Prevention and Early Intervention
Prevention and/or early intervention of childhood abuse could have a substantial impact on the prevalence of adult mental health and substance abuse problems. New biological findings suggest that prevention and early intervention may be the ONLY ways to avoid enduring problems.
Facts and Discussion Points:
* Early intervention and prevention of childhood abuse are crucial recommendations for almost every one of the top axis items, given the link between unresolved childhood abuse trauma and: co-occurring disorders, substance abuse, seclusion and restraint, terrorism, homelessness, aging, HIV/AIDS, criminal justice.1
* Nine out of ten children who need drug treatment are not receiving it. One million, one hundred thousand American children ages 12 to 17 have problems with drugs and alcohol. Approximately 122,000 got treatment in 2000.2
* Teenagers with alcohol and drug problems are 6 to 12 times more likely to have a history of being physically abused and 18 to 21 times more likely to have been sexually abused than those without alcohol and drug problems.3
* Primary prevention of major mental illness in adulthood (and other problems associated with child abuse) through prevention of severe child abuse is possible. This can be shown by intervention studies.4
* Home visiting programs (HFA-Healthy Families America) are associated with reduced rates of child abuse. Families enrolled in HFA are two to three times less likely to maltreat their children than comparable families who are not enrolled.5
* Maladaptive coping skills (dissociation, substance abuse, coercive control, etc.), typical of survivors of chronic abuse, can substantially interfere with successful parenting skills including attachment, bonding, and development of empathy between parent and child at developmentally critical stages. This problem is a primary factor contributing to the cycle of abuse and family dysfunction.6-9
* Until recently, psychologists believed that mistreatment during childhood led to arrested psychosocial development and self-defeating psychic defense mechanisms in adults. New brain imaging surveys and other techniques have shown that physical, emotional, or sexual abuse in childhood (as well as stress in the form of exposure to violence, warfare, famine, pestilence) can cause permanent damage to the neural structure and function of the developing brain itself. These changes can permanently affect the way a child’s brain copes with the stress of daily life, and can result in enduring problems such as suicide, self-destructive behavior, depression, anxiety, aggression, impulsiveness, delinquency, hyperactivity, and substance abuse, and conditions such as Borderline Personality Disorder, dissociative episodes, hallucinations, illusions, psychosis, paranoia, volcanic outbursts of anger, and impaired attention. These results suggest that much more effort is needed to prevent childhood abuse and neglect. New approaches to therapy may also be indicated.10
* Stress sculpts the brain to exhibit various antisocial, though adaptive, behaviors. Whether in the form of physical, emotional or sexual trauma, or through exposure to warfare, famine, or pestilence, stress can set off a ripple of hormonal changes and key brain alterations that may be irreversible.10
Recommendations:
1---Target the young population assessed with addiction problems (the majority of whom have histories of unresolved trauma) in early intervention programs. Insure that all federally funded early intervention and prevention programs appropriately address unresolved past trauma and/or ongoing trauma as a core issue in the development and maintenance of addictions and in the individual’s recovery.
2---Collaborate with HFA to create educational material that includes relevant information that links childhood trauma and violence with the onset of adult difficulties. The material should also identify methods of recognizing and responding to these difficulties.
3---Create trauma/attachment theory-informed parenting programs specifically for women with abuse histories.
4---Research, implement, and evaluate effectiveness of child abuse prevention strategies. Justify intervention based on new findings of permanent damage to the brain caused by child abuse and its impact on the individual, society, and human service fields. Justify cost of prevention strategies by fiscal analysis showing savings of child abuse reduction by x percentage.
Prevention and Early Intervention References
1. E. Giller (personal communication, April 2002).
2. SAMHSA, 2002.
3. Clark, H. W., McClanahan, T. M., Sees, K. L. (Spring 1997). Cultural aspects of adolescent addiction and treatment. Valparaiso University Law Review, Vol. 31(2).
4. The Ross Institute (www.rossinst.com/Trauma.htm).
5. Daro, D., Harding, K. (1999). Healthy Families America: Using research to enhance practice. The Future of Children (p. 168).
6. Green, A. H. (1999). Patterns of violence transmission in physically and sexually abused children. In K. Tardiff (Ed.), Medical management of the violent patient: Clinical assessment and therapy (pp. 405-427). New York, NY: Marcel Dekker.
7. DeZulueta, Felicity, I. S. (January-March 1998). Human violence: A treatable epidemic. In Medicine, Conflict and Survival (ISSN: 1362-3699) Vol.14, pp.46-55.
8. Cole-Detke, H., Kobak, R. (1998). The effects of multiple abuse in interpersonal relationships: An attachment perspective. Journal of Aggression, Maltreatment and Trauma (ISSN: 1092-6771), Vol.2, No.1, pp.189-205.
9. Sable, P. (1995). Attachment theory and Post-Traumatic Stress Disorder. Journal of Analytic Social Work (ISSN: 1052-9950), Vol.2, No.4, pp. 89-109.
10. Teicher, M. H. (March 2002). Scars that won’t heal: The neurobiology of child abuse. Scientific American; and, Saxe, G. as excerpted in National Executive Training Institute (NETI). (2003, July). Training curriculum for the reduction of seclusion and restraint. Alexandria, VA: National Technical Assistance Center (NTAC), National Association of State Mental Health Program Directors (NASMHPD).