Child Maltreatment, Volume 2 Module: Sexual, Emotional & Psychological Abuse
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About this ebook
The 3 modules cover the following areas:
Physical Signs of Abuse uses color photographs and radiographs to help students learn how to distinguish abusive from nonabusive injuries.
Sexual, Emotional, & Psychological Abuse enables course participants to identify sexual abuse, delineates which children are at high risk for abuse and neglect, and addresses various psychological disorders.
Investigation, Care, & Prevention teaches the steps to take when abuse or neglect is discovered, details the agencies and procedures involved, and teaches participants strategies for preventing abuse.
Angelo P. Giardino, MD, Phd
Angelo Giardino, MD is a pediatrics specialist in Salt Lake City, UT and has been practicing for 27 years. He graduated from University Of Pennsylvania School Of Medicine in 1987 and specializes in pediatrics. Angelo Giardino was the medical director of Texas Children's Health Plan, a clinical associate professor of pediatrics at Baylor College of Medicine, and an attending physician for the Texas Children's Hospital's forensic pediatrics service at the Children's Assessment Center in Houston, Texas. Angelo Giardino completed his residency and fellowship training in pediatrics at the Children's Hospital of Philadelphia. Immediately after his fellowship training, Angelo Giardino became the assistant, and then the associate, medical director at Health Partners of Philadelphia, where he had primary responsibility for utilization management, intensive case management, and health care data analysis. He also shared responsibility for the plan's quality improvement program. Additionally, he began the Child Abuse and Neglect Team for Children with Special Health Care Needs, which was funded by a three-year grant from a local philanthropy. In 1998, he was appointed associate chair of clinical operations in the Department of Pediatrics at the Children's Hospital of Philadelphia (CHOP), and in June of 1999 he was asked to chair the CHOP Quality Committee. These accomplishments are only a few of his career.
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Child Maltreatment, Volume 2 Module - Angelo P. Giardino, MD, Phd
EDITORS
ANGELO P. GIARDINO, MD, PHD
Associate Chair, Pediatrics
The Children’s Hospital of Philadelphia
Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine
Adjunct Professor of Nursing, LaSalle University, School of Nursing
Philadelphia, Pennsylvania
JAMES A. MONTELEONE, MD
Professor of Pediatrics and Gynecology
Saint Louis University School of Medicine
Director of the Division of Child Protection
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
p3-2Publisher: Marianne and Glenn E. Whaley
Design Director: Glenn E. Whaley
Developmental Editor: Elaine Steinborn
Production Manager: G.W. Graphics
–Book Design/Page Layout: G.W. Graphics
–Print/Production Coordinator: Charles J. Seibel, III
–Cover Design: G.W. Graphics
–Production: G.W. Graphics
First Edition
Copyright © 2000 by G. W. Medical Publishing, Inc.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
Printed in the United States of America
G. W. Medical Publishing, Inc.
77 Westport Plaza Suite 366, St. Louis, Missouri 63146 U.S.A.
ph (314) 542-4213 fax (314) 542-4239
www.gwmedical.com
ISBN 1-878060-33-3
CONTRIBUTORS
Pasquale J. Accardo, MD
Professor of Pediatrics
New York Medical College
Director of Pediatrics
Westchester Institute for Human Development
Valhalla, New York
Richard C. Barry, MD
Professor of Pediatrics
Saint Louis University School of Medicine
Director of Emergency Care Services
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
Karen M. Bly, RN, BSN, MA, MEd
Nurse/Counselor
Child Protection Unit
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
John R. Brewer, MD
Associate Clinical Professor of Pediatrics
Saint Louis University School of Medicine
Medical Director of Grace Hill Neighborhood Health Clinics
St. Louis, Missouri
Mary E. S. Case, MD
Associate Professor of Pathology
Saint Louis University Health Sciences Center
Chief Medical Examiner
St. Louis, St. Charles, Jefferson and
Franklin Counties, Missouri
Kevin Coulter, MD
Associate Clinical Professor
Department of Pediatrics
University of California, San Francisco
Medical Director
