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After completing the Pediatric ACEs and Related Life Events Screener for Juan Jr.

 Talk about what you learned from the assessment and how you might use it in practice. Use this format to complete the discussion

· What plans would you make for working with this family based on the identified ACEs? 

· How would you administer the ACEs assessment in this case or other cases involving young children?

Pediatric ACEs and Related Life Events Screener

CHILD

Many families experience stressful life events. Over time these experiences can affect your child’s health and wellbeing. We would like to ask you questions about your child so we can help them be as healthy as possible.

Pediatric ACEs and Related Life Events Screener (PEARLS) CHILD – To be completed by: Caregiver

At any point in time since your child was born, has your child seen or been present when the following experiences happened? Please include past and present experiences.

Please note, some questions have more than one part separated by “OR.” If any part of the question is answered “Yes,” then the answer to the entire question is “Yes.”

PART 1: Please check “Yes” where apply. √

Child (Parent/Caregiver Report) – Identified

1. Has your child ever lived with a parent/caregiver who went to jail/prison?

2. Do you think your child ever felt unsupported, unloved and/or unprotected?

3. Has your child ever lived with a parent/caregiver who had mental health issues? (for example, depression, schizophrenia, bipolar disorder, PTSD, or an anxiety disorder)

4. Has a parent/caregiver ever insulted, humiliated, or put down your child?

5. Has the child’s biological parent or any caregiver ever had, or currently has a problem with too much alcohol, street drugs or prescription medications use?

6. Has your child ever lacked appropriate care by any caregiver? (for example, not being protected from unsafe situations, or not cared for when sick or injured even when the resources were available)

7. Has your child ever seen or heard a parent/caregiver being screamed at, sworn at, insulted or humiliated by another adult?

Or has your child ever seen or heard a parent/caregiver being slapped, kicked, punched beaten up or hurt with a weapon?

8. Has any adult in the household often or very often pushed, grabbed, slapped or thrown something at your child?

Or has any adult in the household ever hit your child so hard that your child had marks or was injured?

Or has any adult in the household ever threatened your child or acted in a way that made your child afraid that they might be hurt?

9. Has your child ever experienced sexual abuse? (for example, anyone touched your child or asked your child to touch that person in a way that was unwanted, or made your child feel uncomfortable, or anyone ever attempted or actually had oral, anal, or vaginal sex with your child)

This tool was created in partnership with UCSF School of Medicine.

10. Have there ever been significant changes in the relationship status of the child’s caregiver(s)? (for example, a parent/caregiver got a divorce or separated, or a romantic partner moved in or out)

Please continue to the other side for the rest of questionnaire

How many “Yes” did you answer in Part 1?:

PART 2: Please check “Yes” where apply.

Child (Parent/Caregiver Report) – Identified

√ 1. Has your child ever seen, heard, or been a victim of violence in your neighborhood,

community or school? (for example, targeted bullying, assault or other violent actions, war or terrorism)

2. Has your child experienced discrimination? (for example, being hassled or made to feel inferior or excluded because of their race, ethnicity, gender identity, sexual orientation, religion, learning differences, or disabilities)

3. Has your child ever had problems with housing? (for example, being homeless, not having a stable place to live, moved more than two times in a six-month period, faced eviction or foreclosure, or had to live with multiple families or family members)

4. Have you ever worried that your child did not have enough food to eat or that the food for your child would run out before you could buy more?

5. Has your child ever lived with a parent/caregiver who had a serious physical illness or disability?

6. Has your child ever been separated from their parent or caregiver due to foster care, or immigration?

7.

Has your child ever lived with a parent or caregiver who died?

How many “Yes” did you answer in Part 2?:

This tool was created in partnership with UCSF School of Medicine.

