CSS Exposure To Violence Toolkit

The CSS Toolkit, which is a collection of extended learning opportunities that have been identified in the Bringing the Kids Back into Focus curriculum on CEV. We offer these as short introductions to expand your understanding of companion issues to CEV.

Our goal is to encourage you to learn more about these concerns as a part of strengthening your responses to young children who are exposed to violence.

Extended Learning Opportunities

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Extended Learning Opportunity:

Postpartum Depression and Child Development

Postpartum depression is a mood disorder that begins after childbirth and usually lasts beyond six weeks.

Key Concepts

Several studies of postpartum depression have found it to have a harmful impact on the quality of the early mother-infant relationship. Typically, such relationships have been found to be characterized by either a hostile-intrusive maternal style or a withdrawn one. In this context, infants are typically avoidant and disengaged.

Studies have found an association between postpartum depression and aspects of infant development. Thus, infants of mothers who have had a postpartum depression show cognitive delays, behavioral problems, and a high rate of insecurity of attachment.

These adverse short-term outcomes appear to be mediated by the quality of the early mother-infant relationship.

Postpartum depression is a complex mix of physical, emotional, and behavioral changes that occur after giving birth that are attributed to the chemical, social, and psychological changes associated with having a baby.

About 50%-75% of new mothers experience the "baby blues" after delivery. About 10% of these women will develop a more severe and longer-lasting depression after delivery. One in 1,000 women develop the more serious condition called postpartum psychosis. The levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy but drop sharply after delivery.

By three days postpartum, levels of these hormones drop back to pre-pregnant levels. In addition to these chemical changes, the social and psychological changes associated with having a baby create an increased risk of postpartum depression.

It is believed that this is what causes Postpartum depression, however, much more research is needed to determine the link between the rapid drop in hormones after delivery and depression.

There are several types of Post-partum depression. They include Postpartum blues, Postpartum depression, and Postpartum psychosis.

Postpartum blues

is better known as the "baby blues". This condition affects between 50%-75% of women after delivery. Women who experience the baby blues, will have frequent, prolonged bouts of crying for no apparent reason, sadness and anxiety.

The condition usually begins in the first week (one to four days) after delivery. Although the experience is unpleasant, the condition usually subsides within two weeks without treatment.

Postpartum depression

is a far more serious condition than postpartum blues, affecting about one in 10 new mothers. Women who have had postpartum depression before, risk increases 50 to 80%. Mothers may experience alternating "highs" and "lows," frequent crying, irritability and fatigue, as well as feelings of guilt, anxiety and inability to care for their baby or themselves.

Symptoms range from mild to severe and may appear within days of the delivery or gradually, even up to a year later. Although symptoms can last from several weeks up to a year, treatment with psychotherapy or antidepressants is very effective.

Postpartum psychosis

is an extremely severe form of postpartum depression and requires emergency medical attention. This condition is relatively rare, affecting only one in 1,000 women after delivery. The symptoms generally occur quickly after delivery and are severe, lasting for a few weeks to several months.

Symptoms include severe agitation, confusion, feelings of hopelessness and shame, insomnia, paranoia, delusions or hallucinations, hyperactivity, rapid speech, or mania.

Postpartum psychosis requires immediate medical attention since there is an increased risk of suicide and risk of harm to the baby. Treatment will usually include admission to hospital for the mother, and medicine.

Here are some tips that can help prevent, or help one cope with postpartum depression:

Be realistic about your expectations for yourself and your baby.

Limit visitors when you first go home.

Ask for help -- let others know how they can help you.

Sleep or rest when your baby sleeps!

Exercise; take a walk and get out of the house for a break.

Screen your phone calls.

Follow a sensible diet; avoid alcohol and caffeine.

Keep in touch with your family and friends -- do not isolate yourself.

Foster your relationship with your partner -- make time for each other.

Expect some good days and some bad days.1

With professional help, almost all women who experience postpartum depression are able to overcome their symptoms.

Symptoms

A new mom should seek professional help when:

Symptoms persist beyond two weeks.

She is unable to function normally; she can't cope with everyday situations.

She has thoughts of harming herself or her baby.

She is feeling extremely anxious, scared and panicked most of the day.

Intervention Strategies

How Can I Help?

Make sure that your loved one is evaluated and treated by a trained mental health professional. This is essential to properly diagnose depression and find the right kind of treatment.

The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment for depression. This may involve encouraging the individual to stay with treatment until the symptoms of depression begin to abate (several weeks), or to seek different treatment if no improvement occurs.

Educate yourself, your family, and friends about mental health problems and depression in particular. This will help you understand what you loved one is experiencing.

Someone with depression needs constant support.

This can be draining, especially if it lasts for long periods of time. It is, however, one of the most important parts of successful treatment. People with depression can feel alone and isolated -- giving consistent support and understanding are critical.

Help the person with depression to stick to his or her treatment plan.