Center for Child Protection
San Francisco General Hospital
San Francisco, California
Oscar A. Cruz, MD
Associate Professor of Ophthalmology
Saint Louis University School of Medicine
Director of Pediatric Ophthalmology
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
Bradley V. Davitt, MD
Assistant Professor of Ophthalmology
Cardinal Glennon Children’s Hospital
Saint Louis University School of Medicine
St. Louis, Missouri
Cassandra K. Dolgin, BA, JD
Member of the Missouri Bar
Assistant Attorney General
Office of the Missouri Attorney General
Jefferson City, Missouri
Richard P. Easter*
Chief Investigator
State Technical Assistance Team (STAT)
State of Missouri
Timothy J. Fete, MD
Associate Professor of Pediatrics
St. Louis University School of Medicine
Director of the Division of General Academic Pediatrics
Cardinal Glennon Hospital
St. Louis, Missouri
Allan D. Friedman, MD, MPH
Associate Professor, Department of Pediatrics
Case-Western Reserve University
Director, Department of Pediatrics
St. Joseph Mercy Hospital–Oakland
Pontiac, Michigan
Senior Medical Staff
Henry Ford Health System
Detroit, Michigan
Angelo P. Giardino, MD, PhD
Associate Chair, Pediatrics
The Children’s Hospital of Philadelphia
Assistant Professor of Pediatrics
University of Pennsylvania School of Medicine
Adjunct Professor of Nursing
LaSalle University, School of Nursing
Philadelphia, Pennsylvania
Sheilah Glaze, MSW, LCSW
Medical Social Worker
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
Jesse A. Goldner, MA, JD
Professor of Law
Director of the Center for Health Law Studies
Saint Louis University School of Law
Professor of Pediatrics
Professor of Law in Psychiatry
Saint Louis University School of Medicine
St. Louis, Missouri
Michael Graham, MD
Professor of Pathology
Co-director, Division of Forensic & Environmental Pathology
Saint Louis University School of Medicine
Chief Medical Examiner
City of St. Louis, Missouri
Deputy Medical Examiner
St. Louis and Jefferson Counties, Missouri
E. Richard Graviss, MD
Professor of Pediatrics and Radiology
Saint Louis University School of Medicine
Director, Diagnostic Imaging
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
Stuart L. Kaplan, MD
Professor of Psychiatry
Saint Louis University School of Medicine
Director, Division of Child and Adolescent Psychiatry
Chief, Child Psychiatry
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
Donna M. (Prenger) Kolilis, BS, Business Administration
Director of Administration
Missouri Public Service Commission
Past Administrator
State Technical Assistance Team (STAT) and
Child Fatality Review Program
Missouri Department of Social Services
Gus H. Kolilis, BS, Education
Chief, Missouri Capital Police
Missouri Police Chiefs Association
International Police Chiefs Association
Past Director
State Technical Assistance Team (STAT) and
Child Fatality Review Program
Missouri Department of Social Services
Gregory D. Launius, MD
Instructor, Department of Radiology
Saint Louis University School of Medicine
St. Louis, Missouri
Atchawee Luisiri, MD
Associate Professor of Radiology
Saint Louis University School of Medicine
St. Louis, Missouri
Sandra H. Manske, RN, MA, JD
Member of the Missouri Bar
St. Louis, Missouri
James A. Monteleone, MD
Professor of Pediatrics and Gynecology
Saint Louis University School of Medicine
Director of the Division of Child Protection
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
Lynn Douglas Mouden, DDS, MPH, FICD, FACD
Associate Chief, Bureau of Dental Health
Missouri Department of Health
Jefferson City, Missouri
Wayne I. Munkel, MSW, LCSW
Supervisor of Social Services
Cardinal Glennon Children’s Hospital
Lecturer, School of Social Work
University of Missouri–St. Louis
St. Louis, Missouri
Peggy S. Pearl, EdD
Professor, Department of Consumer and Family Studies
Southwest Missouri State University
Springfield, Missouri
Colette M. Rickert, LPCC, ATR-BC
American Art Therapy Association
American Counseling Association
Anthony J. Scalzo, MD, FAAP, ACMT
Professor of Pediatrics
Division of Emergency Medicine
Medical Toxicologist and Director, Division of Toxicology
Saint Louis University School of Medicine
Medical Director, Missouri Regional Poison Center at
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
Michael J. Silberstein, MD
Professor of Radiology and Pediatrics
Saint Louis University School of Medicine
