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Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013
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Linkages between Child Abuse and Asthma - Presentation to WVAC - May 14, 2013

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  • More information about the Adverse Childhood Experiences Study (ACES) is available online at http://www.acestudy.org/.
  • 2
  • 5
  • This slide shows positron emission tomography (PET) scan graphics of the temporal lobes in a healthy and abused brain. Healthy brain: this PET scan of the brain of a normal child shows regions of high (shown in red) and low (shown in blue and black) activity. At birth, only primitive structures such as the brain stem (in the center of the brain graphic) are fully functional; in regions like the temporal lobes (at the top of the graphic), early childhood experiences wire the circuits. Abused brain: this PET scan of the brain of a Romanian orphan, who was institutionalized shortly after birth, shows the effect of extreme deprivation in infancy. The temporal lobes (at the top of the graphic), which regulate emotions and receive input from the senses, are nearly quiescent. Such children suffer emotional and cognitive problems.
  • This slide is a bar chart representing adverse childhood experiences versus current smoking. ACE Score Percentage 0 5.5 1 6 2 8 3 10 4 to 5 12 6 or more 16
  • This slide has a bar graph titled ACE score versus smoking and COPD (chronic obstructive pulmonary disease). ACE Score Regular smoking by age 14 COPD (percent with problem) (percent with problem) 0 3.9 6.9 1 4.2 8.2 2 7.1 11.1 3 7.8 15.5 4 or more 12.3 17.5
  • Data is from 2010 Child Maltreatment Annual Report published by the U.S. Department of Health & Human Services, Dec.2011, http://www.acf.hhs.gov/programs/cb/stats_research/.
  • Data is from 2010 Child Maltreatment Annual Report published by the U.S. Department of Health & Human Services, Dec.2011, http://www.acf.hhs.gov/programs/cb/stats_research/.
  • Form small groups of 4-6 and ask participants to take five minutes to share answers to the question. After 5 minutes ask each small group to report out. Contribute additional information on warning signs and indicators as needed. Refer participants to Supplementary Participant Handouts in Tab 4 for more information.
  • Additional information in the handouts. Physical Indicators Questionable bruises Questionable burns Questionable fractures (in various stages of healing) Questionable cuts and scrapes (to mouth, eyes, external genitalia)
  • Additional information in the handouts. Behavioral Indicators Uncomfortable with physical contact Wary of adult contacts Behavioral extremes Afraid to go home Wears inappropriate clothing for season to hide injuries Self destructive
  • Additional information in the handouts. Physical Indicators Consistent hunger, poor hygiene, inappropriate clothing Consistent lack of supervision Unattended physical or health problems Abandonment
  • Additional information in the handouts. Behavioral Indicators Begging, stealing food Constant fatigue, falling asleep States there is no caregiver Frequently absent Shunned by peers Self destructive
  • Additional information in the handouts. Physical Indicators Difficulty walking or sitting Torn, stained or bloody underwear / diaper Bruises or bleeding in external genitalia Massive weight change
  • Additional information in the handouts. Behavioral Indicators Withdrawal, chronic depression Overly compliant, passive behavior aimed at maintaining a low profile. Hostility or aggression. Unusual sexual behavior or knowledge. Unusually seductive behaviors with peers and adults.
  • Additional information in the handouts. Physical Indicators Speech disorders Lags in physical development Failure to thrive
  • Additional information in the handouts. Behavioral Indicators Behavior extremes: compliant, passive, aggressive, demanding, rageful. Overly adaptive behavior: “Parents” other children inappropriately. Inappropriately infantile or emotionally needy. Self-destructive, attempted suicide.
  • If embedded video doesn’t work, play play Section 2 of DVD, All About Reporting
  • Refer to Tab 5 Participant Handout, which answers common questions about who should report.
  • Refer to Tab 5 Participant Handout, which answers common questions about who should report. SB 161 is included on Trainers USB Drive
  • SB 161 is included on Trainers USB Drive
  • SB 161 is included on Trainers USB Drive
  • Distribute Disclosure Job Aid Cards to participants (Tab 6). Process with them.
