10/ 11/ 2016 The Forgotten Diagnosis: Child Neglect in Primary Care - - PDF document

▶
10 11 2016
SMART_READER_LITE
LIVE PREVIEW

10/ 11/ 2016 The Forgotten Diagnosis: Child Neglect in Primary Care - - PDF document

Apr 29, 2023 340 likes •509 views

10/ 11/ 2016 The Forgotten Diagnosis: Child Neglect in Primary Care Ob je c tive s Unde rsta nd the incidence and pr evalence o f child neglect na tio na lly a nd why its impo rta nt to identify it. Unde rsta nd the c o nc e pt o f

slide-1
SLIDE 1

10/ 11/ 2016 1

The Forgotten Diagnosis: Child Neglect in Primary Care

  • Unde rsta nd the incidence and pr

evalence o f child neglect na tio na lly a nd why its impo rta nt to identify it.

  • Unde rsta nd the c o nc e pt o f toxic str

ess a nd ho w it impa c ts a c hild’ s de ve lo pme nt.

  • Unde rsta nd ho w to assess, document and manage

ne g le c t in yo ur pra c tic e se tting .

  • Ga in unde rsta nding o f local r

esour ces and CAC’s.

Ob je c tive s

  • F
  • r F

F Y 2014, a n e stima te d 702,000 vic tims o f c hild a b use a nd ne g le c t we re ide ntifie d na tio na lly.

  • Vic tim ra te wa s 9.4 vic tims pe r 1,000 c hildre n

in the po pula tio n.

  • Ne g le c t wa s the g re a te st pe rc e nta g e a t

75%.

Ab use a nd Ne g le c t Na tio na lly

slide-2
SLIDE 2

10/ 11/ 2016 2

  • F
  • r F

F Y 2015, the re we re a to ta l o f 69,972 re po rts re c e ive d.

  • An inc re a se o f 3.1% fro m the prio r ye a r.
  • A to ta l o f 6,708 fo unde d re fe rra ls we re fo r

a b use a nd ne g le c t.

  • Ne g le c t wa s the mo st fre q ue ntly ide ntifie d

type o f ma ltre a tme nt a t 44.9%.

Ore g o n’ s Sta ts

  • Childho o d a dve rsity ha s L

IF E L ONG c o nse q ue nc e s!

  • CDC e stima te s tha t the a ve ra g e life time c o sts fo r no nfa ta l

c hild ma ltre a tme nt is $210,012 ( in 2010 do lla rs).

  • In the U.S. e stima te d e xpe nditure >$100 b illio n a ye a r o n

a ll a spe c ts o f c hild ma ltre a tme nt.

  • >$70 b illio n/ ye a r is spe nt o n indire c t c o sts: spe c ia l

e duc a tio n, juve nile de linq ue nc y, me nta l he a lth a nd he a lth c a re , the a dult c rimina l justic e syste m, a nd lo st pro duc tivity.

T he Co st o f Ab use a nd Ne g le c t

  • Sta te la ws fo c us o n o missio ns

in c a re b y pa re nt o r c a re g ive rs tha t re sult in a c tua l o r po te ntia l ha rm.

  • Ore g o n de fine s ne g le c t a s

a c ts o f o missio n, re sulting in risk o f se rio us ha rm b y pa re nt

  • r c a re ta ke r who is

re spo nsib le fo r c hild’ s we lfa re .

  • Ne g le c t is o fte n multifa c e te d

a nd diffic ult to a sse ss.

De finitio n o f Ne g le c t

slide-3
SLIDE 3

10/ 11/ 2016 3

  • Physic a l ne g le c t
  • Me dic a l ne g le c t
  • Supe rvisio na l ne g le c t
  • E

duc a tio na l ne g le c t

T ype s o f Ne g le c t

Risk F a c to rs fo r Childho o d Ab use a nd Ne g le c t

  • Be g inning pre na ta lly, de ve lo pme nt

is drive n b y o ng o ing inte ra c tio ns b e twe e n b io lo g y a nd e c o lo g y

  • Ge ne tic c o de a nd its inte ra c tio n with

the e nviro nme nt

  • Ge ne -e nviro nme nt inte ra c tio n c a n

impa c t life lo ng b e ha vio r, de ve lo pme nt, a nd he a lth.

E a rly De ve lo pme nt

slide-4
SLIDE 4

10/ 11/ 2016 4

  • E

xa mine s ho w e nviro nme nta l influe nc e s a nd e a rly e xpe rie nc e s a ffe c t ho w diffe re nt g e ne s a re a c tiva te d.

