© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.
1. SCOPE OF PRACTICE 1A. MFT SCOPE OF PRACTICE 1B. LCSW SCOPE OF PRACTICE 2. UNPROFFESIONAL CONDUCT, NEGLIGENCE, LAW, ETHICS, AND STANDARD OF CARE 2A. UNPROFESSIONAL CONDUCT AND NEGLIGENCE 2B. LAW 2C. ETHICS 2D. STANDARD OF CARE 3. LEGAL ISSUES 3A. PRIVILEGE 3B. CONFIDENTIALITY 3C. EXCEPTIONS TO CONFIDENTIALITY: CHILD ABUSE, DEPENDENT ADULT & ELDER ABUSE , TARASOFF, DANGER TO SELF 3D. TREATMENT OF MINORS 3E. SEX WITH CLIENTS 3F. RECORD RETENTION AND STORAGE 3G. TERMINATION 3H. INFORMED CONSENT 3I. MALPRACTICE 4. HIPAA AND THIRD PARTY REIMBURSEMENT FOR MENTAL HEALTH SERVICES 5. CONTINUING EDUCATION 6. PROFESSIONAL ETHICS 6A. CAMFT ETHICAL STANDARDS PT II SECTION D 6B. REVISED CAMFT ETHICAL STANDARDS 6C. NASW ETHICAL STANDARDS 7. REFERENCES
1. Scope of Practice
The Attorney General describes scope of practice as the following: 1. MFTs and LCSWs “may practice psychotherapy” as it relates to the treatment of relational issues and social adjustments. 2. MFTs and LCSWs may diagnose and treat mental disorders as it relates to the treatment of relational issues and social adjustments. 3. MFTs and LCSWs may administer psychological tests, as long as the testing instrument used is within a therapist’s scope of competence as established by education, training, or experience and as long as the test is administered within the context of providing therapy. In other words, stand-alone testing of persons who are not psychotherapy clients would be outside the scope of practice for MFTs and LCSWs. Circumstances exist in which a “special relationship” is presumed by law to exist when one person is particularly vulnerable and dependent on another person who, correspondingly, has some control over the person’s welfare (Kockelman v. Segal, 1998). The relationship between a therapist and his or her patient constitutes this type of relationship. This special relationship imposes an affirmative duty on the therapist to protect others from either the therapist’s own negligence or from the client’s dangerousness towards self or others. 1A. MFT Scope of Practice MFT scope of practice is defined in Section 4980.02 of the California Business and Professions Code, “For the purposes of this chapter, the practice of marriage, family, and child counseling shall mean that service performed with individuals, couples, or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying, and productive marriage and family adjustments. This practice includes relationship and pre-marriage counseling. The applications of marriage, family, and child counseling principles and methods includes, but is not limited to, the use of applied psychotherapeutic techniques, to enable individuals to mature and grow within marriage and the family, and the provision of explanations and interpretations of the psychosexual and psychosocial aspects of relationships.” Pursuant to Business and Professions Code Section 4980.08, effective July 1, 1999, the title "licensed marriage, family and child counselor" or "marriage, family and child counselor" is hereby renamed "licensed marriage and family therapist" or "marriage and family therapist," respectively. Any reference in any statute or regulation to a "licensed marriage, family and child counselor" or "marriage, family and child counselor" shall be deemed a reference to a "licensed marriage and family therapist" or "marriage and family therapist."
1B. LCSW Scope of Practice LCSW scope of practice is defined in Section: 4996.9 of the California Business and Professions Code, “The practice of clinical social work is defined as a service in which a special knowledge of social resources, human capabilities, and the part that unconscious motivation plays in determining behavior, is directed at helping people to achieve more adequate, satisfying, and productive social adjustments. The application of social work principles and methods includes, but is not restricted to, counseling and using applied psychotherapy of a non-medical nature with individuals, families, or groups; providing information and referral services; providing or arranging for the provision of social services; explaining or interpreting the psychosocial aspects in the situations of individuals, families, or groups; helping communities to organize, to provide, or to improve social or health services; or doing research related to social work. “Psychotherapy, within the meaning of this chapter, is the use of psychosocial methods within a professional relationship, to assist the person or persons to achieve a better psychosocial adaptation, to acquire greater human realization of psychosocial potential and adaptation, to modify internal and external conditions which affect individuals, groups, or communities in respect to behavior, emotions, and thinking, in respect to their intrapersonal and interpersonal processes.”
