2 Child Maltreatment and Obesity: Associations, Implications, and Taking Action Kelly Liker, MD Medical Director, Child Abuse Pediatrics Child Abuse Resource And Education (CARE) Team Dell Children s Medical Center of Central Texas
3 Disclosures There are no financial interests or other relationships with manufacturers of commercial products, suppliers of commercial services, or commercial supporters. This presentation does not involve the unlabeled use of a product or product under investigational use. There is no commercial support. 3
4 Fair Use Doctrine This presentation includes the use of creative work of others which is being used under a claim of educational fair use pursuant to 17 USC 107. This presentation was prepared pursuant to the Fair Use Guidelines, and no further distribution is permitted. This noticed is required by the Fair Use Guidelines. 4
5 Objectives Discuss the association between child maltreatment and future obesity Identify ways to integrate our knowledge of the associations between child maltreatment and future obesity to enhance our ability to care for these patients Recognize when childhood obesity may constitute medical neglect and learn how to augment the medical home s approach to such children
6 Sexual abuse medical evaluations eating more lately and has gained 7 to 8 pounds in the past 6 months gained about 8 pounds in the past few months gained approximately 20 pounds since February 6
7 Dr. Felitti Internist, Director of Preventive Medicine at Kaiser Permanente Counterintuitive clinical experiences which led to pilot research which was the foundation for the ACE Study Presentation in Bloomington, MN for Academy on Violence and Abuse in April
8 Index Case Patient went from 408 lbs to 132 lbs in 51 weeks Regains 37 lbs in 3 WEEKS Sleep eating Discloses hx of sexual abuse by grandfather Propositioned by co-worker, triggers sleep eating Familial obesity does not necessarily mean genetic
9 So what are the associations between child maltreatment and obesity?
10 Childhood Abuse and Adult Obesity Body weight and obesity in adults and self-reported abuse in childhood (Williamson, Thompson, Anda, Dietz, and Felitti. International Journal of Obesity 2002; 26, ) Estimated associations between self-reported child abuse and body weight/risk of obesity Retrospective cohort study- 13,777 participants 66% reported some type of abuse Physical, verbal, and sexual abuse associated with increased weight in adulthood Risk of BMI>30 increased most strongly with history of physical abuse Risk of BMI>40 even more strongly associated with abuse Risks augmented with increasing number of types and severity of abuse 10
11 Childhood Abuse and Obesity Treatment Outcome History of sexual abuse and obesity treatment outcome (King, Clark, and Pera. Addictive Behaviors. 1996; Vol. 21. No. 3. pp ) Participants enrolled in 26-week weight management program (behavior therapy + very low calorie diet) 22 of these participants reported history of sexual abuse (matched with random sample of 22 patient who denied, no significant difference in demographics) Sexual abuse victims: Lost significantly less weight Demonstrated more non-adherence to program Had higher rates of mental health problems 11
12 Child Sexual Abuse and Outcomes by Gender Dube. Long-Term Consequences of Childhood Sexual Abuse by Gender of Victim. Am J Prev Med 2005;28(5): Retrospective cohort study, >17,000 participants 25% women and 16% men reported any type of CSA as a child 20% of male victims of CSA-perpetrator was female acting alone Rates of poor behavioral, mental, social outcomes (substance abuse, suicidality/depression, marital/family discord) was similar for men and women.
