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Home > Crisis Intervention in Child Abuse and Neglect > Crisis Intervention in Child Abuse and Neglect: Understanding Special Family Situations
Crisis Intervention in Child Abuse and Neglect
User Manual Series (1994)
Understanding Special Family SituationsIntroduction Because of specific stressors, assessment of a few special family situations deserves discussion. Crisis workers need to be especially sensitive to how child maltreatment may occur in response to divorce, stepfamily, single-parent family, drug dependent and drug related, spouse abuse, mental illness, dual-diagnosed, and poverty-induced crises. Marital Conflict Custody disputes and unresolved issues from divorce, along with the children's confusion and desire for both parents to be with them, set the stage for children to be used as pawns.79 Consequently, the crisis worker must be diligent in monitoring his or her feelings and in neither identifying with nor rejecting any family member. This is particularly true for one with similar experiences in his or her own past or a current marital conflict. The same holds true for a crisis worker who was in a divorced family as a child. Marital separation is said to be more painful than the death of a spouse. The grieving process, related to the separation and loss, needs to be encouraged by crisis workers. Social involvement with other people is of benefit after separation in order to move outside one's sense of loss and feeling of poor self-worth.80 Occasionally, bitter ex-spouses may be vindictive or, in their wish to find flaws in the ex-mate, may believe that sexual or physical abuse of a child is occurring, when it is not. On the other hand, crisis workers must consider whether abuse has occurred, even when investigative workers have indicated that accusations are unfounded. In the face of rejection and unmet emotional needs, a parent may sexually abuse a child.81 The crisis worker can get the most objective information from children by listening and observing family interactions over extended periods of time. Contrary to the predicament of the investigative worker who is often pushed for time, the CPS crisis worker is in a perfect position to observe attentively for hours. Children's behaviors and their parent's attitudes and behaviors can give critical information for evaluation by the crisis worker. Objective but thorough exploration of abusive allegations can be reassuring to the accuser, the accused, and the child. Step-parenting Conflict In many instances, two families are able to merge quite successfully; other families find the merger more difficult. Some families are prone to have conflicts around who has the right to discipline. Lack of agreement may result in conflict between the adults and, possibly, displacement of anger throughout the family. Youth in these families may learn to be manipulative if adults cannot come to a consistent, reasonable, mutually agreeable disciplinary approach. Crisis workers must assess what may be happening in the family. To establish more positive alliances among family members, crisis workers should listen and observe for long time periods, while maintaining objectivity. For instance, is a child acting out as a response to feeling rejected by his step-parent? Children who feel unwanted are likely to act out. Discipline of the children may require special attention and suggestions by the crisis worker.82 In fact, this is a good way to gain immediate credibility regarding professional knowledge, while providing emotional relief for parent(s) and children who are feeling desperate because of ineffective disciplinary techniques. For instance, a step-parent may feel unable to control a child and, therefore, ready to give up. The crisis worker can say, "What if we work together to find effective ways to discipline, so you can be the parent you want to be?" In addition, children in stepfamilies may blame themselves for the continuing arguments between their birth parents. Both parents may also attempt to use the children as pawns or messengers. Some children may perceive that a parent is more loving and solicitous with step-siblings than with them. If so, every effort must be made to apply the same rules, rewards, and responsibilities with all the children. Another area of conflict arises when each side of the step-family feels its traditions or ways of doing things are best. There may be arguments over what is "right" or "wrong." The family may need to realize that there are many different ways to accomplish desirable ends within a family. Respect for each other's feelings or traditions is more desirable than rigid adherence to one tradition. Role strain in step-parents may also be evident, especially when there is lack of clarity in spousal expectations. Step-parents need to be encouraged not to avoid conflict; but, instead, to seek social support, learn to ventilate but manage their emotions, and realize that many role stresses are time limited.83 Rather than withdrawing from the family, it is better for the adults to ventilate feelings with each other and get their roles clarified. Unprepared for Parenthood Generally, the poorest of the poor are single-parent families. As if poverty were not enough, many single parents are adolescents who have little knowledge of children's needs and have unrealistic expectations of their children.84 They do not understand why babies fret or cry. They need help in providing nutrition, preventive health care, emotional nurturance, and discipline. They need to understand their own human growth and development, as well as that of their child. Mistakenly, many had thought that a child would meet their needs for love and admiration. They felt that a child would be all theirs, something that they could control, something that would help them gain status, never realizing that the child would interfere with dating and socializing. The crisis worker must help correct these mistaken dreams while improving the single mother's self-esteem, encouraging