6/28/2010. Objectives

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1 Objectives Differentiate between crisis and post crisis intervention. ti Describe potential chronic effects of drug endangerment. Discuss alternate point of entry and the importance of this concept. Seek to find a balance between labeling and identifying need for service. 1

2 What is a Drug Endangered Child? One who experiences physical harm or neglect from direct or indirect exposure to misuse of illicit or diverted drugs. A child who lives in a house or other structure where illegal drugs are used and/or produced. Many of these children will end up living in a home with grandparents. DEC Seeks to Solve Common Problems Have you been frustrated because there seems to be lack of understanding and communication between different professions? Do you see problems and wish you had more information before being forced to make a decision? Do you later find out a situation was drug-related yet wonder what could have been done about it even if you had known? 2

3 Risks for drug endangered children Increased violent behavior toward children Adult paranoid state Physical assault due to caregiver aggression/irritability Burns from spills in home lab Severe neglect No provisions in the house Caregivers not present, high or crashed Increased sexual abuse Pornography in every home lab Adult euphoria effect from drug Emotional Abuse Caregiver frustration Daily living chaos Lack of regard for safety Toxins in easy reach of child Smoke detectors detached next to child s room Why is meth a problem? Meth affects more than just the user Highly toxic production process Harm to the environment Breathing problems Burns and rashes Possible cancer risk Exposure to over 200 toxic chemicals possible Increased risk of domestic and community violence Compromised safety of professionals, children, and vulnerable adults Tulsa, OK Police Department 3

4 What is a crisis intervention? Presence of lab Immediate danger Weapons and booby traps likely Dangers not yet known Victims on the scene Bad guys not yet in custody Medical needs not yet assessed Children present What if you suspect you are in a lab environment? SAFETY FIRST Make mental notes Make an excuse to leave Do not let your suspicions be known. When you are a safe distance away call and report suspicions to the proper p authorities. Do not try to rescue others in the home let authorities know who in the home needs assistance. 4

5 What ideally happens at a meth scene? Child is identified Backup is called by first responder Hazmat teams and EMS activated Child Given new clothes Urine sample taken Bathed as soon as possible Decontaminated in case of fire, explosion, or chemical spill Medical exam completed Follow-up ordered Safe home located Developmental screening completed within 72 hours Crisis Roles and Responsibilities Law Enforcement Secure scene Arrest suspect Decontaminate if needed Scan scene for dangers Remove children from site Decontaminate if needed Note dangers Contact lab certified team to dismantle lab Dismantle lab Neutralize chemicals Log chemicals Document crime scene Remove hazardous materials Complete paperwork Child Protection Identify children Remove from scene Ensure protocol is implemented Escort, transport, or meet children at medical facility for medical testing Find safe placement Investigate options for family placement Complete paperwork 5

6 Ways Children are Endangered Lack of nurturing and emotional response Developmental delays Depression Attachment disorders Malnutrition and failure to thrive Failure to protect Trading children for drugs Emotional abuse Exposure to drugs, dangerous people Sexual abuse Physical abuse Maslow s Hierarchy of Needs Possible Symptoms of Meth Exposure Vomiting Agitation g Crying Hyperactivity Seizures Stomach Pain Burning eyes Burning, tingling skin Increase in blood pressure Restless Iodine splashes Delayed treatment 6

7 The Use Cycle TC B wr ea n as g kh e Neglect, Sexual Abuse, Strangers in the home Physical, sexual abuse, domestic violence Neglect It doesn t make sense Impaired reasoning Lost jobs Lost jobs Lost lives Lost friends Damaged relationships Paranoia Psychological pain Psychological pain Physical pain Disease Death 7

8 What is the difference between abuse and lifestyle choice? Today s youth are exposed to drugs sex and violence on TV. Children from drug homes likely experienced these things firsthand. Displacement of Need Drug as priority for adults Forced participation in illegal activity Health problems due to exposure Delayed treatment for injuries Lack of treatment for injury Child forced to take on adult role 8

9 Imagine for a moment Realities of the User s World They may not want to quit. They don t care if they hurt you now they can t see it. Chances are, any guilt will be covered with drugs not your fault. They are not in control. They have sick brains. Treatment is scary. Recovery, terrifying. 9

10 Drug Home Description Distinct, antisocial beliefs and practices Environmental danger Chaos Neglect Abuse Loss Isolation Skills Children Learn Lying Stealing Drug Use Violence Manipulation Love is conditional Rolling joints Mixing drinks Making meth IV drug use 10

11 Children s Assumptions About Life Somebody s always coming after you Somebody s coming to take you away Adults may die People aren t trustworthy People who think they can make a difference do not understand Life is hopeless There is nothing better out there for them Attachment and Bonding Secure attachment occurs when baby s needs are met by sensitive caregivers. Insecure attachment occurs when parents are unavailable and uninvolved. Is the basis for the baby s sense of being lovable and worthwhile. 11

12 Outcomes of Healthy Development Hope Will Purpose Competence Fidelity Love Care Wisdom Child Development Institute 2005 What we know about trauma Traumatic experiences create changes in psychological structures Personality Emotional regulation PTSD Attachment disorders Depression School problems Behavioral disorders Beware! May be misdiagnosed as: ADHD Bipolar disorder These children may have experienced trauma but they are not doomed! 12

13 What can help? Parental support Fi Friendship dhi relationships Neighborhood monitoring School achievement Respite from chaos Mentoring Which influences are most powerful? Family Extended dfamily Peers Neighborhood School Community Treatment Provider Families are important! 13

