Pacific Health – What is Child Abuse and What Should I Do If I Suspect a Child is Being Abused?

What is child abuse?

Child abuse refers to parents or adults or some one else who harm, hurt, and neglect children or young people.

How serious is the problem in New Zealand (NZ)?

Surprisingly, the prevalence of abuse against children and young people does not appear to have changed over time between 1998 and 2009 in New Zealand. Based on a Ministry of Health Report in 1998, about 8 children on average between the ages 0 and 14 years died from injuries inflicted by another family member. In 2009, based on a report produced by the Family Violence Death Review Committee, 12 children were killed directly by members of their own family. On average, 8 children die every year at the hands of family members in NZ. At the time of writing this article, another child was killed. The six month old infant died from severe head injuries meted out by a family member.

There are four types of child abuse

Although physical violence is the most common form of abuse, emotional abuse, neglect and sexual abuse are other forms of violence that can hurt children. Emotional abuse is when a parent or adult puts a child down; makes a child feel like they are worthless; and, acts like they do not care about you or want you. Neglect is when a parent or adult does not look after a child’s basic needs such as provide food, care, love and security. Sexual abuse is when a parent, or another member of the family or someone else touches a child inappropriately or makes a child do sexual things. Physical abuse is when a parent or adult or a sibling threatens to hurt a child or hits and beats a child to inflict an injury.

What could I do if I suspect a child is abused?

In New Zealand, if you think or believe that a child is being abused call the Police Child Abuse Team (CAT) or Child Youth and Family (CYF). These organisations work together to explore the seriousness of the situation and determine the next course of action. People who are concerned that their suspicions may be wrong, need not worry about it, because The Children Young Persons and Their Families Act 1984 protects people who notify concerns of abuse in good faith from civil and criminal proceedings.

The Cycle of Abuse – How to Keep It Out of Your Relationship

Abuse comes under many different guises, in many different forms but the results are usually the same, emotional pain. This emotional pain may look like different things to different people but still it remains the same. There are physical abuses that take the form of violence, attack from one to another or from both to each other. Then there is emotional or psychological abuse that is to use words to demean a person usually for control, the stripping of ones self-esteem and confidence. Mental abuse is much the same as emotional abuse and usually used by a person to describe what is happening to them but they do not equate their emotional health being noticeably harmed.

Abuse is common and can range from mild to severe. Affects of abuse is based on perception therefore what one person may feel is mild abuse may be interpreted by the receiver as being monumental, damaging their emotional health significantly. Abuse happens even in children in the form of bullying, name-calling etc. Abuse happens from parents to their children not just your readily identified physical or sexual traits but emotional too. Abuse happens between ‘friends,’ in the workplace, in society. Countries abuse other countries. Abuse happens in relationships that commence with good feelings. Abuse is soul-destroying, abuse is harmful for both the perpetrator and victim although the perpetrator senses some form of warped achievement in the denigration of another. Abuse happens when one person has been abused and transfers their feelings of hurt onto another, abusing them in either the same way or differently. Abuse is about control regardless of the victimisation aspect for the perpetrator. Abuse is negative and a mis-use of trust.

When we can identify what abuse is we are all in better positions to challenge both our own aspects of abuse then secure better ways in managing our emotions without using abuse. Many people who are abusive do not consider themselves to be abusive because they do not correlate the abusive behaviour to being harmful to someone else. These people may use an abusive act as a continuation of how they have been treated. Paradoxically, these same people know how they felt to be abused yet continue with the same pattern. For example, a mother may have grown up being physically chastised and resorts to using the same patterns of ‘discipline’ towards her own children. She may know that at the time of her receiving her ‘discipline,’ it hurt both emotionally and physically but she will continue to do the same to her own children. Or the man who watched his own father use abuse to control his wife, his family. This may be in the form of shouting or physical force to get what he wanted. He then goes onto doing exactly the same with his own wife and family even knowing how he felt as a child. What about the little child who is regularly shouted at, he or she too learns to shout to communicate. Even without the awareness of the abuse taking place, abuse happens and many people would be totally shocked to admit that they too are abusers. Abuse is learnt not just to the perpetrator of abuse but also the person receiving the abuse, victims learn to receive abuse and may retaliate by abusing another. This is what is called cyclical abuse, the continuation of abuse from the abused to being the abuser. However, I must reinforce that abuse ranges from mild to severe therefore abuse is open to many people who may not even think that their actions are abusive to others.

