Home > The Role of Mental Health Professionals in the Prevention and Treatment of Child Abuse and Neglect > The Role of Mental Health Professionals in the Prevention and Treatment of Child Abuse and Neglect: Introduction

The Role of Mental Health Professionals in the Prevention and Treatment of Child Abuse and Neglect
User Manual Series (1993)

Author(s):  U.S. Department of Health and Human Services Peterson, Urquiza

Year Published:  1993

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You are in section: Table of Contents Preface Acknowledgments 1 - Introduction 2 - Working With Abused And… 3 - Responsibilities Of The Mental… 4 - How Child Abuse And Neglect… 5 - Mental Health Treatment… 6 - Treatment Modalities Notes Selected Bibliography Other Resources Glossary of Terms Appendix A - Crime Victim… Appendix B - List Of Other User…

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Introduction

The Mental Health Professional And Child Abuse

Mental health professionals promote healthy human development and functioning through clinical work and/or teaching and research. Their professional expertise includes personality theory; stages of human development; normal and abnormal psychology; personality traits, disorders, and psychopathology; the interactional influence of the family, peers, and the community; the effect of social, historical, and economic periods upon attitudes, values, and behavior; and therapeutic modalities and interventions with children, adults, and families.

It is common for mental health professionals to encounter clients with either a childhood history of abuse or neglect, or a suspicion of or actual evidence of current abuse. Childhood histories of emotional, physical, or sexual abuse or neglect and the subsequent development of maladaptive traits and behavior are at the root of many clients' presenting problems. These faulty or injurious childhood relationships with primary caretakers exist on a continuum of low to high adverse impact. Child maltreatment affects personality development, interpersonal relationships, school and job functioning, and the development of chronic life adjustment problems, personality disorders, psychopathology, and multiple personality disorders. For these reasons, it is essential that mental health professionals:

• know the definitions, dynamics, and effects of all forms of child maltreatment;
  
  
• understand how contextual (environmental) and developmental factors affect the experience; and
  
  
• obtain specialized training to provide effective clinical intervention for children and their families.

Mental Health Disciplines And Child Abuse Intervention

Mental health professionals include several disciplines with varying professional orientations, length of education/training, and clinical supervision requirements for licensure and/or clinical practice. Psychiatrists, psychologists, and clinical social workers have the most extensive specialized training in child abuse and neglect. Other mental health providers, depending on State and local practice, may include psychiatric nurses, counselors, and art therapists.

Psychiatrists, psychologists, and clinical social workers engaged in therapeutic intervention with children and families provide clinical evaluations, psychotherapy, consultation to child protective service (CPS) agencies, and expert testimony in court. The main differences among these professions are the scope of the evaluation performed, the degree of case difficulty requiring specialized training and expertise, the ability to prescribe medications, the training and expertise to administer and interpret psychological testing, and training in experimental and applied research. Mental health professionals employ approaches similar to psychotherapy by drawing upon theories of personality development and theories regarding cognitive, behavioral, and emotional functioning of clients. These intervention models and approaches have a foundation in modern psychoanalytic, psychodynamic, and cognitive theory and incorporate other theories as appropriate (e.g., object relations and attachment theory, role theory, learning theory, family systems theory, and behavioral theory).

Psychiatry

Psychiatrists have a medical degree and a 3- to 4-year residency training program in psychiatry. They are the only mental health professionals legally authorized to prescribe any medications. Both psychiatric residency training and elective postresidency fellowship training focus on working with either adults or children. The cornerstone of child psychiatric training is the body of knowledge about child development.

Psychiatrists provide evaluation and treatment of children, adults, and families. Although it involves a range of referrals, a psychiatric assessment is helpful with parents and children in cases involving:

• a previous psychiatric history;
  
  
• psychotic symptoms such as hallucinations, delusional thinking, or bizarre ideation;
  
  
• suicidal ideation or attempts;
  
  
• severe anxiety and depression;
  
  
• periods of unconsciousness, i.e.,"blackouts";
  
  
• aggressive outbursts;
  
  
• aberrant relationships;
  
  
• developmental delay;
  
  
• behavioral symptoms, such as anorexia nervosa or bulimia; or
  
  
• psychosomatic illness, dramatic, or histrionic symptoms.¹

Psychology

Psychologists either have a doctorate in philosophy, which emphasizes both clinical training in psychology and training in scientific research, or they have a doctorate in clinical psychology, in which the primary emphasis of training is clinical work rather than research. The average length of graduate training is between 5 and 7 years. Psychologists may also complete postdoctoral training programs to acquire more advanced clinical training and/or training in research.

Psychologists provide evaluation and treatment of children, adults, and families. They are the only mental health professionals accredited to perform psychological testing and evaluation. Psychologists employ a battery of tests that evaluate cognitive functioning (how one regards and understands the world), affective functioning (emotions and fantasies), adaptive functioning (how feelings and skills are employed to deal with the challenges and tasks life presents to an individual), and pathological functioning (ways in which the individual's internal conflicts and drives distort or overwhelm the ability to deal effectively with the demands of external reality).

Psychological testing can address these questions about an individual:

• What are the client's intellectual strengths and limitations?
  
  
• Is there evidence of neurological immaturity or impairment?
  
  
• What is the nature of past knowledge and achievements, interests, and aptitudes?
  
  
• How adequate is reality testing?
  
  
• What is the quality of interpersonal relationships?
  
