Florida RNs Watch For Signs of Economy-Related Child Abuse

By Geneva Slupski

March 9, 2009 / Nurse.com

Rita Doval, RN, sadly recalls the laceration on the face of an infant she saw on Halloween at a Miami hospital. The nearly 5-month-old boy accidently became caught in the crossfire of an argument between his parents involving a knife.

Amid the stress and pressure of a tough economy, the risk of child abuse is increasing, warn child advocacy experts. They want nurses and other professionals who come in contact with children regularly to be on heightened alert for child abuse and neglect.

"In general, any kind of stressor does contribute," says Doval, nurse liaison for the University of Miami Child Protection Team. "If you take a family who's already under financial stress and then you add the turmoil with the economy now, I think you push them over the edge."

In the past few months, Doval's team, which includes doctors, social workers, and psychologists, has seen more children with severe head traumas and multiple fractures. They've also seen, as in the case of the infant on Halloween, a rise in injuries caused during fights between parents.

More than 3 million cases of child abuse are reported to authorities annually in the U.S., according to Childhelp, a national child abuse prevention organization in Scottsdale, Ariz. An estimated four children a day die from abuse, according to the agency, which also runs a national child abuse hotline.

Childhelp receives about 200,000 calls annually on the hotline, says executive director John Reid. By the end of 2008, that number had increased by about 10%.

"Healthcare professionals can really be one of the most important links in our ongoing battle against child abuse," Reid says. "They have the professional training. They have access to children in their day-to-day work."

Contributing Factors

An economic downturn is never an excuse to harm a child, Reid says, but it is a factor in a perfect storm for such actions. The agony of unemployment, foreclosure, or simply struggling to buy groceries can cause poor choices such as substance abuse, which can then lead to child abuse.

"You have parents finding it increasingly difficult to put food on the table," Reid says. "All of these are fertile breeding grounds that lead to the abuse and neglect of children. For example, if Dad is suddenly out of work and having a hard time putting food on the table, Dad may turn to risky behavior such as drinking too much."

Constant talk of a bad economy at home and school also might have some children acting out more than usual, says Susan Sherman, ARNP, CPNP. "When you look at the economy as it's going right now, people are kind of in a panic mode and everybody's worried," says Sherman, who works for Children's Advocacy Center of Southwest Florida in Fort Myers. "Children internalize and it may come out in their behavior. I'm not saying the children misbehave and their parents abuse them, I'm just saying it's one more piece of the puzzle that we have to look at as a risk factor. "

Under state law, Florida nurses are among professionals mandated to report suspected child abuse, says Cindy Kuharek, ARNP. Injuries nurses are required to report include head trauma, head or neck bruises, and fractures.

Nurses must pay attention to the history provided when collecting information and watch for inconsistencies, says Kuharek, who works for Help A Child in Pinellas Park, Fla.

For example, multiple marks on a youngster's face that a parent claims are from a rash could actually be "petechial" or high impact bruising. "It's not a rash, he's got a slap mark on his face," Kuharek says. "Nurses know how to tell the difference."

Another detail to consider is the age of the child, Kuharek says. Is the little one developmentally capable of injuring himself or herself in such a way? "Any bruise on a baby is suspect," Kuharek says. "If you see an injury and it's not making sense, then be aware. You may need a more detailed history."

Nurses also should remain open minded and careful not to jump to conclusions when dealing with suspected abuse, Doval says.

"The tone you set with a family early on is very important," she says. "You don't want to use a judgmental or derogatory tone with them. I believe that you treat any and every parent with respect and dignity and you interview them just like you would normal, non-abusive parents."

But abuse doesn't always involve physically hitting or inflicting other types of harm on a child. The current economic conditions also are right for neglect, which can include leaving children improperly clothed, dirty, or hungry, Kuharek says. Neglect is the most common type of abuse, she says.

Supportive Solutions

The silver lining to these gathering storm clouds might be the measures underway in Florida to be proactive when it comes to child abuse and neglect. Child protection teams such as the one Doval works for are in place throughout the state. In addition to conducting assessments and providing court testimony, Doval does community awareness in the Miami area.

