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

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 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 . ces and CAC’s .  Ga in unde rsta nding o f local r esour Ab use a nd Ne g le c t Na tio na lly  F o 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%. 1

10/ 11/ 2016 Ore g o n’ s Sta ts  F o 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%. T he Co st o f Ab use a nd Ne g le c t  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. De finitio n o f 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 o 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. 2

10/ 11/ 2016 T ype s o f Ne g le c t  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 Risk F a c to rs fo r Childho o d Ab use a nd Ne g le c t E a rly De ve lo pme nt  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. 3

10/ 11/ 2016 E pig e ne tic s  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 4

10/ 11/ 2016 T o xic Stre ss Risk F a c to rs tha t c o ntrib ute to T o xic Stre ss 5

10/ 11/ 2016 T o 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 6

10/ 11/ 2016 T o xic Stre ss a nd the Bra in  Amyg da la dysfunc tio n  Hippo c a mpus dysfunc tio n  Inc re a se po te ntia l fo r fe a r a nd a nxie ty  Diminishe d c a pa c ity to turn o ff e le va te d c o rtiso l  Chro nic a c tiva tio n o f stre ss re spo nse  Impa irme nts in me mo ry a nd mo o d-re la te d  Ove r a c tiva tio n o f stre ss func tio ns re spo nse  L  Inc re a se d c o rtiso l imite d a b ility fo r c o nte xtua l le a rning (da ng e r vs. sa fe ty) T o 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 . 7

10/ 11/ 2016 T o xic Stre ss a nd the Bra in 8

10/ 11/ 2016 T he ACE study  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 . Summa ry o f T o 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 9

10/ 11/ 2016 Sc re e ning in Pra c tic e Ba rrie rs to 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 T ips a nd T o o ls fo r Pra c tic e One time encounter R epeat F amily on your panel 10

10/ 11/ 2016 Pra c tic e re c o mme nda tio ns  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 Ca se Study Ca se Study 11

10/ 11/ 2016 Re silie nc e Wha t Do I Do if I Suspe c t Ab use o r Ne g le c t Ma ke the Ca ll!  Your t is a re q ue st fo r a furthe r sa fe ty a sse ssme nt to r epor b e ma de .  T he la w c le a rly sta te s tha t you must r t a ny time yo u epor 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. Child Ab use Ho tline  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 12

10/ 11/ 2016 T a ke Ho me  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 Ore g o n Child Ab use E va lua tio n Ce nte rs  20 c e nte rs se rving 36 c o untie s  F unde d, in pa rt, b y sta te (CAMI) funds www.childabuseintervention.org 13

10/ 11/ 2016 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 Co nta c t 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 Re fe re nc e s 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 14