Discussion: Treating Childhood Abuse Assignment
In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse. Discussion: Treating Childhood Abuse Assignment
In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse.
- Recommend strategies for assessing for abuse
- Analyze influences of media and social media on mental health
- Evaluate the need for mandatory reporting of abuse
To Prepare for this Discussion:
- Read the Learning Resources concerning treating childhood abuse.
- Read the Child Abuse Case Study in the Learning Resources.
By Day 3
- What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.
- How might exposure to the media and/or social media affect the patient? Discussion: Treating Childhood Abuse Assignment
- What type of mandatory reporting (if any) is required in this case? Why?
By Day 6
Respond to at least two of your colleagues by providing at least two ways that their strategies may be expanded or improved. Discussion: Treating Childhood Abuse Assignment
Strategies for assessing abused patient
Stress-related disorders with trauma are disorders that expose individuals to a traumatic or stressful situation. Children under the age of 18 may be exposed to abuse and neglect by a parent, caregiver, or another person in a custodial role. There are four types of abuse, physical abuse, emotional abuse, sexual abuse, and neglect. Listed in the diagnostic criteria are inclusive of reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disorder (PTSD), acute stress disorder, and adjustment disorder. Involuntary memories related to traumatic events are a core symptom of posttraumatic stress disorder (American Psychiatric Association, 2013). Discussion: Treating Childhood Abuse Assignment. Because of the preponderance of childhood maltreatment survivors in treatment for a substance use disorder, regular assessment of childhood traumas is strongly recommended for this population. Psychological distress resulting from traumatic or stressful circumstance quite varies in some cases. The symptoms are well understood within the context of anxiety or fear as many of those exposed to trauma or stress showed signs of anxiety or fear and the clinical characteristics are anhedonia or dysphoric symptoms (American Psychiatric Association, 2013). Discussion: Treating Childhood Abuse Assignment
Strategies employed in assessing the patient.
The first two steps in screening are to determine whether the person has a history of trauma and whether he or she has trauma-related symptoms. Screening tools that can be used during assessment are Distressing Event Questionnaire (DEQ), Davidson Trauma Scale (DTS), and Clinician-Administered PTSD Scale (CAPS), Evaluation of Lifetime Stressors (ELS), Trauma History Questionnaire (THQ) (Sadock, Sadock, & Ruiz, 2014). Without screening, clients’ trauma histories and related symptoms often go undetected, leading providers to direct services toward symptoms and disorders that may only partially explain client screening for trauma history and trauma-related symptoms can help behavioral health practitioners identify individuals at risk of developing more pervasive and severe symptoms of traumatic stress. Discussion: Treating Childhood Abuse Assignment
Screening, early identification, and intervention serve as a prevention strategy in a trauma patient. In assessing the patient, trauma screening is designed for every child within a given system in determining whether such a child has experienced trauma, displays symptoms relating to trauma exposure, and whether to be referred for comprehensive trauma-informed health assessment (The National Child Traumatic Stress Network, n.d.). Discussion: Treating Childhood Abuse Assignment
The first assessment strategy will be a child-completed tool (self-report) to be completed by the client with the patient provided with measures and opportunities of verbalizing experiences aloud or put it into writing (NCTSN, n.d.). Furthermore, to assess the client, the principles of psychological first aid, a core intervention during impact and the immediate post-impact phase of disaster will be used to recognize foremost concerns of safety and security (Pfefferbaum & Shaw, 2013). Discussion: Treating Childhood Abuse Assignment. Another strategy to assessing the client is psychological debriefing, it will facilitate prevention and recovery by normalizing reactions, create coherent narratives of the situation, integrate the experience and validating feelings and mitigate stress (Kleindienst, et al,). Consequently, the use of social support is essential in assessing the client in that it will help create a web of social relationship of being loved, cared for with being readily available at times of needs as coping assistance provided through teaching or caretaking to make the client confide in the provider (Pfefferbaum & Shaw, 2013). Discussion: Treating Childhood Abuse Assignment
Exposure to the media, its effect on the client.
Human brain learned from the collection of information, storing and processing of the information and ability to replicate the information later when needed. In this case, there is a need for first conducting a media history to ascertain the level and type of exposure the client has watched, evaluate the content, and reactions to such media coverage so to determine client context of media exposure, and how it might affect the patient. Childhood abuse has been linked to substance use problems, including both alcohol and illicit drug use and trauma exposure had a significant indirect effect on the relationship between child abuse and lifetime substance use (Mandavia, Robinson, Bradley, Ressler & Powers, 2016). Discussion: Treating Childhood Abuse Assignment
It is obligated by all health care provider to report abuse or suspected abuse of the child protective services (CPS). The hotline can be called 24hr daily to report an abuse. Texas child abuse laws criminalize physical, emotional or sexual abuse of children and as such requires that third parties privy to such abuse report it to the authorities (Findlaw.com, n.d.). Hence, the mandatory reporting type will be physical abuse evidenced by several injuries or bodily harms to the client and this mandatory reporting will be to Texas Department of Protective and Regulatory Services (Findlaw.com, n.d.). Discussion: Treating Childhood Abuse Assignment. Any injury to a child 5 years or younger, immediate need for medical treatment (including suicidal thoughts), sexual abuse where the abuser has or will have access to the victim within the next 24 hours, children age five and under are alone or are likely to be left alone within the next 24 hours, anytime you believe your situation requires action in less than 24 hours should be reported immediately for investigation by the CPS. Survivors of child maltreatment are more likely to develop a substance use disorder when compared to their non-maltreated peers (Watts, O'Sullivan, & Chatters 2018). Discussion: Treating Childhood Abuse Assignment
American Psychiatry Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Washington, DC: Author.