2. UNPROFFESIONAL CONDUCT, NEGLIGENCE, LAW, ETHICS, AND STANDARD OF CARE
2A. Unprofessional Conduct and Negligence
The Business and Professions Code, Section 4982 indicates examples of unprofessional conduct including “negligence or incompetence in the performance of marriage and family therapy; misrepresentation involving type of license held, educational credentials, professional qualification or professional affiliations; performing, or holding oneself out as being able to perform services outside the scope of the license; failing to maintain confidentiality, except as otherwise permitted or required by law; and soliciting or paying remuneration for referrals. Unprofessional conduct is punishable by revocation or suspension of a license or an intern's registration; it is also a misdemeanor punishable by imprisonment in the county jail not exceeding six months, by a fine not exceeding $2,500, or both.” Required Coursework in Psychological Testing and Psychopharmacology: Business & Professions Code 4980.41(f) requires qualifying master's or doctor's degree programs leading to the MFT license to contain survey courses in psychopharmacology. These courses will be required only for those persons who begin graduate study on or after January 1, 2001. Anyone currently in the pipeline will not be affected by this new requirement. In regards to recordkeeping, 2. Interns are not to be supervised by anyone with whom they have a personal relationship. Nor should interns receive supervision from their psychotherapists. the failure to keep records consistent with sound clinical judgment, the standards of the profession, and the nature of the services being rendered is considered unprofessional conduct. No person may, for remuneration, engage in the practice of marriage and family therapy or social work as defined by Section 4980.02, unless he or she holds a valid license as a Marriage and Family Therapist or social worker, or unless he is specifically exempted from such requirement, nor may he advertise himself or herself as performing the services of a marriage, family, child, domestic, or marital consultant, or in any way use these or any similar titles to imply that he or she performs these services without a license as provided by this chapter.
January 19, 2010
Alchoholism and Substance Abuse Dependancy
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.
1. Become familiar with clinical and statistical information regarding substance abuse history, DSM criteria, types of abuse, demographic characteristics, treatment, and outcomes. 2. Define substance abuse and identify its efftects. 3. Become familiar with the medical aspects of alcohol abuse/dependence and other types of chemical dependency. 4. Apply current theories of the etiology of substance abuse. 5. Recognize the role of persons and systems that support or compound the abuse. 6. Become familiar with the major treatment approaches to alcoholism and chemical dependency. 7. Learn the national legal aspects of substance abuse. 8. Obtain knowledge of certain populations at risk with regard to substance abuse. 9. Access community resources offering assessment, treatment and follow-up for the abuser and family. 10. Learn the process of referring affected persons.
Table of Contents: 1. Definitions 2. History 3. DSM Criteria 4. Types of Substance Abuse 5. Prescription Drug Addiction and Dependence 6. Demographic Characteristics 7. Substance Abuse Treatment and Outcomes 8. References
1. DEFINITIONS
Substance abuse is defined as “the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual's physical and mental health, or the welfare of others. It is characterized by a pattern of continued pathological use of a medication, non-medically indicated substance, drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. Some controversy exists regarding the precise distinctions between substance abuse and substance dependence. However, the current clinical standard distinguishes between them by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use. Substance abuse may lead to addiction or substance dependence. Dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse. However, abuse frequently occurs without dependence. Dependence involves added physiological processes while substance abuse reflects a complex interaction between the individual, the abused substance and society.”
