Why do we need to protect children? Children at risk

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1 Children at risk Steven Lucas, MD PhD Pediatrician Akademiska barnsjukhuset Uppsala Why do we need to protect children? 1. Children can t (and shouldn t need to) protect themselves from adults 2. Children who experience abuse and/or neglect may suffer short- and long-term consequences (we ll get back to this) 1

2 What do we need to protect them from? Physical abuse Sexual abuse and assault Psychological abuse Experiencing intimate partner violence Neglect Substance abuse Bullying Physical abuse Sexual abuse and assault Psychological abuse Experiencing intimate partner violence Neglect Substance abuse Bullying 2

3 Physical abuse Sexual abuse and assault Psychological abuse Experiencing intimate partner violence Neglect Substance abuse Bullying Physical abuse Sexual abuse and assault Psychological abuse Experiencing intimate partner violence Neglect Substance abuse Bullying Physical abuse Sexual abuse and assault Psychological abuse Experiencing intimate partner violence Neglect Substance abuse Bullying 3

4 Physical abuse Sexual abuse and assault Psychological abuse Experiencing intimate partner violence Neglect Substance abuse Bullying Physical abuse Sexual abuse and assault Psychological abuse Experiencing intimate partner violence Neglect Substance abuse Bullying Physical abuse Sexual abuse and assault Psychological abuse Experiencing intimate partner violence Neglect Substance abuse Bullying 4

5 Physical abuse Sexual abuse and assault Psychological abuse Experiencing intimate partner violence Neglect Substance abuse Bullying What puts children at risk? Parental issues Mental illness Cognitive disabilities Substance abuse Factors within the child Chronic conditions disease, CP, ADHD Factors in the environment Poverty War Displacement, marginalization 5

6 Parental issues Mental illness Cognitive disabilities Substance abuse Factors within the child Chronic conditions disease, CP, ADHD Factors in the environment Poverty War Displacement, marginalization Parental issues Mental illness Cognitive disabilities Substance abuse Factors within the child Chronic conditions disease, CP, ADHD Factors in the environment Poverty War Displacement, marginalization Parental issues Mental illness Cognitive disabilities Substance abuse Factors within the child Chronic conditions disease, CP, ADHD Factors in the environment Poverty War Displacement, marginalization 6

7 Parental issues Mental illness Cognitive disabilities Substance abuse Factors within the child Chronic conditions disease, CP, ADHD Factors in the environment Poverty War Displacement, marginalization Parental issues Mental illness Cognitive disabilities Substance abuse Factors within the child Chronic conditions disease, CP, ADHD Factors in the environment Poverty War Displacement, marginalization Parental issues Mental illness Cognitive disabilities Substance abuse Factors within the child Chronic conditions disease, CP, ADHD Factors in the environment Poverty War Displacement, marginalization 7

8 Parental issues Mental illness Cognitive disabilities Substance abuse Factors within the child Chronic conditions disease, CP, ADHD Factors in the environment Poverty War Displacement, marginalization How common? Reported cases of violence yearly Reports of physical violence (1% of children 0-18 yrs) Reports of sexual crimes 8000 Cases of psychological abuse? Cases of neglect? 8

9 Abuse type Girls % Boys % Total % Ever been hit by Severe physical abuse a Witnessed Frequently witnessed Emotional abuse by Locked in cellar/closet Multiple types of abuse b Data from Janson S, Jernbro C, Långberg B. Kroppslig bestraffning och annan kränkning av barn i Sverige : en nationell kartläggning Stockholm: Stiftelsen Allmänna Barnhuset; 2011 Abuse type Girls % Boys % Total % Ever been hit by Severe physical abuse a Witnessed Frequently witnessed Emotional abuse by Locked in cellar/closet Multiple types of abuse b Data from Janson S, Jernbro C, Långberg B. Kroppslig bestraffning och annan kränkning av barn i Sverige : en nationell kartläggning Stockholm: Stiftelsen Allmänna Barnhuset;

10 Abuse type Girls % Boys % Total % Ever been hit by Severe physical abuse a Witnessed Frequently witnessed Emotional abuse by Locked in cellar/closet Multiple types of abuse b Data from Janson S, Jernbro C, Långberg B. Kroppslig bestraffning och annan kränkning av barn i Sverige : en nationell kartläggning Stockholm: Stiftelsen Allmänna Barnhuset; 2011 Abuse type Girls % Boys % Total % Ever been hit by Severe physical abuse a Witnessed Frequently witnessed Emotional abuse by Locked in cellar/closet Multiple types of abuse b Data from Janson S, Jernbro C, Långberg B. Kroppslig bestraffning och annan kränkning av barn i Sverige : en nationell kartläggning Stockholm: Stiftelsen Allmänna Barnhuset; 2011 Abuse type Girls % Boys % Total % Ever been hit by Severe physical abuse a Witnessed Frequently witnessed Emotional abuse by Locked in cellar/closet Multiple types of abuse b Data from Janson S, Jernbro C, Långberg B. Kroppslig bestraffning och annan kränkning av barn i Sverige : en nationell kartläggning Stockholm: Stiftelsen Allmänna Barnhuset;

