recognizing and responding to physical child abuse

Recognizing and Responding to Physical Child Abuse

Dr. WhitemanModule 3

Florida Child Abuse Law

• FL. Statute 415 protects children (-18), disabled and elderly from abuse and/or neglect

• Central registry in DCF

• Abuse: any nonaccidental injury, sexual battery, financial or sexual exploitation or injury to the intellectual or psychological capacity of person by parents or other responsible for child’s welfare

Florida Child Abuse Law

• Immunity from liability and confidentiality from civil or criminal charges

• Where do we report a suspected abuse?– Emergency, call 911

–Web reporting• http://www.myflfamilies.com/service-programs/abuse-

hotline/howtoreport

– Florida Abuse Hotline• (800) 962-2873

What to Look for in Assessing Child Abuse

• Unexplained injury

• Impossible explanation of injury

• Different stories of the injury

• Delay in seeking medical treatment

• Important to interview

parents/caretakers separately

• Interview child separately

What to Look for in Assessing Child Abuse

Family Violence Across the Lifespan, 3rd Edition © 2011 SAGE Publications

• Bruises and welts: face and large areas of body

• Burns: cigarette; hot liquids; irons; rope

• Fractures: skull; nasal; long bones

• Lacerations and abrasions: mouth, gums, lips, external genitalia

• Human bite marks

• Example: https://www.youtube.com/watch?v=uWow42TCwzg

What Is Physical Child Abuse• PCA was discovered during the 1960s

• Definitions emerged that focused on act of violence that caused some

form of observable harm– Harm standard

– Endangerment standard

• Slapping, spanking, paddling, and generally hitting children for

purposes of discipline are accepted, pervasive adult behaviors in US

families

– Normalized

– Culture in America

• “Normal” violence : commonplace physical acts such as slapping, pushing, and spanking.

• Surveys show that 75-90% of parents use some form of physical punishment with their children.

• Similar studies of young adults report that 93-95% experienced physical punishment as children or adolescents.

• Why is spanking harmful?– Legitimates violence– Implicit message of acceptance of this form of violence contributes

to violence in other aspects of society.– Models violence– Developmental effects video (http://testtube.com/dnews/dnews-732-

spanking/)

What is the Difference between Discipline and Punishment?

• Often these terms are used interchangeably

• Punishment, in the form of spanking is a reaction to a child’s misbehavior

• Discipline is something you teach– The purpose of teaching discipline is to assist a

child in developing self-discipline

Discussion Question

• Should corporal punishment be considered a form of child physical abuse?

Type of Abuse: Munchausen Syndrome by Proxy

• Fictitious Disorder by Proxy according to DSM- V

• Occurs when a caregiver falsifies medical history and

may injure a child to simulate a disease

• Repeated hospitalizations without clear diagnosis

• Symptoms may clear up when parent not around

• Difficult to diagnose

• Parent at the center of attention

Type of Abuse:Non- Organic Failure to Thrive

• Found in very young children

• Failure to gain weight at home/rapid weight gain out of home such as when hospitalized

• Listlessness and lethargy

• Lack of parent/infant bonding

Type of Abuse: Shaken Baby Syndrome

• Some parents become upset and rather than striking a young infant/child, will shake him/her

• Detrimental especially with infants and children under 2 years– Head is large in comparison to body

– Neck muscles weak

– Skull not formed

Shaken Baby Syndrome

• Results of shaking an infant/young child– Jarring the skull with force causes damage

–May lead to retinal detachment, nerve damage, hemorrhages, and subdural hematoma

– Blindness and neurological damage

EffectsMedical and

neurobiological

Cognitive difficulties

Behavioral problems

Socioemotional deficits

Psychiatric disorders

Examples Bruises; head, chest, and

abdominal injuries; burns; fractures etc.

Deficits in verbal abilities, memory, problem solving, motor skills etc.

Aggression; fighting; defiance etc.

Delayed play skills etc.

Major depressive disorder; ADHD

• Family and Interpersonal Difficulties–Spousal disagreement, tension, abuse

–Parental history of abuse in childhood

–Deficit in positive interaction with children and family members

–Verbal and physical conflicts among family members

–Isolation from friends and the community

–Parenting difficulties

–Unrealistic expectations of children

–Disregard for child’s needs/abilities

–Deficit in child management skills

–View of parenting role as stressful

–Intrusive/inconsistent parenting

–High rates of verbal and physical aggression towards children

–Negative bias/perceptions regarding children

• Biological factors–Reports of physical health problems and disabilities

–Physiological over-reactivity

–Neuropsychological deficits (problem solving, conceptual abilities)

Parents/Caretakers who Abuse: Summary

• Relationship to victim: parents, single parents, or

stepparents

– Strangers and outsiders involved in minority of cases

• Experience emotional and behavior difficulties

• Experience family and interpersonal difficulties

• Parenting difficulties

Aggressive and antisocial behavior

Deficits in social competence

Psychiatric disorders

Other effects

Violent behavior, delinquency etc.