Since abusive behaviours can range from mild to severe and in that covers many different types of abuse, how do we keep free of abusive behaviours especially in our relationships? As previously reported, it is by first identifying what abuse is and what abuse could look like. If you have read this far and find that you do find yourself acting abusive and terrified by this act there are ways to unlearn what you have learnt. First we must identify abuse.

· Are you or have you been abusive to another?

· What does this abuse look like?

· When are you most likely to be abusive, in what situations?

· What outcome do you expect to achieve from using abuse?

· Are you aware of how your recipient may be feeling when you are acting abusively?

· What are the signs that your recipient is feeling abused?

· How do you feel when you are being abusive?

Connecting the abuse to your thoughts will help you to establish insight into your behaviour and how this may affect another. When you have made this connection, you are then in a greater position to tackle this negative behaviour. You may be experiencing discord in your relationship and firmly attribute blame onto your partner without first looking at your own levels of participation. You may be fooling yourself with… ‘Well, he did this… so I did that… ” or vice versa; abusive patterns of behaviour. Now you may think that you are only reacting to an action but what you are really doing is responding by being abusive too. What do you hope to gain? How will these behaviours support a loving and nurturing relationship? Remember, abuse is a mis-use of trust. Relationships need to exhibit trust in order to be fulfilling, when this trust is damaged or gone, the breakdown of the relationship is inevitable. Even for the relationships that continue, the harmony between the couple is obviously missing, continuing the abuse towards each other. The lack of negotiations and straight, honest talking is abuse too.

· How supported do you feel by your partner?

· If you do not feel supported, do you think that your partner’s lack of support is being abusive towards you?

· Are there any situations in your relationship that you require your partner to act but they refuse for whatever reason?

· Do you think they are being abusive towards you?

· How do you feel at these times?

· Have you been able to speak to your partner about your feelings?

· How have they reacted?

Change will only happen when a person feels there is more benefit to change than there is to keep their original behaviour.

· What benefits do you think that your partner may benefit from not changing?

· How complicit have you been in determining a lack of positive change?

More importantly, do you think that change is necessary for your emotional health to be positive? If this answer is ‘yes’ there are several things that you must do to secure change and to maintain change. When employing change of any sort, a good trick is to ask yourself ‘what would not happen if I… and follow this up with something relevant. In this case, ask yourself ‘what would not happen if we resolved and removed abuse from our relationship?’ There are no typos here, the question is as written.

If you have been honest up until now then you would have identified some abusive behaviours in your relationship. Next you must speak with your partner about your feelings. You must try not to use a blame-laden attitude, you are trying to resolve difficulties or making sure you both know what could contribute to abuse. Do not seek to ask your partner when the mood is exacting. Choose a more relaxed time when both of you are free from intrusions or disturbances. Set the scene to be nurturing. Evenings are a good time to have this type of discussion especially when the night air has arrived. Dim the lights, light candles, whatever you usually do for your partner to set a romantic mood. Get this right and the rewards could be fantastic. Ask your partner to respond honestly whether they feel that you have been taking them for granted and if so, how? Please do not use the word ‘abusive’ as this can be lead to a volatile situation due to the word being received as emotive. Follow this up with asking them what change in you would make them feel less taken for granted. Consider this request. Apologise if necessary and clearly state that you would like to create a more trusting relationship with each other therefore any issues must be dealt with that could cause problems later on.

Now that you have given your partner their time to possibly explain any perceived abuse from you, it is your time to explain how you feel. Using the same tactic of not using blame but gently explain what might make you feel taken for granted. Stroke their hand, hair, whatever to support a continuing calm mood. Make your partner feel that you are not being confrontational. However, be clear, do not wimp out and blur your feelings trying to soothe your partner. But do not appear forceful. Give examples to contextualise your thoughts and feelings enabling your partner to connect to particular situations. Otherwise you could end up appearing to be having a go! Keep reassuring your partner of your intentions, to increase trust and positive feelings between you both. You are both quite vulnerable right now but that does not have to be a bad thing, enjoy this level of intimacy. Even the most difficult of conversations can be done uneventfully. It is down to the parties involved to maintain a calm situation. When you both feel a sense of connection, change is usually guaranteed. A feeling of satisfaction is apparent; an appreciation of achievement is evident. This moves you both in your relationship to being closer and more in tuned with each other.

