Child Abuse and Occupational Therapy: From Maltreatment to Treatment Introduction



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Heather Hudson, Fall 2004, University of Puget Sound Evidence-Based Practice Symposium Handout

Child Abuse and Occupational Therapy:

From Maltreatment to Treatment

Introduction:

Child abuse and neglect is a growing epidemic with widespread effects manifesting in both society and in the individual. The purpose of this review is to provide evidence for the use of occupational therapy with this population and to discover what effective interventions are currently being used.



Evidence-Based Practice Question:

What effective early interventions exist for children experiencing or with a history of abuse or neglect that could be used by occupational therapists working with them?



Criteria for Evidence Selection:

Articles selected pertain to identification and intervention for children currently or previously experiencing child abuse, neglect, or maltreatment, not including solely drug abuse or adults with a history of childhood abuse.

Articles summarized in the following table are limited to those published between 1999 and 2004. Summary, implications, and recommendations, however, cover all sources listed in the reference list.

Table Summarizing the Evidence

Reference

Study Design/

Data Collection

Level of Evidence

Sample Size

Outcome/ Intervention

Summary of Results (Conclusion and Implications)

Hinshaw-Fuselier, et al. (1999)

Case Study

Level V

Maltreated twins followed from 19 months to 36 months

Reactive Attachment Disorder (RAD)

In order to diagnose RAD, documentation of “pathogenic parent care” and child development of affect and self-regulation is needed. (Does not mention OT)

Cooper, R. J. (2000)

Opinion/ Expert Article & Review of Literature

Level V

N/A

Conceptualized model of children’s play used to organize literature on the effects of child abuse and neglect on play

If a child does not feel safe he or she will not play. Effects of child abuse can be seen as abnormal play. Insecure parent-child attachment impacts how child explores and responds to his/her environment.

Hyter, et al. (2001)

Descriptive Study

Level V

N/A

Development of a Children’s Trauma Assessment Center

Uses comprehensive transdisciplinary services and team-based assessments.

Family-centered practice.



MacDonald, S. L. & Helfrich, C. A. (2001)

Case Study

Level V

One male infant

Shaken Baby Syndrome

OT intervention includes: assess motor control, promote developmental milestones, educate family members on typical infant/childhood development, validate feelings of frustration that arise when caring for an infant, and prevention.

Nave, et al. (2001)

Case Study

Level V

One, 8 y.o. boy (child witness of domestic violence)

Occupational Therapy Psychosocial Assessment of Learning (OT PAL)

OT involved in helping to develop skills of successful role performance, independent living skills, environmental adaptations, exploration of new roles, assessing classroom environment.

Whiting, C. C. (2001)

Expert Article

Level V

N/A

Psychosocial Intervention Discusses the role of OT in working with children with emotional disturbances secondary to maltreatment in occupation of school performance.

OT particularly suited because of emphasis on play and activity, unique skills in observation, ability to administer assessments, problem identification and analysis, program planning and implementation, behavior, and ability to document intervention.


Summary of the Evidence:

There are many ways in which occupational therapy and occupational therapists may affect the lives of children experiencing abuse or neglect. Intervention may involve working with parents teaching them how to access supports, providing parenting techniques and information on childhood development. Intervention may also involve monitoring the development of at-risk children and providing documentation on development and behaviors. Occupational therapists may also work to support teachers and other staff in a transdisciplinary setting. Intervention may involve setting up group therapy sessions for children and parents. Intervention may also involve providing one-on-one services to children and ensuring opportunities for play, sensory processing, self-awareness, attachment, communication, motor development and social development.



Implications for Consumers:

In order for OT services to be best utilized, consumers, whether parents, children, or teachers, should feel supported and not judged by their therapist. Open communication and understanding are essential components of effective intervention.



Implications for Practitioners:

Children who have experienced or who are experiencing abuse or neglect may present with a multitude of challenges. Practitioners working with this population need to understand the problems and decisions the family and child face. Practitioners need to be highly attuned in recognizing the effects of abuse/neglect and provide appropriate opportunities for the child to develop skills and a healthy self-concept. Occupational therapists are particularly suited to provide intervention to this population due to training in activity analysis, problem-solving, and knowledge of typical childhood development and mental health.



