MALTREATMENT OF CHILDREN WITH DISABILITIES: RESEARCH AND THERAPEUTIC PRACTICE OVERVIEW Patricia M. Sullivan, Ph.D. Professor, Neurology and Psychology Creighton University School of Medicine I. Workshop Description This workshop will summarize past and current research addressing the maltreatment of children with disabilities, co-occurring factors in that maltreatment, sexual behavior problems and violence among maltreated youth with disabilities, and effective therapeutic interventions for maltreated children with disabilities and their families. II. Course Outline Methods: On-line presentation of written materials, Power Point slides, dissemination of electronic publications for handouts, and on-line interaction & discussion with participants. A. Maltreatment Characteristics of Children with Disabilities 1. Incidence a. Disabled (30%) b. Non-disabled (10%) 2. Disability specific incidence rates a. Behavior Disorders b. Learning Disabilities c. Mental Retardation d. Speech Language Disabilities e. Deaf/Hard of Hearing f. Visual Impairment g. Autism h. Health/Orthopedic 3. Age at first maltreatment by disability type a. Preschool School b. Elementary School c. Middle School d. High School e. Delineated by disability types in number two a-h (above) 4. Types of maltreatment a. Neglect b. Physical abuse c. Sexual abuse d. Emotional abuse 5. Severity of maltreatment a. Behavior potentially injurious to the child b. Tissue damaging event including harmful restraint or control c. Serious injury requiring medical or dental services d. Fatality or life-threatening physical abuse 6. Duration of maltreatment a. Single episode b. Total duration less than 1 year c. Duration of 1 year to 3 years d. Duration of longer than 3 years 7. Types of perpetrators a. Familial (immediate family & extended family members) b. Extrafamilial (non-family members) 8. Family stress factors associated with maltreatment a. Inadequate parenting b. Inadequate housing c. Financial problems d. Pregnancy or the presence of a new born e. Illness or disability in the parent f. Mental or emotional problems in the parent g. Social isolation of the family h. Alcohol or drug problems within the home i. Presence a disabled child in the home j. Involved with the legal system B. Co-Occurring Factors in Maltreatment of Children with Disabilities 1. Domestic violence in the home 2. Runaway status a. Disability type b. Risks for runaway c. Tetragenic factors related to disability status 3. Family stress factors a. Drug b. Alcohol abuse c. Parent ill or disabled 4. Academic achievement a. Math b. Reading 5. School attendance a. Absences b. Tardies Medical Neglect of Children with Disabilities 1. Types of medical appointments missed a. Check up (47.9%) b. ENT (24%) c. Follow-up appointment (10.4%) d. Immunization (8.9%) e. Acute (6.7%) f. Allergy (2.1%) 2. Reasons for missed appointments a. Unknown (94.5%) b. Illness (0.4%) c. Insurance (.1%) d. Patient forgot (3.6%) e. Patient felt better (.1%) f. Lack of transportation (1.1%) g. Weather (.2%) 3. Related factors a. Type of insurance b. Disability status c. Ethnicity d. Gender e. Socioeconomic status f. Number of children in home 4. Health care access issues for children with disabilities C. Co-Occurring Sexual Behavior and Sexual Violence Among Maltreated Children with Disabilities 1. Incidence of sexual behavior problems by disability type a. Behavior disorders (37.4%) b. Mental retardation (24.1%) c. Learning disabled (16.4%) d. Health related (11.2%) e. Speech and language (6.5%) f. Hearing impairment (1.3%) g. Multiple disabilities (1.2%) h. Orthopedic disabilities (1.2%) i. Visual impairments (0.4%) j. Autism (0.1%) 2. Effect of co-occurring domestic violence by family stress factor a. Voluntary foster care b. Inadequate parenting c. Inadequate housing d. Financial problems e. Marital problems f. Pregnancy or birth of a newborn child g. Parent that is ill or disabled h. Mental or emotional problems i. Alcohol/drug abuse presence j. Social isolation k. Involved in the legal system l. Step-parent/child conflict m. Child with disability n. Fetal alcohol syndrome o. Family member with AIDS 3. Incidence of sexual violence (adjudication for sexual assault) by disability type 4. Effect of co-occurring domestic violence a. Associated with neglect b. Physical abuse c. Emotional abuse d. Sexual abuse 5. Gender differences in sexual behavior problems a. Disabled vs. Non-disabled males b. Disabled vs. Non-disabled females 6. Gender differences in sexual violence perpetration a. Disabled vs. Non-disabled males b. Disabled vs. Non-disabled females 7. Treatment implications D. Therapy with Maltreated Children with Disabilities 1. Behavioral characteristics of maltreated children with disabilities a. Internalizing behavior problems b. Externalizing behavior problems c. PTSD 2. Therapy guidelines a. Develop individual treatment plans b. Identify treatment goals c. Utilize therapeutic methods to achieve goals 3. Therapy goals a. Alleviate guilt and build trust in peers and adults b. Treat the depression that accompanies these cases c. Teach the child appropriate expressions of anger about what happened to them d. Provide basic information about sexuality and interpersonal relationships e. Address sexual preference issues f. Teach self-protection techniques g. Develop an affective vocabulary to express feelings and emotions h. Attain emotional independence in the children i. Assist in the establishment of a meaningful and stable identity j. Develop a personal value system k. Develop capacity for lasting relationships and for both tender and gentle love 4. Therapy techniques a. Linguistic b. Physical c. Cognitive d. Behavioral e. Psychosexual f. Emotional 5. Ensure therapy goals are both therapeutic and educational III. Learning Objectives: Objective 1: The participants of this presentation will be able to identify the incidence of maltreatment among children and youth with disabilities including the demographic characteristics of age at first maltreatment, perpetrator characteristics, and family stress factors related to maltreatment. The will be able to identify the relative risks for different types of maltreatment for differing groups of children with disabilities. Objective 2: Participants will acquire knowledge regarding the medical neglect of children with disabilities including the types of medical appointments children are most likely to miss and the most frequent reasons for missing medical appointments and their antidotes among patients who frequently fail appointments and those who do not. Participants will learn the role of ethnicity, insurance provider, gender, socioeconomic, disability status, and maltreatment status in children's access to medical appointments. Objective 3: Participants will be able to identify the role of domestic violence and runaway behavior in the maltreatment of children with disabilities. Objective 4: The participants will learn disability specific factors in the occurrence of sexual behavior problems and sexual violence (adjudications for sexual assault) among boys and girls with disabilities. Objective 5: The participants will learn the behavioral characteristics of different types of sexually abused children with disabilities that often require therapeutic intervention, their treatment implications, treatment guidelines, goals, and techniques, the role of the family in the treatment process, and techniques for working with families.