St. Louis, Missouri
Patricia M. Sullivan, PhD
Professor, Department of Otolaryngology and
Human Communication
Creighton University School of Medicine
Director, Center for Abused Children with Disabilities
Boys Town National Research Hospital
Omaha, Nebraska
Thomas R. Weber, MD
Professor of Surgery
Saint Louis University School of Medicine
Director of Pediatric Surgery
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
Thomas F. Weeston, MD
Resident of Child Psychiatry
Saint Louis University School of Medicine
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
Barbara Y. Whitman, PhD
Associate Professor of Pediatrics
Saint Louis University School of Medicine
Director, Family Services and Family Studies
Knights of Columbus Developmental Center
Cardinal Glennon Children’s Hospital
St. Louis, Missouri
ADDITIONAL ILLUSTRATIONS BY
Evaline Alessandrini, MD
Attending Physician, Emergency Medicine
The Children’s Hospital of Philadelphia
Assistant Professor of Pediatrics
University of Pennsylvania, School of Medicine
Philadelphia, Pennsylvania
Louis M. Bell, MD
Division Chief, General Pediatrics
Medical Director, Infection Control
The Children’s Hospital of Philadelphia
Assistant Professor of Pediatrics
University of Pennsylvania, School of Medicine
Philadelphia, Pennsylvania
John M. Flynn, MD
Pediatric Orthopedic Surgeon
The Children’s Hospital of Philadelphia
Assistant Professor of Orthopedics
University of Pennsylvania, School of Medicine
Philadelphia, Pennsylvania
Marc H. Gorelick, MD
Research Director in Emergency Medicine
A.I. duPont Hospital for Children
Wilmington, Delaware
Mark L. Helpin, DMD
Director, Dentistry
The Children’s Hospital of Philadelphia
Chair and Associate Professor of Pediatric Dentistry
University of Pennsylvania, School of Medicine
Philadelphia, Pennsylvania
Mark Joffe, MD
Director, Section of Community Pediatric Emergency Medicine
The Children’s Hospital of Philadelphia
Associate Professor of Pediatrics
University of Pennsylvania, School of Medicine
Philadelphia, Pennsylvania
Susan N. Kamerling, MSN, RN, CCRN
Clinical Nurse Specialist, Trauma Program
The Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
Jane Lavelle, MD
Associate Director, Emergency Medicine
The Children’s Hospital of Philadelphia
Associate Professor of Pediatrics
University of Pennsylvania, School of Medicine
Philadelphia, Pennsylvania
Monica Artiles Liebman, MSN, RN
Clinical Nurse Specialist, Trauma Program
The Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
John M. Loiselle, MD
Assistant Director of Emergency Medicine
A. I. duPont Hospital for Children
Wilmington, Delaware
Frances M. Nadel, MD
Attending Physician, Emergency Medicine
The Children’s Hospital of Philadelphia
Assistant Professor
University of Pennsylvania, School of Medicine
Philadelphia, Pennsylvania
Richard Scarfone, MD
Attending Physician, Emergency Medicine
The Children’s Hospital of Philadelphia
Assistant Professor of Pediatrics
University of Pennsylvania, School of Medicine
Philadelphia, Pennsylvania
Kathy N. Shaw, MD
Chief, Division of Emergency Medicine
Emergency Department
Associate Professor
University of Pennsylvania, School of Medicine
Philadelphia, Pennsylvania
Perry W. Stafford, MD
Director, Pediatric Trauma and Surgical Critical Care
Pediatric General and Thoracic Surgery
The Children’s Hospital of Philadelphia
Associate Professor of Pediatric Surgery
University of Pennsylvania, School of Medicine
Philadelphia, Pennsylvania
*Deceased
pviii-1FOREWORD
I am pleased to introduce these Modules and Workbooks, which were written to accompany the second edition of Child Maltreatment: A Clinical Guide and Reference edited by James A. Monteleone, MD. This presentation is designed to prepare professionals dealing with child abuse situations to cope with their daily challenges confidently and competently, with an enhanced awareness of how what they do fits into the overall scheme of care.
This set of Modules and Workbooks reflects both the authors’ and the publisher’s commitment to educating everyone involved about the problem of child maltreatment. Through this education, it is hoped that a generation of physicians, nurses, teachers, social workers, law enforcement personnel, and other child care workers will be able to improve the standards of care and make their services more widely available in preventive efforts.
