2. The Role of School Nurses in Preventing and Responding to Child Abuse and Neglect

3. Our Mission Lead Mississippi in protecting children and youth from abuse, neglect, and exploitation by providing services to promote safe and stable families

4. Our Vision Children will grow up in families safe from harm, without fear of constant disruption, and that they have the opportunity to experience continuity of relationships. Children will have stability and a sense of belonging. No child under our “watch” continues to experiences abuse or neglect. That families will change for the better as a result of our intervention

5. OLIVIA Y May 2007 a class action lawsuit was filed. Lawsuit approved by the court in January 2008. Officially Olivia Y. vs. Barbour. Settlement agreement requires MDHS change its practice of child welfare in significant ways.

6. The Mississippi Child Welfare Practice Model Components Mobilizing Appropriate Services Timely I Safety Assurance and Risk Management S Involving Children and Families in Case Activities and Decision Making S Strengths and Needs Assessments of Children and Families I Preserving and Maintaining Connections P Individualized and Timely Case Planning

7. What Does All This Have To Do With You? Every 10 Seconds a child is abused in the United States Last year in Mississippi 21,582 reports of child abuse and neglect were investigated. 52% Identifications of abuse and neglect children were reported by educators

9. Why are you so vital ? 1. Close and consistent contact with children. 2.Professional and legal mandated responsibility for reporting suspected maltreatment. 3.Unique opportunity to advocate for children.

10. Concrete Angel

11. Objectives To identify the types of child abuse & neglect To recognize the various indicators of child abuse & neglect To understand the lifelong effects of child maltreatment To discuss the process of reporting abuse or neglect

12. Risk Factors for Child Abuse & Neglect Stress and lack of support Financial trouble Social isolation Marital problems Lack of parenting skills Physical/Mental Illness Abuse of drugs/alcohol History of being abused Unwanted pregnancy Low self-esteem Poor emotional control

13. Types of Child Abuse & Neglect Physical Abuse Sexual Abuse Emotional/Psychological Maltreatment Physical Neglect Medical Neglect

14. What is Physical Abuse? Any type of intentional contact that results in bodily harm such as bruising, abrasions, broken bones, internal injuries, burns, missing teeth, and skeletal injuries

15. Examples of Physical Abuse Hitting a child with a hand or object (extension cords, belts, broom handles) Shaking a child Yanking a child by the arm Twisting a child’s arms or legs Putting a child into hot water Putting tape over a child’s mouth Tying up a child with rope or a cord Throwing a child across a room or down stairs

16. Physical Indicators of Physical Abuse - Bruises - Burns - Bite marks - Broken bones - Joint dislocations - Black eyes - Missing hair or teeth - Welts, scrapes, or cuts

19. Behavioral Indicators of Physical Abuse -Extreme aggressiveness -Passivity (overly compliant), -Developmental delay, -Self-destructive behavior (self-injury) -Fearful of caregivers, does not want to go home -Depression or withdrawal

20. Perpetrator Characteristics Offers conflicting, unconvincing, or no explanation for a child’s injuries Tries to hide the child’s injuries (by the use of clothing or isolating the child) Describes the child in negative terms such as “evil”, “difficult”, or “bad” Has a history of being abused

21. What is Sexual Abuse? Sexual abuse includes obscene or pornographic photographing, filming, or depiction of children for commercial purposes; or the rape, molestation, incest, prostitution, or other such forms of sexual exploitation of children under circumstances which indicate that the child’s health or welfare is harmed or threatened.

22. What is Sexual Abuse? MDHS Guidelines – Sexual molestation or exploitation includes: - Rape - Oral-genital contact - Vaginal or anal manipulation or penetration - Harassing, invasive, or coercive verbal or visual suggestions/stimulation - Indecent exposure - Use of a child in pornography - Encouragement or permission for the child to engage in prostitution - Proposal of sexual intercourse

23. Physical Indicators of Sexual Abuse - Difficulty in walking or sitting - Pain or itching in the genital area - Bruises or bleeding in external genital area - Torn, stained, or bloody underwear - Presence of sexually transmitted diseases - Frequent urinary or yeast infections - Difficulty urinating

24. Behavioral Indicators of Sexual Abuse - Withdrawn - Depression - Role reversal - Overly concerned with the safety of siblings - Inappropriate sex play Threatened by physical contact/closeness - Nightmares/sleep disturbances - Nervous, aggressive, hostile behavior - Regression (enuresis, thumb sucking, etc.) - Emotional detachment - Poor self-esteem

