Kk&s Ch.55 Child Special Areas

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A recent study collected data from the US Department of Justice censuses of all public and private juvenile justice facilities in the United States: The Juvenile Residential Facilities Census (JRFC) and the Census of Juveniles in Residential Placement (CJRP) investigated data on death rates of youth under the age of 21 years who had been charged with, or adjudicated for, an offense and are housed in that facility because of the offense. In the 2-year period covered by the 2000 and 2002 statistics, a total of 62 deaths of youth occurred. The leading cause of death was from

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from suicide (20 cases), followed by accidents (17 cases), illness (14 cases), and homicides by nonresidents (6 cases).

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Key factor leading to foster placement of child?

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parental substance abuse

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which substance most linked to maltreated infants?

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In one California study, 89 percent of maltreated infants tested positive for drugs at birth—cocaine being the drug identified in 85 percent of those who were positive for drug use.

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Children entering foster care have enormous mental health needs; more than ? percent of them have developmental, emotional, or behavioral problems

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80%

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Where do kids tend to do better: orphanages or foster care?

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foster care

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Risk factors for interuption of adoptive care?

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Four factors contributed independently to the risk of disruptions: older age at placement, report of being singled out and rejected by siblings, time in care, and greater degree of behavioral problems.

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The most common forms of maltreatment reported were
2nd?

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being left home alone as a child, indicating potential supervision neglect
2nd physical assault
then physical neglect
then sexual abuse (4.5%)

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DSM codes of abuse?

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physical abuse of child, sexual abuse of child, and neglect of child

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Emotional or psychological abuse occurs when a person conveys to children that they are

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worthless, flawed, unloved, unwanted, or endangered

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Which age group most likely to be abused?

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0 to 3

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Perpetrators of abuse: > male or female?

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female 58%
male 42%

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predictors of physical abuse?

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poverty
psychosocial stress

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Sx suggesstive of physical abuse?

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fearful
distrustful
guarded
aggressive
hypervigilant

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anxiety symptoms, dissociative reactions and hysterical symptoms, depression, disturbances in sexual behaviors, and somatic complaints

Consider what dx?

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sexual abuse

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Some sexual behaviors are particularly suggestive of abuse, such as

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masturbating with an object,
imitating intercourse, and
inserting objects into the vagina or anus
A younger child may manifest age-inappropriate sexual knowledge.

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showing genitals to other children and touching the genitals of others
specific to sexual abuse ?

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less specific

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the following factors tend to be associated with more severe symptoms in the victims of sexual abuse

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greater frequency and duration of abuse, sexual abuse that involved force or penetration
sexual abuse perpetrated by the child's father or stepfather
child's perception of being less believed, family dysfunction, and lack of maternal support. Also, multiple investigatory interviews appear to increase symptoms.

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Sexual abuse that occurs over a period of time evolves through five phases: (put in order)

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engagement, sexual interaction, secrecy, disclosure, and suppression.

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The perpetrator induces the child into a special relationship. The daughter in father–daughter incest has frequently had a close relationship with her father throughout her childhood and may be pleased at first when he approaches her sexually.

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Engagement phase

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The sexual behaviors progress from less to more intrusive forms of abuse. As the behavior continues, the abused daughter becomes confused and frightened, because she never knows whether her father will be parental or sexual. If the victim tells her mother about the abuse, the mother may not be supportive. The mother often refuses to believe her daughter's reports or refuses to confront her husband with her suspicions. Because the father provides special attention to a particular daughter, her brothers and sisters may distance themselves from her.

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Sexual Interaction Phase

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The perpetrator threatens the victim not to tell. The father, fearful that his daughter may expose their relationship and often jealously possessive of her, interferes with the girl's development of normal peer relationships.

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Secrecy Phase

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The abuse is discovered accidentally (when another person walks in the room and sees it), through the child's reporting it to a responsible adult, or when the child is brought for medical attention and an alert clinician asks the right questions.

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Disclosure Phase

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The child often retracts the statements of the disclosure because of family pressure or because of the child's own mental processes. That is, the child may perceive that violent or intrusive attention is synonymous with interest or affection. Many incest survivors rally around their perpetrators, seeking to capture any modicum of tenderness or interest. At times, affection for the perpetrator outweighs the facts of abuse, and children recant their statements about sexual assault, regardless of substantiated evidence of molestation.

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Supression Phase

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Suvivors of sexual abuse:
EEG
MRI (2)

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EEG: limbic irritability
MRI: small hippocampus, especially left
Corpus callosum smaller=poor left-right brain communication

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Studies have shown that four factors were most consistently identified as predictors of future maltreatment:

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1. number of previous episodes of maltreatment;
2. neglect as the form of maltreatment;
3. parental conflict; and
4. parental psychiatric illness.

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Response to terrorism?

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Re-establish sense of safety
Reestablish Usual Routines
Enhance resilience: safety planning, security planning