14 Signs of Neglect in Younger Children Developmental delays Non-compliance Difficult temperaments Frequent injuries Delayed treatment for injuries Unusual pattern of injury Unsafe home environment Periods left unattended Endangerment of Older Children Availability of drugs in the home Attitudes about drugs Exposure to drug activity as normal Seeing self as different or not fitting in Normalization of the drug culture Lack of faith in the system s ability to make life better 14

15 Potential Problems Children involved in drug activity Multi-generational drug use Family experiences more positive effects from drugs than negative Older children not seen as victims of abuse but juvenile offenders Children doubt they would be capable of achieving a different lifestyle Copyright PNTF 15

16 Copyright PNTF Todd County KY, children were inside the home when their father set fire to his meth lab in an attempt to destroy evidence because the PNTF was serving a search warrant on his residence Copyright PNTF 16

17 Caution: Many signs and symptoms of children exposed to methamphetamine h t are similar il to a number of physical, psychological, social, and environmental exposures. Please consider the coupling of symptoms bf before assuming meth exposure. Common Physical Complaints/Observations Complaints of stomach pain Anorexia Hoarding of food Unusual smells Irritated eyes (non-allergy) Chemical smells on clothing Bronchial symptoms Patterns of anxiety and crashing 17

18 Objective #1: Finding the Children RESCUE SHELTER DEFEND PROTECT Operation UNITE Children Consider the APE 13 y.o., previous miscarriage, chemical rash on body, not face 5 y.o. presents to ER for seizures, elevated temp 5 month-old presents with recurrent ear infections, unusual rash after weekend visit 3 y.o. brought to ER for respiratory problem found to have head lice, 38 human bites on body, bruising on penis and evidence of penetrated abuse A-lternate P-oint of E-ntry 18

19 Ways children are Endangered Chaotic and Hazardous Life style Loaded guns Unsafe housing/poor ventilation Toxic waste dumped in play area Exposure to pornographic material/overt sexual activity Dangerous animals Involvement of children in production process Rules of an Addicted Home Don t talk. Don t feel. Don t trust. One in three children live in a substance abusing home (NIH, January 2000). 19

20 Schools are Important! Teachers spend more time with students than others Writing assignments can be revealing Teachers often have insight and information others do not Can be a good place for service delivery May be the safest place children know Long-term Effects to Children There is much we do not know about long-term effects. What we do know: 48% of children who experience trauma have learning difficulties within 1 year of event. Seizures, ear infections, rashes, constipation, and delayed treatment of injuries have resulted in urine-positives for cocaine, benzos, methadone, and methamphetamine in young children. 20

21 Major risk factors 1. Marital conflict 2. Parental psychopathology 3. Poor parenting practices These are the strongest predictors of negative mental health outcomes for this age group. Common Mental Health Service Types 1. Identify and treat those with current problems. 2. Encourage teacher nomination of those who are determined to be at risk. Schools are a key setting for the delivery of preventive mental health interventions for children (WHO, 1990). 21

22 Prevention through Protection Early identification. Placement in a safe environment. Developmental testing and follow-up care. Comprehensive health and mental health h services. Protocol Ideal Training Scenario In place Implemented Train and support best practice Do what is proven Support other professionals Utilize tracking system for children 22

23 Possible Interventions for Future Success Speech and language assessment. Play therapy. Physical therapy. Early educational needs assessment. Immunizations Nutrition Any others that may assist in the positive development of these infants. Partnerships for Success In order to help children overcome the many barriers of living in a substance abuse environment, the development of a multidisciplinary team is crucial. For Example: Child Protection Narcotics Investigators Community Mental Health Centers Law Enforcement Medicine Prosecution School Health Departments Cooperative Extension Children s Advocacy Centers Community Coalitions 23

24 The DEC Response Team Employment includes involvement to drug scene and crisis i intervention ti Law Enforcement Emergency Medical Service Fire/Hazmat Child Protection Emergency Room Nurse/Physician Prosecutor Muhlenberg County Pennyrile Narcotics Task Force provided a truck to transport the children the children. The trailer contains clothing and donations for children. The trailer can also be used to take down a meth lab. 24

25 Outcomes of DEC may include: Physical and emotional protection of children. Breaking the cycle of child abuse. Protection of exposed child s health. Establishment of community protocol through cooperation, sharing of information, and case coordination. Are meth cooks more organized than we are? 25

26 Sources: Swenson CC, Chaffin M. Beyond psychotherapy: treating abused children by changing their social ecology. Aggression and Violent Behavior, accepted 14 July The National Medical Protocol: org Slanberova R, Pometlova M, Syllabova L, Mancuskova M. Learning in the place navigation task, not the new-learning task, is altered by prenatal methamphetamine exposure : Department of Health and Human Services Child Maltreatment Report, The National Institutes of Health: Foundmagazine.com Kyle AD, Hansell B. The meth epidemic in America, two surveys of U.S. counties: the criminal effect of meth on communities the impact of meth on children, July 5, Aos, S.; Phipps, P.; Barnoski, R.; and Lieb, R. The Comparative Costs and Benefits of Programs to Reduce Crime. Vol. 4 ( ). Olympia, WA: Washington State Institute for Public Policy, May Dube SR, Felitti VJ, Dong M, Giles WH, Anda RF. The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to Preventive Medicine : Thank You Pennyrile Narcotics Task Force U.S. Attorney s Office Eastern District of Kentucky David and Amy Parnell and family Rachel Parnell Kentucky State Police National Alliance for Drug Endangered Children Harold Adair, Tulsa, OK Police Department Appalachian Regional Commission University of Kentucky Kentucky Office of Drug Control Policy UNITE To all who work to protect children every day 26