Not everyone that may be abusive would readily admit they do so due to wanting control although this is very high on the list of why abuse happen. Nevertheless, it is nearly always learnt behaviour and may be just a method someone uses to cope with situations, for control or otherwise. Or just maybe they really never thought a particular behaviour was abusive. Whatever the reason for abuse, remember the resulting experience for the recipient is usually depletion on their emotional health. Even if a person thinks that there are more benefits to keeping old behaviours, they need to know categorically, there are never any winners, not them or anyone else. I repeat,people may not want to readily admit to being abusive but this lamentable attitude does not serve anyone positively, change is necessary as perpetrators of abuse are also victims to themselves. Abuse is about control but if do not agree with this then why would someone abuse?

Family Violence and Abuse – Helping Victims and Survivors

Introduction
Abuse and violence in the family refer to physically and emotionally harmful behaviors that occur between family and household members. It includes child abuse, child neglect, intimate partners abuse and violence, marital rape, and elder abuse. It could be a learned behavior that can be unlearned through therapy. Perpetrators try to isolate the family to keep it secret and avoid sanctions. They usually have some power and control over the other members of the family. They may rationalize the violence with their drug use. The use of cocaine, PCP, amphetamine etc may increase violent behavior.

Forms of Abuse
Physical abuse includes hitting, punching, shoving, stabbing, shooting, kicking, and withholding medication, wheelchair, food, and fluids. Sexual abuse includes coercion, marital rape, and withholding sex. Psychological abuse includes threat, harassment, and blackmail. Emotional abuse includes name-calling, insults, and ridicule. Economic abuse includes total control over finance, running up bills, forbidding school or work.

Reality About Violence
Family violence occurs at all levels of society. Separation or divorce may not end violence. Abuser does not need to be provoked. Some survivors wrongly tend to blame self. Treat the violence but also the alcohol, drug, stress, and mental health problems if any. Violence occurs between gays and lesbians too. Abused women are discouraged from disclosure by threats, fear, denial and disbelief expressed by ‘confidants’.

Models of Intervention
The Paternalistic model assumes that the clinician has more knowledge than the patient; that the survivor is responsible for ending the violence; that the clinician should give advice and sympathy; and see the patient as a victim. Whereas, the Empowerment model, which is better, assumes that the clinician should mutually share knowledge with the patient, plan strategies with the patient, respect patient’s competence, experience and strengths, and see the patient as survivor.

Response of Survivors to Violence
Physical signs of abuse include injuries at multiple sites in various stages of healing (head, neck, face, throat, sexual organs), headache, insomnia, and stress. Behavioral sign is that the individual does not leave the abuser or leaves and returns before making a final break. Psychological signs include delayed reaction, depression, lowered self esteem, attributions e.g. self-blame, impaired school or work performance and conduct, poor concentration and poor problem solving.

Why Doesn’t The Individual Leave the Abuser?
Abused individuals do not leave the abuser for variety of reasons, which include fear of being stalked and killed (which is a realistic fear), strong emotional attachment to the abuser, determination to end the abuse, sanctions present in the couple’s culture, fear of stigma, lack of resources to live away from the abuser, and consideration of what will happen to her children if she leaves. She may leave and return, thinking, “Maybe he will change”.

Child Abuse & Neglect
In every state, child abuse and neglect are must be reported. Types of abuse include child sexual abuse, child physical abuse, child emotional abuse, and child neglect. Child that witnesses family violence may also suffer abuse.

Child Sexual Abuse
This is the involvement of children in sexual activities that they do not fully comprehend and to which they do not or cannot freely give consent. This violates child’s trust in the adult that is supposed to protect him/her. Threat to the child, pet, and others keeps the child quiet. It results in confusion, shame, and helplessness. Its effect may last a lifetime and affect mental health. It may be guarded as a family secret.

Observable Signs of Sexual Abuse
The observable signs of child sexual abuse include physical aggression, excessive masturbation, social withdrawal, low self esteem, impaired school performance, sleep disturbance, STD’s, bleeding, soreness, itching, UTI, pregnancy, bruises, swelling, redness, fracture, burns, and unkempt appearance.