13 Compare to: Chandy JM, Blum RW, Resnick MD. Gender-specific outcomes for sexually abused adolescents. Child Abuse Neglect 1996;20: Examined gender differences among adolescents with a history of sexual abuse suggested that 1) females were more likely to engage in internalizing behaviors (suicide ideation, disordered eating), and 2) males were more likely to exhibit externalizing behaviors (delinquency, heavy drinking)
14 Childhood Neglect and Adult Obesity Parental neglect during childhood and increased risk of obesity in young adulthood (Lissau and Sorenson. Lancet 1994; 343: ) Information obtained from random sample of rd -grade children in Copenhagen Follow-up information was obtained for 756 (85%) of original sample Parental support as measured by teacher reports had significant effect on childhood obesity Children with poor hygiene 9.8 times more likely to be obese in young adulthood Analysis for separate groups (overweight vs. obese) and comparing group of children already obese or overweight to those who weren t produced similar results 14
15 ACEs and Health Outcomes in EARLY ADOLESCENCE Adverse Childhood Experiences and Child Health in Early Adolescence (Flaherty, et. al., JAMA Pediatrics 2013) Prospective analysis of 933 children for whom interviews and questionnaires were completed at intervals (from ages 4-14) By age 14, 57% of children had experienced neglect and 57% had experienced caregiver depression 33% physical abuse, 15% sexual abuse, 33% psychological abuse 57% of children had experienced at least 3 different adverse childhood events Strong graded relationship between number of adversities and any health problem Relatively strong effects of concurrent adversities on any health problem, somatic concerns, and caregiver s report of poor health
16 Obesity and Maltreatment Associations in CHILDHOOD (Helton. Obesity prevalence among youth investigated for maltreatment in the United States. Child Abuse & Neglect 2014; Vol. 38, Issue 4, ) CPS data for ~5800 children involved in investigations for abuse/neglect: 1 in 6 children who live in homes without abuse/neglect are obese 1 in 5 children who live in homes with poverty are obese 1 in 4 children who may have been victims of abuse/neglect are obese
17 Domestic Violence and Childhood Obesity Boynton-Jarrett. Association Between Maternal Intimate Partner Violence and Incident Obesity in Preschool-Aged Children. Arch Pediatr Adolesc Med. 2010;164(6): ~1600 children in study Prospective cohort, mother interviewed until children age 5 After controlling for factors such as maternal obesity and depression, children whose mothers reported chronic IPV were 1.8 times more likely to be obese Link was stronger in female children and homes in unsafe neighborhoods
18 What causes childhood obesity? Dietary patterns Physical Activity Levels Sedentary Activities Social determinants Poverty Unsafe neighborhoods Lack of social support network Chronic sleep deficit Some medications, including psychoactive meds Image credit: Susan Terwilliger, Binghamton University
19 Psychological Impact of Abuse
20 Psychological Impact of Sexual Abuse Traumagenic Dynamics (Finkelhor and Browne. The traumatic impact of child sexual abuse: A conceptualization. Am J Orthopsychiat 1985; 55: ) Traumatic sexualization: premature and distorted sexualization Results in increased sexual behaviors or avoidance/inhibition Betrayal: by perpetrator who served in caregiver capacity or caregiver who fails to be protective following a disclosure Lack of trust as impetus for anger, depression, extreme dependency Stigmatization: victims are blamed or told to keep secret, damaged goods Shame and guilt self-mutilation, suicidal behaviors Powerlessness: inability to prevent or stop abuse Results in anxiety, fear, low self-esteem
22 Psychological Impact of Neglect Wide range of behavioral and emotional problems Disordered self-regulation/control Attachment/Trust Issues Social Ineptitude Higher frequency of engagement in high-risk behaviors
23 Trauma-Informed Pediatric Care of Obese Children
24 Trauma-Informed Services Not designed to treat trauma but are sensitive to traumarelated issues in survivors/victims Based on the recognition that many behaviors and symptoms are directly related to trauma that causes or contributes to mental and physical health consequences
25 Why do we need to do this?
26 Violence, Crime, and Abuse Exposure in a National Sample of Children and Youth: An Update (Finklehor, et. al., JAMA Pediatrics 2013) Most children are exposed to at least one (and often more than one) traumatic event by age 17 Physical assault Sexual assault Maltreatment by caregiver Bullying Witness to domestic violence/other violence Property victimization Majority of children reported a traumatic event in the past year ~48% experienced >1 type of victimization ~15% >5 types ~4.9% >9 types
27 Recommendations (Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health. Garner et.al., AAP Policy Statement, 2012) Adopt ecobiodevelopmental framework as a means of understanding social, behavioral, and economic determinants of lifelong disparities in physical and mental health. (Do not distinguish psychosocial problems as different from consequences of other health issues) Educate trainees to link between childhood toxic stress and biosystemic disruptions that can lead to lifelong impairments in health and behavior Strengthen anticipatory guidance and encourage adoption of positive parenting techniques Screen for precipitants of toxic stress that are prevalent in community Participate in innovative service-delivery adaptations that expand the ability of the medical home to support children at risk Identify (or advocate for the development of) local resources that address risks for toxic stress in community
28 Where do we start? 1. Minimize traumatic aspects of medical care Reduce pain, fear, and anxiety associated with care and procedures whenever possible 2. Provide all pediatric patients with basic support and information Assess families for fears/worries, optimize pain management, and work with parents to help them provide effective support for their child. (D-E-F protocol, healthcaretoolbox.org) 3. Screen to identify those who may need more help Provide anticipatory guidance about stress reactions and ways of coping. Assess for more severe distress or risk factors, and make appropriate referrals for additional services if warranted. 4. Maximize continuity of care Help ensure that all those caring for a child are aware of any traumatic stress reactions as well as effective coping resources. 5. Remain aware of one s own stress Pay attention to the challenges of caring for ill and injured children, and promote good selfcare.
