© 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. Learn definition and distinguish between types of abuse
2. Become familiar with relevant facts and statistics
3. Identify spousal/partner abuse symptoms
4. Evaluate the effects of spousal/ partner abuse5. Identify same gender abuse dynamics
6. Become familiar with relevant cultural factors
7. Learn the national domestic violence applicable laws
8. Become familiar with resources and referrals
Table of Contents:
1. Definitions and Types of Abuse
2. Facts and Statistics
3. Symptoms and Effects
4. Domestic Violence and the Law
5. Evaluation, Intervention and Treatment
6. Resources and Referrals
7. References
1. Definitions and Types of Abuse
Domestic violence and emotional abuse is characterized by physically and/or psychologically dominating behaviors used by a perpetrator to control the victim. Partners may be married or unmarried; heterosexual, or homosexual; living together, separated or dating. Domestic violence occurs in all cultures; people of all races, ethnicities, religions, sexes and classes can be perpetrators of domestic violence. Domestic violence is also known as domestic abuse, spousal abuse, or intimate partner violence. Domestic violence is perpetrated by both men and women. Domestic abuse is any form of abuse that occurs between and among persons related by affection, kinship, or trust. It can occur with youth, adults or elders of all ages and walks of life. The perpetrator often will use fear and intimidation as a method of control. The perpetrator may also threaten to use or may actually use physical violence. Domestic abuse that includes physical violence is called domestic violence. Domestic abuse is intentionally trying to control another person. The abuser intentionally uses verbal, nonverbal, or physical methods to gain control over the other person. Domestic abuse includes:
• Physical abuse
• Sexual abuse or sexual assault
• Verbal abuse
• Emotional Abuse
• Financial abuse
• Neglect
• Ritual abuse
• Spiritual abuse
• Criminal harassment
• Stalking, and Cyber stalking(Stark, E., A. Flitcraft, 1996. Women at Risk: Domestic Violence and Women's Health. Sage).
There are many considerations in evaluating abuse including:
• Mode: physical, psychological, sexual and/or social.
• Frequency: on/off, occasional and chronic.
• Severity: in terms of both psychological or physical harm and the need for treatment.
• Transitory or permanent injury: mild, moderate, severe and up to homicide.
An area of the domestic violence field that is often overlooked is passive abuse leading to violence. Passive abuse is covert, subtle and veiled. This includes victimization, procrastination, forgetfulness, ambiguity, neglect, spiritual and intellectual abuse.
Increased recognition of domestic violence began during the women's movement. Awareness regarding domestic violence varies among different countries. Only about a third of cases of domestic violence are actually reported in the United States and the United Kingdom. According to the Centers for Disease Control, domestic violence is a serious, preventable public health problem affecting more than 32 million Americans, or more than 10% of the U.S. population.
There is increasing awareness and advocacy for men victimized by women. In a report on violence related injuries by the US Department of justice (USDOJ August 1997) hospital emergency room visits related to domestic violence revealed that physically abused men represent just under one-sixth of the total patients admitted to hospital reporting domestic violence as the cause of their injuries. The report reveals that significantly more men than women did not disclose the identity of their attacker. This is likely due to shame, stigma, and embarrassment associated with men victimized by women.
According to a July 2000 Centers for Disease Control Report, data from the Bureau of Justice, National Crime Victimization Survey consistently show that women are at significantly greater risk of intimate partner violence than are men. In May, 2007, researchers with the Centers for Disease Control reported on rates of self-reported violence among intimate partners using data from a 2001 study. In the study, almost one-quarter of participants reported some violence in their relationships. Half of these involved one-sided ("non-reciprocal") attacks and half involved both assaults and counter assaults ("reciprocal violence"). Women reported committing one-sided attacks more than twice as often as men (70% versus 29%). In all cases of intimate partner violence, women were more likely to be injured than men, but 25% of men in relationships with two-sided violence reported injury
compared to 20% of women reporting injury in relationships with one-sided violence. Women were more likely to be injured in non-reciprocal violence.
Physical Abuse
Physical abuse is characterized by aggressive behavior that may result in the victim sustaining injury. Physical abuse attacks are used by the perpetrator to control the victim. The abuse is rarely a single incident and typically forms identifiable patterns that may repeat more and more quickly, and which may become increasingly violent.
Physical abuse can include:
• assault with a weapon
• biting, pinching
• burning
• choking
• kicking, pushing, throwing or shaking
• slapping, hitting, tripping, grabbing or punching
• tying down or otherwise restraining or confining
• homicide
Sexual Abuse and Assault
Sexual abuse and assault includes any non-consensual sexual activity ranging from harassment, unwanted sexual touching, to rape. Sexual harassment is characterized by ridiculing another person to try to limit their sexuality or reproductive choices, while sexual exploitation could involve forcing someone to participate in pornographic film-making. Examples of sexual abuse include fondling of genitals, penetration, incest, rape, sodomy, indecent exposure, forced prostitution, forced production of pornographic materials (
Verbal/ Emotional/ Psychological Abuse
Abbott, Pamela and Emma Williamson, 1999.. "Women, Health and Domestic Violence". Journal of Gender Studies).
Domestic violence is not only physical and sexual violence but also psychological. Psychological violence can be defined as intense and repetitive degradation, creating isolation, and controlling the actions or behaviors of the spouse through intimidation or manipulation to the detriment of the individual. Emotional and psychological abuse sometimes involves tactics to undermine an individual's self-confidence and sense of self-worth, such as yelling, mocking, insulting, threatening, using abusive language, humiliating, harassing and degrading. It can also include deprivation of emotional care, and isolating the individual being targeted (Five Year State Master Plan for the Prevention of and Service for Domestic Violence." Utah State Department of Human Services, January 1994).
