FDEI VLE3 Beyond Mandated Reporting

Editor's Notes

1. Switch to Catherine
2. (2 minutes) Before we begin we would like to preface this webinar by saying this topic is difficult, complex and at times upsetting. We appreciate your dedication to your practice to the families and children on your caseload. There are no easy answers and we only have a short amount of time with you today. Our goal is to inform your practice, shape your perspectives and provide you with resources to supplement your work. We will begin our webinar with confront 5 common misconceptions about child abuse and neglect. We will share 10 ways you can spot abuse happening (some more obvious than others). Finally we will discus what you can do as a provider if you suspect child abuse is happening.
3. (2 minutes) The younger the child, the more vulnerable they are to abuse/neglect. Babies who are victims of shaken baby syndrome can suffer bleeding in the eye or brain; damage to the spinal cord and neck; rib and bone fractures. One in every four victims of shaken baby syndrome dies, and nearly all victims experience serious health consequences. Child physical abuse can result in the malformation of the brain, resulting in impaired mental development and lack of growth in vital areas.
4. (2minutes) In case you haven’t looked at a diagram of the brain recently here is a brief look at a child's brain It is also important for us to review some of the terminology related to brain development: Myelin: Is the white fatty tissue that forms a sheath to insulate mature brain cells, thus ensuring clear transmission of neurotransmitters across synapses Plasticity: The brain’s ability to change in response to repeated stimulation. The extent of a brain’s plasticity is dependent on the stage of development and the particular brain system or region affected (Perry, 2006). For instance, the lower parts of the brain, which control basic functions suchas breathing and heart rate, are less flexible, or plastic, than the higher functioning cortex, which controls thoughts and feelings. While cortex plasticity decreases as a child gets older, some degree of plasticity remains. In fact, this brain plasticity is what allows us to keep learning into adulthood and throughout our lives. This is sometimes referred to as the concept of “use it or lose it.” It is through these processes of creating, strengthening, and discarding synapses that our brains adapt to our unique environment. Sensitive periods: There are sensitive periods or development of certain capabilities. These refer to windows of time in the developmental process when certain parts of the brain may be most susceptible to particular experiences.
5. (2minutes) In recent years, there has been a surge of research into early brain development. Neuroimaging technologies, such as magnetic resonance imaging (MRI), provide increased insight about how the brain develops and how early experiences affect that development. There is now scientific evidence of altered brain functioning as a result of early abuse and neglect During fetal development, neurons are created and migrate to form the various parts of the brain. As neurons migrate, they also differentiate, or specialize, to govern specific functions in the body in response to chemical signals (Perry, 2002). This process of development occurs sequentially from the “bottom up,” that is, from areas of the brain controlling the most primitive functions of the body (e.g., heart rate, breathing) to the most sophisticated functions (e.g., complex thought) (Perry, 2000a) The first areas of the brain to fully develop are the brainstem and midbrain; they govern the bodily functions necessary for life, called the autonomic functions. At birth, these lower portions of the nervous system are very well developed, whereas the higher regions (the limbic system and cerebral cortex) are still rather primitive. Higher function brain regions involved in regulating emotions, language, and abstract thought
6. Brains are built in a hierarchical fashion, starting with the simplest circuits and then moving up to more complex circuits. Sensory pathways like those for basic vision and hearing are the first to develop, followed by early language skills and higher cognitive functions. Connections proliferate and prune in a prescribed order: the timing is determined genetically but experiences affect whether the circuits are strong or weak. The brain is never a blank slate – every new competency is built upon competencies that came before. By 3 years of age, a child’s brain has reached almost 90 percent of its adult size. The growth in each region of the brain largely depends on receiving stimulation, which spurs activity in that region. This stimulation provides the foundation for learning.
