Turning Point Curriculum

Turning Point Understanding Child Abuse

A CURRICULUM FOR STAFF OF KING COUNTY SEXUAL ASSAULT RESOURCE CENTER

Turning Point Understanding Child Abuse

A CURRICULUM FOR STAFF OF KING COUNTY SEXUAL ASSAULT RESOURCE CENTER

Copyright © 2011 King County Sexual Assault Resource Center All rights reserved Design © www.DebiBodett.com This curriculum may not be reproduced in whole or in part without permission of: King County Sexual Assault Resource Center 200 Mill Avenue South, Suite 10 PO Box 300 Renton, Washington 98057

www.kcsarc.org

A 10-Session Program for Parents OFFERED IN PERSON, BY PHONE, AND INTERNET

Turning Point Understanding Child Abuse TABLE OF CONTENTS Session 1 Understanding Child Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Session 2 Child Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Session 3 Impact of Child Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Session 4 Needs of the Abused and Neglected Child. . . . . . . . . . . . . 15 Session 5 Positive Communication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Session 6 Coping with Stress and Trauma.. . . . . . . . . . . . . . . . . . . . . . . . . 23 Session 7 Risk and Protective Factors in Child Abuse and Neglect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Session 8 Discipline Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Session 9 Getting Kids to Do What You Tell Them to Do.. . . . . . . . . . . . 47 Session 10 Review Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 7 Stages of Grief Through the Process and Back to Life.. . . . . . . . . . . . . . . . . . . 55

Session 1

Understanding Child Abuse

Turning Point • Session 1: Understanding Child Abuse

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Session 1: Understanding Child Abuse The terrible fact is, child abuse and child neglect can and does occur in any community. There is never an excuse for child abuse, but some contributing factors are emotional stress, economic stress, and unrealistic expectations of ourselves as parents and our children.

Child Abuse Defined Each state defines child abuse and neglect based on minimum standards set by Federal law. The Federal Child Abuse Prevention and Treatment Act defined child abuse and neglect as, at minimum: •

Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or

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An act or failure to act which presents an imminent risk of serious harm.

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Types of Child Abuse and Neglect Physical Abuse is non-accidental physical injury inflicted on a child by a parent, guardian, or caregiver.

It includes: •

Less Severe - bruises, welts, red marks, abrasions, lacerations, wounds, cuts, punctures

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More Severe - bone fractures, skull fractures, internal injuries, burns, scalding, poisoning, subdural hemorrhage, brain damage

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Death

Neglect* is the failure of a parent, guardian, or other caregiver to provide for a child’s needs.

Neglect includes: •

Unmet Basic Needs – lack of food, lack of appropriate clothing, unsanitary living conditions, poor hygiene, unsafe shelter, lack of heat

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Lack of Supervision or Proper Care – abandonment, inadequate supervision, repeated ingestion of substances, over medicating, inappropriately giving drugs, heat exhaustion, freezing

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Medical – untreated illness or injury, severely untreated dental problems, failure to give needed medications, unmet mental health needs, sprains, dislocations, malnutrition, failure to thrive

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Educational – lack of schooling, unmet special education needs

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Emotional – verbal abuse, blaming, threatening, rejection, apathy toward child, locking in or out of the home, expelling from home, permitting the child to use alcohol or other drugs

*These situations do not always mean a child is neglected. Sometimes cultural values, the standards of care in the community, and poverty may be contributing factors, indicating the family is in need of information or assistance. In addition, many States provide an exception to the definition of neglect for parents who choose not to seek medical care for their children due to religious beliefs that may prohibit medical intervention.

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Turning Point • Session 1: Understanding Child Abuse

Sexual Abuse includes any situations in which children are being used for someone else’s sexual gratification. This can range from hands-on abuse, such as fondling, oral sex or intercourse to exposure to sexual material (pornographic pictures or X-rated movies).

Some examples of sexually abusive behaviors include: •

Touching of child’s genitals

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Asking a child to touch older person’s genitals

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Making a child touch another person’s genitals

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Any oral-genital contact

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Attempts or actual penetration of the vagina or anus

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Showing and/or producing pornography

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Watching a child in various stages of undress, whether the child is aware of being observed or not

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Offering a child a gift or reward in exchange for sexual touch/activity

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Forcing and/or encouraging children to engage in sexual behavior with each other

It is important to note that children cannot consent to sexual activity until they are of a certain age (16 years in WA state). It is also important to realize that child sexual abuse ALWAYS negatively impacts the victim, even if it’s not immediately apparent.

