Discussion: Treating Childhood Abuse
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Child abuse places a lifetime mental health burden on individuals affected by these experiences. A mental health professional ability to screen and recognize a history of child abuse is essential in providing adequate care. Al Odhayani, Watson, & Watson (2013), agreed that child abuse has serious consequences for child development and family health throughout the life cycle, and it might be detected during the visit. While universal screening is not recommended, a healthcare provider should be aware of the various presentations and sequelae of child abuse so that that appropriate intervention can be instituted. Many abuse survivors are ashamed of having been victims of childhood physical, emotional, or sexual abuse and may feel that the abuse was self-induced. Screening and assessment, therefore, should be designed to reduce the threat of humiliation and blame and should be done in a safe, non-threatening environment.
Furthermore, Al Odhayani, Watson, & Watson (2013), explained that a child’s behavior is an outward manifestation of inner stability and security. It is a lens through which the healthcare provider can observe the development of the child throughout his or her life. Clinicians need to be aware of and alert to the indicators of child abuse and neglect so that appropriate interventions can be provided to improve outcomes for those children.
Al Odhayani, Watson, & Watson (2013), noted that disclosure is the most apparent indication of sexual abuse. Age-inappropriate sexual behavior or excessively sexualized behavior might be an indicator of abuse. Indirect signs can include any of the following: acting out (with aggression or anger); withdrawal; regression; fears, phobias, and anxiety; sleep disturbance or nightmares; changes in eating habits; altered school performance; mood disturbances; enuresis or encopresis; running away; self-destructive behavior; or antisocial behavior (eg, lying, stealing, cruelty to animals, fire-setting)
As a mental health provider, detailed history taking and non-verbal clues such as indirect signs an essential in assessing for a history of child abuse.
Social Media and Mental Health
Social media and networking play a vital role in the day to day activities. It is essential to understand the purpose of this platform when providing a mental health service. Berry, Emsley, Lobban, & Bucci (2018) stated that despite some evidence for the potential therapeutic benefits of social media use, social media engagement might also be harmful to an individual’s mental health and wellbeing. For example, several studies have reported a significant link between high social media use and low mood and depression. According to Radovic, Gmelin, Stein, & Miller (2016), adolescents described both positive and harmful use of social media. Positive use included searching for positive content (i.e., for entertainment, humor, content creation) or social connection. Detrimental use included sharing risky behaviors, cyberbullying, and for making self-denigrating comparisons with others. Cyber victimization is bullying the patient may experience from the peers or public who knows the patient’s history of sexual abuse. According to Nixon (2014), cyber victimization is related to disruptions in adolescents’ relationships. Specifically, targets of cyberbullying reported more loneliness from their parents and peers, along with increased feelings of isolation and helplessness. Not surprisingly, targets of cyberbullying reported fewer friendships, more emotional and peer relationship problems, lower school attachment, and more empathy. Social media use was significantly associated with increased depression. Given the proliferation of Social media, identifying the mechanisms and direction of this association is critical for informing interventions that address Social media use and depression (Lin et al., 2016).
Mandatory Child Abuse Report
Mental healthcare providers are bounded to report any types of abuse to appropriate law enforcement according to the state’s law. According to McTavish et al. (2018), mandatory reporting law, in the context of child maltreatment, is a specific kind of legislative enactment which imposes a duty on a specified group or groups of persons outside the family to report suspected cases of designated types of child maltreatment to child welfare agencies. Providers should get familiarized with the state of practice abuse report protocol. The state of Maryland requires all citizens to report any form of abuse. Maryland Department of Human Service. (n.d) wrote that all Maryland citizens should report suspected abuse or neglect to the local department of social services or a local law enforcement agency. Ensuring the safety of Maryland’s children is an obligation shared by all citizens and organizations. If you are a health care practitioner, educator, human service worker or a law enforcement officer, you are required by law to report both orally and in writing any suspected child abuse or neglect. Across jurisdictions, mandatory reporting can include other forms of maltreatment (notably physical, sexual and emotional abuse, neglect, children’s exposure to intimate partner violence (IPV) and prenatal exposure to drug abuse), reporting by more than mandated professionals (e.g, by all citizens), reporting abuse perpetrated by non-caregivers and reporting beyond ‘severe’ or ‘significant’ abuse McTavish et al. (2018). The patient’s cousin was jailed from a different case of child abuse; it is essential as a mental health provider to report all incidents of child abuse report by the patient.