7. (5 minutes) Hippocampus: Adults who were maltreated may have reduced volume in the hippocampus, which is central to learning and memory (McCrory, De Brito, & Viding, 2010; Wilson, Hansen, & Li, 2011). Toxic stress also can reduce the hippocampus’s capacity to bring cortisol levels back to normal after a stressful event has occurred (Shonkoff, 2012). Corpus callosum: Maltreated children and adolescents tend to have decreased volume in the corpus callosum, which is the largest white matter structure in the brain and is responsible for inter-hemispheric communication and other processes (e.g., arousal, emotion, higher cognitive abilities) (McCrory, De Brito, & Viding, 2010; Wilson, Hansen, & Li, 2011). Cerebellum: Maltreated children and adolescents tend to have decreased volume in the cerebellum, which helps coordinate motor behavior and executive functioning (McCrory, De Brito, & Viding, 2010). Prefrontal cortex: Some studies on adolescents and adults who were severely neglected as children indicate they have a smaller prefrontal cortex, which is critical to behavior, cognition, and emotion regulation (National Scientific Council on the Developing Child, 2012), but other studies show no differences (McCrory, De Brito, & Viding, 2010). Physically abused children also may have reduced volume in the orbitofrontal cortex, a part of the prefrontal cortex that is central to emotion and social regulation (Hanson et al., 2010). Cortisol levels: Many maltreated children, both in institutional and family settings, and especially those who experienced severe neglect, tend to have lower than normal morning cortisol levels coupled with flatter release levels throughout the day (Bruce, Fisher, Pears, & Levine, 2009; National Scientific Council on the Developing Child, 2012). (Typically, children have a sharp increase in cortisol in the morning followed by a steady decrease throughout the day.) On the other hand, children in foster care who experienced severe emotional maltreatment had higher than normal morning cortisol levels. These results may be due to the body reacting differently to different stressors. Abnormal cortisol levels can have many negative effects. Lower cortisol levels can lead to decreased energy resources, which could affect learning and socialization; externalizing disorders; and increased vulnerability to autoimmune disorders (Bruce, Fisher, Pears, & Levine, 2009). Higher cortisol levels could harm cognitive processes, subdue immune and inflammatory reactions, or heighten the risk for affective disorders. Amygdala: Although most studies have found that amygdala volume is not affected by maltreatment, abuse and neglect can cause overactivity in that area of the brain, which helps determine whether a stimulus is threatening and trigger emotional responses (National Scientific Council on the Developing Child, 2010b; Shonkoff, 2012). Other: Children who experienced severe neglect early in life while in institutional settings often have decreased electrical activity in their brains, decreased brain metabolism, and poorer connections between areas of the brain that are key to integrating complex information (National Scientific Council on the Developing Child, 2012). These children also may continue to have abnormal patterns of adrenaline activity years after being adopted from institutional settings. Additionally, malnutrition, a form of neglect, can impair both brain development (e.g., slowing the growth of neurons, axons, and synapses) and function (e.g., neurotransmitter syntheses, the maintenance of brain tissue) (Prado & Dewey, 2012).
8. Switch to Deserai Children actually experience trauma and stress very similarly to adults. However, they have often not yet developed the coping skills adults have.
9. Deserai This definition is very general. Everyone experiences and manages situations differently, so what is traumatic for one child may not be for another child. There are reasons for this, There are protective factors that are present for children. These protective factors contribute to how a child may experience a specific situation. With many positive present protective factors a child may not experience an event in the same way as a child with less protective factors. . Some children may not need extra support from providers, because they have protective factors present. As providers, we are not able to prevent all trauma from occurring, but we can help facilitate protective factors. http://main.zerotothree.org/site/PageServer?pagename=ter_key_disaster_ptsd
10. Deserai As providers we have a very limited amount of information. This iceberg is an illustration of the amount of information we know and how much information we truly do not know about the children we work with. The part of the iceberg is what we know about the child (non-compliant, distractible, poor social skills, etc.), beneath the surface is what we don’t know. This could be abuse, neglect, domestic violence in the home, etc. It is important to recognize that there may be more to a child’s story than what we can actually see.