29 Where do we start? 1. Minimize traumatic aspects of medical care Reduce pain, fear, and anxiety associated with care and procedures whenever possible 2. Provide all pediatric patients with basic support and information Assess families for fears/worries, optimize pain management, and work with parents to help them provide effective support for their child. (D-E-F protocol, healthcaretoolbox.org) 3. Screen to identify those who may need more help Provide anticipatory guidance about stress reactions and ways of coping. Assess for more severe distress or risk factors, and make appropriate referrals for additional services if warranted. 4. Maximize continuity of care Help ensure that all those caring for a child are aware of any traumatic stress reactions as well as effective coping resources. 5. Remain aware of one s own stress Pay attention to the challenges of caring for ill and injured children, and promote good selfcare.
30 Identifying trauma-how do I ask? What types of violence am I prepared to start asking about? What is the prevalence in my particular community? Consider maternal depression, parental substance abuse, domestic or community violence, food scarcity, poor social connectedness Which visits will I begin to ask screening questions? How will I ask the questions? Pre-visit questionnaire versus direct interview? If questionnaire, who will distribute, explain to patients, and get it to the provider? How do I ensure patient privacy as they answer the questions? If direct interview, what decision supports will help me remember the questions? How do I document results?
31 How do I ask? Few standardized tools for pediatric practices Need to remember to be respectful of confidentiality and privacy Key message: You aren t alone, it s not your fault, and I can help.
32 Sample Scripting: I have begun to ask all of the parents / caregivers in my practice about their family life as it affects their health and safety, and that of their children. May I ask you a few questions? Violence is an issue that unfortunately effects everyone today and thus I have begun to ask all families in my practice about exposure to violence. May I ask you a few questions? Identifying and Responding to Domestic Violence: Consensus Recommendations for Child and Adolescent Health. From
33 When do I ask? When do I ask about what?
34 For positive responses-now What? Assess the child and parent s immediate safety Physical evidence of abuse/neglect? Has the child been directly threatened? In cases of IPV does the parent have a plan to keep child safe? Assess threat of harm to self or others Protective Factors/Resiliencies Resources Don t forget education and prevention Young children sense when their parents are stressed or when there are big changes in their environments These are common responses to upsetting events in very young children There are things you can do to help your child be reassured that she is safe Your safety is my first concern. Getting help and support for you will be the best thing for your child.
35 Identify and Maintain a Resource List: Child abuse hotline Hospital or health plan social workers Family to Family Network (www.familytofamilynetwork.org) Public Health Department AAP for parents (healthychildren.org) Mental health organizations/counseling Services DV shelters/support groups Safe Start Center: Healing the Invisible Wounds: Children's Exposure to Violence - Quick Reference Card National Child Traumatic Stress Network: Parenting in a Challenging World Finding Help Treatments that Work What is child traumatic stress?
36 Resources for Providers The National Child Traumatic Stress Network National Scientific Council on the Developing Child Safe Start Center The International Society for Traumatic Stress Studies Child Trauma Academy Child Sex Abuse Prevention and Protection Center. You can find helpful materials and resources to use in your practice and to pass on to caregivers, such as Warning Signs of Sexual Abuse and Nine Questions to Ask When Selecting a Program for Your Child.