  • Pediatric ACEs and Related Life Events Screener (PEARLS)
    • PART 1:
    • PART 2:
  1. Part 1: 1:
    1. Has your child ever lived with a parent/caregiver who went to jail/prison?: Off
  2. Part 1: 2:
    1. Do you think your child ever felt unsupported, unloved and/or unprotected?: Off
  3. Part 1: 3:
    1. Has your child ever lived with a parent/caregiver who had mental health issues? (for example, depression, schizophrenia, bipolar disorder, PTSD, or an anxiety disorder): Off
  4. Part 1: 4:
    1. Has a parent/caregiver ever insulted, humiliated, or put down your child?: Off
  5. Part 1: 5:
    1. Has the child’s biological parent or any caregiver ever had, or currently has a problem with too much alcohol, street drugs or prescription medications use?: Off
  6. Part 1: 6:
    1. Has your child ever lacked appropriate care by any caregiver? Has your child ever lacked appropriate care by any caregiver?: Off
  7. Part 1: 7:
    1. Has your child ever seen or heard a parent/caregiver being screamed at, sworn at, insulted or humiliated by another adult? Or has your child ever seen or heard a parent/caregiver being slapped, kicked, punched beaten up or hurt with a weapon?: Off
  8. Part 1: 8:
    1. Has any adult in the household often or very often pushed, grabbed, slapped or thrown something at your child? Or has any adult in the household ever hit your child so hard that your child had marks or was injured? Or has any adult in the household ever threatened your child or acted in a way that made your child afraid that they might be hurt?: Off
  9. Part 1: 9:
    1. Has your child ever experienced sexual abuse? (for example, anyone touched your child or asked your child to touch that person in a way that was unwanted, or made your child feel uncomfortable, or anyone ever attempted or actually had oral, anal, or vaginal sex with your child): Off
  10. Part 1: 10:
    1. Have there ever been significant changes in the relationship status of the child’s caregiver(s)? (for example, a parent/caregiver got a divorce or separated, or a romantic partner moved in or out): Off
  11. How many "Yes" did you answer in Part 1?:
  12. Part 2: 1:
    1. Has your child ever seen, heard, or been a victim of violence in your neighborhood, community or school?: Off
  13. Part 2: 2:
    1. Has your child experienced discrimination? (for example, being hassled or made to feel inferior or excluded because of their race, ethnicity, gender identity, sexual orientation, religion, learning differences, or disabilities): Off
  14. Part 2: 3:
    1. Has your child ever had problems with housing? (for example, being homeless, not having a stable place to live, moved more than two times in a six-month period, faced eviction or foreclosure, or had to live with multiple families or family members): Off
  15. Part 2: 4:
    1. Have you ever worried that your child did not have enough food to eat or that the food for your child would run out before you could buy more?: Off
  16. Part 2: 5:
    1. Has your child ever been separated from their parent or caregiver due to foster care, or immigration?: Off
  17. Part 2: 6:
    1. Has your child ever lived with a parent/caregiver who had a serious physical illness or disability?: Off
  18. Part 2: 7:
    1. Has your child ever lived with a parent or caregiver who died?: Off
  19. How many "Yes" did you answer in Part 2?:
  20. Text1:
  21. Text2:

,

1

© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).

Sessions: Case histories. Laureate International Universities Publishing.

Hernandez Family

Juan Hernandez (27) and Elena Hernandez (25) are a married Latino couple who were

referred to the New York City Administration for Children Services (ACS) for abuse

allegations. They have an 8-year-old son, Juan Jr., and a 6-year-old son, Alberto. They

were married 7 years ago, soon after Juan Jr. was born. Juan and Elena were both born

in Puerto Rico and raised in Queens, New York. They rent a two-bedroom apartment in

an apartment complex where they have lived for 7 years. Elena works as babysitter for

a family that lives nearby, and Juan works at the airport in the baggage department.

Overall, their physical health is good, although Elena was diagnosed with diabetes this

past year and Juan has some lower back issues from loading and unloading bags.

They both drink socially with friends and family. Juan goes out with friends on the

weekends sometimes to “blow off steam,” having six to eight beers, and Elena drinks

sparingly, only one or two drinks a month. Both deny any current drug use. While they

do not attend church regularly, both identify as being Catholic and observe all religious

holidays. Juan was arrested 4 years ago for drug possession and was sentenced to 6

months in jail. Elena has no criminal history. They have a large support network of

friends and family who live nearby, and both Elena’s and Juan’s parents live within

blocks of their apartment and visit frequently. Juan and Elena both enjoy playing cards

with family and friends on the weekends and taking the boys out to the park and beach

near their home.

ACS was contacted by the social worker from Juan Jr.’s school after he described a

punishment his parents used when he talked back to them. Juan Jr. told the social

worker that his parents made him kneel for hours while holding two large books (one in

each hand) and that this was a punishment used on multiple occasions. The ACS

worker deemed this a credible concern and made a visit to the home. During the visit,

the parents admitted to using this particular form of punishment with their children when

they misbehaved. In turn, the social worker from ACS mandated the family to attend

weekly family sessions and complete a parenting group at their local community mental

health agency.

