CCIH 2012 Conference, Breakout 2, Jose Miguel De Angula, Protecting and Promoting Early Child Development in Marginalized Populations, A Holistic Response to Child Abuse

6/10/2012 A Holistic Response to Child Sexual Abuse MAP internationalJose Miguel De Angulo & Luz Stella Losada Cochabamba 1

6/10/2012 1 out of 3 girls and 1 out of 5 boys before 18 have been sexually abused Sexual Abuse affects the lives of survivors in many different ways.Children’s violence exist in a context of an andocentric society tolerant to women violence 2

6/10/2012 Devastating impact on the healthAmerican Psychological Association, APA Online“Children and adolescents who have been sexually abusedcan suffer a range of psychological and behavioralproblems, from mild to severe, in both the short and longterm. These problems typically include depression, anxiety,guilt, fear, sexual dysfunction, withdrawal, and acting out.Depending on the severity of the incident, victims of sexualabuse may also develop fear and anxiety regarding theopposite sex or sexual issues and may displayinappropriate sexual behavior.”http://www.apa.org/releases/sexabuse/effects.html 3

6/10/2012 Serious Mental Illness and Unaddressed Sexual/Physical Abuse• 51 – 98% of public mental health clients with severe mental health diagnoses Goodman et al, 1999, Mueser et al, 1998; Cusack et al, 2003• 93% of psychiatrically hospitalized adolescents Ipschitz et al, 1999 Criminal Justice Problems and Unaddressed Sexual/Physical Abuse• More than 75% of girls in juvenile justice system Calhoun et al, 1993• 80% of women in prison and jails Smith, 1998• 100% of men on death row Freedman, Hemenway, 2000• Boys are 1,000 times more likely to commit violence than those who do not van der Kolk, 1998 4

6/10/2012The Relationship of Adverse Childhood Experiences to Adult Health Status A collaborative effort of Kaiser Permanente and The Centers for Disease Control Vincent J. Felitti, M.D. Robert F. Anda, M.D. 5

6/10/2012 Adverse Childhood Experiences determine the likelihood of the ten most common causes of death in the United States. Top 10 risk Factors: smoking, severe obesity, physical inactivity, depression, suicide attempt, alcoholism, illicit drug use, injected drug use, 50+ sexual partners, h/o STD. Long-Term Consequences of Unaddressed Childhood TraumaDisease and Disability Social Problems• Ischemic heart disease • Homelessness• Autoimmune diseases • Prostitution• Lung cancer • Delinquency, criminal behavior• Chronic obstructive pulmonary• Inability to sustain employment disease • Re-victimization• Asthma • Less ability to parent• Liver disease • Teen and unwanted pregnancy• Skeletal fractures • Negative self- and other• Poor self-rated health • perception and loss of meaning• Sexually transmitted infections Intergenerational abuse 6

6/10/2012Positron Emission Tomography (PET) scan: Thetemporal lobes (at the top of the graphic), whichregulate emotions and receive input from the senses,are nearly quiescent. Such children suffer emotionaland cognitive problems. 7

6/10/2012 What is conventionally viewed as a problem is actually a solution to an unrecognized prior adversity. Mechanisms byDeath Early which Adverse Death Childhood Experiences Disease, Disability influence Health & Social Problems and Wellbeing Throughout the Life Adoption of Span Health-risk Behaviors Social, Emotional, & Cognitive Impairment Disrupted Neurodevelopment Adverse Childhood ExperiencesConcep tion 8

6/10/2012 The brainSPECT/PET (single photon/positronemission computed tomography) isa nuclear medicine imaging techniquethat produces a three-dimensionalimage or picture of functionalprocesses in the body 9

6/10/2012 Time-Lapse Imaging Tracks Brain Maturation from ages 5 to 20Red indicates more grey matter, blueless grey mater. Grey matter wanesin a back-to-front wave as the brainmatures and neural connections arepruned. Source: National Institute of Mental health Paul Thompson, Ph.D, Laboratory of Neuroimaging 10

6/10/2012Corpus callosum:the integration of the brain hemispheres• Teicher et al (1997): children (especially boys) who had a history of neglect or abuse had a marked reduction in the size of the corpus callousm when compared with the control group.Teicher et al. (2000)• Boys’ corpus callosum was more vulnerable in cases of neglect• Girl’s corpus callosum was more vulnerable in cases of sexual abuse.Teicher et al, 2004• Participants with a history of abuse/ neglect had a 17% smaller corpus callosum area when compared with the control participants (p = .0001). 11

6/10/2012 Amygdala• Teicher et al. : 33 victims of repeated sexual assault had a size reduction of 8.4% in the left amygdale (p< 0.02). Hippocampus Menna et al. (2002) • those with a history of physical or sexual abuse had an 18% smaller mean of the left hippocampal volume Bremner et al. (1997) • participants who had a history of child abuse and had PTSD had a 12% smaller left hippocampal volume compared with the matched control (p < .05) • This may be a cause for the fragmentation of explicit memories. 12

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6/10/2012The silence of the brain in the victims,shows ……the silence of the victims to discloseand denounce…and the silence of society to facethis horrible crime . 14