One of the strengths of this presentation is the hands-on
aspect, in which participants are challenged to go beyond an intellectual assent to what the book says
and apply their knowledge in practical situations. To give the instructor a broad base of knowledge in presenting these practical exercises, each chapter has been reviewed by those with real experience in dealing with these issues. These individuals come from medicine, nursing, social work, law enforcement, the judicial system, and psychology. This spectrum exemplifies the teamwork approach advocated in Child Maltreatment: A Clinical Guide and Reference. It is hoped that an understanding of the various roles of professionals dealing with child abuse will lead to improved communication about, and handling of, these important cases.
On behalf of the editors and authors, I wish you success in conveying these important truths to those in your classes, whether this takes place in an in-service setting or as part of the formal education leading to a degree program. It is our hope that the practical application of this information will have a positive impact on child abuse training programs as well as on the practice of child abuse management and prevention.
Howard Dubowitz, MD, MS
Professor of Pediatrics
University of Maryland
School of Medicine
Baltimore, Maryland
PREFACE
The reception of Child Maltreatment: A Clinical Guide and Reference and Child Maltreatment: A Comprehensive Photographic Reference Identifying Potential Child Abuse has been gratifying for those of us dealing with child abuse issues. The principles and information offered in this two-volume set have proved vital to many practitioners. To ease the process of conveying the message of these volumes to medical students, nurses, therapists, social services personnel, mental health personnel, law enforcement personnel, and other concerned professionals, we have developed the Instructor’s Manuals and accompanying Student Guides for three modular presentations. It is hoped that the exercises and lesson plans offered here will help instructors of degree as well as in-service programs develop meaningful and pertinent instructional interactions on child abuse topics.
The Instructor’s Manual for each module is designed to clearly identify the goals for each chapter’s presentation and walk the instructor through the process of presenting material and helping participants apply the information learned. To achieve this, we have a brief summary of the content for each topic, followed by exercises that involve the participants, whether it be in a discussion, a role-playing situation, a slide presentation with questions and answers, or an actual clinical experience. Throughout, we have incorporated the principles of effective adult education. Each exercise should be appropriate for a 1-hour class period. With an average of five exercises in each of the 23 chapters, this three-module set represents approximately 100 hours of instructional time.
Each chapter has been formatted to stand on its own, although the option of reviewing previous lessons is included in the lesson outline. This recognizes that some programs may focus on specific areas, such as law enforcement or medical involvement, with less emphasis on other areas. However, using the entire three-module presentation will give participants a global view of the process of dealing with child maltreatment, from prevention to detection and intervention. We recommend using the entire presentation to achieve the most effective participant training.
I want to thank the many contributors who allowed their materials and slides to be used in this project. Their support was essential in developing this manual. I also want to recognize the motivation supplied by the publisher, G. W. Medical Publishing, Inc., who saw the potential to help instructors prepare quality lessons and put the raw materials together in this user-friendly format. Finally, I want to dedicate this publication to the ongoing efforts of the many instructors who strive to prepare their students and in-service trainees for the realities of child maltreatment that face healthcare, law enforcement, and social services professionals every day. My hope is that our society will learn to value its youngest and most vulnerable citizens as our future, and that child maltreatment will be viewed as the destructive force it truly is.