25. Behavioral Indicators of Sexual Abuse (cont’d.) - Change in friends/poor peer relationships - Changes in school performance - Inability to concentrate - Lack of emotional control - Weight changes, presence of eating disorders - Running away - Suicide attempts - Alcohol/drug abuse

26. Perpetrator Characteristics Secretive and isolated Jealous or controlling with family members Unduly protective of the child or severely limits the child’s contact with other children or adults, especially of the opposite sex Overly friendly to the child, especially overindulging the child with gifts Spends excessive time alone with the child

27. What is Emotional/Psychological Maltreatment? Emotional/Psychological Abuse: Any acts and/or threatening statements made/allowed, which result in a substantial impairment, or a threatened impairment of intellectual, psychological or emotional well-being and functioning of a child

28. What is Emotional/Psychological Maltreatment? Emotional/Psychological Neglect: Failure, on a periodic or continuing basis, regardless of cause, to provide adequate nurture to meet the child’s mental needs which results in a substantial impairment of intellectual, psychological or emotional well-being and functioning of the child.

29. Emotional Abuse

30. Behavioral Indicators of Emotional/Psychological Abuse - Feeding or sleeping problems - Rocking/nervous habits - Enuresis (bed-wetting) - Poor school performance - Stuttering - Unrealistic fears - Apathy/Lethargy - Depression - Defiance, property destruction - Violence - Substance Abuse - Low self-esteem - Poor relationships with peers

31. Behavioral Indicators of Emotional/Psychological Neglect - Feeding or sleeping problems - Failure to thrive - Rocking/Nervous habits - Enuresis (bed-wetting) - Low self-esteem - Excessive masturbation - Functional/Social impairment - Apathy/Depression - Substance abuse - Excessive or age- inappropriate fears - Inability to trust or form relationships - Acting out behaviors for attention (biting, stealing, etc.) - Self-mutilation, suicide attempts - Difficulty concentrating or confusion - Poor school performance

32. Emotional Neglect

33. Perpetrator Characteristics Emotional/Psychological Abuse - Constantly blames and ridicules the child - Excessive guilt placed on the child - Hostile or violent behavior - Bizarre discipline techniques - Harms pets or animals

34. Perpetrator Characteristics Emotional/Psychological Neglect - Ignores the child - Does not spend time with the child - Provides no affection to child - No concern for the child as a person - Little/no communication with child

35. What is Neglect? Failure to meet the basic needs of a child The most common form of child maltreatment

36. What is Neglect? Types of Neglect: - Medical neglect - Lack of supervision - Inadequate shelter - Inadequate nutrition - Inadequate clothing - Lack of attention, concern, support - Lack of adequate education - Abandonment - Lack of accommodation for a Special Needs Child

37. Perpetrator Characteristics Abuses drugs or alcohol Appears to be indifferent to the child Behaves irrationally or in a bizarre manner Filthy and unsanitary home Lack of food in the home Disregard for the child’s safety (leaving the child unattended or unsupervised) Refusing or delaying necessary medical/dental care for the child

38. Long Term Effects of Child Abuse & Neglect Shaken Baby Syndrome (blindness, learning disabilities, cerebral palsy, paralysis) Impaired brain development Lifelong poor physical health Depression and anxiety Low self-esteem Difficulty in interpersonal relationships Substance abuse Delinquency Eating disorders

39. Who is Mandated to Report Child Abuse & Neglect? In accordance with Section 43-21-353 of the MS Code of 1972 Annotated, “Any attorney, physician, dentist, intern, resident, nurse, psychologist, social worker, family protection specialist, child caregiver, minister, law enforcement officer, public or private school employee, or ANY OTHER PERSON having reasonable cause to suspect that a child is being abused or neglected…”

40. I Suspect Child Abuse or Neglect. What Do I Do? Watch for indicators mentioned earlier Be approachable for the child Don’t interrogate the child Be a good listener Don’t overreact Reassure the child that he/she is not at fault Write down as much information as possible and make a report

41. What Information Do I Report? Time, date, location, and who was present when the incident took place. Gather specific identifying information about witnesses. Location of child at the time of report. Information about other children living in the household Native American tribal affiliation

42. What Information Do I Report? Name of the person(s) who is allegedly responsible for the abuse or neglect Current location of the alleged perpetrator Perpetrator’s relationship to the child * You don’t need to know all of the above information to make a report. The important thing is to make the report as soon as possible.

43. How Do I Make A Report? Mississippi Centralized Intake 1-800-222-8000 Or www.msabusehotline.mdhs.ms.gov

46. Video