Abuse Information

August 2018
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With structure and support, it’s ACEs low as children learn new habits

At the Boys & Girls Clubs of Fort Wayne, we see families under ever-increasing stresses and the toll it takes on the children.  Unemployment statistics may have declined but the jobs are low-wage, sometimes requiring the adults to work multiple jobs that eat up all the day except for maybe a few minutes with their exhausted child after second shift at midnight.  (70% of the children who come to the clubs are from low-to-no-income families.)  Addictions have consumed parents and now it is Grandmother or a foster parent who comes to pick up the first grader.  (72% live in single/other relative/foster households.)  Food insecurity still affects 18.1% of Allen County children.  When the snacks and meals are served, we can tell which homes have cupboards that are bare most days.  Fragile budgets mean missed rents and bill collectors, followed by the child no longer showing up at our door because the family is homeless again.

These types of home situations generate events called “ACEs” or adverse childhood experiences.[1]  ACEs have been correlated with abuse, neglect, early death, and generational deficits that have been in years past called “the poverty affect.”  More plainly, it is survival mode – and it manifests as “offense is the best defense.”  Time and again, when the youngest children in our programs get into fights or shouting or “melt-downs,” they explain after intervention that “my momma said if I think I’m going to get hit, hit them first harder,” or “I didn’t like how she was looking at me, so I took her down” or “he was disrespecting me.”  They all know they shouldn’t, but they have no practice at resisting earlier ways of reacting.  For the older children, abuse and neglect can feed desperate feelings and angry behaviors, with suicide and gun violence as temptations that we hear discussed in the mentoring sessions.  Allen County has one of the state’s highest rates of self-inflicted injury. As the Indiana State Department of Health reported in 2016, “unhealthy relationships involving high conflict and a family history of suicide can be influential.”[2]

The Clubs’ staff works to address these challenges through programs that seek to wrap the 2,270 members in as many protective factors as possible. As noted by the Indiana Department of Health, protective factors include coping skills; problem solving skills; connection to at least one caring adult; a reason to look forward to the future; a sense of support from the community; and positive reinforcement for behavioral changes.  At the most basic level, the Clubs provide structure, connection, and a refuge. After several years of participation, the factors are long-term, as the children are encouraged to see themselves as achieving their full potential, with goals fueled by hope and grounded in confidence.  In between?  We start with the We C.A.R.E program for the K-3 grade club members. The program is comprised of 18 units delivered over 24 weeks, with the first 10 units and the second half in the summer. This year, in the spring semester, 140 children at 3 sites participated. The first half focuses on relating to each other – forming relationships, understanding their own strengths and limits, and ways to manage their feelings, particularly anger and conflicts. This summer, the second half will address setting boundaries, love for self and others, and safe touch.

Their Spring pre-tests show overwhelmingly that they know what the correct answer on the survey should be – they know it is not right to hit others, call them names, that every person should be respected and differences are good. What the staff sees day-in-day out, however, is a walk that does not match the youngsters’ talk when emotions come into play. When a fist is raised, angry voices flare – staff is there to intercept, redirect and suggest the new way to respond instead. Changing a reaction, particularly for those who have never seen a problem addressed any other way, takes time and practice. Meanwhile, the We C.A.R.E. units flow along, providing the food for thought and the planned interactions that nurture new responses.

In terms of quantifiable results, the pace of change is incremental. The participating children will be surveyed again this fall and encouraged to reflect on what they now do differently. Staff comments will be collected for qualitative insights. We communicate with their schools to learn about changes in their behavior in the daytime classrooms and track results as part of the 21CCLC program evaluations. Last year, that evaluation showed that “71% percent of students maintained the high marks for classroom behavior while another 23% improved their behavior throughout the year. By the end of the year, 88% of students had a Satisfactory (S) or higher grade in classroom behavior.” Parent surveys will be taken to learn more about changes seen at home.

Comments from the youngsters themselves about the impact of the We C.A.R.E. Part 1 are encouraging. “I love it. It teaches me about my emotions,” said Jaylen, age 9, and “Tamyah, age 8 said “I learned how to do a good deed.” Alejandra, age 9, told us “I have learned how to treat my friends,” and Jamarrion, also 9, said “I have learned how to control my anger.”