further education, seeking quality and affordable day care and, very likely, mediating arguments between the teen mother and her parents regarding "ownership" and discipline of the child. Realistic goals and expectations for three generations require considerable communication and negotiation. Usually, involvement of the grandparents is desirable, even if only to keep them from undermining the single mother's realistic goals. Another problem the young single mother has is that of choosing boyfriends. This is especially true for the young woman who has an unresolved history of child sex abuse or other familial violence. Many boyfriends, who are not bonded to the single mother's child, misuse the child. The mother needs encouragement to select boyfriends who are drug-free, nonviolent, and have appropriate sexual boundaries. Improved self-esteem and assertiveness are helpful in the mother's attempt to set boundaries. Substance Abuse Alcohol and many other drugs are disinhibitors, making it easier for users to lose control of impulses, thereby engaging in physical, sexual, or emotional abuse. Likewise, persons who have been victimized may use alcohol to help them express anger, sedatives to mask the emotional pain, or any other drugs for self-medication and escape from misery. When alcohol or other drugs are a part of a family's problems, an evaluation is needed regarding the efficacy of outpatient substance abuse treatment. For instance, one study found once-weekly therapy to be ineffective with cocaine addicts.85 Some clients will even need detoxification, but these decisions require crisis workers to have the skills for evaluating addictions. At least one member of a crisis intervention team, or a consultant, should have expertise in the evaluation and treatment of substance abuse. Drug screens are now used extensively in both outpatient and inpatient treatment settings because they keep clients from "fooling" themselves and others. Whenever substances are being used, yet denied, random drug screens should be considered. Alcoholics Anonymous, Alanon, Alateen, Narcotics Anonymous, and other such support groups are critical parts of intervention and treatment. However, social stresses and internal needs require special attention from crisis workers. It is not easy, for instance, for an adult who is depressed and anxiety-ridden to stop self-medicating with substances. Similarly, it is difficult for some workers to understand that the "substance" becomes the central focus in the life of the addict, making the "substance," not the family, the top priority. Crisis workers can expect persons who are in recovery to use substances from time to time.86 Some crisis workers feel rejected and disappointed when this occurs, in turn rejecting the addicted client. Learning that relapse is part of recovery is essential for successful assessment and treatment. Drug dependency should not be the only concern. Dealing drugs is a major business, putting many youth at risk of seeing drug-related violence on "bad deals." Since prostitution to support a drug habit is interwoven into the drug using, drug-dealing scene, children are at risk of seeing inappropriate sexual behavior and of being used as sex objects. To work with these families requires street-wise training for crisis workers and specific guidelines for clinical intervention.87 Crisis workers need to help the youth in these families find recreational, educational, social, and spiritual activities that move them toward a drug-free, productive life. The spiritual activities must be voluntary and agreeable with the parents, as well as the youth. Spouse Abuse As spouse abuse is increasingly being identified in families who abuse and neglect their children, and has great emotional impact on the children, crisis workers need to screen for domestic violence, possibly using an inventory. Crisis workers must be aware of possible indicators of spousal abuse and skillful in determining the level of risk that a batterer may present to family members. This must be done in a way that does not escalate the risk of violence to others and children. Mothers and children are often fearful of disclosing abuse in the presence of the abuser for fear of retaliation.88 Likewise, confronting an abuser with allegations and statements from family members will increase the risk of harm. It is important to recognize that battering is not only about violent assault but also involves a host of actions in which the batterer establishes increasing levels of power and control over the victim. It must be understood that in many, if not most, circumstances battered women do not feel that they can "just leave." Their concerns are supported by some data that indicate that the potential for lethality increases when a woman tries to leave. Understanding the true level of danger is an essential part of intervention. Access to weapons, substance abuse, mental illness, threats of homicide or suicide, and the patterns and the severity of the abuse itself are all key considerations. The needs of children in violent households are a primary consideration, and assessment should examine the effects of violence on them. Children who witness battering may exhibit a variety of symptomatic behaviors from aggression to fearfulness, depending upon the age and sex of the child, the presence of child abuse and neglect, and other family experiences and characteristics. Crisis response considerations must focus on safety first—for both the mother and her children. A successful plan for their safety should be developed jointly with the mother and should consider her concerns, her experiences, and her resources. Treatment should likewise support ongoing safety for mother and children and may involve the use of shelter services, legal intervention and counseling services, as well as batterers treatment programs for perpetrators. Recent innovative work has demonstrated that intervention can achieve safety for mothers and children without placing the children away from their mothers. Additional