Lifespan in Crisis

life stressors

• Acute or chronic

• More significant response when they occur out of sequence such as a child dies before a parent

• Stressors piling up

financical stressors

• Poverty

• Unemployment

• Housing

relationship issues

• divorce

• caregiving

life span issues

• Health Issues

• Death

• Grieving

drug stressors

• Substance Abuse

• Addiction

life-long developmental effects

• Stressors or trauma that occur early in life can have life-long developmental effects, physically and mentally that can manifest in a variety of ways

• Continuous or frequent response of the stress systems in the brain can lead to dysregulation and negative psychological and behavioral outcomes

psychological theories of violence

• Commonly related to need for power and control

• Bullying

personality traits and risk factors of violence

• Jealousy and possessiveness

• History of violence

• Depression/suicidal

• No current relationships or strong relationships

• Significant Criminal History, specifically violent criminal history

resource theory

Relates to women who are mostly dependent upon their partners

• Couples that share power equally experience lower incidences of conflict

social stress

related to social stressors that increase risk for violence, such as low SES and environment

social learning

Those abused as children are more likely to be violent themselves

alcohol and substance abuse

Those with substance use disorders are more likely to commit violent acts than those who do not

child abuse

any recent act or failure to act by a parent or caretaker that results in serious harm, imminent risk of harm, or sexual abuse of a child

• or an act or failure to act, which presents an imminent risk of serious harm

types of child abuse

Physical abuse

• is the intentional use of physical force that can result in physical injury.

• Examples include hitting, kicking, shaking, burning, or other shows of force against a child.

Sexual abuse

• involves pressuring or forcing a child to engage in sexual acts. It includes

• behaviors such as fondling, penetration, and exposing a child to other sexual activities.

Emotional abuse

• refers to behaviors that harm a child’s self-worth or emotional well-being. Examples include name-calling, shaming, rejecting, withholding love, and threatening.

Medical abuse.

• Medical child abuse occurs when someone gives false information about illness in a child that requires medical attention, putting the child at risk of injury and unnecessary medical care

Neglect

• is the failure to meet a child’s basic physical and emotional needs. These needs iinclude housing, food, clothing, education, access to medical care, and having feelings validated and appropriately responded to.

• Most common form

abuser facts

• 83.2% of perpetrators are between 18-44 years old

• 52% are female and 47.1% are male

• A majority of abusers are parents of the child (77.2%)

• Average response time from CPS in WV in 2020 was 309 hours (over 12 days). National average was 99.

• In WV, the average number of cases per CPS worker is 73 in 2020.

• In 2019 in WV, there were 3,495 CPS cases that were Backlogged - opened beyond 30 days but not resolved yet.

parental risk factors for abuse

• Caregivers with drug or alcohol issues

• Caregivers with mental health issues such as depression

• Caregivers not understanding children’s needs or development

• Caregivers who were abused or neglected themselves as children

• Young or single parents or parents with many children

• Low education or low income

• High levels of parenting stress or economic stress

• Caregivers who use spanking and other forms of corporal punishment

• Caregivers in the home who are not a biological parent

• Caregivers with attitudes accepting of or justifying violence or aggression

sociocultural risk factors for abuse

• Families that have household members in jail or prison

• Families that are isolated from community or other family

• Families experiencing other types of violence such as relationship violence

environmental risk factors for abuse

• Families with high conflict and negative communication styles

• Communities with high rates of violence and crime

• Limited educational and economic opportunities

• High unemployment rates

• Easy access to drugs and alcohol

• Low community involvement among residents

• Few community activities for young people

• Unstable housing and moving frequently

• Food insecurity

child risk factors for abuse

• Children younger than 4 years old

• Children with special needs that may increase caregiver burden

parental behavior

• Shows little concern for the child

• Appears unable to recognize physical or emotional distress in the child

• Blames the child for the problems

• Consistently belittles or berates the child, and describes the child with negative terms, such as "worthless" or "evil"

• Expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child

• Uses harsh physical discipline

• Demands an inappropriate level of physical or academic performance

• Severely limits the child's contact with others

• Offers conflicting or unconvincing explanations for a child's injuries or no explanation at all

physical abuse clues to diagnosis

• Child presents with significant injuries, but history of trauma is denied

• History given does not explain the injuries

• History of the injury changes over time

• History of self-inflicted trauma does not correlate with child’s developmental abilities

• There is an unexpected or unexplained delay in seeking medical care

• Injuries of various ages; multiple organ systems injured

• Injuries are pathognomonic for child abuse (posterior rib fractures, metaphyseal fractures/corner fractures)

behavioral signs of child abuse

• Withdrawal from friends or usual activities

• Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance

• Depression, anxiety or unusual fears, or a sudden loss of self-confidence

• An apparent lack of supervision

• Frequent absences from school

• Reluctance to leave school activities, as if he or she doesn't want to go home

• Attempts at running away

• Rebellious or defiant behavior

• Self-harm or attempts at suicide

emotional signs of child abuse

• Delayed or inappropriate emotional development

• Loss of self-confidence or self-esteem

• Social withdrawal or a loss of interest or enthusiasm

• Depression

• Avoidance of certain situations, such as refusing to go to school or ride the bus