37 Practice Resources AAP Resources: Connected Kids Feelings Need Checkups Too Bright Futures Bright Futures in Practice: Mental Health AAP Medical Home series: Education tips for identifying community resources
38 National Resources National Domestic Violence Hotline: SAFE ( ) or TDD: ( ). Family Violence Prevention Fund website website for teens about dealing with cyber-bullying
39 Our resources and referrals are only as good as the ability/willingness of the family to pursue them. Identify barriers to utilizing resources/accessing services
40 Childhood obesity as a form of neglect
41 Medical Neglect Definition (Jenny. Recognizing and Responding to Medical Neglect. Pediatrics 2007) Non-adherence to medical recommendations Delay in seeking or failure to seek health care
42 Factors necessary for diagnosis: 1. A child is harmed or is at risk of harm because of lack of health care 2. The recommended health care offers significant net benefit to the child 3. The anticipated benefit of the treatment is significantly greater than its morbidity, so that reasonable caregivers would choose treatment over non-treatment 4. It can be demonstrated that access to health care is available and not used 5. The caregiver understands the medical advice given
43 Factors necessary for diagnosis: 1. A child is harmed or is at risk of harm because of lack of health care 2. The recommended health care offers significant net benefit to the child 3. The anticipated benefit of the treatment is significantly greater than its morbidity, so that reasonable caregivers would choose treatment over non-treatment 4. It can be demonstrated that access to health care is available and not used 5. The caregiver understands the medical advice given
44 Childhood Obesity as a Form of Neglect State intervention in life-threatening childhood obesity (Murtaugh and Ludwig, 2011) Severe obesity (BMI>99 th percentile)-children with energy imbalances of up to 1000 kilocalories per day= profoundly dysfunctional eating habits and activity levels. Immediate and potentially irreversible health consequences such as type II DM Hyperglycemia + insulin resistance + poor diet + sedentary lifestyle + poor adherence to treatment= significantly increased risk of vascular disease
45 Childhood Obesity as a Form of Neglect Magnitude of neglect is determined by amount of harm or risk of harm along with chronicity Inorganic failure to thrive as neglect has historically been addressed by state agencies Only a few states have legal precedent for overfeeding and obesity as neglect (including Texas) Mandated reporter laws may obligate physicians to report chronic caregiver neglect resulting in poor health outcomes
46 Childhood Obesity as a Form of Neglect Intermediate State Interventions: In-home social supports Parenting classes Counseling services Financial assistance More Intensive Alternatives: Removal from caregivers/foster care placement Surgery
47 Childhood Obesity as a Form of Neglect Caveats to state intervention: Rare genetic disorders related to obesity Impractical for all children at or above 99 th percentile Variable quality of foster care; no guarantees of reduction in morbidity
48 So when does childhood obesity constitute medical neglect?
49 Criteria for Obesity as Medical Neglect Childhood Obesity and Medical Neglect (Varness et. al., Pediatrics 2009) Reporting is justified when: (1) a high likelihood that serious imminent harm will occur AND (2) a reasonable likelihood that coercive state intervention will result in effective treatment AND (3) the absence of alternative options for addressing the problem
50 Pediatrician s response: Most collaborative, least restrictive Facilitate interpreter services when appropriate. Assess family s perspective on and understanding of child s condition and the proposed treatment Counsel and educate families on instructions for medication administration, risks/benefits of treatment/procedures Consider expanding the circle of caregivers and educate them as well Empower the family to participate in plan development (Jenny. Recognizing and Responding to Medical Neglect. Pediatrics 2007.)
51 Pediatrician s Response Consider written contract Enlist community resources Transportation services, financial aid, respite care, support groups, etc. Arrange for directly observed therapy and/or home nurse visits when appropriate Consider partial hospital or day-hospital programs Refer to CPS if there is harm or risk of harm from lack of medical care (Jenny. Recognizing and Responding to Medical Neglect. Pediatrics 2007.)
52 Final Thoughts Children who have suffered maltreatment (abuse and neglect) are at higher risk of experiencing poor physical and mental health outcomes. These outcomes can be seen earlier than adulthood. Health practitioners must be cognizant of how childhood trauma is associated with presentations of physical and mental health signs and symptoms in children and adulthood and recognize that these associations are as significant as any other biological or environmental factor in child health. Health practitioners should evaluate whether they are providing care in a truly trauma-informed context and analyze gaps in accomplishing this goal.
