Childhood Mistreatment - Research Paper Example

? Counselling Children Childhood mistreatment is risk factor for various psychopathologies and various other deleterious outcomes and some forms of mistreatment are connected to increased incidences of depression, substance abuse and other risky behaviours. Moreover, child mistreatment is associated with aberrations in brain development as well as physical illnesses, which necessitate clear imperative for identifying, disseminating effective psychological treatments for such maltreated children in a timely manner. To carry out children counselling necessitates clear determination of the various forms of traumatic experiences such as children exposed to emotional, sexual or physical abuse or even children exposed to domestic or community violence. Some of the cases in such mistreatment may involve splitting children who have undergone different forms of mistreatment into separate groups, which can even aggravate the situation by creating artificial divisions in what could be the same cohorts of children. Moreover, domestic and community violence are usually intentional and personally directed therefore more common in children compared to other forms of trauma like road accident or natural disaster. The usual treatment models for children who have undergone mistreatment are especially developed forms of trauma like sexual abuse for maltreated as well as violence-exposed children and tested to such cohorts of children. Even though, each model is usually based on underlying theoretical basis where each model gets tailored to include elements that are specific to the particular maltreatment experience a child undergoes. Overtime new research has managed to clarify that most of the children who undergo maltreatment as well as violence aimed at them have experiences of multiple forms of trauma. As the area of treatment progresses, various studies have shown that few treatments appear to work pretty well in the different ranges of various traumas in children. For instance, Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), which was initially developed for sexually abused children, has been undergoing testing in various forms of traumatized children who were exposed to terrorism as well as children exposed to domestic violence or childhood traumatic grief. Thus, the fact TF-CBT indicates superiority to other forms of improving depressive symptoms in the various comparative trials suggests that it is an efficient model for targeting specific symptoms in traumatized children during their development. Therefore, TF-CBT is the optimal intervention for school going children with trauma related to sexual abuse since the model is effective in children grappling with trauma related to community violence toward them. Nevertheless, the optimal intervention for school going children with trauma related to domestic violence the model may not be optimal for school-going children facing serious behaviour problems related to domestic violence; moreover, the model may not be optimal for young pre-schoolers with trauma related to domestic violence because they are in different developmental levels. Therefore, recent models have been developed to typically focus on certain developmental levels, symptom clusters and even levels of severity; for instance, Structured Psychotherapy for Adolescents recovering from chronic stress was created for adolescents having complex trauma symptoms as well as high severity. It is worth noting that many maltreated or violence-exposed children receive little or no intervention for the trauma symptoms or get treatment from community-based therapist who does not offer evidence-based treatments (Cohen, et al, 2006; Jonson-Reid et al, 2007). Although more research is crucial in treating all forms of youth trauma, the detrimental long-term effects of untreated sexual abuse in children may cause the increase of efforts aimed at developing efficient intervention for this form of maltreatment. Even though, TF-CBT was originally designed for sexual abuse, it has however been adopted for children exposed to any form of trauma. The model has been tested in sexually abused and severely traumatized children and is currently being tested in random and controlled trial for children exposed to domestic violence, while another adaptation is under test for Childhood Traumatic grief. TF-CBT targets trauma-related symptoms including anxiety, depression and trauma-related shame as well as trauma-related cognitions like self-blame; moreover, the model incorporates non-offending and parenting element that aims at enhancing parental support for the traumatized child. The model also helps the parent’s emotional distress related to his or her child’s victimization experience and improves positive parenting practices. TF-CBT is a treatment model that integrates cognitive behaviours, interpersonal as well as trauma receptive interventions for kids. Thus, the model combines fidelity while encouraging significant measure of therapist’s elasticity in adapting the model to the certain child setting. The TF-CBT model involves treatment components that include parenting skills, relaxations skills, psycho-education cognitive processing, enhanced safety and future improvement, affective modulation, ordeal narration and joint child-parent sessions. The parenting skills involve the enhancement of parent abilities to utilize praise, selective