Angelo P. Giardino, MD, PhD
November 5, 1999
VOLUME TWO MODULE TABLE OF CONTENTS
INTRODUCTION
Objectives
Checklist for Instructors/Trainers
Participant Registration
Instructor Evaluation Form
Participant Evaluation Form
Evaluation Form Program for Instructors/Trainers
INSTRUCTOR’S MANUAL
CHAPTER 9: SEXUAL ABUSE
Objectives
Lesson Outline
The Lesson
Review and Introduction
Defining Sexual Abuse
Perpetrators of Sexual Abuse and Their Victims
Patterns of Abuse—Longitudinal Progression
The History and Medical Examination
Worksheet 9-1
Conducting a Physical Examination
The Interview
Worksheet 9-2A
Worksheet 9-2B
Appendix
Excerpt from pages 135-137 of Clinical Guide, 2nd Edition
Excerpt from page 132 of Clinical Guide, 2nd Edition
Excerpts from pages 140-142 of Clinical Guide, 2nd Edition
Excerpts from pages 153-162 of Clinical Guide, 2nd Edition
Excerpts from pages 170-174 of Clinical Guide, 2nd Edition
Excerpts from pages 188-190 of Clinical Guide, 2nd Edition
Excerpts from pages 192-204 of Clinical Guide, 2nd Edition
CHAPTER 10: SEXUALLY TRANSMITTED DISEASES
Objectives
Lesson Outline
The Lesson
Review and Introduction
Evaluation of Children Believed to be Sexually Abused
Worksheet 10-1
Answer Key for Worksheet 10-1
Specific Sexually Transmitted Diseases
Laboratory Tests to Detect Sexually Transmitted Diseases
Worksheet 10-2
Treatment of Sexually Transmitted Diseases
Worksheet 10-3
Answer Key for Worksheet 10-3
Appendix
Excerpt from pages 302-303 of Clinical Guide, 2nd Edition
Excerpt from page 303 of Clinical Guide, 2nd Edition
CHAPTER 11: DEVELOPMENTAL ASPECTS OF THE YOUNG CHILD IN MALTREATMENT CASES
Objectives
Lesson Outline
The Lesson
Review and Introduction
Biological, Cognitive, and Language Development
Worksheet 11-1
Answer Key for Worksheet 11-1
Worksheet 11-2
Answer Key Worksheet 11-2
Children and Lying
Worksheet 11-3
Suggestibility and Memory
Vulnerability of Children with Disabilities
CHAPTER 12: MULTIPLE PERSONALITY DISORDER
Objectives
Lesson Outline
The Lesson
Review and Introduction
Defining and Diagnosing Multiple Personality Disorder (MPD)
Dissociation in MPD
CHAPTER 13: PSYCHOPATHOLOGY AND THE ROLE OF THE PSYCHIATRIST
Objectives
Lesson Outline
The Lesson
Review and Introduction
Diagnostic Criteria for Post-Traumatic Stress Disorder
Worksheet 13-1
Answer Key for Worksheet 13-1
Relationship between Maltreatment and Specific Psychopathological Disorders
Neurochemical and Neurohormonal Responses to Stress
Worksheet 13-2A
Worksheet 13-2B
Appendix
Excerpt from pages 294-295 of Clinical Guide, 2nd Edition
Excerpt from pages 294-295 of Clinical Guide, 2nd Edition
CHAPTER 14: MUNCHAUSEN SYNDROME BY PROXY
Objectives
Lesson Outline
The Lesson
Review and Introduction
Clinical Presentation
Worksheet 14-1
Answer Key for Worksheet 14-1
Etiology
Demographic Information and Categories of MSBP
Guidelines When MSBP Is Suspected
Worksheet 14-2
Answer Key for Worksheet 14-2
Worksheet 14-3
Answer Key for Worksheet 14-3
Appendix
Excerpt from pages 330 of Clinical Guide, 2nd Edition
Excerpt from pages 334-335 of Clinical Guide, 2nd Edition
CHAPTER 15: NEGLECT AND ABANDONMENT
Objectives
Lesson Outline
The Lesson
Review and Introduction
Types of Neglect
Worksheet 15-1
Attachment Disorders
Worksheet 15-2
Answer Key for Worksheet 15-2
Failure to Thrive and Fetal Neglect
Drugs and Alcohol
Effects and Outcomes of Child Neglect
Appendix
Excerpt from pages 351-352 of Clinical Guide, 2nd Edition
Excerpt from page 349 of Clinical Guide, 2nd Edition
CHAPTER 16: PSYCHOLOGICAL ABUSE
Objectives
Lesson Outline
The Lesson
Review and Introduction
Forms of Psychological Abuse
Understanding the Causes of Psychological Abuse
Identifying Psychological Abuse
Worksheet 16-1
Answers for Worksheet 16-1
Consequence of Psychological Abuse
Appendix
Excerpt from pages 372-382 of Clinical Guide, 2nd Edition
Excerpt from page 385 of Clinical Guide, 2nd Edition
Excerpt from pages 389-391 of Clinical Guide, 2nd Edition
REFERENCES
ORDERING
Reordering Forms for Workbooks
Related G.W. Medical Publications
SLIDES/OVERHEADS
Slide Legends
Acetate Overheads
INTRODUCTION
Child Maltreatment: Instructional Modules training package is designed to provide the educator/instructor with the materials needed to impart the content of the text, Child Maltreatment: A Clinical Guide and Reference to participants in the learning process. However, we have attempted to structure the Instructor’s Manual sections to enable instructors to present the necessary content without the need to refer to the text, so that its use, while recommended, is