Page 30, Fortson, B. L., Klevens, J., Merrick, M. T., Gilbert, L. K., & Alexander, S. P. (2016). Preventing child abuse and neglect: A technical package for policy, norm, and programmatic activities. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.  “A large body of evidence highlights the importance of intervening with those who have experienced and those at risk of perpetrating abuse and neglect. Abuse and neglect often tend to be cyclical; thus, success in interrupting the cycle of violence can prevent the exposure of many children to abuse and neglect.” https://www.cdc.gov/violenceprevention/pdf/can-prevention-technical-package.pdf


Page 44. Adams, J., Pontones, P., Logsdon, A.L., Hokanson, K., Kenny, R., Indiana Department of Health, Epidemiology Resource Center and the Division of Trauma and Injury Prevention, Suicide in Indiana, 2011-2015. 


July 2018

VINCENT VILLAGE

Fort Wayne Children’s Foundation

According to the Child Welfare League of America, the latest research shows that over 100,000 children in Indiana were referred for investigation of child abuse and neglect within one year’s time.  The Indy Star reported in January 2018, “Indiana has more children in its child welfare system than any surrounding state — including those with nearly twice Indiana’s overall population.”  Child abuse prevention and maybe more importantly, treatment must not go unaddressed. 

Vincent Village houses and serves over 150 children (along with their families) every year.  Many of these homeless youth have faced neglectful and abusive situations themselves in the midst of unstable circumstances in their family.  Many of our families come to us with open cases with the Department of Child Services and our in need or our guidance and support to repair fractured and dysfunctional relationships.  At least 45% of our families come to us with domestic violence experience.  “Domestic violence creates vulnerability to homelessness for women and children with limited economic resources. Among mothers with children experiencing homelessness, more than 80% had previously experienced domestic violence.” (Aratani, Y., 2009 “Homeless Children and Youth, Causes and Consequences. National Center for Children in Poverty.”  Another 25% have a mental illness or addiction issue.  It is imperative that we have the adequate resources and programs to meet the needs of our family and their youth in order to end the cycle of homelessness and the trauma that accompanies it.

When working with such populations in crisis the solution is not one dimensional.  The prevention and treatment must be infused in the whole family.  This includes programming for youth who have experienced the trauma, therapy for parents and families, resources provided for families to address trauma that may be present in their families, and proper parenting instruction. 

Youth who have experienced trauma and abuse and who go untreated grow up to be parents living with this trauma.  These experiences can unintentional continue the cycle of abuse and neglect.  So, in addressing the needs the youth we are working towards not only treatment but prevention.  Treatment in youth will lead to prevention of potential abuse in the future and will end the cycle.  Parents cannot be left out of the treatment and prevention plan as well.  As previously stated, these parents may have been victims themselves of maltreatment and harm and have gone untreated, uncared for and neglected.  Parenting strategies must involve both education (giving them tools and resources) but also providing therapeutic opportunities for them to restore and rebuild their own mental health so they can properly care for their children.  When we work to address the needs of the whole family consistently and over a period of time, the cycle of trauma and abuse can then and only then begin to heal.

Vincent Village, Sarah Neace – Director of Agency Advancement 


June 2018

Saving Babies Lives by Preventing Shaken Baby Syndrome

By Candace Schuler
Parkview Health System  

Abstract/Summary

Shaken Baby Syndrome is both the most common and most serious form of abuse in children under one year of age. The number one reason an infant is shaken is frustration with the baby’s crying. Studies show that teaching parents and caregivers about the dangers of shaking a baby and how to respond appropriately to an infant’s crying is the most effective way to reduce Shaken Baby Syndrome.

Problem Statement

Traumatic brain injury as a result of shaking a baby—aka Shaken Baby Syndrome—is both the most common and most serious form of abuse in children under one year of age. It results in death 25-35% of the time, with 70-80% of survivors suffering life-long physical and developmental problems such as permanent brain damage, speech disabilities, blindness, hearing loss, seizures, behavioral disorders, cerebral palsy, and paralysis.[1]

Background

Although shaking may cause injury to children of any age, infants under the age of one year are the most susceptible to being injured or dying as a result of being shaken. This is because babies’ neck muscles are weak, their heads are heavy in proportion to their body size, and their brains are fragile and undeveloped. Because of this fragility of very young infants, shaking can cause subdural hematoma (tiny veins between the surface of the brain and its outer covering stretch and tear, allowing blood to collect), shearing off or breakage of nerve cells, oxygen deprivation to the brain, retinal hemorrhages, and skull fractures. [2]