Emotional Abuse (or psychological abuse) is a pattern of behavior that impairs a child’s emotional development or sense of self-worth. This may include constant criticism, threats, or rejection, as well as withholding love, support, or guidance. Emotional abuse is almost always present when there are other forms of abuse.

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Substance Abuse is within the definition of child abuse or neglect in many States. Some of the behaviors included in this definition are: •

Prenatal exposure of a child to harm due to the mother’s use of an illegal drug or other substance

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Manufacture of methamphetamine in the presence of a child

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Selling, distributing, or giving illegal drugs or alcohol to a child

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Use of a controlled substance by a caregiver that impairs the caregiver’s ability to adequately care for the child

Family History The cycle of abuse is undeniable, meaning that it occurs in a repeating pattern. This cycle of abuse can occur in two ways; generational and episodic. Generational cycles of abuse are passed down, by example and exposure, from parents to children. Episodic abuse occurs in a repeating pattern within the context of at least two individuals within a family system. This involves spousal abuse, child abuse, and/or elder abuse.

A son, who is repeatedly either verbally or physically abused by his father, will predictably treat his own children in the same way. When a daughter hears her mother frequently tear down, belittle, and criticize her father, she will adapt a learned behavior which involves control through verbal abuse. Similarly, a child who witnesses his parents engaging in abusive behaviors toward one another, will very likely subject his or her spouse to the same abusive patterns. These are examples of generational abuse.

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Turning Point • Session 1: Understanding Child Abuse

Session 2

Child Development

Turning Point • Session 2: Child Development

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Session 2: Child Development Child Perspective In a child’s words: It’s abuse when a parent or other person in charge of taking care of a child acts in ways or uses hurtful words that make the child feel very bad about themselves. Most of the time the person makes the child feel like everything is always their fault, that they are a bad kid, that no one loves them because they are not good enough to be loved.

Research indicates physically abused kids blame themselves for all but the most serious mistreatment.

At the same time, children who are emotionally and/or sexually abused most commonly accept the blame for all of the abuse and believe the words of their abusers. Children experiencing neglect usually believe they “get what they deserve.” Verbally abused children are more angry and more pessimistic about their future. Physical abuse appears to make some children feel they were unwanted from birth.

Normal Child Development Every child is unique, but there are general patterns of physical, emotional, and social development from birth through adolescence. Some children achieve developmental milestones earlier or later than others, but are still within the “normal” range. The information you receive here is only a guideline of what to expect from your child. It is not meant to take the place of regular visits with his or her pediatrician.

It is not uncommon for adults to use harsh and/or abusive behaviors toward a child when they are frustrated or angry with the child. Abuse also happens when children do (or don’t do) certain things demanded by the parent. In many instances the parent’s frustration is due to having unrealistic expectations of the child in relation to the child’s age and/or development. For that reason, it is important to understand the broad range of normal child development.

There are several different models used to describe normal child development. You can use these to evaluate and track your child’s developmental progress.

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Goals Program Goals 1. Participant can explain the difference between discipline and abuse.

2. Participant can identify at least two normal developmental milestones for the age of children in participant’s care, or previously in participant’s care.

3. Participant can identify two age-appropriate teaching/discipline strategies for each child in participant’s care, or previously in participant’s care.

4. Participant can identify at least two coping skills, and talk about at least one that works for him/ her.

5. Participant can name a risk factor and a protective factor.

6. Participant can name two personal/familial strengths.

7. Parent can name and give an example of the PRIDE Skills (children age 2-8 years) or PLAIN Talk skills (children age 9-18 years).

8. Participant can name and explain two way to build resilience.

Participant Goals Self identified (at least 3) 1.

2.

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System identified (CPS, Family Court) 1.

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Turning Point • Session 2: Child Development

Session 3

Impact of Child Abuse

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Session 3: Impact of Child Abuse Brain Development Many people are surprised to learn that a child’s brain development is negatively impacted by violence.

The younger the child at the time of abuse, the greater the impact will be. Early abuse may permanently alter the child’s ability to “feel good.” It also reduces a child’s ability to function in an environment that is stimulating, kind, and nurturing.

Emotional and Behavioral Impact of Impaired Brain Development Due to Abuse and Neglect Persistent Fear Response Child abuse is seldom a one-time event. Rather, it involves repeated behaviors that are physically and emotionally painful and damaging to the child. Children become highly fearful and stressed as they recover from one abusive interaction while anticipating the next one. The repeated traumas and chronic related stress can result in a persistently fearful state of mind, affecting brain chemistry, and causing problems with attention, impulse control, sleep, and fine motor control. If the changes in brain chemistry persist, certain parts of the brain can “wear out,” resulting in diminished cognitive and memory development. Over time, the persistent fear response permanently alters the child’s perception of and response to his environment. While this alteration can be critical to survival in a hostile world, it becomes problematic when the environment changes to one that is safe and nurturing, and the child continues to respond and interact from a position of fear.