In her report sent to the mental health agency, the ACS social worker indicated that the

form of punishment the parents used was deemed abusive and that the parents needed

to learn new and appropriate parenting skills. She also suggested they receive

education about child development because she believed they had unrealistic

expectations of how children at that developmental stage should behave. This was a

particular concern with Juan Sr., who repeatedly stated that if the boys listened, stayed

quiet, and followed all of their rules, they would not be punished. There was a sense

from the ACS worker that Juan Sr. treated his sons, especially Juan Jr., as adults and

not as children. This was exhibited, she believed, by a clear lack of patience and

understanding on his part when the boys did not follow all of his directions perfectly, or

when they played in the home. She mandated family sessions along with the parenting

classes to address these issues.

2

© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).

Sessions: Case histories. Laureate International Universities Publishing.

Intake Session

During the intake session, when I met the family for the first time, both Juan and Elena

were clearly angry that they had been referred to parenting classes and family sessions.

They both felt they had done nothing wrong, and they stated that they were only

punishing their children as they were punished as children in Puerto Rico. They said

that their parents made them hold heavy books or bags of sand as they kneeled, and

they both stressed that at times the consequences for not behaving had been much

worse. Both Juan and Elena were “beaten” (their term) by their parents. Elena’s parents

used a switch, and Juan’s parents used a belt. As a result, they feel they are actually

quite lenient with their children, and they said they never hit them and they never would.

Both stated that they love their children very much and struggle to give them a good life.

They both stated that the boys are very active and don’t always follow the rules, and the

kneeling punishment is the only thing that works when they “don’t want to listen.”

They both admitted that they made the boys hold two large books for up to 2 hours

while kneeling when they did something wrong. They stated the boys are “hyperactive”

and “need a lot of attention.” They said they punish Juan Jr. more often because he is

particularly defiant and does not listen and also because he is older and should know

better. They see him as a role model for his younger brother and feel he should take

that responsibility to heart. His misbehavior indicates to them that he is not taking that

duty seriously and should therefore be punished, both to learn his lesson and to show

his younger brother what could happen if he does not behave.

During the intake session, Juan Sr. stated several times that he puts in overtime any

time he can because money is “tight.” He expressed great concern about having to

attend the parenting classes and family sessions, as it would interfere with that

overtime. Elena appeared anxious during the initial meeting and repeatedly asked if

they were going to lose the boys. I told her I could not assure her that they would not,

but I could assist her and her husband through this process by making sure we had a

plan that satisfied the ACS worker’s requirements. I told them it would be up to them to

complete those plans successfully. I offered my support through this process and

conveyed empathy around their response to the situation.

Classes and Family Sessions

Treatment consisted of weekly parenting classes with the goal of teaching them

effective and safe discipline skills (such as setting limits through the use of time-out and

taking away privileges). Further, the classes emphasized the importance of recognizing

age-appropriate behavior. We spent sessions reviewing child development techniques

to help boost their children’s self-esteem and sense of confidence. We also talked about

managing one’s frustration (such as when to take a break when angry) and helping their

children to do the same.

Family sessions were built around helping the family members express themselves in a

safe environment. The parents and the children were asked to talk about how they felt

3

© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).

Sessions: Case histories. Laureate International Universities Publishing.

about each other and the reason they were mandated to treatment. They were asked to

share how they felt while at home interacting with one another. I thought it was of

particular importance to have them talk about their feelings related to the call to ACS, as

I was unsure how Juan Sr. felt about Juan Jr.’s report to the social worker. It was

necessary to assist them with processing this situation so that there were no residual

negative feelings between father and son. I asked them to role-play—having each

member act like another member of the household. This was very effective in helping

Juan Sr. see how his boys view him and his behavior toward them when he comes

home from work. As a result of this exercise, he verbalized his newfound clarity around

how the boys have been seeing him as a very angry and negative father.

I also used sessions to explore the parents’ backgrounds. Using a genogram, we

identified patterns among their family members that have continued through

generations. These patterns included the use of discipline to maintain order in the home

and the potentially unrealistic expectations the elders had for their children and

grandchildren. Elena stated that she was treated like an adult and had the

responsibilities of a person much older than herself while she was still very young. Juan

Sr. said he felt responsible for bringing money into the home at an early age. He was

forced by his parents to get working papers as soon as he turned 14. His paychecks

were then taken by his parents each week and used to pay for groceries and other bills.

He expressed anger at his parents for encouraging him to drop out of high school so

that he could get more than one job to help out with the finances.

