Mental Health, Wellness, and Children

Let’s recap:

This month has been about promoting mental health and children’s mental health awareness. We’ve talked about National Children’s Mental Health Week and National Children’s Mental Health Awareness Day. We’ve also had guest expert blogs about the importance of children’s mental health and the impact of stress on children.

But what is the most important thing to remember and take away from all of this?

Well, prevention and wellness are key!

“Research has shown that children have a wide range of reactions to exposure to violence. Some children are not adversely affected or may show only brief and transient reactions. Others may be more affected, showing significant symptoms and emotional vulnerability. Some develop intense anxiety disorders or posttraumatic stress disorder.” –Safe Start Issue Brief 1, p. 2

The most important thing is the overall well-being of these children.  The protection of their well-being is achieved by building resilience and preventing exposure.

One way of doing this is through the Centers for Disease Control (CDC) Public Health Model. It provides a great way to start and complete the process of enhancing children’s well-being. By framing it this way, there is a body of proof about building resilience and prevention, it provides the means for identifying those at higher risk, and develops and tests strategies for dissemination to communities. The most important thing is the overall well-being of these children.  The protection of their well-being is achieved by building resilience and preventing exposure.

 

Understanding Children’s Exposure to Violence Brief #1 shares some ideas about program types and interventions that can both enhance resilience and reduce risks for children exposed to violence.

  • For all children, participation in high-quality early care and education programs can enhance physical, cognitive, and social development and promote readiness and capacity to succeed in school.
  • For at-risk families, early identification of and intervention with high-risk children by early education programs and schools, pediatric care and mental health programs, child welfare systems, and court and law enforcement agencies can prevent threats to healthy development by detecting and addressing emerging problems.
  • For children and families already exposed to violence, intensive intervention programs delivered in the home and in the community can improve outcomes for children well into the adult years and can generate benefits to society that far exceed program costs.
  • Outcomes improve when highly skilled practitioners provide intensive trauma-focused psychotherapeutic interventions to stop the negative chain reaction following exposure to traumatic stressors (e.g., child abuse and neglect, homelessness, severe maternal depression, domestic violence).

For further information check out the full issue brief here.

So, the best thing we can do to promote children’s wellness is to continue to work to raise awareness to identify those at-risk and advance interventions!

When a Parent Is Incarcerated: A Primer for Social Workers

Checkout this new pub from the Annie E. Casey Foundation!

When a Parent Is Incarcerated: A Primer for Social Workers.

Description from website:

The goal of this publication is to provide relevant and practical information for public child welfare agencies and social workers when working with incarcerated parents and their children, including a chapter on immigration. This primer also outlines the many compelling reasons why child welfare agencies should develop programs and policies specifically to address the needs of this subset of children in the child welfare system.”

Mandatory Reporting: Implications, Meanings, and Practice

We’ve been talking a great deal about mandated reporting the past few weeks expanding our knowledge about the topic, drilling down into some of the specifics, and thinking through some of the barriers for professionals and systems.  Now we’ve come to what the implications of that reporting might be for mandated professionals, families, individuals, and the children affected.

Since the Penn State scandal became public knowledge, there has been a firestorm of opinion and media and legislative activity across the United States. States are responding by reviewing current mandatory reporting laws and reinforcing who is responsible for reporting abuse and when they should be reporting. There is some individual outcry that everyone should be required to be a mandated reporter and others are opposed to the expansion of legislation, citing it will cause more harm than good. But, overall there is a general agreement that reporting laws are necessary but clarification is essential for them to be carried out properly.

Nancy Fagan, LCSW, a child-welfare specialist with Jewish Family and Children Services, wrote an opinion piece that reiterates the view point that everyone has a clear ethical and legal responsibility to report abuse, but that those responsibilities must be clarified and outlined.  Another writer from the Michigan CASA blog believes even more extremely that “when there is even a question or an inkling of abuse,” that you must assume that abuse is occurring until you are proven otherwise.

On the other end of the spectrum, in a November 27th opinion piece for the Hartford Courant, Joette Katz, the commissioner of Connecticut’s Department of Children and Families and former State Supreme Court Justice, said that she was against requiring everyone to become a mandated reporter. The piece cites that studies have not proven that extensive reporting laws have even helped to reduce the incidence or prosecution rate of abuse cases and in fact can increase the prevalence of spurious reports which take away from the investigation of legitimate cases being reported.