  • Che mic a l mo dific a tio ns to the g e no me tha t re g ula te

g e ne a c tivity

  • Me thyla tio n o f g e ne s whic h c o ntro l the ir e xpre ssio n
  • T

urning g e ne s o ff a nd o n

E pig e ne tic s

slide-5
SLIDE 5

10/ 11/ 2016 5

T

  • xic Stre ss

Risk F a c to rs tha t c o ntrib ute to T

  • xic Stre ss
slide-6
SLIDE 6

10/ 11/ 2016 6

T

  • xic Stre ss a nd the Bra in
  • Impa c ts b ra in de ve lo pme nt in the c o rte x
  • Are a is re spo nsib le fo r ma ny c o mple x func tio ns inc luding

me mo ry, a tte ntio n, thinking , la ng ua g e , a nd c o nsc io usne ss

  • Cha ng e s ma y a ffe c t I

Q a nd the a b ility to re g ula te e mo tio ns

slide-7
SLIDE 7

10/ 11/ 2016 7

  • Hippo c a mpus

dysfunc tio n

  • Diminishe d c a pa c ity to

turn o ff e le va te d c o rtiso l

  • Impa irme nts in me mo ry

a nd mo o d-re la te d func tio ns

  • L

imite d a b ility fo r c o nte xtua l le a rning (da ng e r vs. sa fe ty)

  • Amyg da la dysfunc tio n
  • Inc re a se po te ntia l fo r

fe a r a nd a nxie ty

  • Chro nic a c tiva tio n o f

stre ss re spo nse

  • Ove r a c tiva tio n o f stre ss

re spo nse

  • Inc re a se d c o rtiso l

T

  • xic Stre ss a nd the Bra in
  • Dysfunc tio n in the pre -fro nta l c o rte x
  • L

e a ds to dysfunc tio n o f the a uto no mic ne rvo us syste m

  • Sympa the tic : fig ht o r flig ht re spo nse
  • Pa ra sympa the tic : invo lunta ry b o dily re spo nse s (he a rt ra te )
  • Pro b le ms with de ve lo pme nt o f e xe c utive func tio ns
  • De c isio n ma king
  • Wo rking me mo ry
  • Be ha vio ra l se lf re g ula tio n
  • Mo o d a nd impulse c o ntro l
  • De c re a se d a b ility to limit a myg da la ’ s re spo nse .

T

  • xic stre ss a nd the Bra in
slide-8
SLIDE 8

10/ 11/ 2016 8

T

  • xic Stre ss a nd the Bra in
slide-9
SLIDE 9

10/ 11/ 2016 9

  • T

he ACE sc o re a ttrib ute s o ne po int fo r e a c h c a te g o ry o f e xpo sure to c hild a b use a nd/ o r ne g le c t inc lude d in the

  • study. Add up the po ints fo r a

Sc o re o f 0 to 10. T he hig he r the sc o re , the g re a te r the e xpo sure , a nd the re fo re the g re a te r the risk o f ne g a tive c o nse q ue nc e s.

T he ACE study Summa ry o f T

  • xic Stre ss
  • Imme dia te a s we ll a s lo ng la sting e ffe c ts o n the b o dy
  • Imprints o n the c hild, a t the mo le c ula r le ve l a nd in the ir

b o dy syste ms

  • E

pig e ne tic c ha ng e s a re tra nsmitte d thro ug h g e ne ra tio ns

  • It impa c ts a ll le ve l o f c hild de ve lo pme nt- physic a l,

c o g nitive , e mo tio na l, a nd b e ha vio ra l

  • It is c o stly fo r b o th the individua l a nd so c ie ty
slide-10
SLIDE 10

10/ 11/ 2016 10

Sc re e ning in Pra c tic e

  • L

a c k o f time

  • L

a c k o f tra ining spe c ific to c hild a b use a nd ne g le c t

  • Child is q ue stio ne d in pre se nc e o f c a re ta ke r
  • Unc e rta inty a ro und wha t to do whe n disc lo sure o c c urs
  • F

e a r o f disrupting re la tio nship with fa mily

  • Cultura l b a rrie rs
  • F

e a r o f le g a l ra mific a tio ns

  • +/ - b e lie f CPS is ina de q ua te a nd no t he lpful

Ba rrie rs to Sc re e ning in Pra c tic e

R epeat F amily on your panel One time encounter

T ips a nd T

  • o ls fo r Pra c tic e
slide-11
SLIDE 11

10/ 11/ 2016 11

  • T

ho ro ug h psyc ho so c ia l a sse ssme nt

  • E

a rly disc ussio n o f disc ipline a nd c hild de ve lo pme nt

  • E

xpla na tio n o f c hild te mpe ra me nt

  • No rma lize c rying - e spe c ia lly in infa nc y
  • Childre n with disa b ilitie s- hig he r risk
  • Asse ss fre q ue ntly fo r DV/ IPV
  • E

a rly ide ntific a tio n

  • Re so urc e o f c o mmunity se rvic e s fo r fa milie s

Pra c tic e re c o mme nda tio ns Ca se Study Ca se Study

slide-12
SLIDE 12

10/ 11/ 2016 12

Re silie nc e

Ma ke the Ca ll!