This means making sure that medicines are available if prescribed, attending therapy sessions with the person if needed, helping make recommended lifestyle changes, and encouraging the person to follow up with the proper healthcare provider, especially if the treatment needs to be adjusted.

Living with a depressed person can be very difficult and stressful on family members and friends. Here are some suggestions for living with a depressed person that may make things easier for you and more beneficial for the depressed person:

Recognize that depression is often expressed as hostility, rejection, and irritability.

Adopt an interaction style that puts the depressed person in charge. For example, instead of suggesting, "Let's go to the movies tonight," try this: "I'd like to see a movie tonight. Which one of these do you want to see with me?"

Encourage the depressed person to seek professional help. Accompany and support your loved one, but make it clear that it is his or her responsibility to get better.

Remember that treatment is very effective and your loved one will improve with treatment within a few months.

Support opportunities for the depressed person to be rewarded, such as visiting friends or going out for activities. Don't force these, though.

Make sure you notice and praise any significant improvement. Be genuine.

Leave time for yourself and your own needs. Take breaks from the depressed person from time to time. It will help both of you.

Consider family or marital therapy: these forms of therapy may be beneficial in bringing together all those affected by depression and helping them learn effective ways to cope together.

Consider turning to support groups either for the depressed person, or for you as his or her family member.2

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Extended Learning Opportunity:

Children & Domestic Violence

Children who live in homes where domestic violence occurs see, hear, and absorb so much more than adults realize. Children are usually awake during violent episodes when parents think they are sleeping. Children see and experience the aftermath of the violence and need parents most when parents are least available or able to be present for them.

Domestic Violence has a longer and more serious impact on children than adults. And, according to the National Family Violence Survey, they are more likely to become perpetrators/aggressors and continue the cycle of violence.

Children in the age group birth to six years of age are the most at-risk. In very young children, the issues of brain development, pre-verbal status, and vulnerability are challenged. Where domestic violence exists in the life of a child, the size and growth of their brains are impacted. Their pathways to normal development are affected and disrupted, thus creating atypical behaviors.

Children who are pre-verbal; generally younger than age two do not have the developmental ability to express their concerns or fears. Neither do they have the language skills to discuss what is happening around them. Young children are unable to protect themselves and are thus more vulnerable. They generally have no way of escape. Because of these issues, in response to the exposure to domestic violence, can exhibit behaviors that resemble the following:

Infants (ages birth to two)

Scream and cry often

Have trouble sleeping

Are ill and fussy frequently

Do not eat well (failure to thrive)

Pre-school children (ages 2-6)

May have somatic complaints (complaints about headaches or stomach aches)

May need extra attention

Fear being left alone or going to sleep

Withdraw or hide a lot

May stutter

Act out witnessed violence with other children

May abuse or injure animals

Think it is their fault

Characteristics of Children Living in Homes Where Violence Exists

(Note: Some of these are reactions; others are survival techniques or coping mechanisms. Each child has its own way of responding. These are characteristics found in children from violent homes. Some may contradict each other.)

Loneliness

Isolated (tends not to bring friends home)

Use violence and threats to solve problems

Difficulty in developing close relationships

Blames self

Keeps family secrets

Development of a fantasy world that can go too far

Limited physical expression

Confused about their role in the family

Reverse roles; parentification

Questions safety and being protected

Deny or minimize

Developmental delays (repressed feelings, speech and motor, sensory)

Aggressive language and/or behavior

Tantrums

Preoccupation with horror and violence

Powerlessness and helplessness

Have unusual degree of fear

Associate love with violence

Fear of abandonment

Regressive behaviors (bedwetting, baby talk, fear of the dark, suddenly afraid to sleep, over/under eating, nightmares, phobias)

Children need adults who provide an opportunity to talk about feelings and experiences in a safe and non-judgmental environment. Young children often have questions about the violence that has occurred. Adults have the responsibility of caring for children safe and fun ways.

Children require adults who can validate children’s feelings, model fun, utilize books, art, games and problem solving interactions to provide alternative outlets for feelings, particularly fear and anger.

Intervention Strategies

There are guidelines for talking with children that create a safe and trusting relationship.

There are ways you can help a child as you talk with them if they are affected by violence.

Find a comfortable and private place to talk

Remain calm

Be honest with yourself

Read between the lines

Validate feelings

Listen well

Show belief

Dispel fault

Explore fears

Walk through the process

Explore resources

Address a child at eye-level

Use simple, direct, age-appropriate language

Help the child understand the role you play with or in the child’s life

Address confidentiality and its limits

Respect the child’s right not to talk

Talk to the child (but don’t push)

Provide safety and security

Predict possible and potential reactions

Identify support networks

Arrange referral and follow-up

Things you can say:

“It is ok to be angry at someone you love”

“That must have been scary for you”

“It is not ok for someone to hurt you”

“You are a brave boy or girl”

I am sorry this happened to you”

“What would make you feel better?”