  • Refer to What Happens When You Make a Report Handout Tab 7. Prompt the participants to read the handout pages and mark their questions. Open the floor and respond to questions. Strive to maintain focus on reporting which is the purpose of this training vs. the complexities of CPS response. Note that the initial report will take longer than in the past, due to implementation of the SAMS (Safety Assessment & Management System) Model.
  • If the following embedded video doesn’t work, play Section 3 of DVD, Responsibility to Prevent, (Circles of Caring).
  • These protective factors were identified by The Center for the Study of Social Policy (CSSP) http://www.cssp.org, after a comprehensive analysis of child abuse prevention research in conjunction with a consortium of leading child abuse prevention experts and researchers. These Protective Factors or “Circles of Caring” are conditions in families and communities that, when present, increase the health and well-being of children and families. These attributes also serve as buffers against risk factors for child maltreatment.
  • Responsibility to Prevent, (Circles of Caring)
  • Refer to Protective Factors Handout.
  • Can skip this if needed for time since it’s included in Circles of Caring footage.
  • Can skip this if needed for time since it’s included in Circles of Caring footage. Psychological health; parents feel supported and able to solve problems; can develop trusting relationships with others and reach out for help. Parents who did not have positive childhood experiences or who are in troubling circumstances need extra support and trustworthy relationships.
  • Can skip this if needed for time since it’s included in Circles of Caring footage.
  • Can skip this if needed for time since it’s included in Circles of Caring footage. Connection between normal development and positive parent child interaction. Appropriate adult response to challenging behaviors, traumatic experiences or when development is not on track. What quality childcare programs send home to families. ( “Use your words Daddy.” )
  • Can skip this if needed for time since it’s included in Circles of Caring footage. Response to a crisis: food, shelter, clothing. Assistance with daily needs: health care, education, job opportunities. Services for parents: depression and other mental health issues, domestic violence, substance abuse. Specialized services for children.
  • Transcript

    • 1. Our Babies: Safe &SoundWV Asthma CoalitionSpring Quarterly Meeting– May 14, 20131
    • 2. Connecting the DotsAsthma appears to be a greater risk forchildren who have experienced traumatic andstressful events including child maltreatment.Importance of screening for asthma amongvictims of childhood abuse, and awareness ofthe possibility of physical or sexual abuseamong children with asthma.Healthy lung development is key topreventing SUIDs and SIDS.2
    • 3. Child Abuse IncreasesAsthma RisksThe risk of developing asthma is doubledin children who have suffered physical orsexual abuse, new research in PuertoRico shows.Survey of 1,213 children and their chiefcaregivers found that nearly 40 percenthad been diagnosed with asthma at somepoint.3
    • 4. 2008 Puerto Rico StudyStudy found that victims of sexual orphysical abuse were 2.52 times morelikely to have asthma currently, and 2.35times more likely to be taking asthmamedications.http://www.atsjournals.org/doi/abs/10.1164/rccm.200711-1629OC4
    • 5. EpigeneticsFollow-Up Study published this year linkedAsthma In Puerto Rican Children andExposure to Violence to Genetic Changes“Most asthma studies have focused onenvironmental factors such as air pollution.This is one of the first to look at the impact ofstress on epigenetics, which can causedifferences in gene expression.”5
    • 6. Boston University Study Linked Abusein Childhood Linked to Adult Asthma inAfrican-American WomenAfrican-American women who reportedsuffering abuse before age 11 had agreater likelihood of adult-onset asthmacompared to women whose childhood andadolescence were free of abuse,according to a new study from the SloneEpidemiology Center at the BostonUniversity School of Public Health.6
    • 7. Boston University StudyThe study followed 28,456 African-Americanwomen from 1995 to 2011.Results indicate incidence of adult-onsetasthma was more than 20% higher amongwomen who had been abused duringchildhood.Evidence was stronger for physical abusethan for sexual abuse.7
    • 8. Adverse Childhood Experiences(ACEs) have long-term effects.8