It is important to note that Shaken Baby Syndrome does not happen by accident. It is not a result of bouncing a baby in your arms or on your knee. It does not happen by playfully tossing a baby into the air or driving over bumpy roads with a baby in an infant car seat or on the back of a bicycle. It is highly unlikely to happen as a result of a baby rolling off a bed or being accidentally dropped.[3] As noted above, it is caused by an infant being deliberately and forcefully shaken so hard that its head moves in a rapid, back-and-forth whiplash motion that causes the baby’s fragile, undeveloped brain to repeatedly hit the inside of the skull.

Multiple studies have proven that the number one reason an infant is shaken is frustration; a parent or caregiver becomes so frazzled by a baby's persistent, prolonged crying that they lose control and just shake the baby in an effort to make it stop.[4] Adding to the parents’/caregivers’ level of frustration is the fact that they have never been told that all babies experience prolonged bouts of unsoothable crying in the first few months of life. These crying bouts begin at about two weeks of age, peak in the second month, and generally end by about three or four months. Parents often believe there is something wrong with their baby or with themselves as caregivers when they are unable to soothe and calm their crying infant. This increases the likelihood that they may react in frustration and anger to the crying by shaking or other abuse.

Babies being injured or killed by being shaken in frustration is, unfortunately, not uncommon in the greater Fort Wayne Area. In July 2016, a six-month-old baby boy was fussy and recovering from a respiratory infection. His frazzled mom ran out for a pizza, leaving him with his equally frazzled father. When she returned home 20 minutes later, the baby was unresponsive. His father denies any wrong-doing but the baby’s brain had been slammed so hard against his skull that doctors had to remove bone tissue to accommodate the extensive swelling. He was in a coma for five days and lost an estimated 90% of his brain tissue. Now 15 months old, the baby can breathe on his own but he is still unable to hold his head up, he has diminished eyesight, and he must be fed through a feeding tube. His long-term prognosis is uncertain.[5] In March 2018, a two-month old baby girl was airlifted to Parkview Regional Medical Center, where she died due to injuries caused by being violently shaken. The baby’s father said the infant wouldn’t stop crying and he “lost his temper,” shaking the baby multiple times during the night before finally picking her up out of the crib and throwing her on the bed.[6] These are just two examples of the damage done to infants by shaking them.

Solution

Studies show it’s not enough to just teach parents or caregivers what Shaken Baby Syndrome is and why it’s dangerous. They must also be educated about the normal patterns of infant crying and taught how to respond appropriately to an infant’s unsoothable crying. Thus, to prevent Shaken Baby Syndrome, educators must address the root cause—frustration with infant crying—and teach parents and caregivers how to safely deal with it.[7]

In 2007, the National Center on Shaken Baby Syndrome (NCSBS) developed the Period of PURPLE Crying program to teach parents about the dangers of shaking a baby and the normal patterns of infant crying, and then providing proven, evidence-based strategies for parents to try to soothe a crying infant, including putting the infant down in a safe place and walking away when feeling frustrated.

Each of the letters of the word PURPLE refers to one of the six characteristics or “properties” of normal infant crying that parents and caregivers often find frustrating. They are:

P for Peak of Crying – Crying peaks during the second month, decreasing after that;

U for Unexpected – Crying comes and goes unexpectedly, for no apparent reason;

R for Resists Soothing – Crying continues despite all soothing efforts by caregivers;

P for Pain-like Face – Infants look like they are in pain, even when they are not;

L for Long Lasting – Crying can go on for 30-40 minutes or as much as 5 hours or longer;

E for Evening Crying – Crying occurs more often in the late afternoon and evening.

The word “Period” is used to let parents know that this experience of increased frustrating crying is temporary, and eventually does come to an end.