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Extended Learning Opportunity:

Shaken Baby Syndrome

Shaken Baby Syndrome (SBS) is a form of child abuse. It is the collection of signs and symptoms resulting from the violent shaking of an infant or small child. Of its victims, 25-30% die as a result of their injuries. The rest have lifelong complications. It is likely that many more babies suffer from the effects of SBS and no one knows, because SBS victims rarely have any external evidence of trauma.

Key Concepts

In the past few years, a newly recognized injury to children has been identified. This injury is Shaken Baby Syndrome or "SBS". This is a serious injury and the results can be devastating.

Shaken Baby Syndrome (SBS) is the medical term used to describe the violent shaking of a baby and the results sustained from shaking. This form of child abuse can result in serious brain injury, seizures, mental retardation, paralysis, blindness, broken bones, and more.

An estimated 1,200 to 1,400 cases Shaken Baby Syndrome (SBS) occur each year in the United States. Only 1 out of 4 babies dies, HOWEVER, the other three will need ongoing medical attention for the rest of their short lifespan. Shaken baby syndrome is a serious form of child maltreatment most often involving children younger than 2 years but may be seen in children up to 5 years old.

Bruce and Zimmerman documented that 80%1 of deaths from head trauma in infants and children younger than 2 years were the result of non-accidental trauma. Contrary to early speculations, shaken baby syndrome is unlikely to be an isolated event.2,3 Evidence of prior child abuse is common.4


Shaken Baby Syndrome Statistics

One shaken baby in four dies.

Some studies estimate that 15% of children's deaths are due to battering or shaking, and an additional 15% are possible cases of shaking.

Of the 37 children that died in Florida in 1995-96, 13 died from a combination of Shaken Baby Syndrome/ Head Trauma.

Of the thousands that survive death, serious injury usually occurs.

"SBS" victims range in age from a few days to a few months old; the average is six months.

More than 60% of the victims of Shaken Baby Syndrome are male.

Almost 80% of the perpetrators of Shaken Baby Syndrome are male.

When a baby is shaken, its head whips back and forth, the brain slams against the inside of the skull, and a part of the brain pulls away tearing brain cells, causing bruising, bleeding, and swelling inside the baby’s brain.

When a child is shaken, the head whips back and forth due to the proportionately larger head than the body. Think of the soft brain tissue inside of the hard surface of the skull, connected by small tissues to the skull.

When a child is shaken in anger, the force is 5 to 10 times more than when a child trips and falls.

Consequences of shaking a baby

There are severe consequences for shaking a baby. Even though a child may survive the injury, other life-long injuries can occur.

Speech and learning disabilities

Spinal injury and paralysis

Poor swallowing

Lethargy

Vomiting

Broken bones and discoloration

Pupils dilated

Brain damage leading to retardation

Partial or total blindness

Difficult to arouse

Convulsions

Shock

Coma

Respiratory problems

Seizures

Rigidity

Death

Hearing loss

Cerebral palsy

Crying is the number one cause for babies being shaken. All babies cry. Some babies cry a lot! Crying is the primary way babies communicate.

Prevention Strategies

Coping with Crying Baby

An infant may spend 2 to 3 hours a day crying

20%-30% of infants exceed that amount of time.

A caregiver momentarily succumbs to the frustration of responding to a crying baby by shaking. Caregivers may be inadequately prepared for children. They may be under stress and cannot deal with the frustrations of parenting.

The caregiver personalizes the infants crying as inadequate care-giving.

"Shaken Baby Syndrome" usually happens when a caregiver is angry and looses control.

Ways To Soothe A Crying Baby

Take the baby for a walk outside in a stroller or for a ride in the car seat.

Hold the baby against your chest and gently massage the baby.

Rock, walk, or dance with the baby.

Be patient; take a deep breath and count to ten.

Call a friend or relative that you can trust to take over for a while, then get away, get some rest, take care of yourself.

Offer a pacifier.

Lower any surrounding noise and lights.

Offer the baby a noisy toy; shake or rattle it.

Hold the baby and breathe slowly and calmly; the baby may feel your calmness and become quiet.

Sing or talk to the baby using soothing tones.

Record a sound, like a vacuum cleaner, or hair dryer.

All babies have basic needs that must be met. To meet the basic needs of a child:

Feed the baby

Burp the Baby

Change the diaper

Make sure clothing isn't too tight

Make sure baby isn't too hot, or too cold.

If all else fails, and if you suspect the baby is ill, has a fever, swollen gums, or something serious, call a physician.

What Can You Do?

Become educated about the recognition, diagnosis, treatment, and outcome of shaken baby and abusive head-impact injuries in infants and children;

Be aware of and exercise their responsibility to report these injuries to appropriate authorities;

Support home visitation programs and any other child abuse prevention efforts that prove efficacious; and

Provide or have appropriate referrals to resources to educate parents about healthy coping strategies when dealing with their child.

How can you help yourself?

Call a friend, relative or neighbor.

Listen to soft music.