11. Deserai When children who experienced trauma were compared to children who have not experienced trauma, the findings illustrated many different forms of negative outcomes for the children. Here is what some of the research says, -Children in Foster care-have significantly more difficulty adapting to preschool and kindergarten -They have more difficulty with managing frustration -Victims of violence are more likely to have externalizing behavior (e.g. hitting, yelling, refusal to comply) -Witnesses of violence are more likely to have internalizing behavior (e.g. withdraws, distracted) -Children who had been neglected have more avoidant behavior -More significant the trauma more significant the behavior -Children who have experienced trauma are more likely to be avoided by peers. This is an especially important point, because children need time to practice social skills and children who have experienced trauma are more likely to have difficulty initiating play, difficulty with cooperation and difficulty with problem solving, but if they are avoided by peers, they are lacking an opportunity to practice more appropriate behavior. -Children who have experienced trauma and have protective factors are less likely to have some of the negative outcomes noted. We will spend the largest portion of this webinar discussing how providers can help build resiliency through protective factors.
12. Switch to Catherine Adults and children experiences stress. Many of the families you work with will be experiencing toxics stress. It is important for us to understand how stress effects the brain. Stress: We all experience different types of stress throughout our lives. The type of stress and the timing of that stress determine whether and how there is an impact on the brain. --Positive stress is moderate, brief, and generally a normal part of life (e.g., entering a new child care setting). Learning to adjust to this type of stress is an essential component of healthy development. ƒ --Tolerable stress includes events that have the potential to alter the developing brain negatively, but which occur infrequently and give the brain time to recover (e.g., the death of a loved one). ƒ --Toxic stress includes strong, frequent, and prolonged activation of the body’s stress response system (e.g., chronic neglect). Cortisol: A chemical/hormonal reaction to stress produced in the body. Increases in cortisol help the body engage energy stores and also can enhance certain types of memory and activate immune responses. In a healthy stress response, the hormonal levels will return to normal after the stressful experience has passed.
13. (5 minutes) Persistent fear response: Chronic stress or repeated trauma can result in a number of biological reactions, including a persistent fear state (National Scientific Council on the Developing Child, 2010b). Chronic activation of the neuronal pathways involved in the fear response can create permanent memories that shape the hild’s perception of and response to the environment. While this adaptation may be necessary for survival in a hostile world, it can become a way of life that is difficult to change, even if the environment improves. Children with a persistent fear response may lose their ability to differentiate between danger and safety, and they may identify a threat in a nonthreatening situation (National Scientific Council on the Developing Child, 2010b). For example, a child who has been maltreated may associate the fear caused by a specific person or place with similar people or places that pose no threat. Hyperarousal: When children are exposed to chronic, traumatic stress, their brains sensitize the pathways for the fear response and create memories that automatically trigger that response without conscious thought. This is called hyperarousal. These children may be highly sensitive to nonverbal cues, such as eye contact or a touch on the arm, and they may be more likely to misinterpret them Increased internalizing symptom: Child maltreatment can lead to structural and chemical changes in the areas of the brain involved in emotion and stress regulation (National Scientific Council on the Developing Child, 2010b). For example, maltreatment can affect connectivity between the amygdala and hippocampus, which can then initiate the development of anxiety and depression by late adolescence (Herringa et al., 2013). Additionally, early emotional abuse or severe deprivation may permanently alter the brain’s ability to use serotonin, a neurotransmitter that helps produce feelings of well-being and emotional stability Diminished Executive functioning: Executive functioning skills help people achieve academic and career success, bolster social interactions, and assist in everyday activities. The brain alterations caused by a toxic stress response can result in lower academic achievement, intellectual impairment, decreased IQ, and weakened ability to maintain attention (Wilson, 2011). Delayed developmental milestones: For children to master developmental tasks in these areas, they need opportunities and encouragement from their caregivers. If this stimulation is lacking during children’s early years, the weak neuronal pathways that developed in expectation of these experiences may wither and die, and the children may not achieve the usual developmental milestones Weakened response to positive feedback: Children who have been maltreated may be less responsive to positive stimuli than non-maltreated children. Social interactions: Toxic stress can alter brain development in ways that make interaction with others more difficult. Children or youth with toxic stress may find it more challenging to navigate social situations and adapt to changing social contexts (Hanson et al., 2010). They may perceive threats in safe situations more frequently and react accordingly, and they may have more difficulty interacting with others (National Scientific Council on the Developing Child, 2010b)
14. Switch to Deserai
15. (5 minutes) 1. Unexplained injuries: Visible signs of physical abuse may include unexplained burns or bruises in the shape of objects. You may also hear unconvincing explanations of a child’s injuries. 2. Changes in Behavior: Abuse can lead to many changes in a child’s behavior. Abused children often appear scared, anxious, depressed, withdrawn or more aggressive. 3. Returning to earlier behaviors: Abused children may display behaviors shown at earlier ages, such as thumb-sucking, bed-wetting, fear of the dark or strangers. For some children, even loss of acquired language or memory problems may be an issue 4. Fear of going home: Abused children may express apprehension or anxiety about leaving school or about going places with the person who is abusing them. 5. Changes in eating: The stress, fear and anxiety caused by abuse can lead to changes in a child’s eating behaviors, which may result in weight gain or weight loss.
