P E C P A I N C Funding for this program has been provided by - PowerPoint PPT Presentation

P E C P A I N C Funding for this program has been provided by the New Jersey Department of Children and Families (DCF)

Prevention of Child Abuse and Neglect Webinar Notice of Disclosure: May 2017 CME Accreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Medical Society of New Jersey through the joint providership of Atlantic Health System and the American Academy of Pediatrics, New Jersey Chapter. Atlantic Health System is accredited by the Medical Society of New Jersey to provide continuing medical education for physicians. AMA Credit Designation Statement: Atlantic Health System designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Successful completion of this CME activity, which includes participation in the activity, with individual assessments of the participant and feedback to the participant, enables the participant to earn 1.0 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABP MOC credit. CNE This continuing nursing education activity was approved by New Jersey State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission On Accreditation.

P r e s e n t e d b y Steven M. Kairys, MD, MPH, FAAP Principal Investigator Strengthening Pediatric Partners

The Vision  Safer and Healthier Children

The Goal EPIC CAN seeks to connect healthcare professionals with the most current information, guidance, and community-based resources for appropriately recognizing, intervening, - and preventing - the abuse and neglect of all children.

Objectives At the conclusion of this training, participants will be better prepared to:  Embrace the medical home as a system change concept.  Understand the influence adversity plays in shaping a child’s lifelong behavioral and physical wellbeing.  Utilize appropriate anticipatory guidance and prevention education at well-child visits  Align families with supportive community resources  Create an effective partnership with the Division of Child Protection and Permanency, Child Behavioral Health Services and Prevention, and Community Resources.

What Is Child Abuse and Neglect?

What Is Child Abuse and Neglect? Abused child or abused or neglected child means a child under age 18 whose parent, guardian, or other person having custody and control: Inflicts or allows to be inflicted upon such child physical injury by other than accidental means that causes or creates a substantial risk of death, serious or protracted disfigurement, protracted impairment of physical or emotional health, or protracted loss or impairment of the function of any bodily organ. section 1 of P.L.1974, c. 119 (C. 9:6-8.21), section 1 of P.L.1974, c. 119 (C. 9:6-8.21)

What Is Child Abuse and Neglect? • Creates or allows to be created a substantial or ongoing risk of physical injury to such child by other than accidental means • Unreasonably inflicts, or allows to be inflicted, harm or substantial risk thereof, including the infliction of excessive corporal punishment or by any other acts of a similarly serious nature requiring the aid of the court Uses excessive physical restraint upon the child under • circumstances that do not indicate that the child's behavior is harmful to himself, others, or property

The National Numbers More than 700,000 children are abused in the U.S. • annually Children in their first year of life are more likely to • be victimized Neglect is the most common form of maltreatment • Approximately 88% of the cases, the abusers are • the victims’ parents All data cited from National Children’s Alliance. http://www.nationalchildrensalliance.org/media- room/media-kit/national-statistics-child-abuse

The New Jersey Numbers 74,546 investigations of abuse and neglect • 9,689 first time victims (0-21 years) • 3,038 – 3 years or younger (31%) • 1,184 Less than 1 year of age (39%) • Neglect is the most common form of • maltreatment (79.5%) Sexual abuse represents 8.8% • of substantiated cases of maltreatment https://www.acf.hhs.gov/sites/default/files/cb/cm2015.pdf#page=29

The Effects of Child Abuse and Neglect Across the Lifespan

Childhood Adversity has Lifelong Consequences. Significant adversity in childhood is strongly associated with unhealthy lifestyles and poor health decades later. * Slide adapted from A. Garner, 2013

ACE Categories Women Men Total  Abuse (n=9,367) (n=7,970) (17,337)  Emotional 13.1% 7.6% 10.6%  Physical 27.0% 29.9% 28.3%  Sexual 24.7% 16.0% 20.7%  Household Dysfunction  Mother Treated Violently 13.7% 11.5% 12.7%  Household Substance Abuse 29.5% 23.8% 26.9%  Household Mental Illness 23.3% 14.8% 19.4%  Parental Separation or Divorce 24.5% 21.8% 23.3%  Incarcerated Household Member 5.2% 4.1% 4.7%  Neglect*  Emotional 16.7% 12.4% 14.8%  Physical 9.2% 10.7% 9.9% Data from www.cdc.gov/nccdphp/ace/demographics * Wave 2 data only (n=8,667) * Slide adapted from A. Garner, 2013