Financial/Economic Abuse
Financial abuse occurs when one individual attempts to take total or partial control of another's finances, inheritance or employment income. It may include denying access to one's own financial records and knowledge about personal investments, income or debt, or preventing a partner from engaging in activities that would lead to financial independence.
Financial or economic abuse includes:
• withholding economic resources such as money or credit cards
• stealing from or defrauding a partner of money or assets
• exploiting the partner's resources for personal gain
• withholding physical resources such as food, clothes, necessary medications, or shelter from a partner
• preventing a partner from working or choosing an occupation
Ritual Abuse
Ritual abuse is defined as a combination of severe physical, sexual, psychological and spiritual abuses used systematically and in combination with symbols, ceremonies and/or group activities that have a religious, magical or supernatural connotation. Victims are terrorized into silence by repetitive torture and abuse over time and indoctrinated into the beliefs and practices of the cult or group. Ritual abuse may also be linked to Satanism or devil worship.
Spiritual Abuse
Spiritual abuse may include:
• using the partner's religious or spiritual beliefs to manipulate them
• preventing the partner from practicing their religious or spiritual beliefs
• ridiculing the other person's religious or spiritual beliefs
• forcing the children to be reared in a faith that the partner has not agreed to
Spiritual and religious abuse is also abuse done in the name of, brought on by, or attributed to a belief system of the abuser, or abuse from a religious leader. This can include Priests, Ministers, cult members, family members, or anyone abusing in the name of a deity or perceived deity. Spiritual or religious abuse can find its way into every religion and belief system that exists. It may encompass many other forms of abuse, especially physical, sexual, emotional, psychological and financial (Warshaw, C. (1993). "Limitations of the Medical Model in the Care of Battered Women". in Bart, P., E. Moran. Violence Against Women: The Bloody Footprints. Sage).
Harassment, Stalking and Cyberstalking
Stalking is harassment of or threatening another person, especially in a manner that physically or emotionally disturbs them. Stalking of an intimate partner can occur place during the relationship, with intense monitoring of the partner's activities, or it can take place after a partner or spouse has left the relationship. The stalker may be trying to get their partner back, or they may wish to harm their partner as punishment for their departure. Regardless of the motive, the victim fears for their safety. Stalking may occur at or near the victim's home, near or in their workplace, on the way to any destination, or on the internet (cyberstalking). Stalking can be on the phone, in person, or online. Stalkers sometimes do not reveal themselves, or they may just “show up” unexpectedly. Stalking is often unpredictable and dangerous. Stalkers may utilize threatening tactics including:
• “showing up” wherever the victim is located
• repeated phone calls (often hanging up)
• following the victim
• watching the victim from a hiding place
• sending the victim unwanted packages/gifts/letters
• monitoring the victim's phone calls
• monitoring the victim’s mail or internet use
• sifting through the victim's garbage
• contacting the victim's friends, family, co-workers, or neighbors to obtain information about the victim
• damaging the victim's property
• threatening to hurt the victim or the victim’s family, friends or pets
Cyberstalking is defined as utilizing the internet with the intention to harass and/or stalk another person. Cyberstalking is deliberate and persistent in nature. It may be an additional form of harassment, or the only method the perpetrator employs. The cyber stalker’s communication may be disturbing and inappropriate. Often, the more the victim protests or responds, the more rewarding the cyberstalker experiences the stalking. The best way to respond to a cyberstalker is not to respond. Cyberstalking may graduate to physical stalking, aggression, and violence.
Battering relationships are often characterized by cyclical phases, sometimes referred to as The Cycle of Violence. A period of peace and calm is followed by escalating tension. A woman might feel as though she were walking on eggshells. Minor incidents may occur that the woman tries to minimize or deny, sometimes by taking the blame. When the tension becomes unmanageable, aggression occurs. The victim may be kicked, thrown against a wall, raped, threatened at gun or knife point, slapped, punched or subjected to any of the endless mental and physical abuses that batterers use to intimidate and control their partners.
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January 20, 2010
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
January 17, 2010
Substance Abuse Dependency CEU MFT LMFT
© 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).
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).
June 17, 2009
CEUS Continuing Education for LMFT, LCSW, and LPC Licenses in many states including California
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Aspira's commitment to excellence means that the mental health and social work online courses we offer are the best you'll find. We offer a broad range of course subjects that are board approved for many professions including MFT, LCSW, and LPC. The process is as simple as selecting a course, completing and passing the online exam, and receiving/printing your certificate issued immediately with your payment.
"Great value in a NO-NONSENSE approach to Continuing Education Units required for
professional licensure. No fluff or filler, just the facts in a clear and
concise format...I'd gladly use them again..."
B.C., MA, LMFT, California
Aspira's commitment to excellence means that the mental health and social work online courses we offer are the best you'll find. We offer a broad range of course subjects that are board approved for many professions including MFT, LCSW, and LPC. The process is as simple as selecting a course, completing and passing the online exam, and receiving/printing your certificate issued immediately with your payment.
With Aspira, you can:
- Satisfy your CE requirements conveniently anywhere you have online access.
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Take some time to browse our courses, and become a part of the Aspira family.
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professional licensure. No fluff or filler, just the facts in a clear and
concise format...I'd gladly use them again..."
B.C., MA, LMFT, California
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