Child Abuse Running head: CHILD ABUSE UNIVERSITY OF LA VERNE LA VERNE, CALIFORNIA IMPACT OF CHILD ABUSE ON A HOSPITALIZED CHILD A Paper Prepared for EDUC 596 In Partial Fulfillment of The Requirements for the Degree Master of Science Millicent Ongaco May 2008 Child Abuse Table of Contents I The Problem II Literature Review Page Page III Procedure Page 16 IV Evaluation Page 17 V Reference List VI APPENDIX: Creative Project Child Abuse In-Service Training Agenda Myths on Child Abuse: Facilitator version Myths on Child Abuse: Participant version Scenario Warning Signs of Child Abuse Child Abuse Resources Child Abuse Literature Sample Activity Scenario Power Point In-Service Jesse’s Story: A Survivor’s Story Page 20 Page 22 Page 27 Page 32 Page 38 Page 39 Page 40 Page 41 Page 43 Page 45 See Attached See Attached Child Abuse The Problem Purpose of the Project The purpose of my creative project was to bring awareness of child abuse and educate child life professionals about the impact of violent and traumatic experiences on a child during the hospitalization process In order to highlight this specific population, I chose to provide information to help child life professionals understand the social and emotional development of a child abuse survivor and share ways in which these children tend to cope with these experiences My goal in creating an in-service training for child life professionals is to give practical tools for professionals to use when faced with a child abuse survivor and their families in the hospital I believe the training will be an asset to the child life field and will help child abuse survivors and their families in the hospital understand their past experiences and find a way to begin healing Importance of the Project The creative project is designed to be a resource for child life professionals working with children and families from abusive environments Current professionals in the hospital are educated and trained in working with children and families in regards to medical teachings/procedures, social and emotional issues in the hospital, diagnosis teachings, working with other cultures, etc Many child life professionals have not been educated or trained in how to look for signs of children or families that have directly or indirectly dealt with issues of violence or abuse and how to work with this population The hospitalization process can be traumatizing for an individual living with abusive or violent experiences and it is imperative for child life professionals to understand how to work with this population to provide appropriate services for them and to be sensitive to specific needs Child Abuse 21 National Child Abuse Statistics Child Help Retrieved June 17, 2007, from http://www.childhelp.org/resources/learning-center/statistics Perry, B.D., & Marcellus, J (n.d.) The Impact of Abuse and Neglect on the Developing Brain Scholastic Retrieved April 4, 2008, from http://teacher.scholastic.com/professional/bruceperry/abuse_neglect.htm#author Perry, B.D (2001) The Neurodevelopmental Impact of Violence in Childhood In Schetky D & Benedek, E (Eds.) Textbook of Child and Adolescent Forensic Psychiatry Washington, D.C.: American Psychiatric Press, Inc (221-238) [Electronic version] Retrieved April 4, 2008, from http://www.childtrauma.org/ctamaterials/vio_child.asp Rollins, J., Bolig, R., & Mahan, C (2005) Meeting Children’s Psychosocial Needs Across the Health-Care Continuum Austin, TX: Pro-Ed Teicher, M., Samson, J., Polcari, A., & McGreenery, C (2006) Sticks, Stones, and Hurtful Words: Relative Effect of Various Forms of Childhood Maltreatment The American Journal of Psychiatry 163(6), 993-1101 Retrieved June 14, 2007, from http://0-proquest.umi.com.garfield.ulv.edu/ Webb, N.B., (2007) Play Therapy with Child in Crisis: Individual, Group, and Family Treatment (3rd ed.) New York, NY: Guilford Press Child Abuse 22 INTRODUCTION TO CHILD ABUSE AND ITS IMPACT ON CHILDREN: A WORKSHOP FOR CHILD LIFE PROESSIONALS Learning Objectives: Humanize the issue and scope of violence, trauma, and child abuse Increase child life professionals’ awareness and understanding around the impact violence, trauma, and child abuse can have on a child Learn basic prevention and intervention methods Workshop Length: 2.5 HRS A Introductions (Facilitator/Participant Introductions) Ask participants what hospital they work at and what units/areas of the hospital they are familiar with B Establish the Training Environment Explain to participants the purpose/objectives of today’s workshop Provide disclaimer for topic and give permission to step out of the room if it is too much C Establish CA as Serious, Widespread Social Issue: Exercise: Myths on CA Ask participants to divide into groups of 4-5 people Distribute the envelopes with CA myths and facts 10 Child Abuse 23 Tell participants to look over the statements they were given and decide whether they feel the statements are true or false Have participants tape their statements on the butcher paper under the appropriate column (TRUE or FAULSE) Go over the statements with the group Reflections? Read statistic related to fact SAMPLE (see attachment for more statistics) Child abuse is 15 times more likely to occur in families where domestic violence is present Domestic violence is the single greatest risk factor for child abuse Every year in the US between 3.3 million and 10 million children are exposed to domestic violence Everyday, more than American children die as a result of child abuse in the home Most of the children who die are younger than five years of age Most cases of child abuse go unreported or