Child Abuse Case Study
This week’s case study introduced Morgan, a 19-year-old male that went to see a provider due to change in mood, low energy and lack of motivation. Upon further assessment, Morgan shared that he was molested as a child by a cousin who went to jail but recently has gotten out.
This post will discuss strategies that can be utilized to assess the patient for abuse. It will also discuss how exposure to the media and/or social media may affect the patient, and finally, it will discuss mandatory reporting.
Strategies to Assess for Abuse
Trauma-informed care is the care that revolves around an understanding of one’s experiences and providing care that promotes healing and not traumatization. Trauma-informed care promotes collaboration between patient and provider with the patient being in control and his/her safety as a priority (Nathan & Ferrara, 2020).
In order to assess a patient for abuse, one must builds a therapeutic rapport. Such a rapport encourages the patient to trust and share sensitive information with the provider. Once there is a therapeutic rapport, trauma-informed care must be utilized to bring onto the abuse and how to cope with it.
There are a variety of screening and non-screening tools to use to assess for abuse/trauma. One of the tools that is the childhood trauma questionnaire-short form can help with detecting childhood physical and sexual abuse (Thombs et al., 2007).
For Morgan, the use of screening tools might be challenging as he has dissociated from the trauma. A helpful way to allow him to talk about the event without re-traumatizing him is to use cognitive behavioral methods to promote the expression of the event in a safe/controlled environment.
Exposure to Media and/or Social Media
The exposure to the medial and/or social media most likely can re-traumatized the patient. The fact that Morgan’s cousin has molested other children, the likelihood of the case been broadcasted is high. Morgan might be feeling guilt and remorse related to not coming forward whenever the abuse started. Furthermore, Maercker and Mehr in their research found out that media reporting can negatively affect the victim of trauma by triggering and reminding the individual of the experienced events and therefore cause re-traumatization (2006).
The sexual abuse occurred whenever the patient was younger. As a mandatory reporter, a provider must report any type of abuse that occurred to a child regardless of how long ago the abuse has occurred. According to the department of human and health services (DHHS), laws within the states may vary on how to make a report on an alleged abuse/neglect, however it is strongly recommended to make the report whenever one reports an abuse even if it occurred in the past. The DHHS will therefore investigate and determine the resolution to the case (Reporting, n.d.).
Maercker, A. & Mehr. A. (2006). What if Victims Read a Newspaper Report About Their Victimization? A Study on the Relationship to PTSD Symptoms in Crime Victims. European Psychologist, 11(2), 137–142. Retrieved from https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=7&sid=63625ce5-7576-4cd9-a0ae-3303cc545d0c%40pdc-v-sessmgr04
Nathan, S., & Ferrara, M. (2020). An Innovative Trauma-Informed Curriculum for Sexual Assault Care. Journal of Nursing Education, 59(6), 336–340. https://doi-org.ezp.waldenulibrary.org/10.3928/01484834-20200520-07
Reporting Child Abuse and Neglect. (n.d.). APA Practice Health Organization. Retrieved from https://www.apaservices.org/practice/good-practice/reporting-child-abuse.pdf
Thombs, B. D., Bernstein, D. P., Ziegelstein, R. C., Bennett, W., & Walker, E. A. (2007). A brief two-item screener for detecting a history of physical or sexual abuse in childhood. General Hospital Psychiatry, 29(1), 8–13. https://doi-org.ezp.wald
Week 4 Main Question Post
Week 4 Main Question Post
The client in the case study, Morgan, who is a 19-year-old male, does have symptoms that sound like depression or anxiety, but after further evaluation, he revealed that he was sexually abused by a cousin when he was younger. This cousin was recently released from prison for molesting other children, and Morgan is having difficulty coping with past events. He has been having nightmares, frequently changes jobs, has difficulty interacting with others, startles easily, has difficulty sleeping, and has difficulty talking about past events. Based on these symptoms, post-traumatic stress disorder (PTSD) is a more appropriate diagnosis for Morgan. To be diagnosed with PTSD, an individual must be exposed to a traumatic event either directly or witnessed an event that involved the threat of death, serious injury, or serious harm. The individual will also reexperience the trauma with nightmares or flashbacks, avoid situations that will remind the individual of the trauma, have negative changes in mood or cognition, or have changes in arousal or reactivity, such as not sleeping well. The symptoms must be present for at least one month and cause distress or impairment that affects the individual’s social interactions or occupation (American Psychiatric Association [APA], 2013).