Hyperarousal When children are exposed to chronic traumatic stress, their brains become highly sensitized to the fear response, triggering the mind and body reactions without conscious thought. These children have an altered baseline, causing them to overact to stimuli that other children would find non-threatening.

They may be highly sensitive to non-verbal cues such as eye contact or a gentle touch on their arm, which they perceive as threatening. Because their brains are so intensely focused on possible threats, they may have trouble becoming relaxed enough to learn.

Dissociation Infants and children who are victims of repeated abuse may respond to that abuse by mentally and emotionally removing themselves from a horrible situation. Dissociation allows the child to detach themselves from their physical body so that the abuse becomes “not real.” While dissociating can be an effective tool for surviving the abuse, it becomes problematic when it is triggered by everyday events that are non-threatening. It can interrupt the learning process and get in the way of normal child development.

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Disrupted Attachment Attachment is most simply defined as the emotional relationships we have with other people. The newborn brain is “hardwired” to begin bonding and attachment from the moment of birth. It is also the foundation of other learning, because infants and children learn best when they feel safe, calm, nurtured, and protected by their caregivers.

Babies who have positive interactions with at least one caregiver develop secure attachment. Securely attached children have better self esteem and self-confidence. They believe they are lovable and worthy of care and attention. They even develop stronger immune systems. Children with secure attachments are more optimistic and have greater resilience despite hardship. The emotional stability that securely attached infants experienced promotes brain development and learning ability.

Insecure attachment can result from child abuse and/or neglect. There are some behaviors that are common in child who have been abused including: •

Developmental Delays – brain and body are focused on survival

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Eating Problems – hoarding, failure to thrive, swallowing problems, vomiting

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Soothing Behaviors – primitive, immature, even bizarre such as biting themselves, head banging, rocking, chanting, scratching or cutting themselves

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Emotional Functioning – a range of problems including depression and anxiety. Indiscriminate attachment is common and is actually a “safety seeking” behavior.

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Inappropriate Modeling – children repeat the behaviors they have seen

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Aggression – a major problem with these children is aggression and cruelty

Neglected children tend to lack empathy and have poor impulse control. They feel compelled to lash out and hurt others; typically those younger or less powerful than themselves. They may show regret, but are seldom remorseful.

Resilience Skill #1 Emotional Regulation/Impulse Control Some children need help learning how to control their emotional reactions to events. Negative emotions can be healthily expressed, and parents can teach children positive and/or neutral ways to share their feelings. Talking, deep breathing, and physical exercise are some examples.

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Turning Point • Session 3: Impact of Child Abuse

Session 4

Needs of the Abused and Neglected Child

Turning Point • Session 4: Needs of the Abused and Neglected Child

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Session 4: Needs of the Abused and Neglected Child •

Child may not perceive treatment as violence or abuse.

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Unfortunately, children can become “habituated” or accustomed to certain situations as “normal” or expected. It does not mean there is no abuse; it means that the child perceives the abuse as normal behavior.

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Many kids will not answer “yes” to the question of abuse, especially physical, or emotional, because it may be “business as usual” in their home.

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This is not unlike the way people can get used to sleeping in houses right near a railroad or on high traffic areas.

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More often than not the child who has been exposed to domestic violence in the home has also been physically abused, neglected, emotionally or even sexually abused.

Nurture these children: Children with a history of abuse or neglect need to be held, rocked, cuddled, and nurtured. It may be difficult for them to tolerate both physical touch and kind behavior, because previous touch and interaction is associated with pain, torture, or sexual abuse. Be patient, as it can take a very long time to learn to trust caregivers and their intentions.

Parent these children based on their emotional age (rather than chronological age): Abused and neglected children are frequently emotionally and socially delayed. When they are distressed (fearful, frustrated, tired, overwhelmed), they may immediately regress to a very young age. Suddenly your ten year old may behave like a whiney two year old. Your insistence that they “act their age” will be met with resistance, and for good reason. They are incapable of doing so at that time. Instead, nurture them in ways appropriate to the age of their behavior. Use non-verbal soothing interactions such as rocking, singing, holding them gently, and talking in a quiet voice.

Be consistent and predictable, and always follow through: Learning to trust again is difficult and goes against their survival instinct. Abused children need safe experiences over and over again.

