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HOW TO BUILD RESILIENCY IN CHILDREN WHO SUFFER ADVERSE CHILDHOOD EXPERIENCES AND TOXIC STRESS. LUKE WALDO Child Witness to Domestic Violence.

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Presentation on theme: "HOW TO BUILD RESILIENCY IN CHILDREN WHO SUFFER ADVERSE CHILDHOOD EXPERIENCES AND TOXIC STRESS. LUKE WALDO Child Witness to Domestic Violence."— Presentation transcript:

1 HOW TO BUILD RESILIENCY IN CHILDREN WHO SUFFER ADVERSE CHILDHOOD EXPERIENCES AND TOXIC STRESS. LUKE WALDO Child Witness to Domestic Violence

2 Our Objectives  Provide information about domestic violence, its impacts on parents and children, and how to safely identify and understand it.  Provide information about toxic stress and childhood trauma and how it impacts childhood development and future social and health outcomes.  Provide practices that may mitigate the impacts of toxic stress and childhood trauma and that may build resiliency in the impacted child and adult.

3 What is Domestic Violence? Domestic violence is a pattern of assaultive and coercive behaviors – including physical, sexual, and psychological attacks as well as economic coercion – that adults or adolescents use to exert power and control over their intimate partners.

4 The Power and Control Wheel

5 Cycle of Violence TENSION BUILDING HONEYMOON ABUSE CRISIS

6 Characteristics of an Abusive Personality  Controlling and Entitled:  Rights without responsibilities.  Selfish, Superior and Possessive:  His needs are to be met by others without reciprocity.  Coercive and Manipulative:  Confuses love with abuse. Portrays himself in positive light while demeaning and damning partner.  Contradictory:  Behaves differently from how he sees and speaks of self.  Unaccountable, Denial and Minimization:  Refuses to take responsibility for abuse, its seriousness and shifts blame to victim.  Serial Abuse:  Abuse is part of personality, not reaction to partner.  Traumatized:  Most likely the victim of childhood trauma.

7 Why Victims Stay  Safety  Fear of physical harm to selves and children if they attempt to leave  Fear of retaliation/stalking  Children  Fear of emotional damage to children  Fear of involving the courts  Fear of losing custody and placement of children  Financial  Economic dependence  Lack of alternative housing  Lack of job skills  Social  Lack of support from family/friends  Lack of information regarding alternatives  Cultural and religious constraints

8 Why Victims Stay Emotional Factors  Fear of loneliness  Insecurity over independence and lack of emotional support  Guilt over failure of marriage  Belief that partner needs them and cannot survive alone  Belief that partner will change  Fear/ambivalence over making life changes  All factors focus on ensuring their survival

9 Why Victims May Not Seek Help  Fear of retribution  Fear of losing children  Fear of employers reaction  Protecting relationship(s)  Severe isolation  Shame and humiliation

10 How Do Children Witness Domestic Violence?  Witnessing the abuse  Intervening in the abuse  Hearing the abuse  Witnessing the aftermath  Hearsay  Separate victims  Pawns

11 How Are Children Used in DV Situations?  Scapegoats  Justifying abuse through child’s bad behavior  Intimidation  Threatening violence against the children and/or pets  Legal Pawns  Prolonged court proceedings about custody/placement, especially when the abuser has previously shown little interest in the children  Withheld  Taking children hostage, abducting them or not returning them to other parent  Allies  Talking to children about the abused parent’s behavior. Encouraging the children to abuse the other parent

12 The Effects of Domestic Violence on Children  Behavioral Effects  Act out or withdraw  Aggressive (“bullying”) or passive (“doormats”)  Attention-seeking  Care-taking, filling adult roles  Overachiever or underachiever  Nightmares and/or bedwetting  Physical Effects  Anxious/Nervous  Regression in developmental tasks  Somatic complaints (e.g., headache, stomach aches, difficulty breathing, etc.)  Tired/Lethargic