Other sessions focused on the burden they felt related to their finances and how that

burden might be felt by the boys, just as Juan Sr. might have felt growing up. In one

session, Juan Jr. expressed his fears of being evicted and the lights being turned off,

because his father often talked of not having money for bills. Both boys expressed

sadness over the amount of time their father spent at work and stressed their desire to

do more things with him at night and on the weekends. Juan Jr. discussed memories of

his father’s incarceration and the visits to the jail, where “it was cold” and “the men were

scary.” He said he sometimes feels his father could be taken away again at any

moment. Both parents stated they did not realize the boys understood their anxieties

around paying bills and felt sad that they worried about these issues. We also took a

couple of sessions to address money management. We worked together to create a

budget and identify unnecessary expenses that might be eliminated.

It was clear that this was a family that loved each other very much. Juan Sr. and Elena

were often affectionate with each other and their sons. Once the initial anger subsided,

both Juan Sr. and Elena fully engaged in both the family sessions and the parenting

classes. We assessed their progress monthly and highlighted that progress. I also was

aware that it was important to learn about the Hernandez family history and culture in

order to understand their perspective and emotions around the ACS referral. I asked

them many questions about their beliefs, customs, and culture to learn about how they

view parenthood, marriage roles, and children’s behaviors. They were always open to

4

© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).

Sessions: Case histories. Laureate International Universities Publishing.

these questions and seemed pleased that I asked about these things rather than

assumed I knew the answers.

,

Men-s-and-women-s-views-on-acceptability-of-husband-to-wife-vi_2020_Child-Ab.pdf

Child Abuse & Neglect 108 (2020) 104692

Available online 22 August 2020 0145-2134/© 2020 Elsevier Ltd. All rights reserved.

Men’s and women’s views on acceptability of husband-to-wife violence and use of corporal punishment with children in 21 low- and middle-income countries

Jennifer E. Lansford a,*, Susannah Zietz a, Diane L. Putnick b, Kirby Deater-Deckard c, Robert H. Bradley d, Megan Costa d, Gianluca Esposito e, Marc H. Bornstein b, f

a Duke University, Durham, NC, USA b Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA c University of Massachusetts at Amherst, Amherst, MA, USA d Arizona State University, Tucson, AZ, USA e University of Trento, Italy and Nanyang Technological University, Singapore f UNICEF, New York City, NY, USA; Institute for Fiscal Studies, London, UK

A R T I C L E I N F O

Keywords: Attitudes Child abuse Corporal punishment International Intimate partner violence

A B S T R A C T

Background: Monitoring violence against women and children, and understanding risk factors and consequences of such violence, are key parts of the action plan for the Sustainable Development Goals (SDGs) set by the United Nations General Assembly in 2015. Objective: We examined how men’s and women’s views about the acceptability of husband-to-wife violence are related within households and how views about the acceptability of husband-to-wife violence are related to beliefs in the necessity of using corporal punishment to rear children and to reported use of corporal punishment with children. Participants and Setting:We used nationally representative samples of men and women in 37,641 households in 21 low- and middle-income countries that participated in UNICEF’s Multiple In- dicator Cluster Survey. Methods: We conducted a series of logistic regression models, controlling for clustering within country, with outcomes of whether participants believe corporal punishment is necessary in childrearing, and whether a child in their household experienced corporal punishment in the last month. Results: In 46 % of households, men, women, or both men and women believed husbands are justified in hitting their wives. Children in households in which both men and women believe husbands are justified in hitting their wives had 1.83 times the odds of experiencing corporal punishment as children in households in which neither men nor women believe husbands are justified in hitting their wives (95 % CI: 1.12, 2.97). Conclusions: Working toward the realization of SDG 5 and SDG 16 involving prevention of violence against women and children, respectively, should be complementary undertakings.

* Corresponding author. E-mail address: [email protected] (J.E. Lansford).

Contents lists available at ScienceDirect

Child Abuse & Neglect

journal homepage: www.elsevier.com/locate/chiabuneg

https://doi.org/10.1016/j.chiabu.2020.104692 Received 11 December 2019; Received in revised form 16 June 2020; Accepted 12 August 2020

Child Abuse & Neglect 108 (2020) 104692

2

1. Introduction

Violence against women and children is a public health problem with long-term negative outcomes for the victims themselves, risks of cycles of intergenerational violence, and high economic and social costs to countries (World Bank, 2019). Worldwide prevalence rates of household violence are high, with 20 % of women and girls between the ages of 15 and 49 reporting experiencing physical or sexual violence by an intimate partner in the last year (United Nations, 2019), and approximately 1 billion children between the ages of 2 and 17 experiencing physical, sexual, or emotional abuse in the last year (World Health Organization, 2018).

