 2008 from http://www.childwelfare.gov/pubs/factsheets/fatality.cfm Jesse’s Story. DVD. Center For the Pacific Asian Family, Inc. Jesse’s Story. DVD. Center For the Pacific Asian Family, Inc. Introduction to Domestic Violence and Its Impact on Children: A Workshop for Child Introduction to Domestic Violence and Its Impact on Children: A Workshop for Child Care Providers. Training Curriculum by Center For the Pacific Asian Family, Inc. Myths and Realities of Child Abuse. Stop Child Abuse. Retrieved April 12, 2008 from http://www.stopchildabuse.com.au/about/myths.asp Myths and Realities of Child Abuse. Stop Child Abuse. Retrieved April 12, 2008 from http://www.stopchildabuse.com.au/about/myths.asphttp://www.stopchildabuse.com.au/about/myths.asp National Child Abuse Statistics. Child Help. Retrieved April 13, 2008 from http://www.childhelp.org/resources/learning-center/statistics National Child Abuse Statistics. Child Help. Retrieved April 13, 2008 from http://www.childhelp.org/resources/learning-center/statistics http://www.childhelp.org/resources/learning-center/statistics Signs of Child Abuse. Child Help. Retrieved April 13, 2008 from http://www.childhelp.org/signs-of-child-abuse Signs of Child Abuse. Child Help. Retrieved April 13, 2008 from http://www.childhelp.org/signs-of-child-abuse http://www.childhelp.org/signs-of-child-abuse Webb, N.B., (2007). Play Therapy with Child in Crisis: Individual, Group, and Family Treatment (3rd ed.). New York, NY: Guilford Press. Webb, N.B., (2007). Play Therapy with Child in Crisis: Individual, Group, and Family Treatment (3rd ed.). New York, NY: Guilford Press. Images retrieved from www.google.com Images retrieved from www.google.comwww.google.com