• Desperately seeks affection

• A decrease in school performance or loss of interest in school

• Loss of previously acquired developmental skills

physical signs of child abuse

• Unexplained injuries, such as bruises, fractures, or burns

• Injuries that don’t match the given explanation

• Human hand marks/bite marks

• Failure to thrive

• Multiple injuries at different stages of healing

sexual signs of child abuse

• Sexual behavior or knowledge that's inappropriate for the child's age

• Pregnancy or a sexually transmitted infection

• Blood in the child's underwear

• Statements that he or she was sexually abused

• Inappropriate sexual contact with other children

brusing

- Accidental bruising: most often seen over bony prominences (shins, forearms, forehead)

- Inflicted (non-accidental) bruising:

• Seen centrally or in soft tissue regions (back, chest, abdomen, cheeks, inner thighs, buttocks, genital region, earlobes)

• May have unusual pattern (hand, bite, wire loop, cord, belt)

• Any bruising in a non-mobile infant

shaken baby syndrome

Abusive head trauma (AHT), which includes shaken baby syndrome, is a preventable and severe form of physical child abuse that results in an injury to the brain of a child.

• AHT often happens when a parent or caregiver becomes angry or frustrated because of a child’s crying. It is caused by violent shaking and/or with blunt impact.

• The resulting injury can cause bleeding around the brain or on the inside back layer of the eyes.

Data show:

• AHT is a leading cause of physical child abuse deaths in children under 5 in the United States.

• Babies less than one-year-old are at the greatest risk of injury from AHT.

• AHT accounts for about one-third of all child maltreatment deaths.

• Rib fractures (posterior and lateral) from squeezing

how to prevent AHT

• Be aware of new parents in your family and community who may need help or support.

• Offer to give a parent or caregiver a break when needed.

• Let the parent know that dealing with a crying baby can be very frustrating, but infant crying is normal, and it will get better.

• Encourage parents and caregivers to take a calming break if needed while the baby is safe in the crib.

• Be sensitive and supportive in situations when parents are dealing with a crying baby.

• Be supportive of work policies (e.g., paid family leave) that make it easier for working parents to stay with their infants during the period of increased infant crying (i.e., between 4-20 weeks of age)

risk factors and prevention of shaken baby syndrome

• Caregiver intolerance of infant crying is a risk factor for inflicted injury of all kinds

• The Period of PURPLE Crying Programis an evidence-based education program to decrease the incidence of shaken baby syndrome available since 2007.

• The program approaches SBS/AHT and infant abuse prevention by helping parents and caregivers understand the frustrating features of crying in normal, healthy infants that can lead to shaking or abuse

PURPLE acronym

P: peak of crying

U: unexpected crying

R: resists soothing

P: pain-like face

L: long lasting crying

E: evening (cries the most)

neglect

failure of a parent or caregiver to meet a child’s basic physical, emotional, educational, or medical needs, resulting in or having the potential to result in harm

• also defined as a situation where a child is presently without necessary food, clothing, shelter, medical care or supervisionbecause of the disappearance or absence of the child’s parent or custodian

signs and symptoms of child neglect

• Poor growth or weight gain or being overweight, developmental delay

• Poor hygiene, poor dentition

• Lack of clothing or supplies to meet physical needs

• Taking food or money without permission

• Hiding food for later

• Poor record of school attendance

• Lack of appropriate attention for medical, dental or psychological problems or lack of necessary follow-up care

remedying the consequences of neglect

• Prevention may be possible by screening for parental depression and providing anticipatory guidance on need or supervision, injury prevention tailored to age and developmental level

• Simplifying and clarifying treatment plans for children with chronic conditions

• Making referrals to agencies which assist with food or transportation

• Developmental assessment and referral

• Referral to behavioral or mental health specialist

strategy and approaches to child neglect

Strengthen economic supports to families

• Strengthening household financial security

• Family-friendly work policies

Change social norms to support parents and positive parenting

• Public engagement and education campaigns

• Legislative approaches to reduce corporal punishmen

Provide quality care and education early in life

• Preschool enrichment with family engagement

• Improved quality of child care through licensing and accreditation

Enhance parenting skills to promote healthy child development

• Early childhood home visitation

• Parenting skill and family relationship approaches

Intervene to lessen harms and prevent future risk

• Enhanced primary care

• Behavioral parent training programs

• Treatment to lessen harms of abuse and neglect exposure

• Treatment to prevent problem behavior and later involvement in violence

adverse childhood experiences

• Parent/guardian divorced

• Death of parent or guardian

• Served jail time

• Saw or heard parents hurt another person in the home

• Victim of violence or saw violence

• Lived with anyone who was mentally ill, had a drug or alcohol abuse problem

• Experienced racism

• 2017-2018 study of ACEs and Child Well-Being by HRSA Maternal and Child Health found that 11 states, including WV had significantly higher percentages of children experiencing ACEs than the national average (US average 14% of children had 2 or more, WV had almost 25% or 1/4 children)

• Results: the more ACEs a child experiences, the more likely they are to experience physical and mental health problems as an adult

early life stress (ELS)