53 Final Thoughts A practice that has a plan for identifying trauma, responding to trauma, and following up to ensure resources are utilized is a practice that will improve outcomes for children. There are opportunities in the child welfare system to perform surveillance of weight-related data for children in foster care, educate case workers and foster caregivers in healthy lifestyle promotion, and develop and test obesity interventions in this vulnerable population that is already socially and economically disadvantaged. Interventions that occur at the point when maltreatment is identified not only have the opportunity to make children safer, but they can potentially make children healthier.
DOMESTIC VIOLENCE AND CHILDREN A Children s Health Fund Report January, 2001 Peter A. Sherman, MD Division of Community Pediatrics The Children s Hospital at Montefiore -1- Introduction Domestic violence
SCREENING FOR INTIMATE PARTNER VIOLENCE IN THE PRIMARY CARE SETTING Partner violence can affect one third of the patients cared for in the primary care setting. The primary care setting offers an opportunity
Co Occurring Disorders and the on Children: Effectively Working with Families Affected by Substance Abuse and Mental Illness Definition (Co-Occurring also called Dual Dx) A professional diagnosis of addictive/substance
Eating Disorders Eating disorders are serious conditions that can have life threatening effects on youth. A person with an eating disorder tends to have extreme emotions toward food and behaviors surrounding
Needs of Children in Foster Care Meeting the Complex Needs of Children in Foster Care Karen Rogers PhD, Suzanne Roberts MD, Jennifer Rafeedie PsyD, Cristina Dawes LMFT Karen Rogers PhD, Suzanne Roberts
Supporting Children s Mental Health Needs in the Aftermath of a Disaster: Pediatric Pearls Satellite Conference and Live Webcast Thursday, August 25, 2011 5:30 7:00 p.m. Central Time Faculty David J. Schonfeld,
Essential Trauma Informed Practices in Schools Shannon Cronn, N.C.S.P. Barb Iversen, M.C. Objectives: Participants attending this session will be able to: Define trauma Explain how trauma may impact child/teen
Children, Trauma and the impact of Substance abuse Day One Outpatient (874-1045) Amy Stevenson LCPC CCS (firstname.lastname@example.org) Don Burke LCPC CCS (email@example.com) Assessing families and treating trauma in
Traumatic Stress and Substance Use Problems The relation between substance use and trauma Research demonstrates a strong link between exposure to traumatic events and substance use problems. Many people
Domestic Violence & Women Screening, Intervention, Referral & Resources Breena Holmes, MD Ilisa Stalberg, MSS, MLSP UVM Women s Health Conference May 10, 2013 Objectives 1. Review prevalence data and establish
GOING BEYOND FOSTER CARE Sharon W. Cooper, MD Developmental & Forensic Pediatrics, P.A. University of North Carolina Chapel Hill School of Medicine Sharon_Cooper@med.unc.edu OBJECTIVES Adverse childhood
Poly-victimization July 2015 The Advocate The Wichita Area Sexual Assault Center newsletter Catharine Bolt, LMSW Adult Therapist Poly-victimization is defined as the experience of multiple victimizations
Overview of the Adverse Childhood Experiences (ACE) Study Robert F. Anda, MD, MS Co-Principal Investigator www.robertandamd.com Death Early Death Disease, Disability and Social Problems Adoption of Health-risk
THE EFFECTS OF FAMILY VIOLENCE ON CHILDREN Where Does It Hurt? Child Abuse Hurts Us All Every child has the right to be nurtured and to be safe. According to: Family Violence in Canada: A Statistical Profile
CBT for Youth with Co-Occurring Post Traumatic Stress Disorder and Substance Disorders Lisa R. Fortuna, MD, MPH Michelle V. Porche, Ed. D Sripallavi Morampudi, MBBS Stanley Rosenberg, PhD Douglas Ziedonis,
Supporting children in the aftermath of a crisis David J. Schonfeld, MD Thelma and Jack Rubinstein Professor of Pediatrics Director, National Center for School Crisis and Bereavement Division of Developmental