Sit or lie down, close your eyes, think of a pleasant place for several minutes

Calm down. Take several deep breaths, count to 100, put yourself in a time-out chair until you are calm.

Stop and think about why you are so angry. Is it the child or is the child simply a convenient target for your anger.

Contact a child care/parenting resource.

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Extended Learning Opportunity:

Animal Abuse and Human Abuse

Animal Abuse is defined as cruelty to animals refers to treatment, which causes unacceptable suffering or harm to animals.

Key Concepts

Violent acts toward animals have long been recognized as indicators of a dangerous psychopathy that does not confine itself to animals. Studies have now convinced sociologists, lawmakers, and the courts that acts of cruelty toward animals deserve our attention. They can be the first sign of a violent pathology that includes human victims.

Animal abuse is not just the result of a minor personality flaw in the abuser, but a symptom of a deep mental disturbance. Research in psychology and criminology shows that people who commit acts of cruelty against animals don’t stop there; many of them move on to their fellow humans.

The FBI has found that a history of cruelty to animals is one of the traits that regularly appear in its computer records of serial rapists and murderers, and the standard diagnostic and treatment manual for psychiatric and emotional disorders lists cruelty to animals as a diagnostic criterion for conduct disorders.

Studies have shown that violent and aggressive criminals are more likely to have abused animals as children than criminals considered non-aggressive.

A survey of psychiatric patients who had repeatedly tortured dogs and cats found that all of them had high levels of aggression toward people as well, including one patient who had murdered a boy.

To researchers, a fascination with cruelty to animals is a red flag in the lives of serial rapists and killers.

Animal Cruelty and Family Violence

Because domestic abuse is directed toward the powerless, animal abuse and child abuse often go hand in hand. Parents who neglect an animal’s need for proper care or abuse animals may also abuse or neglect their own children. Some abusive adults who know better than to abuse a child in public have no such qualms about abusing an animal publicly.

In 88 percent of 57 New Jersey families being treated for child abuse, animals in the home had been abused. Of 23 British families with a history of animal neglect, 83 percent had been identified by experts as having children at risk of abuse or neglect. In one study of battered women, 57 percent of those with pets said their partners had harmed or killed the animals. One in four said that she stayed with the batterer because she feared leaving the pet behind.7

While animal abuse is an important sign of child abuse, the parent isn’t always the one harming the animal. Children who abuse animals may be repeating a lesson learned at home; like their parents, they are reacting to anger or frustration with violence. Their violence is directed at the only individual in the family more vulnerable than themselves: an animal.

One expert says, "Children in violent homes are characterized by ... frequently participating in pecking-order battering," in which they may maim or kill an animal. Indeed, domestic violence is the most common background for childhood cruelty to animals.8

Stopping the Cycle of Abuse

There is "a consensus of belief among psychologists ... that cruelty to animals is one of the best examples of the continuity of psychological disturbances from childhood to adulthood. In short, a case for the prognostic value of childhood animal cruelty has been well documented," according to the Cornell University College of Veterinary Medicine.9

Schools, parents, communities, and courts that shrug off animal abuse as a "minor" crime are ignoring a time bomb. Instead, communities should be aggressively penalizing animal abusers, examining families for other signs of violence, and requiring intensive counseling for perpetrators. Communities must recognize that abuse to ANY living individual is unacceptable and endangers everyone.

Additionally, children should be taught to care for and respect animals in their own right. After extensive study of the links between animal abuse and human abuse, two experts concluded, "The evolution of a more gentle and benign relationship in human society might, thus, be enhanced by our promotion of a more positive and nurturing ethic between children and animals."10

Intervention Strategies

Urge your local school and judicial systems to take cruelty to animals seriously. Laws must send a strong message that violence against any feeling creature — human or other-than-human—is unacceptable.

Be aware of signs of neglect or abuse in children and animals.

Take children seriously if they report animals’ being neglected or mistreated.

Don’t ignore even minor acts of cruelty to animals by children.

Talk to the child and the child’s parents. If necessary, call a social worker.

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Extended Learning Opportunity:

Definitions of Bullying, Domestic Violence, Teen Dating Violence, Gang-related Violence, Homicide, and Suicide

They are not interchangeable and it is not suggested that they are entirely one and the same. Each experience of violence/abuse is unique and distinct. But the point? Exactly! There are points of interconnectedness.

Being aware of and alert to the connections will strengthen us in whatever work we do- whether we are Early care and education professionals, social workers, domestic violence service providers, prevention workers, teen dating violence educators, bullying awareness specialists, gang intervention/prevention specialists, suicide prevention/intervention crisis workers, etc.

Teen Dating Violence –a pattern of behavior in an intimate relationship where one person (adult or adolescent) uses physical, sexual, verbal, psychological and/or financial coercion, in order to gain or maintain power and control over their adolescent partner. (working definition used by the Illinois Teen Dating Violence Symposium, 2001).