2. HISTORY
Throughout history, in fact for thousands of years, substance abuse has existed. Early Egyptians drank wine while narcotics were used dating back to 4000 B.C. Medicinal use of marijuana has been dated back to 2737 B.C. in China. During the 19th century, the active substances in drugs began to be extracted. At that time, substances including morphine, laudanum, and cocaine were unregulated and prescribed by physicians for a variety of illnesses. During the American Civil War, morphine was commonly used, and wounded veterans returned home with morphine kits and hypodermic needles. Opium dens grew and by the early 1900s there were an estimated 250,000 addicts in the United States (Office of Applied Studies, Substance Abuse and Mental Health Services Administration). The problems of addiction became gradually identified. Legal measures against drug abuse in the United States were first established in 1875, when opium dens were outlawed in San Francisco. The first national drug law was the Pure Food and Drug Act of 1906, which required accurate labeling of patent medicines containing opium and certain other drugs. In 1914 the Harrison Narcotic Act forbade sale of substantial doses of opiates or cocaine except by licensed doctors and pharmacies. Later, heroin was totally banned. Subsequent Supreme Court decisions made it illegal for doctors to prescribe any narcotic to addicts; many doctors who prescribed maintenance doses as part of an addiction treatment plan were jailed, and soon all attempts at treatment were abandoned. Use of narcotics and cocaine diminished by the 1920s. The spirit of temperance led to the prohibition of alcohol by the Eighteenth Amendment to the Constitution in 1919, but Prohibition was repealed in 1933. In the 1930s most states required antidrug education in the schools, but fears that knowledge would lead to experimentation caused it to be abandoned in most places. Soon after the repeal of Prohibition, the U.S. Federal Bureau of Narcotics (now the Drug Enforcement Administration) began a campaign to portray marijuana as a powerful, addicting substance that would lead users into narcotics addiction. In the 1950s, use of marijuana increased again, along with that of amphetamines and tranquilizers. The social upheaval of the 1960s brought with it a dramatic increase in drug use and some increased social acceptance; by the early 1970s some states and localities had decriminalized marijuana and lowered drinking ages. The 1980s brought a decline in the use of most drugs, but cocaine and crack use soared. The military became involved in border patrols for the first time, and troops invaded Panama and brought its de facto leader, Manuel Noriega, to trial for drug trafficking (Office of Applied Studies, Substance Abuse and Mental Health Services Administration). Throughout the years, the public's perception of the dangers of specific substances changed. The surgeon general's warning label on tobacco packaging gradually made people aware of the addictive nature of nicotine. By 1995, the Food and Drug Administration was considering its regulation. The recognition of fetal alcohol syndrome brought warning labels to alcohol products. The addictive nature of prescription drugs such as diazepam (Valium) became known, and caffeine came under scrutiny as well. Drug laws have tried to keep up with the changing perceptions and real dangers of substance abuse. By 1970 over 55 federal drug laws and countless state laws specified a variety of punitive measures, including life imprisonment and
even the death penalty. To clarify the situation, the Comprehensive Drug Abuse Prevention and Control Act of 1970 repealed, replaced, or updated all previous federal laws concerned with narcotics and all other dangerous drugs. While possession was made illegal, the severest penalties were reserved for illicit distribution and manufacture of drugs. The act dealt with prevention and treatment of drug abuse as well as control of drug traffic. The Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and rehabilitation; the 1988 act created the Office of National Drug Control Policy. Its director, often referred to as the drug “czar,” is responsible for coordinating national drug control policy (Office of Applied Studies, Substance Abuse and Mental Health Services Administration).
1. Become familiar with clinical and statistical information regarding substance abuse history, DSM criteria, types of abuse, demographic characteristics, treatment, and outcomes. 2. Define substance abuse and identify its efftects. 3. Become familiar with the medical aspects of alcohol abuse/dependence and other types of chemical dependency. 4. Apply current theories of the etiology of substance abuse. 5. Recognize the role of persons and systems that support or compound the abuse. 6. Become familiar with the major treatment approaches to alcoholism and chemical dependency. 7. Learn the national legal aspects of substance abuse. 8. Obtain knowledge of certain populations at risk with regard to substance abuse. 9. Access community resources offering assessment, treatment and follow-up for the abuser and family. 10. Learn the process of referring affected persons.