support services should include safe-visitation arrangements, advocacy, and assistance in ensuring adequate housing, health care, and employment. Mental Illness Crisis workers must be aware that many families have members who have a variety of personality and other mental disorders.89 It is documented that neglectful mothers likely have character disorders and/or depression. Some may even be psychotic.90 In practice, it is better for crisis workers to stay nonjudgmental and unbiased toward these family members because some have been scapegoated or given the role of the "problem" family member.91 Some parents may have adapted to past stress by becoming homeless, mentally ill, self-medicated with substances, or by refusing to take prescribed antipsychotic medications. Whatever the past, the openminded crisis worker assumes nothing and instead observes the family's present interactional patterns and miscommunication. Sometimes, the person who is most in contact with reality is the designated mentally ill member. In other families, the current crisis can only be resolved through psychiatric hospitalization, an adjustment of medications, or new solutions within the family. If a mentally ill parent must be hospitalized, care for the children could, perhaps, be provided by homemakers, relatives, or others within the child's home so that out-of-home care is unnecessary. Recently, the prevalence of childhood sexual victims among sufferers of various psychiatric disorders has become evident. Borderline and dissociative identity disorders are good examples.92 It behooves the crisis worker to study the literature on both of these disorders, as such enlightenment could reduce frustration in working with these clients. Some clients with borderline personality disorder may appear withdrawn and dependent; others may seem irresponsible, remorseless, overly seductive, envious, self-centered, unstable, or resistive. Still others may seem very manipulative, rigid, jealous, blaming, argumentative, perfectionistic, self-defeating, immature, impulsive, sadistic, or suspicious.93 Clear boundaries and expectations are required with such clients who get more demanding when roles are nebulous. It is the intervener's task to try to establish a fresh start with such a client through honesty, openness, positive role modeling, and gentle confrontation. Clients with dissociative identity disorder have two or more distinct personality states which take control of the clients' behavior. There is an inability to recall important information. Crisis workers may feel confused or perplexed by the changing attitudes or personalities of such a client who requires long-term psychotherapy by a highly trained professional. These clients need long-term treatment, but it all starts with a credible crisis worker who is not blaming, accusing, or self-righteous, and who never uses threatening tactics. Some of the most appreciative and responsive clients are those who seem most impossible at the first meeting. Dual Diagnoses Crisis workers must have skills for assessing individuals who have dual diagnoses such as mental illness and alcoholism or other drug addictions.94 They must also be cognizant of other forms of co-morbidity: mental retardation and addiction; mental illness and mental retardation; and sexual addiction and drug addiction. There is debate among professionals about which problem needs to be assessed and treated first. Generally, crisis workers must think about assessing and treating the total person and the total family. Dual assessment and treatment plans for both diagnoses are usually required. There are some clients who, early in crisis intervention, must be detoxified prior to attempting treatment. However, drug usage and other problems, such as child sexual abuse, are so closely connected that assessing and treating one without assessing and treating the other poses a continuing risk to the family. Poverty As the number of children living in poverty increases, more children are at risk of harm from the repetitive trauma of poverty. These children represent at least one-fifth of all children in this country; and, with the decreasing availability of low-cost housing and the increasing cuts in public assistance, more families can be expected to suffer from the chronic stress of poverty until new opportunities for the poor are developed. Many families living in poverty have lost hope and no longer have the energy to overcome any additional sources of stress. Withdrawal or sudden outbursts may seem to be their only coping responses. Concrete services, instillation of realistic hope, and prospects of job training or jobs can provide a boost of energy to such clients. Initially, the crisis worker may need to go with the clients to seek health care, food, and clothing. As progress is made, however, the clients can be encouraged to assume more responsibility for completing tasks alone. They need to hear encouragement and praise from the worker. If they are to maintain their gains, an ongoing case manager may be needed. Summary Professional crisis workers do not pre-judge their clients, but can better understand families' behaviors by studying the stresses created by certain conditions. Marital conflicts can create a multitude of fears and worries in adults and children. Step-parenting requires more negotiation than parenting and works best when the step-parents agree to discipline all the children mutually. To offer the best intervention to abusive or neglectful families, crisis workers need special knowledge regarding teen parenting and single parenthood, chemical dependency, dual diagnoses, spouse abuse, the effects of mental illness, and poverty. Enlightened crisis workers recognize that sexually transmitted diseases, including HIV/AIDS, may further complicate the lives of their CPS families. Nevertheless, by concentrating on a family's strengths, intervention goals can be attained in a few weeks.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. |
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