13 The Effects of Domestic Violence on Children  Social Effects  Bully/Victim of bullying  Difficulty making friends  Difficulty trusting others  Difficulty with clear boundaries  Isolated  Poor conflict resolution  Emotional Effects  Anger  Burdened, inappropriate roles  Confusion, conflicted loyalties  Depression  Fear  Grief/Sense of loss  Guilt (e.g., feels responsible for the violence)

14 The Effects of Domestic Violence on Children  Cognitive/Attitudinal Effects  Belief that abuse and violence are acceptable in relationships  Belief that aggressive behavior enhances self- image  Exposure to violence associated with lower cognitive functioning  Long-term Effects  Correlation with adverse health outcomes in adulthood  Correlation with increased rates of depression, anxiety  Correlation with increased risks for juvenile delinquency/anti-social and high-risk behaviors

15 The Impacts of Childhood Trauma The Adverse Childhood Experiences (ACE) study Collaboration between the CDC and Kaiser Permanente. Provided a physical examination to 17,000 patients, then surveyed them regarding their personal adverse childhood experiences such as abuse and neglect.

16 The ACE Study: Major Findings Almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. The short- and long-term outcomes of these childhood exposures include a multitude of health and social problems. The ACE Score is used to assess the total amount of stress during childhood and has demonstrated that as the number of ACE increase, the risk for serious health problems increases in a strong and graded fashion. (Center for Disease Control and Prevention)

17 The ACE Study: Impacts on Health Physical and Behavioral Impacts Alcoholism Chronic Obstructive Pulmonary Disease Depression Fetal death Health-related quality of life Illicit drug use Ischemic heart disease Liver disease Risk for IPV Multiple sexual partners STIs Smoking Suicide attempts Unintended pregnancies Early initiation of smoking Early initiation of sexual activity Adolescent pregnancy

18 The Impacts of Toxic Stress and Childhood Trauma Social and Emotional Impacts  Attachment disorder/ Difficulty forming relationships  Difficulty identifying, expressing and managing emotions  Dissociation  Hypersensitivity to triggers  Aggressive, angry, and/or profoundly sad responses  Struggles with self-regulation  Hypervigilance/guarded  Withdrawn and isolated  Persistent fear responses  High risk behaviors  Self-harm  Unsafe sexual activity  Excessive risk taking  Substance use/abuse  Violence  Running away from home

19 The Impacts of Toxic Stress and Childhood Trauma Impacts on Learning  Deficits in abstract reasoning skills  Deficits in language development  Difficulty understanding and responding to rules, boundaries and laws  Difficulty planning and anticipating the future  Difficulty problem-solving  Reduced size of parts of the brain responsible for:  Attention  Consciousness  Language  Memory  Perceptual awareness  Thinking  Survival mode  Impulsive

20 As professionals in this field, it is our goal to help foster resiliency in the children with whom we work.

21 How to Foster Resiliency and Healing in Children  Safe environment  Strong and caring relationships with safe adults, especially mom  Strong relationships within the family and community  Support child’s strengths and interests  Participation in positive activities  Permission to be angry, hurt, confused, etc.  Opportunities to talk about events and express feelings

22 How to Foster Resiliency and Healing in Children  Early Intervention:  “Early intervention with children, by ameliorating the intensity and severity of the child’s response to trauma, can ‘decrease the probability of developing…sensitized neural systems’ that lead to persistence of trauma symptoms and defenses.” (Perry et al, 1995)  Safe Environment:  Adult remains calm, ensures child’s safety and provides “appropriate structure, limits, routines, and nurturance.” (Hodas, 2006)

23 Safety and Assessment Dangerousness Assessment  Indicators Provided By Partners, Children or Other Family Members  The history of violence in the relationship and her fear of further violence and escalation; Abuse during pregnancies  Gun ownership or easy access to gun  Threats to kill her, the children or himself if she leaves  Strangulation  Forced sex  Severe and persistent monitoring and stalking; Severe and irrational jealousy  Severe isolation  Recent instability – unemployment, evictions, etc.  Substance abuse – alcoholism and/or use of “uppers”

24 Safety and Assessment Safety Precautions  Workers must ensure that their involvement does not compromise their own safety or the safety of anyone in the family.  Promoting safety for all parties is the primary goal.  Inquiry into private family matters often is viewed by the abuser as a threat to his or her control over the family.  Separate interviews should be conducted with the children, alleged victim, and alleged perpetrator.

