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Behind Closed Doors As counselors, we are often on the front line. It is common that we are the first person notified or made aware of a crisis situation.

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Presentation on theme: "Behind Closed Doors As counselors, we are often on the front line. It is common that we are the first person notified or made aware of a crisis situation."— Presentation transcript:

1 Behind Closed Doors As counselors, we are often on the front line. It is common that we are the first person notified or made aware of a crisis situation.

2 Introduction  It is often the counselor’s responsibility to: –Intervene –Ensure safety –Provide counseling to those in crisis –Referrals to agencies

3 Introduction  Purpose –Present real life situations that occur in all schools –Give you insight into the many different types of crisis situations that you may face –Listen to your comments, opinions, and insights as we present

4 Introduction  We will present the child involved, the crisis situation, and course of action:  Jennifer---Physical Abuse  Dana--Sexual Abuse  Marci--Teen Pregnancy  Candace--Stereotypes, Gangs, & Eating Disorders

5 Issue #1--Sexual Abuse November 2003October 2003November December 2003November 2003December State of Indiana: Children with Sexual Abuse Marion County: Children with Sexual Abuse

6 Sexual Abuse  Statistics –60 million survivors of childhood sex abuse –31% if women in state prison were abused –95% of teen prostitutes were abused –Long term effects: fear, anxiety, depression, anger, hostility, inappropriate sex behavior, poor self-esteem, substance abuse, difficulty in relationships

7 Sexual Abuse  Legal Distinctions  A. Child Sexual Abuse  B. Statutory Rape  C. Rape

8 Sexual Abuse  I. Childe Sexual Abuse –States Abuse Laws Vary –Major element: Perpetrator defined as a caretaker  II. Statutory Rape –Laws are much more diverse & complex –Learn the legal terms for each state –Age usually ranges from years (IN-16) –Based on age differences too (ex: 16 yr.old can have sex with 17 yr.old but not 23 yr.old  III. Rape –Definition: Unlawful sexual activity with a person without consent usually by threat or force

9 Sexual Abuse  Indiana’s Law (handout)

10 Sexual Abuse  I. Physical Cues that indicate Sexual Abuse –Signs of difficulty in walking or sitting –Torn, stained, or bloody clothing –Indications of internal injury or bleeding –Complaints of pain or itching in genital area –Venereal disease in children under 13 –Pregnancy during or before adolescence  II. Most cases of sexual abuse leave no sign

11 Sexual Abuse  I. Behavioral Cues of Sexual Abuse –Having poor peer relationships –Appearing withdrawn, engaging in fantasy behavior –Engaging in delinquent acts –Displaying of bizarre, sophisticated, or unusual sexual knowledge or behavior –Verbal disclosure –Self mutilation –Engaging in sexual activities with another child

12 Sexual Abuse  I. Do children lie about being molested? –Not usually

13 Sexual Abuse  I. Why do many children NOT tell when they are abused? –Fear –Unaware of the nature of the abuse –Lack of trust –“At fault” feeling –Protection of perpetrators –Secrecy

14 Sexual Abuse  Behind Closed Doors –Case Study Handout

15 Sexual Abuse  Plan of Action –1. Did proper authorities get notified? –2. What was done to ensure the safety of the child? –3. What outside organizations were contacted for additional help for the child? –4. What support plant was put in place for the child? –5. What could have been to prevent this?