Domestic Violence - can be defined generally as "a pattern of assaultive and/or coercive behaviors, including physical, sexual, and emotional abuse, as well as economic coercion, that adults use against their intimate partners to gain power and control in that relationship. (National Clearinghouse on Child Abuse and Neglect Information).

Gang –Related Violence - One common definition of a gang is a group of three or more individuals who engage in criminal activity and identify themselves with a common name or sign.

Suicide- Suicide is the act of deliberately taking one's own life (Webster’s Dictionary).

Homicide - the willful killing or death of a person caused by gross negligence of an individual other than the victim (Chicago Violence Prevention Strategic Plan 1998).

Power - The exercise of a faculty; the employment of strength; the exercise of any kind of control; influence; dominion; sway; command; government. (Webster’s Dictionary).

Abuse - to use wrongly or improperly; to trick or deceive; to injure by maltreatment; to assail with abusive words (Webster’s Dictionary).

From Bullying to Battering was a 2 day seminar sponsored by Safe Place, a domestic violence and sexual assault center in Austin, Texas. Barri Rosenbluth, director of School-based Services at Safe Place believes: “Bullying is at the heart of domestic violence.”

Researchers Stein and Sjostrom ( 1994) suggest that sexual harassment is the older cousin of bullying. If bullying is left unaddressed in the earlier years of life, children will carry those behaviors into the high school setting, and exhibit itself as sexual harassment, where the risks, consequences and penalties tend to be more serious and impactful on young people’s lives.

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Extended Learning Opportunity:

Bullying

Bullying can be defined as repeated physical or psychological intimidation that creates a pattern of harassment and abuse. It can be in two forms: direct and indirect. (International Researcher, Dan Olweus).

Bullying is characterized by three criteria:

  • It is aggressive behavior or intentional harm doing;
  • It is carried out repeatedly and over time; and
  • It occurs within an interpersonal relationship characterized by an imbalance of power (Being A Friend, Having A Friend…Powerful Ways To Prevent Bullying, Chicago Department of Public Health, 2000

Key Concepts

  • Bullying is a form of violence- NOT a childhood passage, normal.
  • Bullying can be direct (hitting, tripping, stealing, threatening etc.) and indirect (rumors, gossip, facial expression, body language, exclusion-don’t play with…don’t invite them to…you’re my friend, not….)
  • Children cannot handle acts of bullying by themselves- they need the assistance of caring adults and a system that has a plan for response
  • “Feeling safe” is a high level need for children –
  • Bullying affects EVERYONE- those who see it, do it and experience it!
  • According to research, Dan Olweus, etc., healthy friendships are a powerful deterrent to bullying- when you are a good friend and you have good friends, you are at less risk for being the victim of serious injury from bullying.
  • Know your local resources to refer individuals who may need professional counseling to assist them in processing their experiences of bullying.
  • There are concrete strategies to prevent bullying and respond to when it does happen

Important Messages For Children

Bullying hurts.

You are not alone.

Find a safe adult to tell.

Everyone is affected by bullying– the person who’s doing it, being hurt by it or watching it

It takes courage to tell someone.

Bullying CAN be stopped.

You deserve to feel safe.

Prevention Strategies

Refuse to allow cruel behavior to be considered normal- Use as your mantra: IT’S NOT OK TO BULLY HERE.

RESPOND to it when you see it – do not turn your back on it expecting children to handle it themselves.

Be a safe personality for children to report bullying – it is NOT tattling or teasing; it is an act of violence; let children know that you know the difference

Know how to recognize warning signs that someone is being bullied

Children who bully also need our intervention and help

Examine your own attitudes about bullying…do you tolerate it, place responsibility on the victim, ignore it, minimize it, model it in the way you express your emotions and solve your problems

Create an anti-bullying policy- get the participation and buy-in of all members

Develop a common language- practice empathy, compassion, assertiveness and self-respect

Agree on the response process (once bullying has been identified)– what then? What does the one being bullied get to do, say? What does the one who is doing the bullying get to do, say? How do the others (bystanders) feel about what happened? What do they want to do, say? How does the group know if the “problem is solved?” Build in follow-up, accountability for consequences, letting go and moving on.

Remain aware of the environment you help to create- your choice of words, tone of voice, inclusion of those around you, speaking up when bullying does occur, being clear that it is NOT OK, encouraging the healthy building of friendships.

Source: Being A Friend, Having A Friend Resource Guide, Chicago Department of Public Health, 2002

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Extended Learning Opportunity:

Teen Dating Violence

Teen Dating Violence is characterized as a pattern of behavior in an intimate relationship where one person (adult or adolescent) uses physical, sexual, verbal, psychological and/or financial coercion, in order to gain or maintain power and control over their adolescent partner. (working definition used by the Illinois Teen Dating Violence Symposium, 2001).

