Dynamics of a failure to provide adequate medical/dental care EDU 365 CHILD ABUSE AND NEGLECT DETECTION FOR EDUCATORS KATHERYN MCAHON
Dec 17, 2015
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