So in order to understand the implications of mandated reporting, one has to think about their own understanding about the subject. In a recent lecture on child protection laws, Margaret Lynch Professor of Community Pediatrics, King’s College, gave a lecture at the University College London on child protection laws, and as part of the lecture she provided an exercise that required participants to look at the subject of reporting from personal, public, and professional perspectives and confront their own understanding about the subject. One of the scenarios asked participants whether they would be suspicious of the idea of a father cuddling with his 11-year-old daughter in bed after she’s had a scare. Each person had a very different understanding of what should have been done or how they should have responded from a reporting perspective.

This scenario is a clear example of the implications of mandated reporting legislation. When presented with a possibly scenario of abuse, how do people respond? How do you know when it is abuse or when it’s not? In a room full of policy makers, doctors, and advocates every person had a different understanding about the presented scenario. They each would interpret legislation and guidelines differently. So do states push forward with the mindset that everyone should report if they have any reason to suspect abuse or should they follow the Commissioner’s advice for targeting reporting laws and cautioning guidelines?

A study published in Clinical Pediatrics in 2010, by Benjamin H. Levy and Kathryn Crowell, Child Abuse Experts Disagree About the Threshold for Mandated Reporting, attempted to see if setting forth guidelines for using reasonable suspicion for reporting abuse might help to create an overall threshold for the context of reporting abuse. However, they found that there really wasn’t any guidance that helped to determine the interpretation of the meaning of abuse. The study concluded that experts even showed a wide range of variation in defining that suspicion. Basically, there’s absolutely no consensus on how even experts can interpret suspicion. This and other studies also discuss that abuse investigations themselves can be just as traumatic as any suspected abuse, so there is no need to put a child through the trauma of the reporting process on an “inkling” of suspicion. This may especially be the case if everyone is a mandated reporter because they’ll start reporting anything because they’re afraid of facing penalties for not reporting.  If experts are not even clear about what reporting laws mean then it may be even more difficult for the average person to know what to look for as well.

Looking back at the exercise about child protection, we just have to keep in mind that everyone has an identity affected by their life experiences, beliefs, and culture that impact their understanding of abuse. The implications of mandated reporting laws can have a strong impact on everyone involved in the reporting process. So, this must be kept in mind as states review their laws and as people understand what abuse is and what constitutes reasonable suspicion for reporting.

While it isn’t always clear what is meant by “reasonable suspicion,” there are signs that you can look out for whether you are a practitioner, parent, teacher, or individual. Prevent Child Abuse America suggests the following:

What You Can Do: Recognize the Warning Signs

PINWHEELS FOR PREVENTION ™ CAMPAIGN

The behavior of children may signal abuse or neglect long before any change in physical appearance. Some of the signs may include:

  • Nervousness around adults
  • Aggression toward adults or other children
  • Inability to stay awake or to concentrate for extended periods
  • Sudden, dramatic changes in personality or activities
  • Unnatural interest in sex
  • Frequent or unexplained bruises or injuries
  • Low self-esteem
  • Poor hygiene

They also provide a webpage that lists the steps to report and where to actually go to report.

What you can do: Report Suspected Abuse or Neglect

http://www.preventchildabuse.org/help/report_abuse.shtml

In addition the following website provides some guidelines for what reporters can expect and how to respond:

http://www.childhelp.org/pages/what-to-expect

If a child discloses that he or she has been abused by someone, it is important that you listen to them most of all.
(http://www.childhelp.org/pages/about-abuse)

DO NOT
•   Investigate
•   Ask leading questions (a question that suggests the answer or contains the information the questioner is looking for – That man touched you, didn’t he?)
•   Make promises
•   Notify the parents or the caretaker

DO
•   Provide a safe environment (be comforting, welcoming, and a good listener).
•   Tell the child it was not his/her fault
•   Listen carefully
•   Document the child’s exact quotes
•   Be supportive, not judgmental
•   Know your limits
•   Tell the truth and make no promises
•   Ask ONLY four questions
•   What happened?
•   Who did this to you?
•   Where were you when this happened?
•   When did this happen?
•   Asking any additional questions may contaminate a case!