Key Concepts

  • Teens begin dating earlier than we might think. These relationships are serious.
  • Teens struggle with issues of power, control and violence.
  • Risk factors include: exposure to violence; substance use; jealousy; skill deficits; conflict and anger; teen pregnancy.
  • Protective factors include: healthy relationship skills; positive peer relationships; good school performance; participation in organized leisure activities.
  • Teens experience enormous pressure to be in a dating relationship.
  • Teens feel pressure to have sex within a relationship –to avoid getting a “bad reputation”.
  • Families often do not take teen-dating violence seriously.
  • Individuals who come from homes where violence occurs between family members may view violence as a normal part of relationships

Important Messages For Teens

  • You are not alone.
  • If it feels scary, bad or wrong, it’s abuse.
  • Get some help and support for yourself.
  • You have rights when you are in a dating relationship. You ALWAYS have the right to feel safe.
  • ANY violence is unacceptable and a warning sign that this is not a healthy relationship

Prevention Strategies for Adults Working With Teens

When intervening with youth to prevent teen dating violence

Include the whole population

Focus on skills, attitudes and behavior change

Programs should avoid blaming

Include a peer counseling component if possible

Use local statistics instead of national statistics

Use several presentation methods

Incorporate the program into existing structures

Provide multiple sessions in multiple years

Theory-based programs are more effective

Sources: Research of Paul Schewe, PhD., Univ. of Illinois STAR Project; Illinois Center for Violence Prevention Teen Dating Violence Training

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Extended Learning Opportunity:

Sudden Infant Death Syndrome (SIDS)

SIDS is the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. (Willinger et al, 1991).

Key Concepts

In a typical situation parents check on their supposedly sleeping infant to find him or her dead. This is the worse tragedy parents can face, a tragedy that leaves them with a sadness and a feeling of vulnerability that lasts throughout their lives. Since medicine cannot tell them why their baby died, they blame themselves and often other innocent people. Their lives and those around them are changed forever.

SIDS Statistics

Although the rate of SIDS is declining dramatically, about 2,500 infants still die each year from SIDS in the United States.1

Prevention Strategies

Unfortunately, we cannot expect to prevent all SIDS deaths now. To do so requires a much greater understanding of SIDS, which will be achieved only with a commitment from those who value babies and with a considerably expanded research effort. However, there are things that can be done to reduce the risk of SIDS.

  1. Place infants to sleep on their backs, even though infants may sleep more soundly on their stomachs. Infants who sleep on their stomachs and sides have a higher rate of SIDS than infants who sleep on their backs.
  2. Place infants to sleep in a baby bed with a firm mattress. There should be nothing in the bed but the baby - no covering, no pillows, no bumper pads and no toys. Soft mattresses and heavy covering are associated with the risk for SIDS.
  3. Do not over-clothe the infant while he/she sleeps. Keep the room at a temperature that is comfortable for you. Overheating an infant may increase the risk for SIDS.
  4. Avoid exposing the infant to tobacco smoke. Don't have your infant in the same house or car with someone who is smoking. The greater the exposure to tobacco smoke, the greater the risk of SIDS.
  5. Breast-feed babies whenever possible. Breast milk decreases the occurrence of respiratory and gastrointestinal infections. Studies show that breast-fed babies have a lower SIDS rate than formula-fed babies do.
  6. Avoid exposing the infant to people with respiratory infections. Avoid crowds. Carefully clean anything that comes in contact with the baby. Have people wash their hands before holding or playing with your baby. SIDS often occurs in association with relatively minor respiratory (mild cold) and gastrointestinal infections (vomiting and diarrhea).
  7. Consider using home monitoring systems (apnea/bradycardia monitors) in an attempt to prevent sudden death in high-risk infants. The risk of SIDS in the following groups exceeds that of the general population by as much as 5 to 10 times:

Infants born weighing less than 3.5 pounds.

Infants whose sibling died of SIDS.

Infants exposed to cocaine, heroin, or methadone during the pregnancy.

The second or succeeding child born to a teenage mother.

Infants who have had an apparent life-threatening event.

Source: American SIDS Institute

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Extended Learning Opportunity:

Attachment Theory

Attachment is the term used by John Bowlby (1969, 1982) to describe the affective bond that develops between an infant and a primary caregiver. Attachment is a pattern of interaction that develops over time as the infant and caregiver interact, particularly in the context of the infant's needs and bids for attention and comfort.

Key Concepts

Securely attached infants have confidence in the availability of their caregivers as a source of comfort in times of distress. Through their prior experience with a sensitive and responsive caregiver these infants develop a confidence that supportive care is available to them. And, because their own cues and signals have been responded to, they develop confidence in their own ability to solicit the care they need.

A history of insensitive, inconsistent, or unresponsive care results in an anxious attachment relationship. Anxious attachments fall into one of three broad types. A history of inconsistent care leads to a heightened expression of attachment behaviors such as crying and clinging to the caregiver.