16. (5minutes) 6. Changes in sleeping: Abused children may have frequent nightmares or have difficulty falling asleep, and as a result may appear tired or fatigued. 7. Changes in school performance and attendance: Abused children may have difficulty concentrating in school or have excessive absences, sometimes due to adults trying to hide the children’s injuries from authorities. 8. Lack of personal care or hygiene: Abused and neglected children may appear uncared for. They may present as consistently dirty and have severe body odor, or they may lack sufficient clothing for the weather. 9. Risk-taking behaviors: Young people who are being abused may engage in high-risk activities such as using drugs or alcohol or carrying a weapon. 10. inappropriate sexual behaviors: Children who have been sexually abused may exhibit overly sexualized behavior or use explicit sexual language It is important to know, some signs that a child is experiencing violence or abuse are more obvious than others. The less oblivious signs do not mean the child is suffering less.
17. Here we will pause and ask for participants to participate by typing answers to these questions. This will help us understand what resources to supplement them with as the presentation comes to a close.
18. We would like to switch gears now to what you do when you believe a child is being abused or neglected. Research indicates it takes many times for a child to disclose abuse before an adult believes them. For their emotional health it is important for them to know you believe them. You can say things like “I believe you”, “I understand”. Children may think they have done something wrong or that people may think bad of them for the abuse, so it is important to stay judgment free. It is important to not looked shocked or disappointed. Many times the person who committed the abuse is someone the child loves, so it is also important not to place judgment on this person. Disclosing abuse or neglect can be very scary, so the more details you can give the better. For example, “My job is to make sure you are safe, so I will need to call people that can help make sure that is happening. They may come to talk to you. You are not in trouble, they just want to understand more about what happened. They are safe people to talk to” If you believe a child is being abused or neglected you need to report it. You are not in charge of investigating, so you don’t need to have a certain amount of facts before you can report abuse or neglect. Since you are not the one investigating you do not need and should not push the child for more details than needed. If you suspect immediate danger you can call 911. Also, most child protective workers will ask if you think there is an immediate danger. If you say yes they will send someone out much faster.
19. As noted before, you are not responsible for investigating. The best thing you can do is listen and show support. This will actually be a very important step in healing for the child. By listening, not judging and not pressuring you will show them that they are not bad for what happened and that it is okay to talk about it. You do not want to confront the offender for a variety of reasons including (impede the investigation, cause anxiety for the child, compromise your own safety). There are times where someone might believe it is best to contact the perpetrator, but ultimately it is best to avoid this. You can discuss the abuse or neglect with the child’s parent, if the perpetrator is not parent. This will be difficult information for the parent to hear, so use sensitivity. The parent may have a difficult time filtering their reaction, so it is best to not discuss this with the parent in front of the child. There are circumstances where telling the family (including the perpetrator) that you need to make a call may be appropriate. You do not want to place judgment or blame, but if you have a relationship with this family and you believe they will know it is you then it is okay to talk with the person. You can say things like (“I understand this is difficult, but I am legally mandated to report this”). It may also help to walk the family through the process if you don’t think it will impede the investigation. There are times a family may be able to lean on you for support through this, which will help maintain the relationship and will ultimately be better for the child. I had a situation that occurred once, where I had a child who would fake injuries and then say a staff member injured him. This continued on for quite some time and we knew he was faking the injuries because we watched him do it (scratch his skin, bite himself, etc.). One day, he came to me and said, my mom hit me with the belt and he showed me a huge mark on his back. I made a call, although, there was a part of me that thought he possibly did it. I also called his mom and explained the situation. She broke down and said, she lost her patience and made a really bad decision. I was able to help her process the situation and child protective services was able to provide resources to her. This was an example, of a time, when I have to call regardless of what I think and it was also helpful to speak with the parent. Do NOT tell the perpetrator if you believe you will be in danger, if it puts the child in danger, if it impedes the investigation. If you see a family member afterward and they know it was you, first ensure you are safe, but then you can show empathy and explain that you legally have to report situations like that regardless of what you believe is true.