The primary tool used to teach parents and caregivers about the danger of shaking a baby is the Shaken Baby Simulator doll, which is the size of a newborn infant. When the simulator is shaken, LEDs in the head light up to show the areas of the baby’s brain that are damaged by shaking. As one father who participated in the program commented, “The fake baby shaking gadget helped me truly grasp the fragility of an infant.” The program also includes a 10-minute educational DVD and a 10-page full color booklet about the Period of PURPLE Crying and the dangers of shaking an infant, as well as a 17-minute film titled, “Crying, Soothing, and Coping: Doing What Comes Naturally,” to provide parents with proven techniques for coping with a crying infant.

Parkview Health System delivers the Period of PURPLE Crying Program in three “doses” to increase its effectiveness. The first dose is given to all Parkview moms and families after the birth of their baby. This most often occurs in the hospital maternity room but can also occur in prenatal classes, pediatric offices, public health settings, or during home visits. The second dose is delivered via program presentations delivered in conjunction with Parkview’s community partners, i.e., churches, libraries, schools, and non-profit organizations that work with families and children, including “train the trainer” education to staff at Healthier Moms and Babies so they can train their clients/constituency and reinforce the information presented. The third dose is a public education campaign/community awareness to educate grandparents, babysitters, boyfriends, neighbors, and relatives about the PURPLE program so parents will receive support and reinforcement from them and others will have an understanding of what the parents are going through.

Conclusion

The most recent sample of parents (n=101) surveyed found that 100% understood the PERIOD  of Purple Crying program content and saw value in it, and 99% intended to share the content with their baby’s other caregivers. A sample of maternity nurses (n=63) who participated in the program showed that 100% modeled appropriate behaviors and techniques.

[1] National Center on Shaken Baby Syndrome, https://www.dontshake.org/learn-more, accessed 2018 May 13

[2]  American Association of Neurological Surgeons, http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Shaken-Baby-Syndrome , accessed 2018 May 13

[3] National Center on Shaken Baby Syndrome, https://www.dontshake.org/learn-more, accessed 2018 May 13

[4] Barr, RG., Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers. Proc Natl Acad Sci USA 2012 Oct 16;109 Suppl 2:17294-301. doi: 10.1073/pnas.1121267109. Epub 2012 Oct 8.

[5] Spencer, S., Shaken for Life: The survivors of shaken baby syndrome. 2017 May 11. WSBT 22 Anchor/Reporter http://wsbt.com/news/local/shaken-for-life-the-survivors-of-shaken-baby-syndrome

[6] WANE Staff Reports, Father arrested in baby’s death, 2018 March 29,

[7] CDC, Preventing Abusive Head Trauma in Children, https://www.cdc.gov/violenceprevention/childmaltreatment/Abusive-Head-Trauma.html , accessed 2018 May 13

 


May 2018

Intergenerational Patterns

By Bradley Williams
SCAN Inc.

Over the past 30 years there have been many studies on the intergenerational patterns of Child Abuse and/or Neglect. These studies have begun to show us the levels of nuance and complexity that exist within the subject. There are several theories that have been cited in order for us to better understand this complexity and how it impacts families within our community. The most prevalent theories are as follows:

  • 1)Social learning theory proposes that the behaviors of an individual is shaped through observing and imitating. This theory suggests that adults’ parenting is influenced by their own childhood experiences and their own parents’ behaviors. If the individual experiences abusive or neglectful parenting then they may develop the belief that such behaviors are acceptable and/or effective and replicate them with their own children.
  • 2)Attachment theory emphasizes the importance of an early quality attachment with a caregiver. If the caregiver is not caring and sensitive to the infant’s needs, the affected individual struggles to form healthy attachments into adulthood. This is theorized to increase the likelihood of abusive behaviors as an adult.
  • 3)Trauma-based models suggest that maltreatment, like any other form of violence, produces trauma symptoms. If untreated and unresolved, these symptoms may increase the likelihood that the individual will engage in violent behavior, including child maltreatment, as an adult.
  • 4)Ecological or transactional theories see child maltreatment as the result of multiple influences and systems, including family, community and societal factors. Research grounded in these theories looks for specific risk factors or pathways to better explain intergenerational patterns of maltreatment. (Children’s Bureau)

These theories all factor in to the treatment of families that are involved in substantiated cases of abuse and/or neglect. When the parents have certain experiences or backgrounds the risk of abuse and/or neglect can become even more prevalent and can lead to their children internalizing their experiences and act the same way when they become parents themselves. These factors have been identified through strong studies on Intergenerational Patterns of Child Maltreatment (IGM).