Table of Contents: 1. Definitions 2. History 3. DSM Criteria 4. Types of Substance Abuse 5. Prescription Drug Addiction and Dependence 6. Demographic Characteristics 7. Substance Abuse Treatment and Outcomes 8. References
1. DEFINITIONS
Substance abuse is defined as “the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual's physical and mental health, or the welfare of others. It is characterized by a pattern of continued pathological use of a medication, non-medically indicated substance, drug or toxin, that results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems. Some controversy exists regarding the precise distinctions between substance abuse and substance dependence. However, the current clinical standard distinguishes between them by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use. Substance abuse may lead to addiction or substance dependence. Dependence requires the development of tolerance leading to withdrawal symptoms. Both abuse and dependence are distinct from addiction which involves a compulsion to continue using the substance despite the negative consequences, and may or may not involve chemical dependency. Dependence almost always implies abuse. However, abuse frequently occurs without dependence. Dependence involves added physiological processes while substance abuse reflects a complex interaction between the individual, the abused substance and society.”
2. HISTORY
Throughout history, in fact for thousands of years, substance abuse has existed. Early Egyptians drank wine while narcotics were used dating back to 4000 B.C. Medicinal use of marijuana has been dated back to 2737 B.C. in China. During the 19th century, the active substances in drugs began to be extracted. At that time, substances including morphine, laudanum, and cocaine were unregulated and prescribed by physicians for a variety of illnesses. During the American Civil War, morphine was commonly used, and wounded veterans returned home with morphine kits and hypodermic needles. Opium dens grew and by the early 1900s there were an estimated 250,000 addicts in the United States (Office of Applied Studies, Substance Abuse and Mental Health Services Administration). The problems of addiction became gradually identified. Legal measures against drug abuse in the United States were first established in 1875, when opium dens were outlawed in San Francisco. The first national drug law was the Pure Food and Drug Act of 1906, which required accurate labeling of patent medicines containing opium and certain other drugs. In 1914 the Harrison Narcotic Act forbade sale of substantial doses of opiates or cocaine except by licensed doctors and pharmacies. Later, heroin was totally banned. Subsequent Supreme Court decisions made it illegal for doctors to prescribe any narcotic to addicts; many doctors who prescribed maintenance doses as part of an addiction treatment plan were jailed, and soon all attempts at treatment were abandoned. Use of narcotics and cocaine diminished by the 1920s. The spirit of temperance led to the prohibition of alcohol by the Eighteenth Amendment to the Constitution in 1919, but Prohibition was repealed in 1933. In the 1930s most states required antidrug education in the schools, but fears that knowledge would lead to experimentation caused it to be abandoned in most places. Soon after the repeal of Prohibition, the U.S. Federal Bureau of Narcotics (now the Drug Enforcement Administration) began a campaign to portray marijuana as a powerful, addicting substance that would lead users into narcotics addiction. In the 1950s, use of marijuana increased again, along with that of amphetamines and tranquilizers. The social upheaval of the 1960s brought with it a dramatic increase in drug use and some increased social acceptance; by the early 1970s some states and localities had decriminalized marijuana and lowered drinking ages. The 1980s brought a decline in the use of most drugs, but cocaine and crack use soared. The military became involved in border patrols for the first time, and troops invaded Panama and brought its de facto leader, Manuel Noriega, to trial for drug trafficking (Office of Applied Studies, Substance Abuse and Mental Health Services Administration). Throughout the years, the public's perception of the dangers of specific substances changed. The surgeon general's warning label on tobacco packaging gradually made people aware of the addictive nature of nicotine. By 1995, the Food and Drug Administration was considering its regulation. The recognition of fetal alcohol syndrome brought warning labels to alcohol products. The addictive nature of prescription drugs such as diazepam (Valium) became known, and caffeine came under scrutiny as well. Drug laws have tried to keep up with the changing perceptions and real dangers of substance abuse. By 1970 over 55 federal drug laws and countless state laws specified a variety of punitive measures, including life imprisonment and
even the death penalty. To clarify the situation, the Comprehensive Drug Abuse Prevention and Control Act of 1970 repealed, replaced, or updated all previous federal laws concerned with narcotics and all other dangerous drugs. While possession was made illegal, the severest penalties were reserved for illicit distribution and manufacture of drugs. The act dealt with prevention and treatment of drug abuse as well as control of drug traffic. The Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and rehabilitation; the 1988 act created the Office of National Drug Control Policy. Its director, often referred to as the drug “czar,” is responsible for coordinating national drug control policy (Office of Applied Studies, Substance Abuse and Mental Health Services Administration).