Al Odhayani, A., Watson, W. J., & Watson, L. (2013). Behavioural consequences of child abuse. Canadian family physician Medecin de famille canadien, 59(8), 831-6.
Berry, N., Emsley, R., Lobban, F., & Bucci, S. (2018). Social media and its relationship with mood, self-esteem and paranoia in psychosis. Acta psychiatrica Scandinavica, 138(6), 558-570.
Lin, L. Y., Sidani, J. E., Shensa, A., Radovic, A., Miller, E., Colditz, J. B., Hoffman, B. L., Giles, L. M., … Primack, B. A. (2016). Association between social media use and depression among u.s. young adults. Depression and anxiety, 33(4), 323-31.
Maryland Department of Human Service. (n.d). Reporting suspected child abuse or neglect. Retrieved from http://dhs.maryland.gov/child-protective-services/reporting-suspected-child-abuse-or-neglect/
McTavish, J. R., Kimber, M., Devries, K., Colombini, M., MacGregor, J., Wathen, C. N., Agarwal, A., … MacMillan, H. L. (2017). Mandated reporters’ experiences with reporting child maltreatment: a meta-synthesis of qualitative studies. BMJ open, 7(10), e013942. doi:10.1136/bmjopen-2016-013942
Nixon C. L. (2014). Current perspectives: the impact of cyberbullying on adolescent health. Adolescent health, medicine and therapeutics, 5, 143-58. doi:10.2147/AHMT.S36456
Radovic, A., Gmelin, T., Stein, B. D., & Miller, E. (2016). Depressed adolescents’ positive and negative use of social media. Journal of adolescence, 55, 5-15.
In the United States, Child Protective services investigate over 2 million reports of child maltreatment, 18% of those cases involve child abuse. (Pediatrics, 2015). This is more than 650,000 children left as victims of mistreatment, 1500 children died from abuse.
Strategies to access for abuse
When accessing for child abuse one needs to keep in mind that abuse can be physical, emotional, and sexual. A complete comprehensive assessment is essential, acknowledging the past history of the child for unexplained injuries, the child’s demeanor, history of anxiety, reluctance to answer questions (fear of retribution). Often there is a sense of denial that the injury occurred, inconsistencies to the child and witnesses stories. Physical injuries need to be accessed for injuries to multiple systems, different stages of healing, unexplained injuries, and other physical changes such as dirty clothing, poor hygiene, hunger, and lack of sleep causing fatigue. I choose these main assessments to be able to look at my patient as a whole. Evaluating their everyday life for abrupt changes often indicates a stressor that could be abuse.
Social media and media exposure
In today’s age everyone has social media excess; this can be a good thing or a terrible thing. Social media can create a frenzy of fear for victims, and can also provide a support system for those who do not have one. Social media can easily be misused and harm the victim more.
In the case story, Morgan discloses the abuse he encountered from his cousin while living with them. The fact that there are other children is also a concern. However, that is third party information, unless another child comes forward or the cousin that abuse cannot be questioned. As a mandated reporter because Morgan reported to you that he was abused you need to question the incident further, how old was Morgan at time of abuse? How long has abuse occurred? Where did abuse occur? These determine whether a report needs to be reported of not. If Morgan is 19, an adult it is his choice.
When the history or physical examination reveals suspicious injuries, and the pediatrician has a reasonable suspicion that a child has been abused, a report to CPS for further investigation is mandated by law. Mandatory reporting laws do not require certainty, and failure to make a report can result in civil or criminal penalties for the physician, or most dire, additional injury or death of a child.49 all state laws provide some type of immunity for good-faith reporting, although laws vary slightly between states. Many states have laws that permit physicians to evaluate children who are suspected victims of abuse, to conduct tests, and to take photographs of children’s injuries without parental consent. In practice, parents are informed of testing, radiographs, and photographs that will be taken, and parental refusal is uncommon. Pediatricians can look to specific state laws for additional guidance if these issues arise. (Pediatrics, 2015).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Pediatrics (2015).Retrieved from https://pediatrics.aappublications.org/content/pediatrics/early/2015/04/21/peds.2015-0356.full.pdf Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.