16 Sexual Abuse  What authorities need to be notified? –Child protective services –School Principal or school district designee –Maybe even law enforcement  What else needs to be done to ensure safety –School should NOT investigate –If school is afraid to send kid home, call CPS –CPS or Law should contact parent –CPS or Law initiates investigation –CPS will send feedback report after 30 days

17 Sexual Abuse  What outside organizations should be contacted? –Social Workers –Legal Representatives –Outside Therapists Know local therapists & agencies  What support plans need to be put in place? –Regular meetings with school counselor –Counselor should serve as coordinator

18 Sexual Abuse  Counselors Duty  Legal Issues –Reporting: Should report sexual abuse –Questions: Call CPS & present hypothetical situation  Ethical Issues –Clear & Imminent Danger Statutory Rape Rape

19 Sexual Abuse  Prevention Activities –Conduct in service training for school personnel –Develop a consultation of network counselors –Know CPS workers, therapists, etc. –Develop a system for maintaining accurate professional school counseling records –Establish an abuse prevention program at school

20 Issue # 2--Physical Abuse  Definition of Physical Abuse –Indiana State Definition –Harm Standard –Endangerment

21 Physical Abuse  Statistics –Indiana (2003) 61,492 children reported –51 Fatalities in the last 5 years –Perpetrators-age, race, relationship

22 Physical Abuse  Risk Factors  1. Family Problems –Lower socioeconomic status –Marital issues –Domestic violence  2. Parenting –Single parents –Inexperienced or isolated parents –Heavy child care responsibilities  3. Other Factors –Emotionally disturbed –Alcohol or drug problems

23 Physical Abuse  What to Look for –Unexplained damage to the body –Evidence of an accumulation of injuries over time –Patterned injuries –Damage in unlikely places –Excessive damage to eyes or mouth

24 Physical Abuse  Signs from the child –Changes in behavior –Learning problems –Over complaint, always watchful, withdrawn

25 Physical Abuse  Signs from the adult or caregiver –Discipline –History of abuse –Unconvincing explanations

26 Physical Abuse  Impact of Physical Abuse –Physical –Social –Emotional –Adult impact

27 Physical Abuse  Interventions for Parents –Anger management goals –Educating useful skills –Appropriate social services marital counseling, psychotherapy

28 Physical Abuse  Interventions for Child –Anxiety management techniques –Play therapy –Social skills training

29 Physical Abuse  Prevention –Early Detection and knowledge –Tranferrance –Focus on general population and subgroups Media campaigns Peer helplines Social support In-home service

30 Physical Abuse  Case Study –Kellie –First grader –Three incidences –CPS involvement

31 Issue #3--Teen Pregnancy  Teen Pregnancy remains a major problem  The U.S. still has highest rates among industrialized countries  Fact: 10, 974 teens gave birth in Indiana in 2003  Fact: All high school counselors will have to assist pregnant teens every school year

32 Teen Pregnancy  Statistics –4 in 10 girls become pregnant by age 20 –> 900,000 teen pregnancies annually –40% of pregnant teens are 17 or younger –8 in 10 teen pregnancies are not planned –79% of pregnant teens are not married –Some teens are having sex earlier –Hispanics now have the highest teen birth rate

33 Teen Pregnancy  Why should we care? –4 in 10 teen mothers graduate –Half of teen mothers drop out of school before becoming pregnant –52% of all mothers on welfare had a child as a teen –Teen pregnancy costs taxpayers $7 million/yr –Teen mothers have babies with higher rates of defects

34 Teen Pregnancy  Helpful Information –Few school officials take a stand against teen pregnancy –Arguments over abstinence vs. birth control use up resources –Programs have a high rate of effectiveness –Peer pressure effects teen behavior –Prevention is geared towards girls, not boys

35 Teen Pregnancy  Signs that someone is At-Risk at school –Low grade average –Poor self-esteem –Provocative clothing –Long term relationship

36 Teen Pregnancy  What should we do? –Increase your commitment to prevent teen pregnancy (become an activist) –Maintain good relationships with kids –Provide programs to students –Create a newsletter to parents to increase their awareness –Group therapy sessions on the pressure to have sex as teens

37 Teen Pregnancy  Helpful Website  –Lesson Plans –How to start a Prevention Program –Forum

38 Teen Pregnancy  Take a role in stopping the cycle!  Daughters of teen parents are 22% more likely to have a baby as a teen  13% of sons of teen parents end up in prison  Children of teen mothers do worse in school  Too many teens still believe “it won’t happen to me”