attention as well as contingency reinforcement programs, while psycho-education involves offering children as well as the parent information regarding the form of trauma the child experiences. Moreover, psycho-education involves offering validation of the child and parent reaction by the counsellor regarding their trauma reaction as well as normalizing the feelings (Bamba, 2010). The relaxation component of the model involves focus on breathing, progressive muscle relaxation together with other personalized interventions that assist a child in reducing physiological hyper arousal. Affective modulation the concept includes identification of feelings and articulation of actions, enhancing the child’s capability to employ positive self-talk, thought interruption skills as well as improving the child’s social and problem-solving skills. The cognitive processing component involves helping the child and parent recognize the connection between thoughts, behaviours and feelings, and altering the thoughts to be precise and helpful. The component for developing a narrative of the child’s trauma experience involves encouraging the child to create gradually a detailed description of what transpired at the time of the child’s maltreatment or violence exposure experiences as well as processing cognitive distortions regarding the experiences. The joint session that occur between the child and the parent after performing the other components involve the child sharing the trauma narrative with the parent together with other joint parent-child activities that contribute open communication between the parent and child. The model’s component of enhancing safety deals with the current and imminent safety issues regarding the child; the element aims at developing strong skills in this view (Cohen, Mannarino, Murray and Igelman, 2006). TF-CBT has been tested in various random but controlled trials against different active treatments involving children between the age of three to seventeen years of age and those with various sexual abuse experiences. Comparing TF-CBT to nondirective supportive therapy, which is made up of supportive play for young children and nondirective supportive client-centred therapy for mature children,sixty nine sexually abused kids between the ages of three to seventeen seven years were used in study carried out by Cohen and Mannarino (Cohen, Mannarino, Murray and Igelman, 2006). In the study, it was evident that children who received TF-CBT demonstrated significant improvement compared to children that nondirective treatment with regard to improvements in internalising, externalising trauma symptoms as well as sexualised behaviour problems. Psychoanalytic treatment specifically designed for sexually abused children focuses on reducing trauma symptoms as well as bringing unconscious defence mechanisms for great awareness by use of transference in an attempt to embrace positive adaptation. Therefore, this form of treatment involves internalizing and externalising symptoms by complementing the treatment with supportive work to help make sure that children attend the therapy as well as enabling the caregivers to address emerging issues within the family (Kelleher, Cleary and Jackson, 2012). A randomised study of maltreated children using psychoanalytic treatment for children aged between 6 and 14 years and sexually abused demonstrated that children receiving personal psychoanalytic therapy experienced great improvement in trauma symptoms. Nevertheless, due to the design it is hard to ascertain factors or combination of factors responsible for the established improvement. Physical abuse is a common form of abuse that frequently occurs to children because many children experience physical abuse and even though these physically abused children can develop wide variety of emotions and behaviour difficulties. Up to date research focus on addressing physical abusive behaviours of parents who perpetrate the abuse as well as externalising behaviour problems of children who experience abuse (Maschi et al, 2009). Abuse-Focused Cognitive Behaviour Therapy (AF-CBT) targets offending parenting skills including increased use of positive child management practices as well as reducing the use of harsh and coercive discipline practices. This model concurrently targets physically abused children externalization behaviour problems and tries to increase pro-social behaviour as well as improving peer interactions. AF-CBT never specifically focuses on internalised symptoms but rather focuses on improving familial and peer interactions that may result in improved self-image as well as self-efficacy and thereby improving depressive and anxiety symptoms in such children. This approach for child-directed components includes socialization models of stress and CBT that describe the child’s experience of family aggression and violence. Moreover, this approach includes perceptive processing of circumstances as well as the sequence of referral incidents in trying to change belligerence supportive beliefs, distortions and even other misattributions regarding the incident. As well the approach incorporates psycho-education regarding child abuse laws, child safety as well as the common child abuse reactions; in addition, the approach incorporates coping skills discussions and training in order to address the daily problems and the development of social support plan skills training