6/10/2012 Why society has kept in silence for so many generations doing nothing toanalyze and deal with this horrible crime? Two Fundaments of a Public Health Approach• Creating a culture of human rights respect toward children by deconstructing the androcentric and adultocentric society.• Equipping society in the areas of informed response to sexual violence in the health care, criminal justice, educational and human services systems, organizations, families and society. 15

6/10/2012 A Public Health Approach • I. Primary Prevention • II. Secondary Prevention Early detection and Intervention • III. Tertiary prevention Creating Cultures of Trauma-Informed response in Health Care, juridical and educational systems as well as in society (Healing environments and responses) I. Primary Prevention• To construct safe & healthy environments in which children may experience comprehensive development and protection from all forms of sexual aggressions.• Multiple strategies for reduction of risks in order to avert human suffering and to control the tremendous personal, family, social & economic costs of sexual aggressions 16

6/10/2012 MAP International work in Bolivia• Development projects focused on building local capacity to care for the different personal and social health determinants.• Those programs have a foundations this missions principle: “The comprehensive proclamation of Jesus’ message of salvation should always be incarnated on God’s redemptive actions through Jesus’ followers committed to love and justice.” – Encarnational in peoples sufferings and hopes – Carry & lived up by communities (team based organization) – Needs to be transformational pursuing justice & grace removing the historical roots that generate personal and social sins. Breeze of Hope Center (CUBE) The Comprehensive Management of Sexual Abused Children Program with multiple activities of prevention, advocacy and comprehensive management of cases. 17

6/10/2012 Centro Una Brisa de Esperanza • CUBE came as a response to a long history of inaction of the government, and society to engage with the thousands of children victims of sexual abuse each year are appearing in our cities. Objectives of the Program• Multidisciplinary work on identification, investigation, judicialization and treatment of sexual aggressions offering psychological, legal, medical and social support to victims• Massive information about consequences of sexual abuse, myths, procedure when a victim is identified, prevention measurements, and other related topics. (Schools, organizations, Universities, churches, media, courts, government offices, etc)• Advocacy and political incidence (Pressure the State to provide Support Centre, prevention measures, and implement legal actions against aggressors).• Research and documentation of the situation to foster solid legal protection of children rights, establishment of protection policies and restoration centers.• Production and provision of materials with information to be used with different audiences. 18

6/10/2012 Holistic Cases Management Psychotherapeutic Socio- Perspective communitarian Perspective Trans disciplinary TeamsMedicalperspective Legal PerspectiveOne of the interdisciplinary team (lawyers, psychology and social worker) planning case management 19

6/10/2012Friendlyenvironmentsfacilitate young girlsto expressthemselves Different activities allow the expression of difficult situations reducing stress and anxiety and providing tools for individual therapy 20

6/10/2012 Music therapy is also a valuable tool to process the adverse experiences Activities like sewing allows the recuperation of hands control.A way also tostrength self esteemcreativeness andrelationships 21

6/10/2012Enjoying lunch together Fun activities with the children & youth 22

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6/10/2012 Young mothers coping with their new roleHealth Check ups 24

6/10/2012Workshops with parents -Myths -Consequences of Sexual Aggressions -Role in child healing process - Group therapyVoluntaries network receiving training 25

6/10/2012 Massive communication means (TV, radios and newspapers)Workshops with students from different schools 26

6/10/2012Youth to Youth skills development Training youth in the different schools 27

6/10/2012 Information provided to members of different organizations NGOs Network for mutual supportPublic information and visualization of the problematic of Sexual Aggression 28

6/10/2012Workshops with teachers Partnership with institutions advocating for children’s rights protection 29

6/10/2012Massive campaignsagainst sexual abuseand day of solidaritywith the victims.•August 9th Nationalday of solidarity withvictims from SAs Government recognition ofMAP’s work with children (2004) 30

6/10/2012Authorities taking position against Sexual violence Workshop with the elected people to make the new constitution for BoliviaLAW 3773 “National law ofsolidarity with victims and against sexual aggressions” 31

6/10/2012 Governor Resolution for getting committed to developprogram and policies on child sexual abuse prevention Training youth in the different schools 32

6/10/2012 Training for Administrators of JusticeTHE MOST CHILDREN GROWING CITIZENS THAT ALWAYSVALUABLE ON SAFE AND EXPERIENCED FULLTHINGS ARE NURTURING RESPECT FOR THEIRFRAGILE & ENVIRONMENTS WILL RIGHTS … LEARN VERYMANY TIMES BRING THE HIGHEST WELL TO RESPECT THEPEOPLE ARE WEALTH & VALUES TO RIGHTS OF OTHERSCARELESS OUR COUNTRIESWITH THEM A SOCIETY THAT CAN NOT TAKE CARE OF THE SOURCE OF LIFE OF ITSCOUNTRY, THE CITIZENS IN THEIR EARLY AND MOST CRITICAL STAGES OFTHEIR DEVELOPMENT, IS A SOCIETY CONDEMNED TO LIVE IN MISERY AND DISINTEGRATION 33

CCIH 2012 Conference, Breakout 2, Jose Miguel De Angula, Protecting and Promoting Early Child Development in Marginalized Populations, A Holistic Response to Child Abuse

by Christian Connections for International Health on Jul 20, 2012

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CCIH 2012 Conference, Breakout 2, Jose Miguel De Angula, Protecting and Promoting Early Child Development in Marginalized Populations, A Holistic Response to Child Abuse Document Transcript