Substance Abuse and Sexual Violence: The Need for Integration When Treating Survivors Kelli Hood, M.A. Objective To understand the necessity for therapeutic strategies in clients with cooccurring Substance
Workforce Development Online Workshop Descriptions Behavioral Health Service Delivery Workshops: The Effects of Violence Exposure on Children (1.5 hours) Regretfully, violence against children and youth
Summary of Arkansas Strategic Plan for Early Childhood Mental Health Arkansas Early Childhood Comprehensive Systems Social-Emotional Workgroup 2014-2015 Early Childhood Mental Health Early childhood professionals
Testifying in Court about Trauma: How to Prepare It is critical that therapists willingly go to court to try to impart their knowledge to the judge. The judge will only make a good decision if he or she
Trauma Informed Services Part 1 The Hidden Aspect of Addiction Many individuals struggling with addiction have personal and family histories of trauma including sexual, emotional, and/or physical abuse
FACT SHEET TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS According to SAMHSA 1, trauma-informed care includes having a basic understanding of how trauma affects the life of individuals seeking
Child Abuse and Neglect AAP Policy Recommendations When Inflicted Skin Injuries Constitute Child Abuse Committee on Child Abuse and Neglect PEDIATRICS Vol. 110 No. 3 September 2002, pp. 644-645 Recommendations
How Health Reform Will Help Children with Mental Health Needs The new health care reform law, called the Affordable Care Act (or ACA), will give children who have mental health needs better access to the
Trauma Informed Care: Top 10 Tips for Caregivers and Case Managers Dr. David Ott Christina Suarez, LCSW Kimberly Brien Our Goals Today Provide information about concepts associated with trauma informed
Using Evidence for Public Health Decision Making: Violence Prevention Focused on Children and Youth Community Guide Slide Modules These slides are designed to be used with overview slides also available
Project First Step: Approaches to Co-occurrence occurrence of Child Maltreatment & Substance Abuse in New Hampshire Natl. Conference on Substance Abuse, Child Welfare & the Courts Jan. 2007 Glenda Kaufman
Tracy Arwood, MS Clemson University Sangeeta Panicker, PhD American Psychological Association Assessing Risk in Social and Behavioral Sciences Assessing Risk in Social and Behavioral Sciences Content Authors
An Introduction to Elder Abuse for Nursing Students Created by: Faculty at the University of California, Irvine Program in Nursing Science and staff at the Center of Excellence of Elder Abuse and Neglect
PREVENTION/INTERVENTION CENTER COBB COUNTY PUBLIC SCHOOL SAFE AND DRUG FREE PROGRAM www.cobbk12.org/~preventionintervention CONTRACT FOR SERVICE PROVIDERS As a member of the Cobb County Schools Coalition
Prescription drugs are the 3 rd most commonly abused drugs amongst teens in Nebraska, and the same statistic holds true on a national level. The rise in prescription drug abuse is becoming increasingly
Interpersonal Violence and Teen Pregnancy: Implication and Strategies for Community-Based Interventions Mission: To engage, educate and empower youth to build lives and communities free from domestic and
Social and Emotional Wellbeing A Guide for Children s Services Educators Social and emotional wellbeing may also be called mental health, which is different from mental illness. Mental health is our capacity
Page 1 of 12 Policy Applies to: All Mercy Hospital staff. Compliance by Credentialed Specialists or Allied Health Professionals, contractors, visitors and patients will be facilitated by Mercy Hospital
Substance-Exposed Newborns State of Oklahoma 2013 Substance-Exposed Newborns State of Oklahoma 2013 Legal Background Federal guidelines in the Child Abuse Prevention and Treatment Act (CAPTA) require states
Health Education Core ESSENTIAL QUESTIONS It is health that is real wealth, and not pieces of gold and silver. Gandhi Increased Focus Classroom Real Life Connection Student Reflection Student Assessment