School Violence
School violence is usually due to child drug use, child’s access to guns, antisocial and impulsive behaviors, family dysfunction, community unresponsiveness, interpersonal disputes, and bullying and harassment by peers.

Child Abduction
Most abduction is done by a parent. 70% are by fathers, 25% by their mothers. Parents that are likely to abduct include those that have threatened or attempted it in the past, suspect abuse by the other parent, may be paranoid, may intend to use it as revenge, punishment, trophy, or one that strongly believes that child be raised in his or her home country.

Child Abuse Assessment and Intervention
Explore and be aware of your own attitude to abuse survivors so as not to be judgmental. Do a thorough history & physical assessment. Use private, quiet uninterrupted environment. Honestly state the purpose of the interview. Inform victim of the pending physical assessment. Use a calm and supportive approach. If possible, interview child separately first before joint interview with parent or guardian. Pay attention to child’s affect (look) and behavior, mother’s understanding of the problem, discrepancies in their stories, and parent’s emotional responses. Document your assessment fully. Report suspected abuse to CPS. Coordinate services such as further assessment, psychological testing, individual psychotherapy, family psychotherapy, and group psychotherapy.

Intimate Partner Violence (IPV)
IPV is a pattern of coercive and assaultive behavior between intimate and dating partners. Abuse of female partners is the more prevalent IPV. Female violence is more often in self-defense. Many IPV end in homicide or homicide-suicide. Leaving or an attempt to leave by the victim increases homicide risk. There is a higher homicide risk with handgun, history of suicidal ideation or attempt, battering during pregnancy, sexual abuse, substance use, extreme jealousy, and controlling behavior (“if I can’t have you, no one can”). Few women kill their abusers if there is no intervention. Assessment of IPV should be part of mental health assessment. Ask partners about history of conflicts, “pushing and shoving”, and quality of relationship. Observe for hesitation, looking away, and unease. Be supportive, let victim know she is not alone. Describe and map the extent of injuries. Assess for attribution e.g. self-blame. Assess for depression, PTSD, and anxiety. If patient is the abuser, assess potential for further violence. Consult legal advisor for “Duty to Warn”. Courts have made it mandatory abusers (happens to be mostly men) to be treated. Treatment includes confronting the violence, affirming that responsibility lies with the abuser, behavior therapy, anger control, attitude change to women, couple counseling, and cognitive behavior therapy (CBT). Empower the woman, using laws, community resources, support groups, and safe shelters. Mutually set goals with the victim. Mutually consider and choose from options. Help mobilize natural, social and professional supports.

Rape and Sexual Assault
This affects men, women and children, especially women and children. Sexual assault is a forced act of sexual contact without consent. It is usually done to humiliate, defile or dominate the victim. Rape is a felony, yet majority is unreported. Survivors of marital rape do not seek care because of embarrassment and humiliation. Careful assessment and questioning is needed. In caring for the victim, listen, be nonjudgmental, and provide emotional support. Document your observation and assessment fully. Help collect evidence if patient chooses to litigate. In the acute stage, assess for fear, disorganization, shock, and restlessness. In the second stage, assess for flashbacks, phobias to places and people, and sexual difficulties. Encourage the victim to discuss feelings. Explore options e.g. changing phone number. Explore available community services and support groups. Refer for physical treatment and psychotherapy. Plan for a follow-up phone contact in a few days.

Elder Abuse
There are about 5 million abused elderly persons in the US annually. Spouse abuse overlaps with elder abuse. The abused does not report for fear of being abandoned to a nursing home or being isolated. Signs include bruises on arms, wrists, ankles, face lacerations, vaginal lacerations, fractures, malnutrition, poor hygiene, dehydration, flinching and shrinking away in the presence of abuser. Help and care include reporting a suspected abuse to the Adult Protective Services (APS), counseling, psychotherapy, substance abuse and treatment of the abuser, if necessary.

Reference: Stuart, G. W. & Laraia, M. T. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis, MO: Elsevier Mosby.

Drug Addictions and Substance Abuse – The Myths and Facts

Myth.
Drug Addiction is a bad habit, the result of moral weakness and over-indulgence.