  • Mothers’ social isolation and tendency to respond to minor provocations with verbal or physical aggression (Berlin, Appleyard, & Dodge, 2011)
  • Maternal substance abuse, or substance abuse while pregnant (Appleyard, Berlin, Rosanbalm, & Dodge, 2011)
  • Young parental age, parents’ history of mental illness or depression, and parents living with another violent adult (Dixon, Browne, Hamilton-Giachritsis, 2005)
  • Parental age, educational achievement, psychiatric history, and poverty (Sidebotham, Heron & ALSPAC Study Team, 2006)
  • Mothers’ marital status, depressive symptoms, and adult experiences of victimization (Thompson, 2006)
  • Mothers’ life stress, anxiety, and depression (Egeland, Jacobvitz, & Sroufe, 1988)
  • Parents’ experience of intimate partner violence (Renner & Slack, 2006) (DeCraene)

By working with children and their parents, these negative factors can be addressed and worked on to better prepare not just the parents, but teach children that there are other ways to address problems outside of the abuse or neglect that they may have experienced.

Children that learn through their parents that violence or aggression is the primary response to adversity can begin to internalize this attitude and behave in a similar fashion not only while growing up, but when they have children of their own. This is why intervention and preservation services are so vital to addressing abused or neglected children. Through these systems of care they are able to learn that there are other, better alternatives to using violence or aggression through exposure to non-violent adult role models, non-violent problem solving skills, and developmental assistance that can improve the children’s level of self-confidence can break this cycle of abuse or neglect. Most of these lessons can be applied to the parents as well, reducing recidivism rates and keeping the family out of the Department of Child Services system in the future.

By working with these families and children, we help them see that there are other ways to deal with the stresses and struggles that come with being a parent. When they are exposed to non-violent problem-solving techniques and can internalize that there are safer ways to deal with problems, we begin to break the cycle of generational abuse and neglect, protecting the future children of our communities before there is even an opportunity for them to face the trauma of abuse and neglect.

Paper written by Bradley Williams with SCAN Inc.

Sources

  • “Intergenerational Patterns of Child Maltreatment: What the Evidence Shows.” Child Wellfare Information Gateway, Childrens Bureau, Aug. 2016, www.childwelfare.gov/pubPDFs/i... to explain intergenerational maltreatment.
  • DeCraene, Melva. “GENERATIONAL EFFECTS OF VIOLENCE.” Edited by ICDVP Competencies Committee, Community Crisis Center, www.crisiscenter.org/pdfs/Generational_Effects_Of_Violence_doc.pdf.


Abuse Information

Abuse is the non accidental situation causing harm to a child at the hands of a parent or guardian. Federal Child Abuse Prevention and Treatment Act, 2003 states child abuse and neglect is an act or failure by parent or caretaker resulting in death, physical, emotional, sexual, neglect or exploitation.

From the 1600-1800’s – children were seen as property of parents. Punishment in every form of abuse including capital punishment.

In 1884 – First case of maltreatment brought to court

In 1899 – First court system to protect a child took place in Illinois

Over 2 million reports of child abuse and neglect are made to state child protective service agencies annually.

More than 1 million children experience demonstrative evidence of abuse and neglect annually.

More than 1,100 children die annually as a consequence of child abuse and neglect.

Of the 872,000 victims of child maltreatment in 2004, 62% were neglect, 18% physical abuse, 10% sexual abuse, 7% emotional abuse, 2% medical neglect nand 15% other maltreatment types such as abandonment, congenital drug addiction, etc.

8% of adolescents report sexual abuse – 74% know their assailant, 34% are under 2 years old and age 14 is the most common age for sexual abuse.

Reports of sexual abuse are up to 30-40% of females or 10-12% of girls under age 14 years old.

Substance abuse is 1/3 to 2/3 of maltreated children

9% of children are in a family with a parent who abuses alcohol or drugs.

Indiana facts on abuse

Deaths in Indiana were 53 in 2003 with 43% under age 5, 54 deaths in 2005. Allen County had 6 of these caused by head blunt force, shaken baby, asphyxiation, and strangulation.

3.4 cases of child abuse per 100,000 children annually in U.S. There were 1490 deaths in 2003 with 81% less than 4 years old.