Parenting Fundamentals ACE Awareness f Prevention Adverse Childhood Experiences The infmation provided in this booklet was excerpted from: The Ace Study http://acestudy.g/ Centers f Disease Control and
. Maryland Department of Human Resources FY2015 Title IV-E Training Updates (January-June 2015) In-service Instruction Courses 1 Advanced CPS Risk Assessment Interviewing This workshop offers intense practice
CORE-INFO: Emotional neglect and emotional abuse in pre-school children Introduction This leaflet summarises what is currently known about children aged less than six years who have been emotionally neglected
The Goal of Substance Abuse Screening The goal of substance abuse screening is to identify individuals who have or are at risk for developing alcohol or drug-related problems, and within that group, identify
Neglected Children: Controversies and Challenges Tel Aviv, Israel June 2014 Howard Dubowitz, MD, MS, FAAP University of Maryland School of Medicine, USA Why is child neglect so important? It s common Maltreatment
Resource Library Banque de ressources SAMPLE POLICY: CHILD ABUSE Sample Community Health Centre Keywords: child abuse, high risk Policy The centre recognizes that abuse may take many forms such as economical,
BRiK Building Resiliency in Kids INSTITUTE FOR HEALTH & RECOVERY Acknowledgments The original source of this curriculum was Einat Peled and Diane Davis (1995) Groupwork with Children of Battered Women:
Measuring Childhood Obesity: Public Health Surveillance OR School-based Screening and Parent Notification? Minnesota Department of Health Martha Roberts, MPH March 24, 2008, 10:00-11:30 AM University of
What does it mean to be suicidal? Although most young people think about death to some degree, suicidal thinking occurs within a very particular context. When emotional pain, feelings of hopelessness or
WRITTEN STATEMENT ON BEHALF OF THE AMERICAN ACADEMY OF PEDIATRICS PRESENTED TO THE INSTITUTE OF MEDICINE COMMITTEE ON DISABILITY IN AMERICA JANUARY 9, 2006 PAUL LIPKIN, MD, FAAP CHAIR, AAP COUNCIL ON CHILDREN
Bullying: Impact on Victims, Bullies, Bystanders and Schools Barbara Ball SafePlace Can You Name This Problem? Aggressive behavior intended to hurt or control Physical, sexual, verbal, emotional, digital
Page 1 of 7 Diseases and Conditions Antisocial personality disorder By Mayo Clinic Staff Antisocial personality disorder is a type of chronic mental condition in which a person's ways of thinking, perceiving
Social issues SNAPSHOT The impact of domestic violence on children Key Points Domestic violence and children Children, especially babies and young children, affected by domestic violence experience significant
Great Bay Mental Health Associates, Inc. Notice to Clients and Consent to Mental Health Treatment Agreement Courtney A. Atherton, MA, LCMHC, MLADC Patient Name (please print): Welcome to the therapy services
Therapy and Professional Training Specialists www.mifamilytherapy.com Help When it s Needed Everyone at some point is faced with challenges that require extra thought and attention. Most of the time people
Supporting students and staff after the shooting in Aurora, CO David J. Schonfeld, MD Daniel Nelson, MD National Center for School Crisis and Bereavement Cincinnati Children s Hospital Medical Center firstname.lastname@example.org
APPLICATION FOR CHILD AND YOUTH MENTAL HEALTH SUPPLEMENTARY SERVICES PROGRAM REQUESTED: Respite Services Supportive Intensive Home and Community-Based Case Management Case Management Services Waiver Referrals
AGENCY OVERVIEW MFT & MSW* Intern-Trainee Program 2015-2016 Training Year Non-profit mental health agency established in 1945 Recipient of the CAMFT School and Agency Award for 2009 Clients from diverse
10 Colorado s winnable battles Flagship Priority: Mental Health and Substance Abuse ELEVATING HEALTH AND ENVIRONMENT Mental and emotional well-being is essential to shaping a state of health for Coloradans.
