Dynamics of a failure to provide adequate medical/dental careEDU 365 CHILD ABUSE AND NEGLECT DETECTION FOR EDUCATORS

KATHERYN MCAHON

Child Abuse defined

Nebraska State Statute 28-710 states that:

(b) Child abuse or neglect means knowingly, intentionally, or negligently causing or permitting a minor child to be:

(i) Placed in a situation that endangers his or her life or physical or mental health;

(ii) Cruelly confined or cruelly punished;

(iii) Deprived of necessary food, clothing, shelter, or care;

(iv) Left unattended in a motor vehicle if such minor child is six years of age or younger;

(v) Sexually abused; or

(vi) Sexually exploited by allowing, encouraging, or forcing such person to solicit for or engage in prostitution, debauchery, public indecency, or obscene or pornographic photography, films, or depictions;

Retrieved from http://nebraskalegislature.gov/laws/statutes.php?statute=28-710

Adequate Medical Care

The exact definitions of what constitute adequate medical care are somewhat scattered, but in general lean toward:

Prompt treatment of injury and illnesses requiring medical intervention

Regular preventative checkups and immunizations

Dental care both preventative and when dictated by injury

By The NumbersChild Fatalities

Neglect Only Physical Abusemultiple Mistreatment Types

In 2005, National Child Abuse and Neglect Data Systems logged 899,000 children as suffering abuse and/or neglect. 62.8 percent of those children suffered neglect alone, including medical neglect.

Retrieved from http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-neglect.html

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More than four children die every day as a result of child abuse.

CHILDHELP.ORG

Among industrialized nations, America has one of the worse rates of child death due to maltreatment.

Medical Neglect

Medical neglect

Medical neglect is the failure to provide appropriate health care for a child (although financially able to do so), thus placing the child at risk of being seriously disabled or disfigured or dying. According to NCANDS, in 2005, 2 percent of children (17,637 children) in the United States were victims of medical neglect (USDHHS, 2007). Concern is warranted not only when a parent refuses medical care for a child in an emergency or for an acute illness, but also when a parent ignores medical recommendations for a child with a treatable chronic disease or disability, resulting in frequent hospitalizations or significant deterioration.

Even in non-emergency situations, medical neglect can result in poor overall health and compounded medical problems.

Information taken from: http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-neglect.html

Medical Neglect Cont…

Parents may refuse medical care for their children for different reasons religious beliefs, fear or anxiety about a medical condition or treatment, or financial issues. Child protective services agencies generally will intervene when:

Medical treatment is needed in an acute emergency (e.g., a child needs a blood transfusion to treat shock);

A child with a life-threatening chronic disease is not receiving needed medical treatment (e.g., a child with diabetes is not receiving medication); or

A child has a chronic disease that can cause disability or disfigurement if left untreated (e.g., a child with congenital cataracts needs surgery to prevent blindness).

In these cases, child protection services agencies may seek a court order for medical treatment to save the child’s life or prevent life-threatening injury, disability or disfigurement.

Information taken from: http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-neglect.html

Remember…

Although medical neglect is highly correlated with poverty, there is a distinction between a caregiver’s inability to provide the needed care based on cultural norms or the lack of financial resources and a caregiver’s knowing reluctance or refusal to provide care. Children and their families may be in need of services even though the parent may not be intentionally neglectful. When poverty limits a parent’s resources to adequately provide necessities for the child, services may be offered to help families provide for their children.

Information taken from: http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-neglect.html

Reasons for Inadequate Care

Poverty

Location

Culture

Religion

Ignorance

Poverty

For some families, medical and/or dental care do not fit in the strict budgets they follow.

If parents are employed as part time workers, they may be ineligible for health coverage while simultaneously making too much to qualify for state assistance.

Even families with coverage are sometimes hesitant to use it for financial reasons, citing that the out of pocket portions are still outside of their ability to pay.

Location

Some families may be providing inadequate care due to the locations in which they live. This is especially common in rural areas where services available may be very basic.

Culture

Depending on the cultural mores of the family in question, they may not believe that the care the child is receiving is inadequate. Though Western culture emphasizes prevention over intervention, not all cultures do, choosing instead only to seek treatment when something is actively wrong, leading to questions of neglect.

Religion

Some religions forbid the use of certain therapies or medicines as a part of their religious teachings.

Jehovah’s Witnesses may not receive blood transfusions

Scientologists oppose pharmaceutical psychiatry

Catholics oppose euthanasia (though this is only of concern in WA and OR right now)

Christian scientists resist most medical intervention and instead look to prayer for healing

Information from: http://www.religioustolerance.org/medical2.htm

Religion Cont…

Religiously motivated medical neglect is often the most frequently cited form of neglect in the media, often because the cases involve very young children who were willfully kept from treatment, and sometimes forcibly removed by Child Protective Services.