39 Teen Pregnancy  Teachers and counselors are often the first people told by the student  How will you handle the situation?  What can you do to help?  What issues will we face? (abortion, miscarriages, raising the baby) –1/3 of teen pregnancies will end in abortion, 1/3 will miscarry, 1/3 will keep baby

40 Teen Pregnancy  Video clip: “Teen Pregnancy in America”  Brochures 

41 Teen Pregnancy  CASE STUDY –Sharika is a 15 year old sophomore that suspected she was pregnant. After discussing her problem with a teacher she had a test done at a local clinic. It was positive. She explained that she just started having sex with her live-in 18 year old boyfriend. They used condoms a few times. The principal contacted the mother about the pregnancy. Currently, she is 8 months along and plans on raising the baby.

42 Teen Pregnancy  Plan of Action –1. Did proper authorities get notified? –2. What was done to ensure the safety of the child? –3. What outside organizations were contacted for additional help for the child? –4. What support plant was put in place for the child? –5. What could have been to prevent this?

43 Issue #4--Eating Disorders, Stereotypes, & Gangs  Eating is controlled by many factors: –Appetite –Food availability –Family, peer, and cultural practices –Attempts at voluntary control –www.abouteatingdisorders.orgwww.abouteatingdisorders.org

44 Eating Disorders, Stereotypes, & Gangs  Dieting to a dangerously low body weight is highly profiled by: –current fashion trends –sales campaigns for foods –Some professions

45 Eating Disorders, Stereotypes, & Gangs  Facts  Diet industry claims an annual profit of $10 billion a year  Eating disorders involve serious disturbances in eating behavior such as: –Extreme reduction of food intake –Severe overeating –Feelings of concern about body weight & type

46 Eating Disorders, Stereotypes, & Gangs  Eating disorders are real, treatable, medical illnesses in which certain patterns of eating take on a life of their own  Three types: –Anorexia Nervosa--(our focus for the presentation) –Bulimia Nervosa –Binge-eating--not a proven psychiatric disorder

47 Eating Disorders, Stereotypes, & Gangs  Common Behaviors of Anorexia Nervosa –Restricting amount & type of food –Excessive and/or compulsive exercise –Abuse of diuretics/laxatives –Smoking –Hiding food –Vegetarianism/special diet –Elaborate food preparation –Avoidance of eating in public, mirrors –Weighing: self, food –Self mutilation –Substance abuse

48 Eating Disorders, Stereotypes, & Gangs  Anorexia Nervosa: Common Verbalizations –Denial of behavior –Denial behavior is a problem –Need to lose weight –Very knowledgeable about nutrition, diet –Talk about food, menus, recipes –Requests for reassurance re: thinness, size of body parts, etc. –Body as a collection of parts vs.. whole –Self-denigration

49 Eating Disorders, Stereotypes, & Gangs  Anorexia Nervosa: Common Beliefs –Thin=good, lucky, beautiful, intelligent, in control, etc. –Fat=bad, unlucky, ugly, stupid, out of control –Certain foods are “bad” or “dangerous” –Being fat is the worst possible outcome –Others bodies are “fine” but others are untrustworthy when giving feedback –Self as inadequate, unworthy or damaged

50 Eating Disorders, Stereotypes, & Gangs  Anorexia Nervosa: Common Experiences  Depression  Anxiety, panic, and/or obsessions  Able to present good façade  History of substance abuse self/family  Shame  Early history of trauma, abuse  Live in fear of being found out  See their behaviors as helpful

51 Eating Disorders, Stereotypes, & Gangs  Anorexia Nervosa: Common Physical Problems  Malnutrition  Dehydration  Electrolyte imbalances  Dry skin/hair  Halitosis  Fatigue/weakness  Cramps, bloating, diarrhea  Dental erosion  Hypo/hyperglycemia  Blood pressure problems