Child Abuse Assessment and Reporting
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.
1. Assess child abuse risk factors 2. Evaluate the need for a Suspected Child Abuse Report 3. Become familiar with relevant child abuse statistics 4. Differentiate between the roles of mandated and non-mandated reporters 5. Identify the symptoms and warning signs of child abuse 6. Utilize applicable clinical assessment and treatment tools 7. Utilize applicable treatment interventions 8. Identify and have accessibility to relevant resources Table of Contents: 1. Definition 2. History and the Law 3. Types of Child Abuse 4. Statistics 5. Mandated Reporters 6. Child Abuse Symptoms 7. Clinical Assessment 8. Treatment 9. Resources 10. References 1.
Definition
Child abuse is the physical, psychological or sexual maltreatment of children. The
Centers for Disease Control and Prevention (CDC) defines child maltreatment as “any act or series of acts or commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child”. Most child abuse occurs in the home, with a lesser amount occurring in the organizations, schools or community organizations. Currently, there are four widely recognized and identifiable categories of child abuse including neglect, physical abuse, psychological/emotional abuse, and sexual abuse. Different jurisdictions have developed their own definitions of what constitutes child abuse for the purposes of removing a child from his/her family and/or prosecuting a criminal charge. The Mental Health Journal defines child as “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of serious harm.”
2. History and the Law
Child sexual abuse is illegal in every civilized society with consequences often including severe criminal penalties, and in some jurisdictions, life imprisonment or capital punishment. A legal adult's sexual intercourse with a child below the legal age of consent is defined as statutory rape, based on the principle that a child is not capable of consent and that any apparent consent by a child is of course not considered to be legal consent. The United Nations Convention on the Rights of the Child (CRC) is an international treaty that legally obliges states to protect children's rights. Articles 34 and 35 of the CRC require states to protect children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. States are also required to prevent the abduction, sale, or trafficking of children. As of November 2008, 193 countries are bound by the CRC, including every member of the United Nations except the United States and Somalia. Child sexual abuse has gained increased public attention throughout the past few decades and has become one of the most high-profile crimes. Since the 1970s the sexual abuse of children and child molestation has increasingly been recognized as deeply damaging to children and thus unacceptable for society as a whole. While sexual use of children by adults has existed throughout history, it has only become the object of significant public attention in recent times. The first published work dedicated specifically to child sexual abuse appeared in France in 1857: Medical-Legal Studies of Sexual Assault (Etude Médico-Légale sur les Attentats aux Moeurs), by Auguste Ambroise Tardieu, the noted French pathologist and pioneer of forensic medicine (Masson, 1984, pp. 15–25). Prior to the 1970’s and 1980’s, sexual abuse remained secretive and socially unspeakable. Studies on child molestation did not emerge until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 44 out of 50 U.S. states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the Child Abuse Prevention and Treatment Act in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically. Finally, the National Abuse Coalition was created in 1979 to create pressure in congress to create more sexual abuse laws. Feminism contributed to increased awareness of child sexual abuse and violence against women, and made them public, political issues. Judith Lewis Herman, Harvard professor of psychiatry, wrote the first book ever on father-daughter incest when she discovered during her medical residency that a large number of the women she was seeing had been victims of father-daughter incest. Herman notes that her approach to her clinical experience grew out of her involvement in the civil rights movement. Her second book Trauma and Recovery, considered a classic and ground-breaking work coined the term complex post-traumatic stress disorder. "In it she defines this concept not only in terms of prolonged trauma, but in terms of what she calls "subjection to totalitarian control." Examples of this concept include:...hostages, prisoners of war, concentration-camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and organized sexual exploitation (In 1986, Congress passed the Child Abuse Victims' Rights Act, which