Implications for Researchers:

It is inherently difficult to provide high levels of evidence such as randomized controlled trials through research with this population due to the variance in types, length, and severity of abuse/neglect. Since this epidemic is largely hidden, concealed, and rarely openly discussed, research is also difficult because of the uncertainty with which the population is identified and monitored. Low levels of evidence such as case studies and descriptive studies, however, still provide indispensable information to this field. Nevertheless, further research with this population is needed to support the effectiveness of current and future modes of occupational therapy intervention. Future research should include studies on both direct and indirect OT service provision, the involvement of OT in parent education, and the role of OT as part of the transdisciplinary team.



Recommendations for Best Practice:

Occupational therapy is an essential component of the transdisciplinary team providing services to abused and neglected children and their parents. Occupational therapy should continue to be involved in this area through both identification and intervention with the ultimate goal of breaking the cycle of abuse and neglect.



References
Armytage, P., Willich, D., Slater, S., & de Kam, M. (1980). An evaluation of a group treatment programme for families with child maltreatment problems. Australian Occupational Therapy Journal, 27, 115-123.

Baldwin, L. C. (1990). Child abuse as an antecedent of multiple personality disorder. The American Journal of Occupational Therapy, 44, 978-983.

Cermak, S. A. (1997). Sensory processing in the postinstitutionalized child. The American Journal of Occupational Therapy, 51, 500-507.

Colman, W. (1975). Occupational therapy and child abuse. The American Journal of Occupational Therapy, 29, 412-417.

Cooper, R. J. (2000). The impact of child abuse on children’s play: A conceptual model. Occupational Therapy International, 7, 259-276.

Davidson, D. A. (1995). Physical abuse of preschoolers: Identification and Intervention through occupational therapy. The American Journal of Occupational Therapy, 49, 235-243.

Davis, S. (1990). Helping young girls come to terms with sexual abuse. British Journal of Occupational Therapy, 53, 109-111.

Gil, E. (1991). Application of established child therapies to work with abused children. In The Healing Power of Play: Working with Abused Children (pp. 51-82). New York, NY: The Guilford Press.

Hinshaw-Fuselier, S., Boris, N. W., & Zeanah, C. H. (1999). Reactive attachment disorder in maltreated twins. Infant Mental Health Journal, 20, 42-59.

Howard, A. C. (1986). Developmental play ages of physically abused and nonabused children. The American Journal of Occupational Therapy, 40, 691-695.

Hughes, D. A. (1999). Adopting children with attachment problems. Child Welfare, 78, 541-560.

Hyter, Y. D., Atchinson, B., Henry, J., Sloane, M., & Black-Pond, C. (2001). A response to traumatized children: Developing a best practices model. Occupational Therapy in Health Care, 15, 113-140.

Irving, N., Carr, A., Gawlinski, G., & McDonnell, D. (1988). British Journal of Occupational Therapy, 51, 116-119.

Lascaris, D. (1979). The role of the occupational therapist on the child protective team. Australian Occupational Therapy Journal, 26, 121-124.

MacDonald, S. L. & Helfrich, C. A. (2001). Shaken baby syndrome: Assessment and treatment in occupational therapy. Occupational Therapy in Mental Health, 16, 111-125.

Nave, J., Helfrich, C. A., & Aviles, A. (2001). Child witnesses of domestic violence: A case study using the OT PAL. Occupational Therapy in Mental Health, 16, 127-140.

Semmler, C. J. (1983). The therapist, and expert witness in a custody case: A case study. Physical & Occupational Therapy in Pediatrics, 3, 61-68.

Whiting, C. C. (2001). School performance of children who have experienced maltreatment. Physical & Occupational Therapy in Pediatrics, 21, 81- 89.



Wright, S. A. (1994). Physical and emotional abuse and neglect of preschool children: A literature review. Australian Occupational Therapy Journal, 41, 55-63.


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