In July, the Children's Services Council of Palm Beach County (Fla.) was instrumental in bringing the Nurse-Family Partnership program to Florida. With services in place throughout the country, Denver-based Nurse-Family Partnership works with low-income, first-time parents to improve the health and well-being of children and families. Nurses visit first-time moms in their homes during and after their pregnancies, says Terri Kanter, RN, BS. Kanter is a senior community health nursing supervisor for the Palm Beach County Health Department.

"Home visits from nurses are an important part because you see [parents] in their home situations," says Kanter, who supervises the county's Nurse-Family Partnership nursing team. "There is a lot of opportunity to impact that person's life. The relationship that nurse develops with a client serves as a model for that client and her child."

The goal at Children's Advocacy Center of Southwest Florida is to keep parents and children together as much as possible, Sherman says. The center tries to refer parents to whichever social service they need, whether it's finding food, clothing, or job placement. Services such as in-home counseling and parenting classes provided through the Florida Department of Children and Families also help keep families together.

"I've been doing this job for eight years, and some weeks it's easier and some weeks it's harder," Sherman says. "We like to say around here, 'It's all about the kids.'"


Early intervention

During the holiday season, I read an article that warned readers, holiday stress can contribute to child abuse.

Last month I posted an article called "Men Will Be Men", because it discusses how job-loss affects men, and their relationship with the women in their lives.

I don't think foster/adoptive parents are immune to the stress and worries parenting brings, especially in a very bad economy.

I don't think biologic parents are the only people abusing and neglecting children.

Given the many problems Child Protective Services is facing in the US, Canada, the UK and Australia, it's good to see other programs like The Nurse Partnership Program working WITH parents, so the children of struggling parents don't have to become another "forgotten" CPS statistic.

Opportunity vs. Safety

Ever since one of our first time members wrote about the Family-Nurse Partnership some two years ago, I have read about the orgazation on various occasions and to me it is one of the best initiatives around. Nowhere in there work have I heard about outplacement. It is all about supporting first-time families, starting at the early stages of pregnancy.

Parenthood is something many children learn by example, but for many the examples given be their own parents are mainly negative. With so many abusive families, so many broken families, so many violent or negligent families, many first-time parents simply have no possitive role-model to follow. Outside assistance can help break the cycle of abuse and neglect that run in many families, at the same time, it's not enough.

Like the artices referenced show, stress factors such as financial uncertainty can be a major contributing factor to child abuse. We cannot prevent fluctuations in the economy. The economy is simply beyond human control, but it shouldn't have to be so bad as it now is or has been in previous recessions. Of course that come at a cost. If we want to lower the financial uncertainty of families, that counts as much in good times as in bad times.

Some countries have chosen for a system that is highly reactive to economic fluctuations and have a system that leans more towards capitalism, while other countries have a system that has more socialist tendencie, which tend to buffer more of the fluctuations. No country in the western world has a pure capitalist system, nor does any country have a pure socialist system. All countries are somewhere on the continuum between these two approaches. Of all western countries the US leans furthest to the capitalist model, while a Sweden is one of the countries that lean furthest to the socialist model. As a result people in the US have more opportunities than the Swedes to become really rich, but also run more risk to to loose everything. The faster you rise, the harder you fall.

There is a price being paid for being so reactive towards economic fluctuations in either approach. Countries that lean more to the socialist model tend to stay in a recession longer than countries that lean more to the capitalist model. If all goes well and the US economy is growing again in let's say two years time, the economy of Sweden is probably still in a recession for at least another year. At the same time the stress on the American population is much more and goes much deeper during that time frame than the stress in the Swedish population, even when the recession lasts longer.

It's a choice people have. It's a trade-off between opportunity and safety. In the US opportunity is valued higher, while in a country like Sweden safety is value higher. As a result the relative number of millionaires in the US is much higher than in Sweden, while the well-being of the population at large is much better in Sweden than in the US. It's choice, do we want all people to fare relatively well or do we personally want to belong to the group of people that are doing well, irrespective of others?

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