    • 9. The Adverse ChildhoodExperiences (ACE) Study• The largest study of its kind ever done toexamine the health and social effects ofadverse childhood experiences over thelifespan (18,000 participants)
    • 10. The Adverse Childhood Experiences(ACE) StudySummary of Findings:• Adverse Childhood Experiences (ACEs)are very common• ACEs are strong predictors of laterhealth risks and disease• This combination makes ACEs the leadingdeterminant of the health and social well-being ofour nation
    • 11. Categories of AdverseChildhood ExperiencesCategoryPrevalence (%)Abuse, by CategoryPsychological (by parents) 11%Physical (by parents) 11%Sexual (anyone) 22%Household Dysfunction, by CategorySubstance Abuse 26%Mental Illness 19%Mother Treated Violently 13%Imprisoned Household Member 3%
    • 12. Evidence from ACE StudySuggests:These chronic diseases inadults are determineddecades earlier, by theexperiences of childhood.AffectiveResponse
    • 13. Adverse Childhood Experiencesvs. Current Smoking024681012141618200 1 2 3 4-5 6 or moreACE Score%
    • 14. ACE Score vs. Smoking and COPD02468101214161820PercentWithProblem0 1 2 3 4 or moreACE Score:Regular smoking by age 14 COPD
    • 15. ImplicationsResearch findings highlight importance ofscreening for asthma among victims ofchildhood abuse, and awareness of thepossibility of physical or sexual abuseamong children with asthma.16
    • 16. Facts about Child MaltreatmentIn West Virginia (2010)32,244 CPS referrals.4,133 substantiated cases.3,961 child victims.8 children died.17
    • 17. Child Abuse is Declining in WV18
    • 18. What are some potentialwarning signs and indicators?19
    • 19. What are some physical indicators ofpossible physical abuse?Physical IndicatorsQuestionable bruisesQuestionable burnsQuestionable fractures (in various stagesof healing)Questionable cuts and scrapes (to mouth,eyes, external genitalia)
    • 20. What are some behavioral indicatorsof possible physical abuse?Behavioral IndicatorsUncomfortable with physical contactWary of adult contactsBehavioral extremesAfraid to go homeWears inappropriate clothing for season tohide injuriesSelf destructive
    • 21. What are some physical indicators ofpossible child neglect?Physical IndicatorsConsistent hunger, poor hygiene,inappropriate clothingConsistent lack of supervisionUnattended physical or health problemsAbandonment
    • 22. What are some behavioral indicatorsof possible child neglect?Behavioral IndicatorsBegging, stealing foodConstant fatigue, falling asleepStates there is no caregiverFrequently absentShunned by peersSelf destructive
    • 23. What are some physical indicators ofpossible sexual abuse?Physical IndicatorsDifficulty walking or sittingTorn, stained or bloody underwear / diaperBruises or bleeding in external genitaliaMassive weight change
    • 24. What are some behavioral indicatorsof possible sexual abuse?Behavioral IndicatorsWithdrawal, chronic depressionOverly compliant, passive behavior aimed atmaintaining a low profile.Hostility or aggression.Unusual sexual behavior or knowledge.Unusually seductive behaviors with peersand adults.
    • 25. What are some physical indicators ofpossible emotional abuse?Physical IndicatorsSpeech disordersLags in physical developmentFailure to thrive
    • 26. What are some behavioral indicatorsof possible emotional abuse?Behavioral IndicatorsBehavior extremes: compliant, passive,aggressive, demanding, rageful.Overly adaptive behavior: “Parents” otherchildren inappropriately.Inappropriately infantile or emotionally needy.Self-destructive, attempted suicide.
    • 27. Childhood Asthma and NeglectExtrinsic Asthma/Sensitivity to inhalentallergens– Dust mites– Animal dander– Cockroaches– Pollen– MoldIntrinsic Asthma– Emotional StressMedical Neglect– Failure to maintainasthma medicationSmoking28
    • 28. Mandate to ReportSection 2.All About Reporting29
    • 29. Who Must ReportWV Code §49-6A-630
    • 30. New Mandated ReportersWho Must ReportPer SB 161 (effective June 8, 2012)31youth camp administrator or counseloremployee, coach or volunteer of an entity thatprovides organized activities for childrencommercial film or photographic printprocessor
    • 31. Additional Requirements RegardingChild Sexual Abuse ReportingPer SB 161 (effective June 8, 2012)32Any person over 18 who receives a disclosurefrom a credible witness or observes any sexualabuse or sexual assault of a child shall reportthe circumstances or cause a report to be madeto the Department or the State Police or otherlaw-enforcement agency having jurisdiction.Reports shall be made immediately and notmore than 48 hours after receiving such adisclosure or observing the sexual abuse.