ACE Scores Number of individual adverse childhood experiences are summed … ACE Scores Prevalence 0 36.4% 64% reported 1 26.2% experiencing one or more 2 15.8% 3 9.5% 37% 4 6.0% reported experiencing 5 3.5% two or more 6 1.6% 7 or more 0.9%

Table 1: Ace-related Odds of Having a Physical Health Condition HEALTH CONDITION 0 ACEs 1 ACEs 2 ACEs 3 ACEs 4+ ACEs Arthritis 100% 130% 145% 155% 236 % Asthm a 100% 115% 118% 16 0 % 231% Cancer 100% 112% 101% 111% 157% COPD 100% 120% 16 1% 220 % 399% Diabetes 100% 128% 132% 115% 20 1% Heart Attack 100% 148% 144% 28 7% 232% Heart Disease 100% 123% 14 9% 250 % 28 5% Kidney Disease 100% 83% 164% 179% 26 3% Stroke 100% 114% 117% 180% 28 1% Vision 100% 167% 18 1% 199% 354 %

ACEs Impact Multiple Outcomes Relationship Isolation Problems Smoking Anxiety Difficulty in job High perceived Hallucinations performance Promiscuity stress Sleep Depression General Health and Risk Factors for Disturbances Social Functioning Common Diseases Mental Memory Health Disturbances Alcoholism ACEs Panic Reactions Obesity Prevalent Poor Anger Sexual Diseases Control Health Cancer Liver Disease Unintended Chronic Lung Teen Pregnancy Disease Pregnancy Early Age of First Heart Disease Sexual Dissatisfaction Intercourse * Adapted from A. Garner, 2013

How ACEs Impact Health Death Mechanism s by The impact of which Adverse Early violence in Childhood Death childhood Distress, Experiences manifests Disability, influence throughout the and Social health and well- Problem s entire life course. being throughout Adoption of the lifespan. Health-risk Intervention is Behaviors most effective when issues are Social, Em otional, and identified and Cognitive Im pairm ent treated in early childhood. Disrupted Neurodevelopm ent Conception Adverse Childhood Experiences

Toxic Stress Moderate, short-lived stress responses that are normal part of life and healthy development. A child can learn to manage and control these experiences with support of caring adults in context of safe, warm, and positive relationships. Stress responses that could affect brain architecture but generally occur for briefer periods which allow brain to recover and thereby reverse potentially harmful effects. Strong, frequent or prolonged activation of body’s stress management system. Stressful events that are chronic, uncontrollable, and/or experienced without child having access to support from caring adults. National Scientific Council on the Developing Child, 2009

Excessive Stress Disrupts Architecture of Child ’ s Developing Brain  Neural circuitry for dealing with stress is especially malleable during fetal and early childhood periods  Excessive stress programs hormone system toward exaggerated and prolonged response to stressors Bugental et al, 2003; National Council on the Developing Child, 2005; Teicher, 2011

Toxic Stress Can Affect Brain Developm ent  Organizational changes  Brain chemistry imbalances  Structural changes Healthy Child Severe Emotional Neglect Centers for Disease Control and Prevention

Behavioral, Mental, and Social Problem s Associated with Traum atic Brain Developm ent  Hypervigilance - “ Always on the ready ”  Persistent physiological hyperarousal & hyperactivity  More impulsive, aggressive behaviors  Less able to tolerate stress  Reactive Attachment Disorder, other disorders Kuelbs, 2009; Perry, 2001; Shore, 2001; Teicher et al, 2002

Reporting Child Abuse and Neglect

State law (N.J.S.A.9:6-8.10), Requires “Any person having reasonable cause to believe that a child has been subjected to child abuse or acts of child abuse shall report the same immediately to the Division of Youth and Family Services by telephone or otherwise… ” L. 1971, c.437, s.3; amended by L. 1987,c.341,s.4.

In New Jersey, EVERYONE Is a Mandated Reporter of Child Abuse and Neglect