Strategies to Assess for Abuse
Assessing for abuse will vary based on the individual’s age and may require a full physical and mental assessment. When performed a physical assessment, another medical professional should be present for the assessment. A parent or guardian may also need to be present to reduce stress and anxiety for the client. When conducting a mental health assessment, the mental health professional must ask questions regarding emotional, physical, and sexual abuse. If there is a report of trauma or abuse, a trauma screening or trauma-informed mental health assessment should be conducted that involves questions specific for trauma that are not leading to gather information and identify the needs of the client. For children and adolescents, the parents should be present for part of the interview, but some questions may also need to be discussed without the parents present to assess for trauma and abuse within the home (Screening and Assessment, 2017). For Morgan, since he is 19 years old, I would conduct his mental health assessment without anyone else present, and there is no need for a physical assessment for abuse since the abuse occurred years earlier. However, I would utilize a trauma screening or trauma-informed mental health assessment to ensure that I gather the necessary information needed to assist with determining treatment options for him.
Exposure to Media/Social Media
Media and social media may have either a positive or negative effect on individuals that have been abused or experienced trauma. There are many resources and support groups available for individuals with PTSD, and media or social media may be useful for seeking support or discussing past traumatic experiences (Salzmann-Erikson & Hiçdurmaz, 2016). However, there are also movies, television shows, videos, pictures, and discussions that involve violence and negativity in media and social media. Exposure to these may be distressing to the individual watching the video and could cause anxiety, PTSD, or worsening of PTSD symptoms due to the reminder of previous abuse or trauma (Ramsden, 2017). Therefore, individuals who have experienced abuse or trauma or have been diagnosed with PTSD should be aware of their limitations regarding media and social media and avoid unnecessary stressors.
As the mental health professional caring for Morgan, I would ask if anyone had reported the sexual abuse he endured from his cousin. As a mandatory reporter, I would then report the abuse to the Child Abuse Hotline. The perpetrator, who is Morgan’s cousin, had previously been imprisoned for molesting other children, and he has been released. The reporting of Morgan’s sexual abuse may or may not result in additional charges of child molestation for his cousin. However, as a practitioner, I would rather report the information, even if no course of action is taken against the perpetrator, so that I will not be charged for not reporting childhood sexual abuse when I was aware of a child that had been sexually abused. In my opinion, it is better to play it safe and report abuse even if the client states that the abuse had previously been reported by another provider (Mandatory Reporting Requirements: Children Arkansas, 2020).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://dsm-psychiatryonline-org.ezp.waldenulibrary.org/doi/full/10.1176/appi.books.9780890425596.dsm15
Mandatory reporting requirements: Children Arkansas. (2020). RAINN. Retrieved September 20, 2020, from https://apps.rainn.org/policy/policy-state-laws-export.cfm?state=Arkansas
Ramsden, P. (2017, June 22). Vicarious trauma, PTSD and social media: Does watching graphic videos cause trauma? Longdom. Retrieved September 20, 2020, from https://www.longdom.org/proceedings/vicarious-trauma-ptsd-and-social-media-does-watching-graphic-videos-cause-trauma-37421.html
Salzmann-Erikson, M., & Hiçdurmaz, D. (2016). Use of social media among individuals who suffer from post-traumatic stress. Qualitative Health Research, 27(2), 285–294. Retrieved September 20, 2020, from https://doi.org/10.1177/1049732315627364
Screening and assessment. (2017, December 11). The National Child Traumatic Stress Network. Retrieved September 20, 2020, from https://www.nctsn.org/treatments-and-practices/screening-and-assessment
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