allowed victims a civil claim in sexual abuse cases. The number of laws created in the 1980s and 1990s began to create greater prosecution and detection of child sexual abuse perpetrators. During the 1970s a large transition began in the legislature related to child sexual abuse. Megan's Law which was enacted in 2004, gives the public access to knowledge and identification of sex offenders nationwide. Anne Hastings described these changes in attitudes towards child sexual abuse as "the beginning of one history's largest social revolutions." According to John Jay College of Criminal Justice professor B.J. Cling, "By the early 21st century, the issue of child sexual abuse has become a legitimate focus of professional attention, while increasingly separated from second wave feminism...As child sexual abuse becomes absorbed into the larger field of interpersonal trauma studies, child sexual abuse studies and intervention strategies have become degendered and largely unaware of their political origins in modern feminism and other vibrant political movements of the 1970s. One may hope that unlike in the past, this rediscovery of child sexual abuse that began in the 70s will not again be followed by collective amnesia. The institutionalization of child maltreatment interventions in federally funded centers, national and international societies, and a host of research studies (in which the United States continues to lead the world) offers grounds for cautious optimism. Nevertheless, as Judith Herman argues cogently, 'The systematic study of psychological trauma...depends on the support of a political movement.'" Herman, Judith Lewis, 1997. Trauma and recovery: The aftermath of violence from domestic abuse to political terror. Basic Books). Increasing awareness of child sexual abuse in the United States has ignited civil lawsuits for monetary damages. Increased awareness of child sexual abuse has also encouraged more victims to step forward, whereas in the past victims were often secretive about their abuse. Some states have enacted specific laws lengthening the applicable statutes of limitations so as to allow victims of child sexual abuse to file suit sometimes years after they have reached the age of majority. Such lawsuits can be brought where a person or entity, such as a school, church or youth organization, was charged with supervising the child but failed to do so with child sexual abuse resulting. In the Catholic sex abuse cases the various Roman Catholic Dioceses in the
United States have paid out approximately $1 billion settling hundreds of these lawsuits since the early 1990s. Due to the fact that lawsuits often involve demanding procedures, concern exists that children or adults who file suit will be re-victimized by defendants through the legal process. The child sexual abuse plaintiff's attorney Thomas A. Cifarelli has written that children involved in the legal system, particularly victims of sexual abuse and molestation, should be afforded certain procedural safeguards to protect them from harassment during the legal process. A 2000 World Health Organization Geneva report, “World Report on Violence and Health (Chap 6 - Sexual Violence)” states, “Action in schools is vital for reducing sexual and other forms of violence. In many countries a sexual relation between a teacher and a pupil is not a serious disciplinary offence and policies on sexual harassment in schools either do not exist or are not implemented. In recent years, though, some countries have introduced laws prohibiting sexual relations between teachers and pupils. Such measures are important in helping eradicate sexual harassment in schools. At the same time, a wider range of actions is also needed, including changes to teacher training and recruitment and reforms of curricula, so as to transform gender relations in schools.” 3. Types of Child Abuse • Neglect, in which the responsible adult fails to adequately provide for various needs, including physical (failure to provide adequate food, clothing, or hygiene), emotional (failure to provide nurturing or affection) or educational (failure to enroll a child in school). • Physical abuse is physical aggression directed at a child by an adult. It can involve striking, burning, choking or shaking a child, and the distinction between discipline and abuse is often poorly defined. The transmission of toxins to a child through their mother (such as with fetal alcohol syndrome) can also be considered physical abuse in some jurisdictions. • Child sexual abuse is any sexual act between an adult and a child, including penetration, fondling, exposure to adult sexuality and violations of privacy. • Psychological abuse, also known as emotional abuse, which can involve belittling or shaming a child, inappropriate or extreme punishment and the withholding of affection.