25 Safety and Assessment Safety Precautions  Do not leave voicemail messages asking to speak with the alleged victim about the abuse.  Find creative means of contact (e.g., at the alleged victim's place of work or through the children's school).  Safeguard domestic violence information from the alleged abuser. Do not leave domestic violence resource information in plain sight.  Reflect thoroughly on potential consequences if suggesting to alleged victim that she leave the home or pursue other actions such as restraining orders.

26 Initial Contact Observations  Visible injuries or injuries that are hidden or attempted to be hidden  Flinching or signs of anxiety  Use of dominating or intimidating body language  Weapons  Holes in walls, broken furniture, broken doors and windows  Locks on the outsides of doors  Telephone is broken, disconnected, or missing  Home is not adequately accessible for family member’s disabilities  Guard animals, especially if family members exhibit fear of the animals  Home is in an isolated location

27 Interviews Process  Interview the alleged adult victim first without the alleged batterer present and without the alleged batterer’s knowledge whenever possible.  If the alleged batterer is present, do separate interviews out of earshot of the alleged batterer.  If you cannot separate the partners, focus on issues other than the domestic violence. Resistance to separate interviews with adults may be an indication of domestic violence and a batterer’s control.

28 Interviews Interviewing the Alleged Adult Victim  Immediately ask the alleged adult victim if it is safe to conduct an interview and what might be a safe manner to do so.  Never ask the alleged adult victim about domestic violence in front of the alleged abuser. Disclosures may make it unsafe if the alleged abuser is in the vicinity.  Use strategies to build rapport, encourage conversation and support the alleged adult victim.

29 Interviews Interviewing the Alleged Adult Victim  Ask about other issues first before asking about domestic violence. Ask about relationship issues, including positive aspects. Begin with more general questions and follow with more specific and detailed questions.  Ask open-ended questions about well-being to start the conversation. However, express concerns and ask questions about bruises or other injuries.

30 Interviews Interviewing the Alleged Adult Victim  Ask questions on the coercive tactics the alleged abuser may use.  The alleged adult (and children) may express positive feelings toward the alleged abuser. When asking questions about the abuse, focus on the alleged abuser’s violence and controlling behaviors, not personality.

31 Interviews Interviewing the Alleged Adult Victim  Affirm to the alleged adult victim that the abuse is not deserved and not the fault of the alleged adult victim.  The adult victim may not talk with us from fear of removal of children and/or fear of abuser. This affirmation stresses our concern that both she and the children are in danger.  Stress that our priority is to work with the non-offending parent in planning to protect the children and parent together, whenever safe and possible.

32 Interviews Interviewing the Alleged Adult Victim  Express concerns for the safety of the alleged adult victim and the safety of the children.  Identify what the alleged adult victim has done to stay safe and keep the children safe.  Consider that the adult victim’s actions have been survival strategies.  Recognize that because many adult victims lack access to financial resources or other housing options they may believe that it is better to stay with the alleged abuser.

33 Efficient, Effective Safety Planning Requires knowledge about the abuser’s pattern of coercive control. Builds on victim’s efforts to promote the safety and well-being of the children. Is developed in collaboration with the victim. May include a domestic violence shelter, police or protective order, but does not mandate or rely on these interventions. Includes informal resources (friends, family, employer). Attempts to account for the other critical needs of the children, like stability. Is well documented.