  
• What are the adaptive strengths (application of assets and liabilities to new problems; flexibility of approach, persistence, frustration tolerance, and reaction to novelty)?
  
  
• To what degree are impulses maintained under control (undercontrolled, overcontrolled)?
  
  
• How does the person defend psychologically (protect the self from feelings, ideas, and experiences that create anxiety through avoidance, repression, etc.) against unacceptable internal needs and demands or external experiences? How rigid are the client's defenses?
  
  
• What are the areas of conflict?²

Clinical Social Work

The social work master's degree is versatile and enables social workers to be involved as practitioners and administrators in a range of subspecialties (e.g., CPS, medical social work, corrections, community organizations, and clinical practice). For the purposes of this manual, the focus will be on clinical practice or the provision of assessment and psychotherapy.

In most States, clinical social workers possess a 2-year master's degree and postdegree requirements for clinical supervision. The historical orientation and distinguishing characteristic of social work training is to view the client in the context of intrapersonal, interpersonal, and intersystemic functioning.³

Master's level social workers are often actively involved in multidisciplinary training. They tend to have less involvement in research because the emphasis of the master's degree is on clinical practice. Social workers obtain doctorates in social work to pursue university-level teaching, train in research design and methodology, and develop expertise in research-based public policy setting. There are doctorates in the clinical practice of social work; however, the majority of social workers practice with a master's degree.

Psychiatric Nursing

Psychiatric nurses are involved in clinical practice with a nursing degree, a master's degree, and postdegree requirements for clinical supervision in most States. They may work in outpatient clinics but are more often employed in inpatient units. Nurses obtain master's degrees and/or doctorates in nursing to pursue careers involving teaching, research, or health policy development.

Counseling

Counselors may or may not have a master's degree depending on the requirements of the State in which they practice and the level of complexity of the work they perform. Some social service agencies employ and train counselors with a bachelor's degree to provide crisis intervention, problem solving, client support, service referrals, and advocacy for social services or criminal justice intervention. The master's degree is most often obtained in counseling psychology or a related field. In some States, counselors working with children and families obtain their licensing as marriage, family, or child counselors.

Art Therapy/Expressive Arts Therapy

Art therapists or expressive arts therapists are professionals who have combined interests in psychology and art. They typically practice with a master's degree in art therapy or psychology and art. A variety of art forms such as drawing, painting, sculpting with clay, sandplay, making puppets and art projects, or woodworking are used. Poetry, drama, movement, and music may also be part of this treatment modality. Traditional verbal communication during assessment and treatment may demand a skill or developmental level not always available to the child. Art therapy helps to meet children's needs by:

• facilitating the development of a therapeutic relationship;
  
  
• creating a medium for children to express feelings of fear, pain, anger, anxiety, and conflict in a manner less threatening than verbal expression;
  
  
• building feelings of self-acceptance and self-confidence; and,
  
  
• helping children learn communication and coping skills. ^{4 5}

Child Abuse Intervention as a Subspecialty

Child abuse intervention has emerged as a subspecialty in many disciplines over the past 30 years. Social work, law enforcement, and the judiciary have the longest history of specialization with the establishment of CPS and juvenile officers investigating child abuse and neglect cases and the Juvenile or Family Court to adjudicate the cases.

For mental health professionals, the dramatic increase in cases and in attention to the problem of sexual abuse has led to clinical specialization with child victims and adult survivors of sexual abuse. As a result, a new term to characterize this work has been coined: "abuse-focused therapy." Abuse-focused therapy focuses on the original abuse context as one of the key issues in treatment, relating this trauma to later and current experiences and behavior. This perspective assumes that childhood abuse or neglect is relevant to a variety of child, adolescent, and adult mental health problems and that therapeutic attention to these events will have a significant impact on current psychological functioning.⁶

Effective therapeutic interventions for physically abusive and neglecting parents have also been developed by mental health professionals. Examples include standardizing parenting education curricula for parents ordered by the court to attend classes as a condition of family reunification, expanding didactic parenting education to include adult-child group play sessions facilitated by staff to teach parents how to interact with and discipline children, refining home-based services programs as intervention methods for physically abusive and neglecting parents, supporting the development of self-help groups, and targeting supportive and home-based services for high-risk mothers during the pre- and postnatal periods.

Other evidence of the emergence of child abuse and neglect as a subspecialty is the organization of national and statewide professional associations based on a multidisciplinary membership of mental health, social work, medical, and criminal justice professionals and the judiciary. Professional journals that specifically focus on child abuse and neglect and/or victimization are another important development because they keep the field updated on new research. Since clinical practice with child abuse victims and their families has entered its third decade, there has been a substantial increase in the number of books and journals written by experienced clinicians and researchers on the psychodynamics of abuse and neglect, therapeutic interventions, and treatment modalities. Child abuse intervention as a subspecialty in mental health could be strengthened if basic and advanced training were offered in undergraduate- and graduate-level courses, if courses in child abuse and neglect were required for those applying for licensure and license renewal, and if licensing examination questions on this subject were required for all mental health disciplines.

previous

You are in section: Table of Contents Preface Acknowledgments 1 - Introduction 2 - Working With Abused And… 3 - Responsibilities Of The Mental… 4 - How Child Abuse And Neglect… 5 - Mental Health Treatment… 6 - Treatment Modalities Notes Selected Bibliography Other Resources Glossary of Terms Appendix A - Crime Victim… Appendix B - List Of Other User…

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Updated on October 9, 2009