unknown, particularly in cases of neglect and sexual abuse where there are often no obvious physical signs of harm At the end of the exercise, ask a few participants to share their thoughts D Establish a Definition of Child Abuse: 25 Scenario Break participants off into small groups of or people Distribute Scenario Ask groups to read through the scenario and first discuss what they see or feel about the scenarios Then talk about responses to the discussion questions Have participants stay in their groups Ask different groups to share the group’s feelings about what they read Ask each group to respond to different discussion questions After reviewing the groups’ responses, using butcher paper or white board, ask participants to describe child abuse Have them think about the characteristics of child abuse If participants struggle, have them refer to the last scenario, films or stories they know Write down the participants’ thoughts and ideas on paper to eventually formulate: 1) A definition of child abuse and 2) A list of types of abuse Things to Keep in Mind: The “Cycle of Violence” theory: This theory points to how the abuse can be reoccurring and how it can become a distinctive pattern Also, emphasize how the reoccurrence of abuse further strengthens the control the perpetrator has over the victim’s actions, thoughts, and decisions Child Abuse 43 SAMPLE ACTIVITY “Putting Myself Back Together” adapted from A Window Between Worlds Objective: Allows children to look at and discover the many feelings they have inside themselves as they color and name emotions on a paper doll made up of puzzle pieces Materials: Colored markers and pencils- for coloring Permanent markers- for writing words Handout of paper doll made up of puzzle pieces - or for each participant Handout with various emotions that the child can refer to Music- something upbeat, such as "Putamayo World Beats" or Disney Hits, etc Time: 40-60 minutes Age Range: and up Introduction: ”Today we are going to talk about all the different feelings that we have Can anyone share some feelings they have experienced or know of?” Example by teen age boy Encourage them to think of a few feelings that they have in that very moment Have them think of where they might feel these feelings inside their body Do they feel it in their chest? Do they feel it in their heart? Do they feel it in their stomach? Would that feeling have a certain color? What color would happiness be for them? What color would sadness be? What color would love be? Opening: Do an exercise with the children with music to shake their feelings out Have them dance around the room and ask them to make the faces that they make when they feel a certain emotion What face you make when you feel happy? Child Abuse 44 What face you make when you feel sad? What face you make when you feel angry, tired, excited? Creation: Show the children the paper doll that they will be writing and coloring their feelings on Have the children write inside each puzzle piece a word that describes a feeling that they have right now or a feeling that they had sometime today You will have to help the younger children write these words on their paper doll You can encourage the older children to think of where in their body they might feel their different feelings They can then write that feeling in the place that they feel it After the puzzle pieces are filled with the words of emotions then have the children color in each puzzle piece with a color that portrays each feeling You can ask them to think of what colors come to their mind when they think of each emotion They can be any color Their color for happiness or sadness may be a different color than the person sitting next to them chose for happiness or sadness Each person's paper doll will turn out different! Older children may want to create two dolls in one workshop; one to represent their feelings in the present moment and one to represent what they want their feelings to become in the future This leaves them with an empowered feeling of "putting themselves back together" with the feelings they want to have! Closing Circle: At the end, give all the children a chance to share their paper doll The older children can share what it felt like for them to create their second doll, what it felt like for them to choose the feelings they wish to feel in the future This can be an empowering process! If they don't want to share be sure to let them know that it's okay Remind them to respect each others art and feelings while they share Have them notice how many different feelings and colors there are on everyone's dolls Even though each doll is different and unique, they all share similar feelings! At the end congratulate them for such wonderful work and for sharing their feelings! Child Abuse 45 Michael, a year old boy, was admitted into the hospital as a newly diagnosed AML (Acute Myeloid Leukemia) patient During admitting, it was discovered that Michael and his mother, Angela, were living at a confidential location They were both survivors of domestic violence and living at a shelter Angela did not speak about the past abuse and it is not confirmed by her or Michael whether he was a victim of child abuse The individuals that have come into contact with both Angela and Michael describe how close they are to each other and how Angela is reluctant to trust others Michael’s primary nurse shared he has a difficult time using words to express himself and often times gets angry and exhibits some aggressive behavior towards others His moods can switch quickly, from being social and open to being angry and hitting others