    • 32. Additional Requirements RegardingChild Sexual Abuse ReportingPer SB 161 (effective June 8, 2012)33 If the reporter feels that reporting the alleged sexualabuse will expose themselves, the child, thereporters children or other children in the subjectshousehold to an increased threat of seriousbodily injury, the individual may delay making thereport while he or she undertakes measures toremove themselves or the affected children from theperceived threat of additional harm. The individual must make the report as soon aspractical after the threat of harm has been reduced.
    • 33. Types of Disclosure Indirect Hints• "My babysitter keeps bothering me." Disguised Disclosures• "I know someone who is being touched in a bad way." Disclosures with Strings Attached• "I have a problem, but if I tell you about it, you have topromise not to tell."
    • 34. What should you do when aparent or child discloses?35
    • 35. DisclosureWhat to do when a parent or child discloses?1. Find a private place to talk with the person.2. Reassure the person making the disclosure ("I believe you.”)3. Listen openly and calmly, with minimal interruptions.4. Write down the facts and words as the person has statedthem. (Exact words are important to investigators.)5. Do not promise not to tell, but respect the person’sconfidentiality by not telling others who don’t need to know.6. Tell the truth.7. Be specific. Let the child know what is going to happen.8. Assess the child’s immediate safety.9. Be supportive. Report the disclosure within 48 hrs to CPS.
    • 36. DisclosureWhat NOT to Say When Someone Discloses To You1. Don’t ask “why” questions such as:• “Why didnt you stop him or her?”• “Why are you telling me this?”2. Dont say "Are you sure?"3. Dont ask "Are you telling the truth?"4. Dont say "Let me know if it happens again."5. Avoid leading questions ("Did your uncle touchyou too? Was he wearing a blue jacket?”)
    • 37. How do you make a report?You should contact CPS whenever youreasonably suspect a child has been abused orneglected or is subject to conditions whereabuse or neglect is likely to occur.CPS will accept your report and determine “Isthe child safe or does the child need protected?”38
    • 38. To Whom Do You Report?WV Child Abuse and Neglect Hotline1-800-352-651324 hours a day - 7 days a weekFor serious physical abuse and sexual abuse, also contactthe state police and local law enforcement.39
    • 39. Responsibility to PreventSection 3.What Child Abuse PreventionLooks Like40
    • 40. Responsibility to Prevent“No epidemic has ever been resolved bypaying attention to the treatment of theaffected individual.”-- George W. Albee, Ph.D.41
    • 41. Protective Factors:A New Prevention FrameworkSuitable for universal, positive approach tofamilies (no “risk” factors or deficit approach)Easily communicated to all audiencesBased on hard evidence42
    • 42. Protective Factors“Circles of Caring”Knowledge of Parenting & ChildDevelopmentParental ResilienceSocial ConnectionsSocial & Emotional Development of ChildrenConcrete Support in Times of Need
    • 43. Knowledge of Parenting & ChildDevelopmentInformation about how childrendevelopHow to deal with challengingbehaviorsAlternatives to how we were raised
    • 44. Parental ResilienceAble to solve problemsFeel supportedAbility to bounce back
    • 45. Social ConnectionsRelationshipsCommunity normsMutual assistance networks
    • 46. Social and EmotionalDevelopment of ChildrenPositive parent-child interaction.Appropriate adult response to challengingbehaviors or when development is not on track.Children learn to express themselves and theiremotions.
    • 47. Concrete Support in Times of NeedResponse to crisis.Assistance with daily needs.Services for children and parents.
    • 48. Remember…WV Child Abuse and Neglect Hotline1-800-352-651324 hours a day - 7 days a weekFor serious physical abuse and sexual abuse, also contactthe state police and local law enforcement.
    • 49. For More Information Contact:The TEAM for West Virginia Children1-866-4KIDSWV304-697-0340Email: pcawv@teamwv.orgTwitter: @TEAM4WVChildrenhttp://slideshare.net/PCAWVhttp://www.preventchildabusewv.org51

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