The United Nations (1979) Convention on the Elimination of All Forms of Discrimination against Women and the United Nations (1989) Convention on the Rights of the Child identified violence toward women and children, respectively, as problems to be elim- inated at a national level. The World Health Organization (WHO) noted that the Sustainable Development Goals (SDG), set by the United Nations General Assembly in 2015 to reach by 2030, represent the first time that prevention of violence against women and children has reached the international development agenda (García-Moreno & Amin, 2016). SDG Target 5.2 is to eliminate all forms of violence against women and girls, and Target 16.2 is to end abuse, exploitation, trafficking, and all forms of violence against and torture of children. Indicators of whether countries have achieved these targets include the proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual, or psychological violence by a current or former intimate partner in the previous 12 months (Indicator 5.2.1) and the proportion of children aged 1–17 years who experienced any physical punishment and/or psychological aggression by caregivers in the past month (Indicator 16.2.1).

Children develop attitudes about the acceptability of violence in part from the ways in which they are treated by parents, peers, and others and from observing societal norms about violence. For example, children who have been spanked are more likely to report believing that spanking is an appropriate form of discipline than are children who have not been spanked (Deater-Deckard, Lansford, Dodge, Pettit, & Bates, 2003). Likewise, children who witness violence between their parents are themselves more likely to abuse an intimate partner in adulthood (Smith, Ireland, Park, Elwyn, & Thornberry, 2011). The cultural spillover theory of violence holds that violence in one domain tends to generalize (spill over) into other domains (Baron & Straus, 1989; Baron, Straus, & Jaffee, 1988). Empirical support for spillover theory has been found in anthropologic studies demonstrating that corporal punishment of children is more frequent in societies that also have more other forms of interpersonal violence (Lansford & Dodge, 2008).

Data from 25 low- and middle-income countries (LMIC) demonstrated that women who believed that husbands were justified in hitting their wives were more likely to believe that it is necessary to use corporal punishment to rear children and were more likely to report that children in their household had experienced corporal punishment and psychological aggression (Lansford, Deater-Deckard, Bornstein, Putnick, & Bradley, 2014). Societal norms about the acceptability of husband-to-wife violence and corporal punishment also moderated the link between caregivers’ individual attitudes about the necessity of using corporal punishment and children’s experience of corporal punishment, suggesting that, in countries in which violence is more accepted, corporal punishment may be caregivers’ default response, regardless of whether they personally believe it is necessary for childrearing. By contrast, in countries in which violence is less accepted, caregivers’ personal attitudes may be more predictive of their use of corporal punishment in childrearing.

What is conspicuously missing from such investigations are data on men’s views of the acceptability of husband-to-wife violence; such data are crucial to understanding both intimate partner violence and ways in which parents’ attitudes about the acceptability of violence are related to corporal punishment of children. “Dyadic concordance types” have been described in relation to whether just the mother, just the father, both parents, or neither parent uses corporal punishment, with more antisocial behavior reported by young adults who were corporally punished by both parents (Rebellon & Straus, 2017). What is unknown is whether concordance between the views of men and women within a particular family in relation to perceptions of the acceptability of husband-to-wife violence and beliefs about the necessity of using corporal punishment to rear a child properly are related to whether anyone in the household uses corporal punishment with the child. It is possible that endorsement of husband-to-wife or parent-to-child violence by either the mother or father is sufficient to increase the likelihood of corporal punishment. It is also possible that concordance (or discordance) between men’s and women’s endorsement of violence, as well as whether it is men or women who endorse violence, is important to under- standing violence within the family. Because power imbalances between men and women in many countries contribute to violence against women (Jewkes, Flood, & Lang, 2015), a key objective of the present study is to understand both men’s and women’s views regarding husband-to-wife and parent-to-child violence.

The present study therefore addresses two questions. First, how are men’s views about the acceptability of husband-to-wife violence related to the attitudes of women in their household about the acceptability of husband-to-wife violence? We hypothe- sized significant concordance between the views of men and women in the same household regarding the acceptability of husband-to- wife violence because both men’s and women’s views regarding the acceptability of violence are related to norms of their culture. Second, how are men’s and women’s views about the acceptability of husband-to-wife violence related to beliefs in the necessity of using corporal punishment to rear children and to the reported use of corporal punishment with children. Grounded in the cultural spillover theory of violence and prior research suggesting links between different forms of family violence, we hypothesized that in households in which men and women believed husbands were justified in hitting their wives, caregivers would be more likely to believe that corporal punishment is necessary to rear children and to use corporal punishment.

J.E. Lansford et al.