I. Introduction Division of Child and Family Services Treatment Plan Goal Status Review Aggregate Report The more efficient and effective the delivery of our services, the greater our opportunity for realizing
PhD. IN (Psychological and Educational Counseling) I. GENERAL RULES CONDITIONS: Plan Number 2012 1. This plan conforms to the regulations of the general frame of the programs of graduate studies. 2. Areas
May 2014 Postal Address: Central Australian Mental Health Services (CAMHS) Child and Youth Team 3/15 Leichhardt Terrace PO Box 721 Alice Springs NT 0871 Tel: 8951 5950 Fax: 8953 1858 To the National Children
Research Brief Child Abuse Treatment JUNE 2016 In 2014, it was determined that 3.6 million allegations of child abuse or neglect were reported to Child Protective Service agencies across the United States,
3.5 Guidelines, Monitoring and Surveillance of At Risk Groups 3.5.6 Children of Parents who are Affected by Drug and Alcohol Misuse Background There is overwhelming evidence that the misuse of drugs and
Talking to Your Child About Weight When, Why, & How To Have This Important Conversation Introduction As is also the case with adults, the topic of weight can be an extremely sensitive issue children, adolescents,
Providing support to vulnerable children and families An information sharing guide for registered school teachers and principals in Victoria Service Coordination Tool Templates 2006 reference guide Providing
VENTURA COUNTY ALCOHOL & DRUG PROGRAMS women s services Helping women recover (805) 981-9200 1911 Williams Drive, Oxnard, CA 93036 www.venturacountylimits.org recovery VCBH ALCOHOL & DRUG PROGRAMS WOMEN
CHAPTER 6 Diagnosing and Identifying the Need for Trauma Treatment This chapter offers mental health professionals: information on diagnosing and identifying the need for trauma treatment guidance in determining
ABOUT US n Riveredge Hospital maintains the treatment philosophy of Trauma Informed Care. n Our commitment to providing the highest quality of care includes offering Animal Assisted Therapy, and Expressive
What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated
The Amazing Brain: Trauma and the Potential for Healing By Linda Burgess Chamberlain, PhD, MPH A baby s brain is like a flower ready to bloom. From the first moments of life, a baby s brain is absorbing
Assessment of depression in adults in primary care Adapted from: Identification of Common Mental Disorders and Management of Depression in Primary care. New Zealand Guidelines Group 1 The questions and
Parent Tips What Parents Should Know About Bullying What is Bullying? The Pinellas County Schools Policy against Bullying and Harassment defines bullying as: Systematically and chronically inflicting physical
Applied Psychology s AP 6001 PRACTICUM SEMINAR I 1 CREDIT AP 6002 PRACTICUM SEMINAR II 3 CREDITS Prerequisites: AP 6001: Successful completion of core courses. Approval of practicum site by program coordinator.
Study Guide - Borderline Personality Disorder (DSM-IV-TR) 1 Pervasive pattern of instability of interpersonal relationships, selfimage, and affects, and marked impulsivity that begins by early adulthood
Protection of the Rights of Children and Women Suffering from Drug Addiction in the Family and Society - Shelter Don Bosco, Mumbai, India - Article 24 of the Convention on the Rights of the Child recognizes
Substance Abuse, Violence, Mental Health, and Academic Success July 2009 The mission of the American school has expanded considerably over the last thirty years. We expect our schools to teach the traditional
Relationship Violence Prevention in Youth Jennifer Keller, Ph.D. Depression Clinic, Stanford School of Medicine Pacific Graduate School of Psychology, Palo Alto University Community Health Awareness Council
Our Mission To provide free psychological services to young people and their families. Our Vision Optimising sustainable psychological health and emotional wellbeing for young people. 1 Helping Students,
GUIDELINES FOR THE MANAGEMENT OF SELF INJURY Policy & Procedures Next review date: Currently under review Last reviewed: June 2013 By: Dean of Students 1. RATIONALE We aim to provide a positive, safe and
National Clearinghouse on Child Abuse and Neglect Information National Adoption Information Clearinghouse Gateways to Information: Protecting Children and Strengthening Families Substance Abuse and Child
Eating Disorder Policy Safeguarding and Child Protection Information Date of publication: April 2015 Date of review: April 2016 Principal: Gillian May Senior Designated Safeguarding Person: (SDSP) Anne
Social Work 625 001 Interpersonal Practice With Children and Youth Fall, 2010 Office Hours: Wednesdays 12-1, and by appointment E-Mail: email@example.com Douglas Davies, M.S.W., Ph.D. Office: 3740 Social
HEALTH SERVICE IMPACT OF GENDER-BASED VIOLENCE 1. PURPOSE OF PAPER This paper provides a snapshot of the impact of gender-based violence on health and the consequent impact on key health services and settings.
Keynote Session 1 Navigating Teenage Depression Prof. Gordon Parker Professor Gordon Parker is a leading international expert on depression and mood disorders. He is Scientia Professor of Psychiatry at