5 exposure to violence

5 exposure to violence - 1 Graduate Training Course on...

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Unformatted text preview: 1 Graduate Training Course on Social Work II: Social Work for Children and Youth with Special Needs Class 5. 31.07.09: Children and exposure to violence in the home; school violence, community upheaval I. Witnessing violence and being victimized by violence A. Both can have serious psychological effects B. Research on exposure to violence--not being immediately victimized but either seeing it happen, or hearing about it--shows that children can have extreme psychological and behavioral reactions C. II. These reactions might be different depending on the age of the child "Post-traumatic stress disorder" (PTSD) A. Definition 1. The official definition in ICD-9 1 : Code 309.81 -- acute, chronic, or delayed reactions to traumatic events such as military combat, assault, or natural disaster. 2. In the U.S., an alternate diagnostic system is used called the DSM-IV. 2 To summarize the DSM-IV description: a) The person has been exposed to a traumatic event... b) The traumatic event is persistently re-experienced (such as recurrent and intrusive thoughts, recollections, or dreams about the event; or re-experiencing the initial shock or fear) c) Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness d) Persistent symptoms of "increased arousal", meaning difficulty sleeping, exaggerated response to normal situations, difficulty concentrating 1 International Classification of Diseases, Ninth Revision, (ICD-9) is based on the World Health Organization's International Classification of Diseases (ICD-9). ICD-9-CM is the official system of assigning codes to diagnoses. 2 Diagnostic and Statistical Manual of Mental Disorders, version IV (DSM-IV) is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders. It is used in the United States and in varying degrees around the world by mental health clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers. __________________________________________________ ***Questions for class discussion or thinking between classes. 2 e) Duration of symptoms is more than one month (though there can be a delay after the event when the symptoms begin) f) Causes significant impairments in functioning (social, workrelated, school, etc.) 3. PTSD can occur in people of all ages from pre-school to adulthood a) PTSD was initially applied to adults (soldiers affected by warfare) b) Not everyone who experiences a traumatic event suffers from PTSD c) Diagnosing children and adolescents with PTSD was due to increased awareness of the traumatic effects of child abuse, and the symptoms of anxiety, depression, and behavioral problems in child victims that could not be explained by other factors ***The PTSD disorder was based on the experience of westerners initially, though research shows that it occurs across many cultures and nationalities. In what ways do you think Vietnamese children would show signs of PTSD? III. Group Exercise A. Objective: to develop social work interventions for different scenarios involving a child's exposure to violence. B. Directions: 1. Class will split into eight work groups. Each work group will be assigned one of four scenarios below. 2. Each group should assign: a) a group discussion leader who will start and stop the group, and keep track of time, b) a notetaker using posterboard, c) a person who will report back to the class. 3. The class will convene after the work group time for general discussion. Scenarios 1. (Groups 1 and 2) In a small northern town during a sudden rain storm, the river quickly flooded the town. Several people lost their homes, many were injured, and there were a few fatalities, among them a young child. You are assigned as a social worker to assist, and you will also have other social workers and assistants to help. Develop a plan of action. What are the main things that the social workers and assistants should do? 2. (Groups 3 and 4) You work as a social worker assigned to an intermediate school. There has been an increase in bullying of younger students by a few older students. You know of at least five children who may have experienced bullying, and parents are asking school officials to take action. A school official asks for __________________________________________________ ***Questions for class discussion or thinking between classes. C. 3 your help. What should do? 3. (Groups 5 and 6) A mother asks you to talk to her 10 year old daughter who does not seem to listen to teachers and also has fights with other children. You ask the child about life at home, and how people at home get along. She tells you that her father and mother fight almost every day, and often her father hits her mother. When they fight, she goes outside and sings. How should you proceed to help the girl and family? 4. (Groups 7 and 8) A 15 year old boy is brought to the health clinic by his mother. The boy appears depressed to his family, does not want to leave the house, and has stopped playing soccer. The doctor suspects some emotional problems, and asks you to help. When you meet with the boy alone, he tells you that he has been involved in gang activities with other older boys. He has witnessed criminal activities (such as robberies), has been involved in fights, and he was threatened by the boys that if he stopped his participation he would be punished. In what ways should you intervene? IV. Conducting a crisis assessment Adapted from: Webb, N. B. (2003). Social work practice with children (2nd ed.). New York: Guilford. A. Factors related to the individual 1. Adjustment before the crisis (home, school, peers, health status) 2. Developmental history (age-related milestones, problems) 3. Past experience with crisis or violence 4. Individual perception about current crisis or violent events 5. Individual interests, strengths (what helped them cope in the past) Factors related to the crisis situation 1. Nature of event (single vs. recurring, how many others it affected, extent of violence, witnessed vs. victim) 2. Issues about loss (loss of loved ones, friends, familiar setting) 3. Physical injury, pain 4. Extent that threat of injury or violence is still present Factors related to the support system 1. Availability of support (birth family, extended family, friends) 2. Availability of services in neighborhood and community 3. Extent of stigma associated with event and victim B. C. V. Developmentally appropriate interventions General categories A. Individual focus 1. Play therapy (may include drawing, toys, or imagining stories) with younger children __________________________________________________ ***Questions for class discussion or thinking between classes. 4 2. 3. B. Individual therapy with older children and adolescents Individual therapy with adults as needed Group and family focus 1. Peer group work especially with adolescents and adult victims 2. Family therapy may include a combination of meetings with parents only and parents with children, and may also include extended family and friends as appropriate 3. Participation in other outside interest groups (such as dance, sports, etc.) Community focus 1. Post-crisis debriefing meeting with those involved in the crisis event, as a community. This re-establishes and reinforces available support systems. 2. Problem solving groups engaging those affected by the crisis in community recovery efforts will help re-establish individuals' coping abilities C. __________________________________________________ ***Questions for class discussion or thinking between classes. ...
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