Low levels of intimacy; increased conflict and negative affect etc.

Major depressive disorder, substance abuse etc.

Attention problems; low-self-esteem etc.

Criminal/ violent behavior

Substance abuse

Psychiatric disorders

Arrests for delinquency; marital violence (males), physical abuse of own children, prostitution

Abuse of alcohol and other substances; Self-destructive behavior; depression etc.

Antisocial and other personality disorders; PTSD

• Criminal behavior

• Substance Abuse

• Socioeconomic Difficulties

• The Individual Pathology Model

Researchers assumed perpetrators as disturbed individuals “crazy or sick”

-Less than 10% of perpetrators meet criteria for psychiatric disorders.

-Abusers exhibit anger control problems, substance abuse, parental difficulties, depression.

Explaining Child Physical Abuse

• Difficult Child Model– Focuses on the behavior of child as the cause of

CPA

– Children with special characteristics (mental disability, aggressiveness, young age, etc.) and specific temperaments (defiant, annoying, etc.) are placed at risk

Explaining Child Physical Abuse

• Parent-Child Interaction Model– Difficult child behaviors interact with specific

parental behaviors to result in abuse

– For example, punitive parenting is associated with negative child behavior and outcomes• Punished children (spanking) more likely to develop

mental illness

– Some suggest problems result from attachment issues early on

Explaining Child Physical Abuse

• Social Learning Theory– Parenting styles are passed on from one generation

to another

– Parents neglected as children were 2 times more likely to abuse their own children

– Parents abused as children were 5 times more likely to physically abuse their own children

Explaining Child Physical Abuse

• Situational and Societal Conditions– Economic disadvantage: suggest children from low

income families at great risk of abuse as well as children from unemployed families

– Abusers report more social isolation, limited support from friends and family members

Explaining Child Physical Abuse

• Stress– Situational variable as they affect level of stress

within families associated with abuse• Intolerance for children’s misbehavior

• Stressful life events: a new baby, illness, death of a family member, poor housing conditions

Explaining Child Physical Abuse

• Cultural Acceptance of Corporal Punishment– Some injuries result from out of control physical

punishment

– No federal laws against spanking children

Discussion Questions

• Which model or models seem most useful in

explaining physical abuse of children?

• Treatment for physically abusive adults

-Anger management

-Child management

-Stress management

_The most frequently used behavioral approach is to train parents in the use of nonviolent child management skills (i.e., parent training )

Evidence-based:

The Triple P--Positive Parenting Program

Parent-Child Interaction Therapy

Treatment for physically abused children -Therapeutic day treatment programs -Individual therapy -Group therapy -Play sessions

Family interventions -Family therapy (Multidimensional Family Therapy) -Cognitive-behavior therapy (CBT) -Intensive family preservation programs

(HOMEBUILDERS)

Responding: Protecting the Child

• Child Protective Services: – Large number of cases

– Inadequate budgets

– Narrow focus on reporting and investigations,

– Responses primarily to allegations (little in the form of prevention services)

Responding: Out of Home Care

• Federal law mandates goal of social

service agencies is to preserve or reunite

the family

• Judicial determination can be made to

place the child outside the home

• Children lost in the foster care system

Community Interventions

• Social Networks: include hotlines, support groups

such as Parents Anonymous, educational classes,

and most effective, home visitation programs

• Economic Assistance: families often need basic

necessities such as food and shelter

• Child Care: provides relief for stressed parents

• Community interventions

-Crisis hotlines

-Support groups (e.g., Parents Anonymous)

-Educational resources

-Salvation Army

-Assistance in completing government forms for assistance such as: food stamps, state funds for child support, and Temporary Assistance for Needy Families (TANF).

• Parental competency -Parent education programs and

support groups -Home visitations

• Community awareness campaigns

-Educating the public through mass-media campaigns

Example: radio and television; in newspapers, billboards.

-UNICEF: Stop Child Abuse Now!

• Case study Discussion

Family Violence Across the Lifespan, 3rd Edition

© 2011 SAGE Publications

Next Steps

• Research your local newspaper online for articles on local issues related to the sexual abuse of children.

• What cases did you find? Did the cases impact the local community?