Report it!
•   Call your local law enforcement agency
•   Call your local Child Protective Services Agency
•   Call the 24-Hour Childhelp® National Child Abuse Hotline and we will connect you to the appropriate agency.

Questions that will be asked when you call
http://www.dshs.wa.gov/ca/safety/abusereport.asp

  1. The name, address and age of the child.
  2. The name and address of the child’s parent, guardian or other persons having custody of the child.
  3. The nature and extent of the abuse or neglect.
  4. Any evidence of previous incidences.
  5. Any other information which may be helpful in establishing the cause of the child’s abuse or neglect and the identity of the perpetrator.

You do not need to have all of the above information when you call to make a report, but the more accurate information you can provide, the better equipped the offices will be to assess the child’s risk.

We’ve also included some further resources below that can help reporters clarify reporting laws and some further signs that you can look for if you suspect a child might be abused:

Prevent Child Abuse America

http://www.preventchildabuse.org/index.shtml

Child Abuse and Neglect Recognizing and Preventing Child Abuse

http://helpguide.org/mental/child_abuse_physical_emotional_sexual_neglect.htm

Mandatory Reporters of Child Abuse and Neglect: Summary of State Laws

http://www.childwelfare.gov/systemwide/laws_policies/statutes/manda.cfm

Quick note! Check out the Child Trauma Webinar Series!

 

Child Trauma Webinar Series

The Zero to Six Child Welfare Series is currently underway on the Learning Center for Child and Adolescent Trauma website.

See all of the available presentations here: http://learn.nctsn.org/file.php/1/pdf/NCTSN_Zero_to_Six_Child_Welfare_Speaker_Series.pdf

This is a great opportunity for clinicians and anyone else in the field of traumatic stress to learn more!

School Innovations to Fight Bullying: Resources and Stories

“Bullying is nothing new, but attitudes about it have changed. Some of those things that were accepted as part of the norm aren’t as accepted as part of the norm any longer…Now, our hope is to teach children not only the academic skills in school but also those social skills: How do we get along together? How do we build a more successful community? How do we work together? These are skills kids can use throughout their lifetime.” – Cindy Skala, the school social worker

“How to UnMake a Bully”

 There are many approaches schools can take to combat bullying within their walls, but the better ones are the innovative ones. For example, Glendaal Elementary School in Scotia’s new video project. With the help of Skala and Mike Feurstein, a filmmaker who serves as a teacher’s aide, students at Glendaal created a 30-minute video about how three students stood up to their school bully Russell. The video portrays many of the strategies schools everywhere try to teach their students. One of the most successful strategies is letting the students participate in teaching. “It’s important to do this in kids’ voices and to listen to what kids have to say. Simply telling kids these behaviors are bad and here’s what you should do about them is not a real effective strategy for getting things to change. Adults can’t really know the reality the kids are dealing with,” says Stan Davis, a school counselor and author of “Schools Where Everyone Belongs: Practical Strategies for Reducing Bullying.” Glendall and Feurstein have already begun a sequel about bullying and bystanders and hope to continue producing videos about other issues students face.

To watch this movie go to http://www.youtube.com/watch?annotation_id=annotation_430612&v=N0f6qQrvD8k&src_vid=8c2AR62HRlc&feature=iv

For further information about the project and the sequel, go to http://www.timesunion.com/living/article/Unmaking-a-bully-2195325.php#page-1.

Other schools are getting creative as well. For instance, the New York Association for Pupil Transportation is using the 2011 National School Bus Safety Week to highlight issues of bullying both at school and on the bus. (http://readme.readmedia.com/Bullying-Not-on-Our-School-Buses/3064207). Also, New Jersey school districts have declared the first week of Bully Prevention Month as “Week of Respect” and “pull out all stops with daily doses of anti-bullying reinforcement.” (http://www.app.com/article/BZ/20111005/NEWS01/310050025/Schools-turn-peer-mediation-battle-bullying)

Here are some resources for schools, teachers, and parents to work together to create innovative programs of their own:

General overview of the problem, action steps, and links for schools.

http://palmharbor.patch.com/articles/caregivers-tackle-bullying-in-schools-community-8f50701d

Connect for Respect – The national PTA provides resources and trainings for parents, caregivers, and teachers on how to work together to reduce bullying and its effects on students.