34 Visitation The abuser’s relationship as a parent presents complex issues. Tactics of manipulation and control may be present in the abuser’s relationship with the children:  Start with the assumption that visits between the abuser and children, if they occur, should be supervised.  Check on possible restraining orders, no-contact orders or conditions of probation and parole that would affect visitation.  Arrange visits carefully to ensure the safety of the children and the adult victim. Schedule separate visits when possible to increase safety and to allow the non-offending parent uninterrupted parenting time with the children.

35 Visitation  Give the visit supervisor adequate information on domestic violence and tactics of the specific abuser.  Talk to the child and non-offending parent to identify any of the abuser’s behaviors that cause discomfort or fear.  Ask the non-offending parent and the child to identify subtle tactics the abuser uses to manipulate or threaten the child and watch for those in visitation.  Have a child use a code word if feeling unsafe.

36 Visitation  Reassure the child that it is the responsibility of the visit supervisor to intervene in the visit.  Set limits on behaviors and conversation allowed in the visits.  Do not allow the child to be used to exchange information, gifts, or other property or tell the abuser about the non-offending parent.

37 How to Foster Resiliency and Healing in Children  Social Support:  Give children the opportunity to develop a personal narrative.  With early intervention and appropriate social support, “most children and adolescents…will recover almost completely from the fear and anxiety within a few weeks.” (NIMH, 2001)  Mental Health Treatment:  Mental health treatment may be necessary if recovery is delayed or there are coexisting issues such as depression and avoidance.

38 Community Resources: Milwaukee  ALMA Center (414) 265-0100  Asha Family Services (414) 875-1511  Hmong American Friendship Association (414) 344-6581  Milwaukee Women’s Center (414) 671-6140  Sojourner Family Peace Center (414) 276-1911  Belle Resource Center (414) 344-4466  Beyond Abuse (414) 276-1911  Sojourner Truth House (shelter) (414) 933-2722  The Healing Center (Sexual Abuse) (414) 671-4325  UMOS Latina Resource Center (414) 389-6500

39 Community Resources: Southeastern Wisconsin  Advocates of Ozaukee: (877) 375-4034  Friends of Abused Families: (262) 673-7298  Safe Harbor: (920) 452-8611  Sister House: (262) 542-3828  Waukesha Women’s Center: (262) 547-4600  Women’s Horizons: (262) 652-9900

40 QUESTIONS?

41 References American Psychological Association:  http://www.apa.org/monitor/2011/09/tools.aspxhttp://www.apa.org/monitor/2011/09/tools.aspx  http://www.apa.org/pi/families/resources/children-trauma.pdf http://www.apa.org/pi/families/resources/children-trauma.pdf American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision). Center for Disease Control and Prevention: http://www.cdc.gov/ace/about.htmhttp://www.cdc.gov/ace/about.htm Center on the Developing Child at Harvard www.developingchild.harvard.eduwww.developingchild.harvard.edu Futures Without Violence: http://www.futureswithoutviolence.org/content/features/detail/803 http://www.futureswithoutviolence.org/content/features/detail/803 Ganley, A and Hobart, M. (2010). Social Worker’s Practice Guide to Domestic Violence (DSHS Publication No. 22-1314). Washington State Department of Social and Health Services’ Children’s Administration. Hodas, Dr. Gordon R. 2006. “Responding to Childhood Trauma: The Promise and Practice of Trauma Informed Care”  http://www.dpw.state.pa.us/ucmprd/groups/public/documents/manual/s_001585.pdf http://www.dpw.state.pa.us/ucmprd/groups/public/documents/manual/s_001585.pdf National Child Traumatic Stress Network: http://www.nctsnet.org/http://www.nctsnet.org/ The National Center for Trauma-Informed Care:  http://www.samhsa.gov/nctic/healing.asp#risking http://www.samhsa.gov/nctic/healing.asp#risking


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