to enhance social competence. In addition another approach for addressing trauma and emotional as well as behavioural difficulties experienced by young children is the Child-Parent Psychotherapy (CPP) that bases on dyadic relationship model focused on children less than 6 years old who experience domestic violence (Degges-White and Colon, 2012). The approach is considered a trauma-focused relationship-based treatment model that incorporates psychodynamic theoretical basis as well as cognitive behavioural components. This approach uses parent-child relational play, action and language in an attempt to correct specific areas that are deregulated because of young children exposure to domestic violence. The focus of the treatment involves sensory motor disorganization and the disruption of biological rhythms; child fearful behaviour; child reckless, self-endangering and accident-prone behaviour; child aggression toward a parent; benevolent influences in the parent’s past and termination of the treatment. In addition to affective modulation and parenting skills, the model includes an active case management component; moreover, the approach has been adopted in for very young children who experience childhood traumatic grief. In a randomised but controlled study of CPP preschool children exposed to family violence as well as their victimised mothers were randomly assigned to receive together with individual psychotherapy. The study involved severely traumatised cohort of children where most of them experienced community violence, with another large group that experienced physical abuse and a small number of children who had experienced sexual abuse. The approach was implemented in a period of 50 weeks with weekly sessions offered to child-mother dyads that lasted approximately 60 minutes. After the study, CPP approach was found to be superior in case management in improving total number of trauma symptoms and total behaviour problems in preschool children who experienced domestic violence-related trauma symptoms. Moreover, mothers in the study of the approach showed significant improvement in the total personal trauma symptoms compared to mothers who received case management, in spite of the fact that many mothers from both groups received different forms of psychotherapy in the course of the study (Cohen et al, 2006). There are various treatments aimed at externalising problems in children exposed to domestic violence with the child being the focus of treatment, with the behavioural interventions based on theory and research supporting the idea that externalising behaviour problem in children arises from learned behaviour patterns that result from exposure to domestic violence. The components for intervention include emotional, communal and active support aimed at the parent and child during the transition period, problem solving in parents and training in child management skills. Making parents understand a set of child management skills has overtime been shown to be efficient in some populations that indicate conduct problems. Grief experience within children is influenced by individual and developmental factors therefore children respond to loss in ways that reflect their personal temperament, their coping strategies, cognitive processing capabilities as well as the previous experiences of loss to a child. From developmental aspect, children who face traumatic experiences like loss of a loved one before attaining the age of six can express the loss in way hard for adults find difficult to understand. Research shows that kids can be able to process grief efficiently when they are in the presence of consistent adults who help the children identify and express their feelings of loss. However, for many children, their parents are overcome by their feelings that they are unable to parent effectively or even to be emotionally available for the grieving child, especially when children lose a love sibling. Therefore, manual intervention made of two components that include instrumental and emotional support to parents as well as teaching parents a set of child management skills as essential in managing children with conduct problems (Gamino & Ritter, 2009). Moreover, another essential approach for counselling children who have undergone traumatic experiences is play therapy a therapy that involves pairing resilient peers who are socially withdrawn and neglected in order to focus on social interaction skills as well as enhancing positive play (Brassard, Rivelis and Diaz, 2009). Play training aims at the interactive and imaginative play performed between groups of preschool children that are directed by an adult. The intervention has undergone various studies in different settings that include child study labs, classrooms as well as playrooms; with three key components that include pairing of resilient children with abused children in play sessions, creating play corner for use in free play and trained parent volunteers who serve has play supporters (Mishna et al, 2012). Pairing resilient peer with a withdrawn child offers the opportunity for significant decrease in solitary play within children who are withdrawn following mistreatment, which consequently increase the withdrawn children’s positive and interactive play (Fantuzzo et al, 2005). Application of this intervention in deprived preschool children to imaginative play training helped traumatised children show