Fact
Drug Addiction is a chronic, life-threatening condition, like hypertension, atherosclerosis and adult diabetes.

Fact.
Genetics and substance abuse – drug addiction has roots in generic susceptibility, social circumstance and personal behavior.

Fact.
Certain drugs are highly addictive, rapidly causing biochemical and structural changes in the brain. Others can be used for longer periods of time before they begin to cause inescapable cravings and compulsive use.

Myth
If an addict has enough will power, he or she can stop abusing alcohol and using drugs.

Fact.
Few people addicted to alcohol and other drugs can simply stop using them, no matter how strong their inner resolve. Most need one or more courses of structured substance abuse treatment to reduce or end their dependence on alcohol and other drugs.

Myth.
Many people relapse, so treatment obviously does not work.

Fact
Like virtually any other medical treatment, addiction treatment cannot guarantee lifelong health. Relapse, often a part of the recovery process, is always possible, and treatable Even if a person never achieves perfect abstinence, addiction treatment can reduce the number and duration of relapses, minimize related problems such as crime and poor overall health, improve the individual’s ability to function in daily life and strengthen the individual to better cope with the next temptation or craving. These improvements reduce the social and economic costs of addiction.

Myth
We have reached the limits of what we can do to treat drug addiction.

Fact
The more we learn about addiction, the more effective substance abuse recovery programs become. Matching clients to the services they most need, while supporting continuous and focused engagement in treatment is imperative. Today’s treatment providers are better able to do this than ever before.

Tips on substance abuse treatment

Substance abuse adds substantially to the nation’s health care bill. Studies show that adequate and accessible treatment is the most effective method to improve the health of drug abusers and relieve the burden of drug-related health care costs.

Substance Abuse and Health Care Costs.

About one-third of AIDS cases are related to intravenous drug use, and 90 percent of pedantic AIDS cases are related to maternal exposure to HIV.

Untreated alcoholics incur general health care costs that are at least 100 percent higher than those of the non-alcoholic. More than 5 percent (221,000) of the 4 million women who give birth each year use illicit drugs during their pregnancy, with expenditures ranging from $48,000 to $150,000 for each delivery.

Substance abuse treatment reduces hospital admission rates by 38 percent. Hospital admissions for drug overdose decreased by 58 percent among those treated.

The Minnesota Alcohol and Other Drug Authority reported saving $22 million in annual health care by providing substance and drub abuse treatments.

Factors Affecting Mental Health

Mental health must really be watched for intensely and it should be taken cared of completely. If you want to avoid mental health problems from occurring, it is important that you know the factors that can lead to it. Here are some of the factors:

Abuse or violence: Abuse or violence is one of the most serious factors that really affect mental health. Abused individuals are more likely to experience some mental disorders or mental illnesses. Abuse may vary. It can be physical, psychological or sexual abuse. These kinds of violence may not be that evident in just one look. Unlike for physical abuse, this can be easily recognized. You can really see some real evidence for this case. You can actually see bruises, wounds, scratches and all those evident proofs for such abuse. Experiencing abuse or violence can greatly lower one’s self-esteem and self-confidence. It can also cause severe depression and anger as well. This will hinder an individual’s happy life, thus making it more miserable. This will later result to mental deficiencies in the future.

Broken family: When you belong in a broken family, it can greatly affect your mental health. Broken family comes in a form of separation or divorce between parents. It can also be through a death of a parent or any family member. This situation can be very devastating and frustrating. Anyone who might experience this kind of situation will undergo severe depression and loneliness. When these feelings are extremely acknowledged inside a person’s life, it can definitely cause some mental disturbances or mental illnesses. It is important that you know how to cope with this kind of situation. If you cannot overcome this certain situation in your life, then there might be great tendencies of some mental health problems.

Disease condition: Unfortunately, there are also some disease conditions that can badly affect an individual’s mental health. You may experience brain injuries due to some accidents, or brain damage due to some diseases. You may also experience mental disturbances due to drug abuse or drug addiction as well. These experiences can greatly affect the brain and can really result to some mental changes or worse, mental illnesses.

You see, there are so many factors that can greatly affect mental health. If you want to avoid these things from happening, consider these factors mentioned above and have a healthy life.