These infants are likely to be preoccupied with the whereabouts of the caregiver and fearful of exploring and mastering their environments. This pattern of anxious attachment is known as anxious resistant.1

In contrast, infants classified as anxious avoidant have learned to cut off attachment behaviors in times of distress. Rather than displaying signs of distress such as crying and seeking proximity to the caregiver for comfort, these infants avoid contact and interaction with their caregivers.

In response to a history of interacting with a chronically unresponsive caregiver, the anxious avoidant infant has come to expect that the caregiver is unavailable for comfort and protection in times of distress.2

Finally, some infants develop what is called a disorganized attachment. These children look confused, presenting contradicting behaviors simultaneously, such as reaching out to their caregiver with a grimace on their face or starting to approach then stopping in place and "freezing."

A pattern often associated with abuse, disorganized attachment suggests the child has learned that the person who is supposed to be a place of refuge at times of threat is also the source of threat.3

Source: Edited from the Zero to Three Journal, October/November, 1999

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Extended Learning Opportunity:

Post Traumatic Stress Disorder in Children

Post Traumatic Stress Disorder is the development of certain symptoms following exposure (experienced or witnessed) to an extreme trauma that involves injury, death, threat of such harm, and to which a person responds with intense fear, helplessness, or horror.

Key Concepts

The diagnosis of Posttraumatic Stress Disorder (PTSD) was formally recognized as a psychiatric diagnosis in 1980. At that time, little was known about what PTSD looked like in children and adolescents. Today, we know children and adolescents are susceptible to developing PTSD, and we know that PTSD has different age-specific features.

People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life. Most people who are exposed to a traumatic, stressful event experience some of the symptoms of PTSD in the days and weeks following exposure.

There are a number of traumatic events that have been shown to cause PTSD in children and adolescents. Children and adolescents may be diagnosed with PTSD if they have survived natural and man made disasters such as floods; violent crimes such as kidnapping, rape or murder of a parent, sniper fire, and school shootings; motor vehicle accidents such as automobile and plane crashes; severe burns; exposure to community violence; war; peer suicide; and sexual and physical abuse.

Statistics

Research and documentation of PTSD began seriously after the Vietnam War. The National Vietnam Veterans Readjustment Study estimated in 1988 that the prevalence of PTSD in that group was 15.2% at that time and that 30% had experienced the disorder at some point since returning from Vietnam.1

PTSD is not only a problem for veterans, however. Although there are unique cultural- and gender-based aspects of the disorder, it occurs in men and women, adults and children, Western and non-Western cultural groups, and all socioeconomic strata. A national study of American civilians conducted in 1995 estimated that the lifetime prevalence of PTSD was 5% in men and 10% in women.2

A few studies of the general population have been conducted that examine rates of exposure and PTSD in children and adolescents. Results from these studies indicate that 15 to 43% of girls and 14 to 43% of boys have experienced at least one traumatic event in their lifetime.3

Of those children and adolescents who have experienced a trauma, 3 to 15% of girls and 1 to 6% of boys could be diagnosed with PTSD.4

Symptoms

Very young children may report generalized fears such as:

stranger or separation anxiety

avoidance of situations that may or may not be related to the trauma

sleep disturbances

and a preoccupation with words or symbols that may or may not be related to the trauma.

Children may also display posttraumatic play in which they repeat themes of the trauma. In addition, children may lose an acquired developmental skill (such as toilet training) as a result of experiencing a traumatic event.

Clinical reports suggest that elementary school-aged children may not experience visual flashbacks or amnesia for aspects of the trauma. However, they do experience "time skew" and "omen formation," which are not typically seen in adults.

Time skew refers to a child mis-sequencing trauma related events when recalling the memory.

Omen formation is a belief that there were warning signs that predicted the trauma. As a result, children often believe that if they are alert enough, they will recognize warning signs and avoid future traumas.

Elementary school-aged children reportedly exhibit posttraumatic play or reenactment of the trauma in play, drawings, or verbalizations. An example of posttraumatic play is an increase in shooting games after exposure to a school shooting.

Posttraumatic reenactment, on the other hand, is more flexible and involves behaviorally recreating aspects of the trauma (e.g., carrying a weapon after exposure to violence).5

Prevention/Intervention Strategies

Gather information on PTSD and pay attention to how your child is functioning.

Watch for warning signs such as sleep problems, irritability, avoidance, changes in school performance, and problems with peers.

It may be necessary to seek help for your child. Consider having your child evaluated by a mental-health professional who has experience treating PTSD in children.

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Extended Learning Opportunity:

Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common mental disorders that develop in children. Children with ADHD have impaired functioning in multiple settings, including home, school, and in relationships with peers. If untreated, the disorder can have long-term adverse effects into adolescence and adulthood.

Key Concepts

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that becomes evident in some children in the preschool and early school years. It is hard for these children to control their behavior and/or pay attention. A child with ADHD faces a difficult but not impossible task ahead. In order to achieve his or her full potential, he or she should receive help, guidance, and understanding from parents, guidance counselors, and the public education system.

Statistics

It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States.

This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD.