Physical Abuse
Physical abuse is abuse involving contact intended to cause feelings of intimidation, pain, injury, or other physical suffering or harm. Forms of physical abuse include: • striking • punching • pushing, pulling • slapping • Whipping • striking with an object • locking in or out of a room or place/false imprisonment • excessive pinching • kicking • having someone fall • kneeing • strangling • head butting • drowning • sleep deprivation • exposure to cold, freezing • exposure to heat or radiation, burning • exposure to electric shock • placing in "stress positions" (tied or otherwise forced) • cutting or otherwise exposing somebody to something sharp • exposure to a dangerous animal • throwing or shooting a projectile • exposure to a toxic substance • infecting with a disease • withholding food or medication • assault • bodily harm • humiliation • torture
1. Assess child abuse risk factors 2. Evaluate the need for a Suspected Child Abuse Report 3. Become familiar with relevant child abuse statistics 4. Differentiate between the roles of mandated and non-mandated reporters 5. Identify the symptoms and warning signs of child abuse 6. Utilize applicable clinical assessment and treatment tools 7. Utilize applicable treatment interventions 8. Identify and have accessibility to relevant resources Table of Contents: 1. Definition 2. History and the Law 3. Types of Child Abuse 4. Statistics 5. Mandated Reporters 6. Child Abuse Symptoms 7. Clinical Assessment 8. Treatment 9. Resources 10. References 1.
Definition
Child abuse is the physical, psychological or sexual maltreatment of children. The
Centers for Disease Control and Prevention (CDC) defines child maltreatment as “any act or series of acts or commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child”. Most child abuse occurs in the home, with a lesser amount occurring in the organizations, schools or community organizations. Currently, there are four widely recognized and identifiable categories of child abuse including neglect, physical abuse, psychological/emotional abuse, and sexual abuse. Different jurisdictions have developed their own definitions of what constitutes child abuse for the purposes of removing a child from his/her family and/or prosecuting a criminal charge. The Mental Health Journal defines child as “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of serious harm.”
2. History and the Law
Child sexual abuse is illegal in every civilized society with consequences often including severe criminal penalties, and in some jurisdictions, life imprisonment or capital punishment. A legal adult's sexual intercourse with a child below the legal age of consent is defined as statutory rape, based on the principle that a child is not capable of consent and that any apparent consent by a child is of course not considered to be legal consent. The United Nations Convention on the Rights of the Child (CRC) is an international treaty that legally obliges states to protect children's rights. Articles 34 and 35 of the CRC require states to protect children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. States are also required to prevent the abduction, sale, or trafficking of children. As of November 2008, 193 countries are bound by the CRC, including every member of the United Nations except the United States and Somalia. Child sexual abuse has gained increased public attention throughout the past few decades and has become one of the most high-profile crimes. Since the 1970s the sexual abuse of children and child molestation has increasingly been recognized as deeply damaging to children and thus unacceptable for society as a whole. While sexual use of children by adults has existed throughout history, it has only become the object of significant public attention in recent times. The first published work dedicated specifically to child sexual abuse appeared in France in 1857: Medical-Legal Studies of Sexual Assault (Etude Médico-Légale sur les Attentats aux Moeurs), by Auguste Ambroise Tardieu, the noted French pathologist and pioneer of forensic medicine (Masson, 1984, pp. 15–25). Prior to the 1970’s and 1980’s, sexual abuse remained secretive and socially unspeakable. Studies on child molestation did not emerge until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 44 out of 50 U.S. states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the Child Abuse Prevention and Treatment Act in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically. Finally, the National Abuse Coalition was created in 1979 to create pressure in congress to create more sexual abuse laws. Feminism contributed to increased awareness of child sexual abuse and violence against women, and made them public, political issues. Judith Lewis Herman, Harvard professor of psychiatry, wrote the first book ever on father-daughter incest when she discovered during her medical residency that a large number of the women she was seeing had been victims of father-daughter incest. Herman notes that her approach to her clinical experience grew out of her involvement in the civil rights movement. Her second book Trauma and Recovery, considered a classic and ground-breaking work coined the term complex post-traumatic stress disorder. "In it she defines this concept not only in terms of prolonged trauma, but in terms of what she calls "subjection to totalitarian control." Examples of this concept include:...hostages, prisoners of war, concentration-camp survivors, and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and organized sexual exploitation (In 1986, Congress passed the Child Abuse Victims' Rights Act, which allowed victims a civil claim in sexual abuse cases. The number