significant increase in their imagination levels, positive effect, increased cooperation and interaction with peers as well as less aggressive play. Emotional abuse is one of the most elusive child maltreatment and probably the most understudied even though there are many reported child victims of psychological abuse. Nevertheless, the definition of emotional abuse proves difficult thus challenging even for researchers to establish and treat as indicated by the scarcity of randomised studies to examine interventions for children exposed to emotional abuse. Childhood traumatic grief is regarded as a condition where children lose a significant person in traumatic circumstances such that the children develop trauma and other trauma-related symptoms that impinge on typical childhood grieving. The Cognitive Behavioural Therapy for Childhood Traumatic Grief (CBT-CTG), being an adaptation of TF-CBT where sequential trauma and grief-focussed components of treatment are offered by incorporating grief-focussed module that is made up of grief-focussed treatment components for children. The grief-focussed components include grieving over what is lost, resolving ambivalent feeling regarding the loss, preserving positive memories of the deceased, redefining relation from one that involved interaction to one that only involves memory, joint child-parent session as well as the termination and closure of issues (Henderson et al, 2006). Therefore, there are significant overlaps in effective components of the many of the effective treatment models that can be applied to maltreated or violence-exposed children. Owing to the fact that there are limited symptom clusters that children develop related to child mistreatment and violence exposure, it only makes sense that a limited number of treatments would be necessary in addressing the problems. Therefore, developing systematic and detailed descriptions of counselling interventions is crucial since it is impossible to evaluate an intervention adequately without clear treatment manual describing its use and implementation. Moreover, it adopting existing efficient models as well as testing the promising ones is beneficial than developing new models unless the adaptations are incompatible with the target population. In conclusion, conducting counselling for trauma treatment involves an essential step of measuring the broad range of mental health symptoms and evaluating other potential factors that are capable of mediating treatment response. Researchers have been able to come up with capable interventions for some of the mistreatment consequences in children; however, it seems there is need for research in broad range of traumatic experiences that children may have exposed to as well as assessing the children for various symptoms. Knowing what is helpful to maltreated and violence-exposed children is the beginning; thus offering the routine in which the community can adopt the treatment and counselling is crucial. Other interventions apart from mental health from the traumatised children are also helpful in intervening when a child has been exposed traumatic experience; for instance of such instances is the child-parent interactive styles. Finally, even though there are many challenges in the act of counselling children who have been exposed to traumatising activities, significant progress has been achieved in developing and distributing effective psychosocial treatments that help children recover from deleterious effects of maltreatment. References Bamba, S. (2010). The Experiences and Perspectives of Japanese Substitute Caregivers and Maltreated Children: A Cultural-Developmental Approach to Child Welfare Practice. Social Work, 55(2), 127-137. Brassard, M. R., Rivelis, E., & Diaz, V. (2009). School-based counseling of abused children. Psychology In The Schools, 46(3), 206-217. Cohen, J. A., Mannarino, A. P., Murray, L. K., & Igelman, R. (2006). Psychosocial Interventions for Maltreated and Violence-Exposed Children. Journal Of Social Issues, 62(4), 737-766. Degges-White, S., & Colon, B. R. (2012). Counseling boys and young men. New York: Springer Pub. Fantuzzo, J., Manz, P., Atkins, M., & Meyers, R. (2005). Peer-Mediated Treatment of Socially Withdrawn Maltreated Preschool Children: Cultivating Natural Community Resources. Journal Of Clinical Child & Adolescent Psychology, 34(2), 320-325. Gamino, L. A., & Ritter, R. H. (2009). Ethical practice in grief counseling. New York: Springer Pub. Henderson, D. A., & Thompson, C. L. (2011). Counseling children. Belmont, CA: Brooks/Cole Cengage Learning. Jonson-Reid, M., Jiyoung, K., Barolak, M., Citerman, B., Laudel, C., Essma, A., & ... Thomas, C. (2007). Maltreated Children in Schools: The Interface of School Social Work and Child Welfare. Children & Schools, 29(3), 182-191. Kelleher, L., Cleary, M., & Jackson, D. (2012). Compulsory participation in a child protection and family enhancement program: Mothers' experiences. Contemporary Nurse: A Journal For The Australian Nursing Profession, 41(1), 101-110. Maschi, T., Morgen, K., Hatcher, S., Rosato, N., & Violette, N. M. (2009). Maltreated Children's Thoughts and Emotions as Behavioral Predictors: Evidence for Social Work Action. Social Work, 54(2), 135-143. Mishna, F., Morrison, J., Basarke, S., & Cook, C. (2012). Expanding the Playroom: School-Based Treatment for Maltreated Children. Psychoanalytic Social Work, 19(1/2), 70-90. Read More