11 Abuse type Girls % Boys % Total % Ever been hit by Severe physical abuse a Witnessed Frequently witnessed Emotional abuse by Locked in cellar/closet Multiple types of abuse b Data from Janson S, Jernbro C, Långberg B. Kroppslig bestraffning och annan kränkning av barn i Sverige : en nationell kartläggning Stockholm: Stiftelsen Allmänna Barnhuset; 2011 Abuse type Girls % Boys % Total % Ever been hit by Severe physical abuse a Witnessed Frequently witnessed Emotional abuse by Locked in cellar/closet Multiple types of abuse b Data from Janson S, Jernbro C, Långberg B. Kroppslig bestraffning och annan kränkning av barn i Sverige : en nationell kartläggning Stockholm: Stiftelsen Allmänna Barnhuset; 2011 Abuse type Girls % Boys % Total % Ever been hit by Severe physical abuse a Witnessed Frequently witnessed Emotional abuse by Locked in cellar/closet Multiple types of abuse b Data from Janson S, Jernbro C, Långberg B. Kroppslig bestraffning och annan kränkning av barn i Sverige : en nationell kartläggning Stockholm: Stiftelsen Allmänna Barnhuset;

12 Andel kvinnor och män i årsåldern som utsatts för våld under barndomen Typ av våld Andel kvinnor % Andel män % Utsatt för allvarligt fysiskt våld (vid upprepade tillfällen blivit slagen med knytnäve/tillhygge, sparkad, skadad med vapen etc) Utsatt för upprepat psykiskt våld (vid upprepade tillfällen blivit förtryckt, förnedrad, mobbad, kränkt etc) Vid upprepade tillfällen sett/hört våld mellan föräldrarna 6 4 Utsatt för grovt sexuellt våld (med våld påtvingat samlag eller liknande) 13 4 Associations to poor health 12

13 PTSD Depression Hazardous drinking Poor general physical health Psychosomatic symptoms Myocardial infarction 13

14 Drug abuse Alcoholism Chronic obstruktive pulmonary disease (COPD) Depression Late misscarriage Poor health-related quality of life Ischemic heart disease Lever disease Risk för intimate partner violence Many sexual partners Sexually transmitted infections (STI) Smoking Suicide and suicide attempts Unwanted pregnancy Early smoking debut Early sexual debut Teenage pregnancy Children s experiences of abuse and neglect are Common Potentially harmful but Many children at risk are not unhealthy, why is this? 14

15 Resilience Resilience Ability to handle stress effectively Good capacity to solve problems Seeking help A belief that something can be done to deal with difficult feelings and cope Social support Close contact with others, such as friends and family To talk about the trauma with loved ones Spirituality/faith Identifying oneself as a survivor as opposed to a victim Helping others Finding a positive significance for the trauma 15

16 This is where we come in Pediatrics Public information School programs Legislation Child Social services health Children s ombudsman Educated personnel CRC Multiprofessional Child Protection Teams Identification of children at risk Child psychiatry Pediatrics Public information School programs Legislation Child Social services health Children s ombudsman Educated personnel CRC Multiprofessional Child Protection Teams Identification of children at risk Child psychiatry 16

17 Public information Legislation Pediatrics School programs Child Social services health Children s ombudsman Educated personnel CRC Multiprofessional Child Protection Teams Identification of children at risk Child psychiatry Pediatrics Public information School programs Legislation Child Social services health Children s ombudsman Educated personnel CRC Multiprofessional Child Protection Teams Identification of children at risk Child psychiatry Child Protection Team Akademiska sjukhuset Emergency/urgent care Pediatrics NCK/Gynecology Youth health Adult emergency Pediatric surgery Radiology Child health/school health Child psychiatry Barnahus Barn som far illa Social services/kommuner Police/Prosecutors/Law R&D enforcement Research Forensic medicine Quality assurace Child psychiatry Education Regional network Örebro, Prevention Västerås, Borlänge, Gävle, Regional and national efforts Eskilstuna, Karlstad, Uppsala Advocacy 17

18 Tack! 18