52 Eating Disorders, Stereotypes, & Gangs  Anorexia is the 3rd most chronic illness in adolescent women  Anorexia is estimate to occur in.5% to 3% of all teenagers  Anorexia usually occurs in adolescence  Over the past 40 years, anorexia has been steady in teenagers but has increased threefold in young women

53 Eating Disorders, Stereotypes, & Gangs  90% of eating disorder cases are in females, but rate for males is increasing  In 2000 teens 13% of girls& 7% of boys had an eating disorder  Men are more apt at concealing eating disorders so the incidence may be underreported  Men with eating disorders often struggle with sexuality

54 Eating Disorders, Stereotypes, & Gangs  Most studies on eating disorders have been using white, middle class females  Studies now report all races are affected  There is evidence that show that African American & Hispanics are at risk due to cultural attitudes

55 Eating Disorders, Stereotypes, & Gangs  Populations at risk:  Women athletes  Male athletes  Men & women in military  Vegetarians  Girls who undergo early puberty

56 Eating Disorders, Stereotypes, & Gangs  What causes eating disorders? –Not one single cause –Concerns about weight or body shape –Cultural/family pressures –Emotional/personality disorders –Genetics & biological factors

57 Eating Disorders, Stereotypes, & Gangs  Avoidant personalities  Dependent personalities  Narcissistic personalities  **All have been linked with Anorexia oc49.html

58 Eating Disorders, Stereotypes, & Gangs  Accompanying emotional disorders –Obsessive compulsive disorder –Phobias –Panic disorder –Post-traumatic stress –Depression –Body dysmorphic disorder –Muscle dysmorphia

59 Eating Disorders, Stereotypes, & Gangs  Other contributing factors: –Negative family influence –Genetic Factors –Cultural pressures

60 Eating Disorders, Stereotypes, & Gangs  Standard Criteria for Confirming Diagnosis –Patient’s refusal to maintain a normal body weight –Intense fear of becoming fat –Distorted self image –Denial of emaciation & starvation –Loss of menstrual cycle for 3 months –Restricting/Severe Dieting –Binge/Purge Behavior (anorexia bulimia)

61 Eating Disorders, Stereotypes, & Gangs  Treatment:  At this time, no treatment program is completely effective and 50% never achieve normal weight  General treatment: –Hospitalization –Nutritional therapy –Drug therapy –Interpersonal therapy –Family therapy –Treating medical problems

62 Eating Disorders, Stereotypes, & Gangs  Video Clip: “Trouble in Mind:Eating disorders”

63 Eating Disorders, Stereotypes, & Gangs  Case Study –Ray

64 Eating Disorders, Stereotypes, & Gangs  Course of Action –Counselor met with Ray. Talked about the issues that his teachers have brought up. He denied the accusations –The counselor made an agreement with Ray. If he didn’t want to eat school lunch, he had to bring his own. He could keep in teacher lounge refrigerator. If Ray didn’t comply, the counselor would involve people out of school –Ray didn’t bring lunch for 2 days. On the 3rd day he ate some pizza during lunch & went to rest room to throw it up. His teachers reported it to counselor

65 Eating Disorders, Stereotypes, & Gangs  The counselor determined he either made himself get sick or he got sick because he hadn’t been eating on regular basis  Counselor called his mom & told her about the behaviors. Ray’s mom said she would take him to the doctor

66 Eating Disorders, Stereotypes, & Gangs  Ray’s mom still hasn’t taken Ray to Dr.  Ray is angry with teachers & counselor for calling his mom & still denies problem  Ray has been eating at school, maybe to keep everyone off his back  Ray meets with counselor every week and his teachers give counselor feedback  If the counselor feels Ray’s health is in danger, the parent will be contacted again and urged to take Ray to the Dr.

67 Eating Disorders, Stereotypes, & Gangs  If the parent does not comply, the counselor will need to report this scenario to the school police and file a CHINS report  Police will then take Ray to Wishard Hospital where he will be evaluated


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