In some cases, the parents are tried and convicted of child abuse and in some cases, murder. Unfortunately, the laws in regard to this are still vague.

Ignorance

Some parents are guilty of providing inadequate medical or dental care because they are simply unaware of what to do.

Education regarding this is getting better and most hospitals provide lists of when to take babies/children in for checkups or screenings.

Still some are simply unaware of what to do and when.

Effects of Inadequate Care

Children who receive inadequate medical/dental care experience greater difficulty in educational settings which often leads to poorer educational outcomes.

Some areas of concern:

Vison

Hearing

Dental

Lead exposure

Asthma

Information retrieved from: http://www.epi.org/publication/a_look_at_the_health-related_causes_of_low_student_achievement/

Vision

Children with undiagnosed vision issues have more trouble

learning to read

Developing fine motor control

A possible exacerbating factor may be childcare where children are exposed to excessive time in front of television, leading to developmental issues of the eye.

Hearing

Children with undiagnosed hearing issues may be less attentive in class

Current research indicates that this may be a complication of earlier untreated ear infections or it may be a result of their generally less robust health.

Dental

Children suffering from dental issues are more distracted during class and tend to perform worse on tests

Children who receive inadequate dental care are three times more likely to develop cavities and experience dental issues later in life

Lead Exposure

Children living in older homes are exposed to greater levels of lead.

Excessive lead exposure has been tied to poorer cognitive output and may also contribute to hearing loss.

Asthma

Poor medical care may result in the development or worsening of Asthma due to living conditions (including living in cramped environments where mold is a concern, or living with a parent who smokes)

Asthma is the largest cause of chronic school absences

It also has an attendant range of issues including:

Drowsiness and sleeping in class due to poor sleep at home

Irritability and behavior issues

Physical fitness issues due to inability to exercise

Social Effects of Inadequate Care

Children who receive inadequate medical or dental care may be:

Less likely to succeed academically

Feel less confident in pursuing friendships

Be less likely to engage in team sports

Long Term Effects of Inadequate Care

Children who receive inadequate care often grow up to be adults who suffer poorer life outcomes as a result. Some common effects are:

Lack of preventative care leading to greater need for serious intervention later

Poorer self-reported health

Poorer compliance in maintaining drug regimens

Increased hospitalizations

Increased health care costs

Information retrieved from: http://www.medscape.com/viewarticle/432047_9

Education

Researchers have found that the best way to improve outcomes in overall health is to increase patient knowledge regarding preventative care, treatments and outcomes.

This is equally important when dealing with child health

Options for Care

For families constrained by financial issues, resources exist to receive medical care.

Many states have health insurance programs specifically designed to cover children

Immunization clinics serve many communities, and many are no-cost or low cost.

Schools offer vision and dental screenings

Education is available for parents through outreach via hospitals and community centers

If You Feel Neglect/Abuse is Occurring

DO

Listen

Offer support and validation

Monitor your body language

Report the abuse to the correct authority

DO NOT

Investigate

Accuse

Local Resources

DHHS Immunization Clinics

A complete schedule of immunization clinics in the state of Nebraska is available at http://dhhs.ne.gov/publichealth/EPI/Documents/2015_Directory.pdf

A complete list of low cost dental clinics is available at http://dhhs.ne.gov/publichealth/Documents/NE%20Dental%20Clinics%20PHA-PAM-40_7-25-13.pdf

Community Action Network offers assistance obtaining education and financial management which may enable families to access medical care while covering other necessities. For more see http://www.canhelp.org/

More Resources

American Humane Association http://www.americanhumane.org/children/

Nebraska Department of Heath and Human Services http://dhhs.ne.gov/children_family_services/Pages/children_family_services.aspx

National Children’s Alliance http://www.nationalchildrensalliance.org/

Child Help http://www.childhelp.org/pages/child-abuse-education-prevention-resources

Children’s Bureau https://www.childwelfare.gov/preventing/preventionmonth/resource-guide/

Citations

Nebraska Revised Statute 28-710 Retrieved from http://nebraskalegislature.gov/laws/statutes.php?statute=28-710

American Humane Society. (2013) Child Neglect. Retrieved from: http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-neglect.html

Rothstein, R. (2011) A look at the health related causes of low student achievement. Economic Policy Issue. Retrieved from http://www.epi.org/publication/a_look_at_the_health-related_causes_of_low_student_achievement/

Citations Cont…

Andrus, M., Roth, M. (2002) Health literacy: A review. Pharmacotherapy 22(3) 11p. Retrieved from http://www.medscape.com/viewarticle/432047_9

Immunization Schedules retrieved from http://dhhs.ne.gov/publichealth/EPI/Documents/2015_Directory.pdf

Child Dental Health (2014) MEDline plus. Retrieved from http://www.nlm.nih.gov/medlineplus/childdentalhealth.html