  • Your

r epor t is a re q ue st fo r a furthe r sa fe ty a sse ssme nt to b e ma de .

  • T

he la w c le a rly sta te s tha t you must r epor t a ny time yo u ha ve re a so na b le c a use to b e lie ve a c hild ha s b e e n a b use d o r ne g le c te d.

Wha t Do I Do if I Suspe c t Ab use o r Ne g le c t

  • www.o re g o n.g o v

“Child Ab use Ho tline ”

  • Multiple re so urc e s, inc luding Ho w to Re po rt Child Ab use &

Ne g le c t, sta te de finitio ns o f c hild a b use & ne g le c t, b o o kle t “Wha t yo u c a n do a b o ut Child a b use ”

  • Multno ma h 503 731 3100
  • Wa shing to n 503 681 6917
  • Cla c ka ma s 971 673 7112

Child Ab use Ho tline

slide-13
SLIDE 13

10/ 11/ 2016 13

  • Re me mb e r risk fa c to rs fo r ne g le c t
  • Ne g le c t is c o mmo n!
  • Do n’ t b e a fra id to e xa mine , ta lk to kids, c a ll fo r

c o nsulta tio n

  • K

no w whe n to re po rt, ho w to re po rt & whe re to re po rt

  • Unde rsta nd sta te la w, yo ur re spo nsib ilitie s a s a me dic a l

pro vide r

T a ke Ho me

  • 20 c e nte rs se rving 36

c o untie s

  • F

unde d, in pa rt, b y sta te (CAMI) funds

Ore g o n Child Ab use E va lua tio n Ce nte rs

www.childabuseintervention.org

slide-14
SLIDE 14

10/ 11/ 2016 14

1713 Pe nn L a ne | Ore g o n City, OR 97045 T e l: 503-655-7725 | F a x: 503-655-7720 inta ke @ c hildre nsc e nte r.c c

Ga b rie lle Pe te rse n, MSN, CPNP g a b rie lle @ c hildre nsc e nte r.c c T e l: 503-655-7725

Co nta c t

www.c hilda b use inte rve ntio n.o rg www.c hildre nsc e nte r.c c www.Ore g o n.g o v/ dhs/ c hildre n/ pa g e s/ a b use / inde x.a spx www.a lb e rta fa milywe llne ss.o rg www.De ve lo ping c hild.ha rva rd.e du www.a c e study.o rg www.c hildwe lfa re .g o v

Re fe re nc e s

slide-15
SLIDE 15

10/ 11/ 2016 15

Ba rlo w S, F re e b o rn D, Co le B, & Willia ms M (2012). Adva nc e d pra c tic e nurse b a rrie rs to re po rting c hild ma ltre a tme nt. Jo urna l o f Pe dia tric He a lth Ca re 24(3), 10-17. De pa rtme nt o f Huma n Se rvic e s, 2015. 2015 Child We lfare Data Bo o k. Ore g o n De pt. o f Huma n Se rvic e s: Childre n, Adults a nd F a milie s Divisio n. April 2016. De pa rtme nt o f He a lth a nd Huma n Se rvic e s,2014. Child Ma ltre a tme nt

  • 2014. U.S. De pa rtme nt o f He a lth a nd Huma n Se rvic e s.

Dub o witz, H (2013). Ne g le c t in Childre n. Pe dia tric Ann. 2013 April; 42(4): 73-77. F la he rty E , Stirling J, e t. Al (2010). Clinic a l re po rt- T he pe dia tric ia ns ro le in c hild ma ltre a tme nt pre ve ntio n. Pe dia tric s 126(4), 833-841.

Re fe re nc e s

Ga rne r, A.S. e t a l. Po lic y Sta te me nt (2012). E a rly Childho o d Adve rsity, T

  • xic Stre ss, a nd the Ro le o f the Pe dia tric ia n:

T ra nsla ting De ve lo pme nta l Sc ie nc e Into L ife lo ng He a lth. Pe diatric s, 129 (1), 224-231.

 Ho rno r & He re nde e n, Adva nc e d Pra c tic e Nursing in Child Ma ltre a tme nt: Pra c tic e Cha ra c te ristic s, Jo urna l o f Pe dia tric He a lth Ca re . 28(5), 438-443. Murry S. & L e win L (2014). Pa re nting suppo rt ne e ds a sse ssme nt: sc re e ning fo r c hild ma ltre a tme nt risk in yo ung fa milie s. Jo urnal

  • f Pe diatric He alth Care 28:3, 208-216.

Sho nko ff, J.P. e t a l. T e c hnic a l Re po rt (2012). T he L ife lo ng E ffe c ts

  • f E

a rly Childho o d Adve rsity a nd T

  • xic Stre ss. Pe diatric s, 129

(1), 232-246.

Re fe re nc e s