of laws created in the 1980s and 1990s began to create greater prosecution and detection of child sexual abuse perpetrators. During the 1970s a large transition began in the legislature related to child sexual abuse. Megan's Law which was enacted in 2004, gives the public access to knowledge and identification of sex offenders nationwide. Anne Hastings described these changes in attitudes towards child sexual abuse as "the beginning of one history's largest social revolutions." According to John Jay College of Criminal Justice professor B.J. Cling, "By the early 21st century, the issue of child sexual abuse has become a legitimate focus of professional attention, while increasingly separated from second wave feminism...As child sexual abuse becomes absorbed into the larger field of interpersonal trauma studies, child sexual abuse studies and intervention strategies have become degendered and largely unaware of their political origins in modern feminism and other vibrant political movements of the 1970s. One may hope that unlike in the past, this rediscovery of child sexual abuse that began in the 70s will not again be followed by collective amnesia. The institutionalization of child maltreatment interventions in federally funded centers, national and international societies, and a host of research studies (in which the United States continues to lead the world) offers grounds for cautious optimism. Nevertheless, as Judith Herman argues cogently, 'The systematic study of psychological trauma...depends on the support of a political movement.'" Herman, Judith Lewis, 1997. Trauma and recovery: The aftermath of violence from domestic abuse to political terror. Basic Books). Increasing awareness of child sexual abuse in the United States has ignited civil lawsuits for monetary damages. Increased awareness of child sexual abuse has also encouraged more victims to step forward, whereas in the past victims were often secretive about their abuse. Some states have enacted specific laws lengthening the applicable statutes of limitations so as to allow victims of child sexual abuse to file suit sometimes years after they have reached the age of majority. Such lawsuits can be brought where a person or entity, such as a school, church or youth organization, was charged with supervising the child but failed to do so with child sexual abuse resulting. In the Catholic sex abuse cases the various Roman Catholic Dioceses in the
United States have paid out approximately $1 billion settling hundreds of these lawsuits since the early 1990s. Due to the fact that lawsuits often involve demanding procedures, concern exists that children or adults who file suit will be re-victimized by defendants through the legal process. The child sexual abuse plaintiff's attorney Thomas A. Cifarelli has written that children involved in the legal system, particularly victims of sexual abuse and molestation, should be afforded certain procedural safeguards to protect them from harassment during the legal process. A 2000 World Health Organization Geneva report, “World Report on Violence and Health (Chap 6 - Sexual Violence)” states, “Action in schools is vital for reducing sexual and other forms of violence. In many countries a sexual relation between a teacher and a pupil is not a serious disciplinary offence and policies on sexual harassment in schools either do not exist or are not implemented. In recent years, though, some countries have introduced laws prohibiting sexual relations between teachers and pupils. Such measures are important in helping eradicate sexual harassment in schools. At the same time, a wider range of actions is also needed, including changes to teacher training and recruitment and reforms of curricula, so as to transform gender relations in schools.” 3. Types of Child Abuse • Neglect, in which the responsible adult fails to adequately provide for various needs, including physical (failure to provide adequate food, clothing, or hygiene), emotional (failure to provide nurturing or affection) or educational (failure to enroll a child in school). • Physical abuse is physical aggression directed at a child by an adult. It can involve striking, burning, choking or shaking a child, and the distinction between discipline and abuse is often poorly defined. The transmission of toxins to a child through their mother (such as with fetal alcohol syndrome) can also be considered physical abuse in some jurisdictions. • Child sexual abuse is any sexual act between an adult and a child, including penetration, fondling, exposure to adult sexuality and violations of privacy. • Psychological abuse, also known as emotional abuse, which can involve belittling or shaming a child, inappropriate or extreme punishment and the withholding of affection.
Physical Abuse
Physical abuse is abuse involving contact intended to cause feelings of intimidation, pain, injury, or other physical suffering or harm. Forms of physical abuse include: • striking • punching • pushing, pulling • slapping • Whipping • striking with an object • locking in or out of a room or place/false imprisonment • excessive pinching • kicking • having someone fall • kneeing • strangling • head butting • drowning • sleep deprivation • exposure to cold, freezing • exposure to heat or radiation, burning • exposure to electric shock • placing in "stress positions" (tied or otherwise forced) • cutting or otherwise exposing somebody to something sharp • exposure to a dangerous animal • throwing or shooting a projectile • exposure to a toxic substance • infecting with a disease • withholding food or medication • assault • bodily harm • humiliation • torture
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