• Maltreatment/abuse

• Neglect

• Separation

• Parental loss

• Extreme poverty

• Starvation

• Domestic/community/school violence

ELS and childhood trauma

ELS and Childhood Trauma are negatively associated with adult mental and physical health-related quality of life

• Increased risk for mental disorders

• Risk behavior patterns such as substance abuse, and suicide attempts later in life

• Research suggests close association of ELS/CT withrequency of medical consultations, and a number of medical diagnoses.

physical issues of child abuse

• Premature death

• Physical disabilities

• Learning disabilities

• Substance abuse

• Health problems, such as HIV, STDs heart disease, immune disorders, chronic lung disease and cancer

behavioral issues of child abuse

• Delinquent or violent behavior

• Abuse of others

• Withdrawal

• Suicide attempts or self-injury

• High-risk sexual behaviors or teen pregnancy

• Problems in school or not finishing high school

• Limited social and relationship skills

• Problems with work or staying employed

• Revictimization

emotional issues of child abuse

• Low self-esteem

• Difficulty establishing or maintaining relationships

• Challenges with intimacy and trust

• An unhealthy view of parenthood

• Inability to cope with stress and frustrations

• An acceptance that violence is a normal part of relationships

mental health disorders associated with child abuse

• Eating disorders

• Personality disorders

• Behavior disorders

• Depression

• Anxiety disorders

• Post-traumatic stress disorder (PTSD)

• Sleep disturbances

• Attachment disorders

• Substance Abuse

reporting to child or adult protective services

CPS/APS will ask for all information about the child including name, DOB, address, etc.

• Will try to speak with the child/adult separately (such as at school)

• Speak with parents/children/caregivers and writes report

• Completes a Risk Assessment

Result Options:

• Unsubstantiated: file closed, no further action

• Risk Assessment score indicated danger of imminent harm, child may be removed

• Treatment plan: visitations by CPS/APS worker, counseling, education program, etc.

• Case Review: closure of case or new treatment plan

early attachment and development

• To form a secure attachment, infants need to have positive experiences with their caregiver where their needs are met and they learn they can rely upon their caregiver.

• When abuse and neglect are present, infants are unable to form a secure attachment and their mental health suffers.

• Research tells us and we know social emotional development is a key factor in development of other areas as well- if we aren’t able to successfully interact with others in a way that makes us feel safe, we may not be confident to explore our environment... neglect situations can result in lack of experiences to aid in development.

• Children need sensory rich environments to develop appropriately

domestic violence

Intimate partner violence (IPV): abuse or aggression that occurs in a romantic relationship

• “Intimate partner” refers to both current and former spouses and dating partners.

• Range from one episode of violence that could have lasting impact to chronic and severe episodes over multiple years

types of domestic violence

• Physical violence: is when a person hurts or tries to hurt a partner by hitting, kicking, or using another type of physical force.

• Sexual violence: is forcing or attempting to force a partner to take part in a sex act, sexual touching, or a non-physical sexual event (e.g., sexting) when the partner does not or cannot consent.

• Stalking: is a pattern of repeated, unwanted attention and contact by a partner that causes fear or concern for one’s own safety or the safety of someone close to the victim

• Psychological aggression: is the use of verbal and non-verbal communication with the intent to harm another partner mentally or emotionally and/or to exert control over another partner

characteristics of domestic violence

• Physical Violence: Hitting, kicking, slapping, etc.

• Sexual Violence: Harassment, assault, rape

• Emotional/Psychological Abuse: Degrading, minimizing, denying and

blaming, gaslighting

• Intimidation: Keep the victim fearful

• Threats

• Coercion, convincing victim to do something illegal, threatening to hurt children

• Economic

• Isolating from resources

domestic violence stats

• 1 in 3 women and 1 in 4 men have experienced severe physical violence from a partner (increase from 2021 stats)

• 1 in 5 women and 1 in 13 men have experienced sexual violence by a partner

• 14% of women and 5% of men have been stalked by a partner (increase from 2021 stats)

sexual abuse and sexual violence

• Sexual violence is sexual activity when consent is not obtained or freely given.

• Starts early: 1 in 3 female victims experienced sexual violence for the first time between 11-17 years oldand 1 in 8 reported before age 10; similar ratios for men.

• Sexual violence is connected to other forms of violence; girls who have been sexually abused are more likely to experience additional sexual violence and become victims of IPV in adulthood

• Engaging in bullying in early middle school is linked to sexual harassment in high school

consequences of sexual abuse

• PTSD and other psychological disorders like anxiety, depression, and suicidal thoughts

• Reproductive and sexual-health problems

• GI and cardiovascular problems

• Impacts on employment

• Difficulty maintaining relationships, returning to work or school, difficulty regaining sense of normalcy

• Higher risk of engaging in high-risk behaviors such as smoking, drug use, binge-drinking, and sexual risk taking

societal impacts of IPV

• Lifetime economic costs associated with IPV including medical care for injuries related to IPV, lost productivity from paid work, criminal justice costs and others is $3.6 TRILLION

• Individual costs over a victim’s lifetime was $103,767 for women and $23,414 for men