20. After they investigated there was enough information found to indicate child abuse or neglect did occur. After they investigated there was not enough information found to indicated child abuse or neglect did occur. This does not mean it didn’t occur, there just wasn’t enough information. Some departments have specific programs that focus on keeping the family together. There may be an indicated case of abuse or neglect, and the plan of action is to keep the child in his/her current placement and provide services to support the family in the future. Foster care-when a child lives with a family that is licensed for children who have been taken out of the custody of their parent Relative Foster Care-When a child lives with a family member in a foster care situation.
21. Many Departments will require a verbal report and then a follow up written report. This is generally a one page document that you complete and mail to the nearest office. When you make the call they will ask for details such as child’s address, phone number, parent’s name, etc. They will also ask for information related to the person who you suspect committed abuse They will also ask for details related to other siblings in the home, birthdates, etc. They will ask for details related to the abuse, but there will be questions you do not know the answer to and that is okay. It isn’t your job to investigate, just to report Most departments allow you to make an anonymous report. All will keep your information confidential. There are some legal circumstances where it may be impossible to keep your information confidential, but this is very rare. For example, I have made over 150 reports. Some of these have gone to court, I have never been asked to testify related to an abuse case, and my report remained confidential. The person who the abuse or neglect was revealed to needs to be the one to make the call in most cases. Many times people will go to the social worker, disclose the information and ask the social worker to make the call, but it actually needs to be the person.
22. Many departments will either take the call or take it as a report. If they take the call that means they will be investigating. If they take it as a report that means they will be filing the information, but not opening an investigation. When they do this they are keeping the information in case other reports come in. If this happens they can combine the information. If they only take it as a report, this doesn’t mean they don’t believe abuse or neglect could have occurred, it just means there isn’t enough details for them to investigate. If you learn of new information you can call again with that information. If they do take the call, many departments will send you a follow up letter letting you know what was decided. If they take the call they generally have 24 hours to respond. “Respond” means different things for different departments.
23. Making a call is never easy. It is difficult to hear that information and it is difficult to know if you did the right thing. As a mandated reporter you do not have an option. If you believe a child has been abused or neglected you must make the call. You may worry about the safety of the child, your own safety, your relationship with the child and/or parent, whether the call will make things worse for the child, whether the parent will want you to continue delivering services. All of these are normal feelings! You can talk about the situation to a supervisor or friend as long as you don’t disclose identifying information. Even though it is hard, you did the right thing! If you have experienced abuse or neglect it is normal for a situation like this to trigger past memories. Even if the abuse or neglect is different from what you experienced it may still trigger similar feelings. It is important to acknowledge these feelings and seek help if needed. Lastly, use your coping strategies. Even if you think you aren’t bothered by making the call, still use your strategies preventatively. Understanding how the process works ahead of time, will alleviate anxiety and make you feel more comfortable when you need to make the call. It is also a great idea to think through different scenarios ahead of time, so you know what you would do in that situation. The more prepared you are the easier the situation will be when it happens. If you need more support after you make a call know what your options are. For example, your community may have resources through child protective services that can help you process the situation. In addition, know what works for you to manage stress and seek out those options if you need more support after you make a call.
24. Switch to Catherine
25. When Catherine is finished speaking Switch to Robyn