Symptoms

Symptoms of ADHD will appear over the course of many months, and include:

Impulsiveness: a child who acts quickly without thinking first.

Hyperactivity: a child who can't sit still, walks, runs, or climbs around when others are seated, talks when others are talking.

Inattention: a child who daydreams or seems to be in another world, is sidetracked by what is going on around him or her.

Whatever the specialist's expertise, his or her first task is to gather information that will rule out other possible reasons for the child's behavior. Among possible causes of ADHD-like behavior are the following:

A sudden change in the child's life—the death of a parent or grandparent; parents' divorce; a parent's job loss

Undetected seizures, such as in petit mal or temporal lobe seizures

A middle ear infection that causes intermittent hearing problems

Medical disorders that may affect brain functioning

Underachievement caused by learning disability

Anxiety or depression.

Some Simple Behavioral Interventions

Children with ADHD may need help in organizing. Therefore:

Schedule. Have the same routine every day, from wake-up time to bedtime. The schedule should include homework time and playtime (including outdoor recreation and indoor activities such as computer games). Have the schedule on the refrigerator or a bulletin board in the kitchen. If a schedule change must be made, make it as far in advance as possible.

Organize needed everyday items. Have a place for everything and keep everything in its place. This includes clothing, backpacks, and school supplies.

Use homework and notebook organizers. Stress the importance of writing down assignments and bringing home needed books.

Children with ADHD need consistent rules that they can understand and follow. If rules are followed, give small rewards. Children with ADHD often receive, and expect, criticism. Look for good behavior and praise it.

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Extended Learning Opportunity:

The Effects of Community Violence on Children

Key Concepts

The study of community violence includes examining both predatory violence (usually a stranger trying to take something of value using physical threats or direct violence) and violence arising from nonfamily interpersonal conflicts (this usually concerns acquaintances involved in an altercation).

Both types of violence may include brutal acts such as shootings, rapes, stabbings, and beatings. Historically, the focus of media attention and scholarly research has been on crime-related trauma involving adults.

However, increasingly it is recognized that many children and adolescents are exposed to violence in their own neighborhoods and schools. Furthermore, community violence is now recognized as a public health issue, especially among the young.

Unfortunately, there is no immunization for our children against exposure to community violence. However, researchers have identified factors that may increase a child's risk for exposure to community violence. Living in poor, inner-city areas and being a minority appears to increase the risk for community violence exposure. Many parents blame themselves for not protecting their child adequately. They may become overprotective or use punitive discipline in response to their child's trauma-related acting out behavior.

Prevention/Intervention Strategies

Despite parents' best efforts, children and adolescents may be exposed to community violence. However, they can be helped to cope with the physical and psychological consequences. A caring, supportive adult in the child's life can greatly ease a child's distress.

Spend time with the child and be sure the child understands that you are willing to listen.

Encourage the child to talk about the trauma, but do not force him or her to speak.

Answer questions honestly in developmentally appropriate language.

Be aware that children may develop new problem behaviors in reaction to the trauma.

These reactions will require patience and understanding.

Seek assistance from friends, family, medical professionals, and mental-health professionals for you and your child.

Some progress has been made in developing violence prevention programs. The current focus for these programs is gang prevention and conflict resolution skill-building for high-risk youths.

However, violence prevention programs appear to be more effective if children are engaged early (beginning before age 6) and the program includes intervention in children's home and school social environments.1

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Extended Learning Opportunity:

Grief & Loss with Children

Children who experience a major loss may grieve differently than adults. A parent’s death can be particularly difficult for small children, affecting their sense of security or survival. Often, they are confused about the changes they see taking place around them, particularly if well-meaning adults try to protect them from the truth or from their surviving parent’s display of grief.

Symptoms

Limited understanding and an inability to express feelings put very young children at a special disadvantage. Young children may:

  • revert to earlier behaviors (such as bed-wetting)
  • ask questions about the deceased that seem insensitive
  • invent games about dying or pretend that the loss never happened

Coping with a child’s grief puts added strain on a bereaved parent. However, angry outbursts or criticism only deepen a child’s anxiety and delays recovery. Instead, talk honestly with children, in terms they can understand.

Take extra time to talk with them about death and the person who has died. Help them work through their feelings and remember that they are looking to adults for suitable behavior.

Intervention Strategies

If someone you care about has lost a loved one, you can help them through the grieving process.

Share the sorrow. Allow them — even encourage them — to talk about their feelings of loss and share memories of the deceased.

Don’t offer false comfort. It doesn’t help the grieving person when you say “it was for the best” or “you’ll get over it in time.” Instead, offer a simple expression of sorrow and take time to listen.

Offer practical help. Baby-sitting, cooking and running errands are all ways to help someone who is in the midst of grieving.

Be patient. Remember that it can take a long time to recover from a major loss. Make yourself available to talk.

Encourage professional help when necessary. Don’t hesitate to recommend professional help when you feel someone is experiencing too much pain to cope alone.

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