Findlaw.com (n.d.). Texas Child Abuse Laws. Retrieved from https://statelaws.findlaw.com/texas-law/texas-child-abuse-laws.html
Kleindienst, N., Priebe, K., Petri, M., Hecht, A., Santangelo, P., Bohus, M., & Schulte-Herbrüggen, O. (2017). Trauma-related memories in PTSD after interpersonal violence: an ambulatory assessment study. European Journal Of Psychotraumatology, 8(1), N.PAG. doi:10.1080/20008198.2017.1409062
Mandavia, A., Robinson, G. N., Bradley, B., Ressler, K. J., & Powers, A. (2016). Exposure to Childhood Abuse and Later Substance Use: Indirect Effects of Emotion Dysregulation and Exposure to Trauma. Journal Of Traumatic Stress, 29(5), 422-429. doi:10.1002/jts.22131
National Child Traumatic Stress Network. (n.d.). What is a trauma-screening tool or process? Retrieved from nctsn.org. Discussion: Treating Childhood Abuse Assignment
Pfefferbaum, B., & Shaw, J.A. (2013). Practice parameters in disasters preparedness. Journal of America Academy on Child & Adolescent Psychiatry 52(11), 1224-1238. Retrieved from http://www.jaacap.com/article/s0890-8567(13)00550-9.pdf
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2014). Kaplan and Sadock Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (11th Ed.). Philadelphia: PA: Wolters & Kluwer.
Watts, J. R., O'Sullivan, D., & Chatters, S. J. (2018). Strengthening the Working Alliance for Clients With Substance Use Disorders and Child Maltreatment Histories. Journal Of Mental Health Counseling, 40(1), 58-74. doi:10.17744/mehc.40.1.05. Discussion: Treating Childhood Abuse Assignment
Treating Childhood Abuse
Based on Morgan’s interview, it appears that there is no current abuse or trauma occurring. At this point I would evaluate his symptoms to see if he qualifies for a diagnosis of posttraumatic stress disorder (PTSD) or other trauma and stressor-related disorder. Morgan reports that he directly experienced sexual violence, has recurrent intrusive thoughts regarding those events, has nightmares, is easily startled, and struggles with interpersonal relationships. These symptoms are consistent with a diagnosis of PTSD (APA, 2013). While PTSD symptoms usually occur soon after the traumatic event, they can develop months or years later (Sadock et al. 2014). Child sexual abuse is a notable public health issue as it occurs in close to one in five women and one in ten men (Hebert et al. 2016). Discussion: Treating Childhood Abuse Assignment
Media and PTSD
There is a significant amount of media and social media attention placed on PTSD, particularly as it applied to military service members. This portrayal of mental illness result in people developing opinions and prejudices possibly without ever having met a person with PTSD (UWIRE, 2016). “’The media create and perpetuate mental health stigma and discrimination through repeated use of negative and inaccurate images of the mentally ill, mental health professionals, and mental health treatments’” (UWIRE, 2016, para. 2). On the other hand, when used responsibly and accurately, media can be helpful in combating stigmas surrounding PTSD (UWIRE, 2016). Discussion: Treating Childhood Abuse Assignment
The reporting of the abuse of children, developmentally disabled children, and elderly is mandatory in all 50 states (Sadock et al. 2014). The difficult part of this case is that the patient is currently an adult and the alleged abuse occurred when he was a minor. In the State of Vermont, an adult can make a report, or consent to have a mandated reporter make the report regarding previous abuse to Department for Children and Families (DCF). However, if the adult patient does not want the abuse reported and does not provide consent to the reporter, the past abuse cannot be reported. Discussion: Treating Childhood Abuse Assignment
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Hebert, M., Langevin, R., & Daigneault, I. (2016). The association between peer victimization, PTSD, and dissociation in child victims of sexual abuse. Journal Of Affective Disorders, 193227-232. doi:10.1016/j.jad.2015.12.080
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
UWIRE. (2016). Marvel'lous PTSD portrayals in media. Retrieved from http://link.galegroup.com.ezp.waldenulibrary.org/apps/doc/A440791048/EAIM?u=minn4020&sid=EAIM&xid=8509621a. Discussion: Treating Childhood Abuse Assignment