http://www.pta.org/bullying.asp

The Olweus Bullying Prevention Program provides resources, training, webinars, and other information about what bullying is and how to deal with it. It also provides specific resources for administrators, teachers, school staff, and parents.

http://www.olweus.org/public/index.page

Free Casey and Bella books, DVD, and curriculum created by Jan Lavascio to help children learn about bullying and how to deal with it.

http://www.caseyandbella.com/

Adaptability of training is critical

Maternal and Child Health Leadership Skills Development Series

http://www.jhsph.edu/wchpc/MCHLDS/index.html

The John’s Hopkins Bloomberg School of Public Health is offering a Maternal and Child Health Leadership Development Series for the public. This series offers an online tutorial on the conceptual framework needed to help build the neccessary leadership skills required for those working in this field. This framework helps participants to use the skills they learn from the series to develop and create personalized training sessions which can be completed at their own pace and according to their specific needs. A clear outline and description of the training modules used in the series is located here on the site.

Many organizations and groups have difficulty forming a clear and shared vision for themselves that will motivate staff and encourage program growth. This series is an excellent example of a leadership training that can be adapted to each individual person or program’s cultural needs and help the participants reach success. The ease of adaptability and compatibility of a training program with an individual’s or organization’s cultural needs is vital to its success whether it is a community organization, Federal agency, or non-profit.

More information and resources on a variety of trainings and curriculum related to child health and wellness can be found here:

Resources on Training and Curricula

http://www.safestartcenter.org/resources/curricula-training-manuals.php   

Zero to Three Training and Professional Development

http://www.zerotothree.org/about-us/areas-of-expertise/training-and-professional-development/training-and-professional.html

Education and training key to child wellbeing

Recognizing and Supporting the Social and Emotional Health of Young Children Birth to Age 5

http://www.ecmhc.org/tutorials/social-emotional/index.html

This training for early childhood mental health consultants, offered by the Georgetown University Center for Child and Human Development Center’s Early Childhood Mental Health Consultation, works to help them more fully explore the family context in which social and emotional learning occurs, so they can help parents support the healthy development of their children and properly care for them in everyday situations.

A recent study on epigenetics and stress demonstrates the necessity of this kind of training. The new study discusses and reiterates the long-held understanding that when a mother is under stress while pregnant, this stress may be the result of (repeated) exposure to a violent or traumatic event, that stress can have a long-term detrimental effect on her child’s health and wellbeing.

The problems caused by the exposure to stress can also carry on into and harm the child’s early youth and adolescent development, especially if whatever was causing the initial distress during the pregnancy is not dealt with or continues to escalate. This information only emphasizes the importance and need for early training and education that can combat the effects of the negative exposure and trauma.

There are also several other available resources that support parents and caregivers in helping their child cope with distressing events such as violence that they may be exposed to as they grow up (i.e. bullying, community violence, domestic violence), disasters & terrorism, or the loss of a loved one.

Resources:

Silent Realities

In this guide, the authors explain how exposure to violence may disrupt the development of young children ages birth to 5, and the importance of talking with children about traumatic events as a necessary part of the healing process. The authors provide specific recommendations for creating nurturing environments in homes and early care settings to help young children cope.

Healing the Invisible Wounds: Children’s Exposure to Violence (A Guide for Families)

This guide helps parents and caregivers identify if their child has been witness to or experienced violence. Sometimes there may not be clear physical signs, but children often suffer from “invisible wounds” that affect them emotionally and psychologically.

Moving From Evidence to Action: Safe Start Center Series on Children Exposed to Violence
Issue Brief #1: Understanding Children’s Exposure to Violence

This issue brief assists practitioners in understanding the impact of exposure to violence in the development of children as well as the environmental and family factors that may provide a buffer and prevent or reduce the impact of exposure to violence.

Updates:

Check out the Georgetown University Center for Child and Human Development’s National Technical Assistance Center for Children’s Mental Health’s next Webinar:

September 15, 2011, 1:00 – 2:30 PM E.D.T.

A Collaborative Approach to Promoting Social Emotional Well-Being for Children, Youth and Families in the Child Welfare System

http://gucchdtacenter.georgetown.edu/resources/2011calls.html

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