Caregivers need to be predictable so that children can begin to expect safety and security. New or chaotic social situations may be overwhelming and disorganizing. Try to prepare them for these events as far in advance as is possible.

Model appropriate behaviors: Many abused and neglected children have only learned inappropriate ways of interacting with others. The best way to teach them positive social skills is to model them.

Narrate what you’re doing as you go, in play-by-play fashion. This increases learning as children are taking in the new information both visually and audibly.

In addition to narrating your own behavior, you can “coach” their behavior by using play-by-play descriptions of appropriate behavior you want them to use “in the moment.” Acknowledge and praise their use of pro-social behaviors.

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Another area that these children struggle with is socially appropriate physical boundaries and contact.

They are often unaware of how close to sit or stand by someone, when to hug, when and how long to maintain eye contact, and the difference between a stranger, an acquaintance, and a close friend, relative, or caregiver. They are also unfamiliar with social etiquette in regards to picking their nose, touching their genitals, and appropriate topics of conversation.

Listen – Play – Converse: When you take the time to listen to these children, they will explain things from their perspective. It is during these moments that you will gain insight into what they are thinking and why they do the things they do.

Play is vital to children’s growth and development. It is of great benefit to the child to have parents and adult caregivers play alongside them. Letting the child lead the play will maximize the benefits.

Abused and neglected children learn to shut off their painful and negative emotions. Over time, they begin to shut off all emotion, negative and positive. It is important for parents and caregivers to talk about emotions and feelings, letting children know that there are no “bad” feelings. All feelings are OK to feel. To help with this, parents should identify, name and explain feelings, along with teaching healthy ways to express them.

Have Realistic Expectations: Children who have been neglected or abused may not function at the level of their chronological age socially, emotionally, physically, and cognitively. They may be unable to control their emotions, have frequent outbursts, be quiet or submissive, have difficulty learning, struggle making and retaining friendships, have unusual eating or sleeping habits, be verbally or physically aggressive, and/or be unresponsive to physical or verbal affection.

Don’t move too quickly to punishment or consequences: There are many challenging behaviors common to maltreated children. It is important to remember that the child adopted these behaviors as a means for survival. In many ways, that the child employed these actions is nothing short of ingenious.

It can take years for a child to drop these behaviors, because to do so can bring on feelings of imminent danger. Trying to understand the root of troublesome behaviors will better serve the child and the parent.

Resilience Skill #2 Optimism Children who are optimistic are better equipped to meet the challenges of change in the home, and the impact of abuse and neglect. Parents and caregivers can help develop a sense of optimism in children by explaining events in these terms: Negative Events: Temporary (having a distinct beginning and end), Specific (limited to a specific event), and External (the action or event was bad, not the child.

Good Events: Permanent (long lasting), Global (larger than a particular moment), and Internal (the child is part of the good thing).

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Turning Point • Session 4: Needs of the Abused and Neglected Child

Session 5

Positive Communication

Turning Point • Session 5: Positive Communication

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Session 5: Positive Communication Behavior is influenced by many factors, some positive and some negative. One of the strongest predictors of behavior is whether the behavior will result in something desirable. If a person expects a positive outcome from a behavior, or thinks there is a high probability of a positive outcome, they will probably engage in that behavior. With the positive outcome, the behavior is reinforced, leading a person to repeat the behavior.

Strategic Attention Theory Attention is a reward for children. Young children will work for their parents’ attention. Therefore, providing strategic attention in the form of positive language, eye contact, and physical affection following specific behaviors will cause those behaviors to increase in frequency and duration.

Negative attention (yelling, lecturing and even physical aggression) can also increase specific behaviors.

Abused and neglected children have usually received more, and more intense, attention for misbehavior than for appropriate behavior. Consequently, the child’s misbehavior was reinforced and continued to occur. In other words, some attention was better than no attention at all. These children found that they could not alter the abusive behavior, and deduced that they were to blame for the poor treatment they received.

The strategic and meaningful use of positive language can significantly improve a child’s behavior.

PRIDE Skills: (for children age 2 to 12 years) Praise, Reflect, Imitate, Describe, Enjoy PLAIN Talk with Adolescents: Praise, Listen, Attitude, Initiate, Negotiate

Resilience Skill #3 Causal Analysis Children need to make sense of the events that occur in their lives. Due to their limited knowledge and experience, they often create inaccurate explanations for circumstances and events. It is important that children have an accurate and age appropriate understanding of the events that have occurred.

They know that something “bad” occurred, and parents can help by providing a basic explanation in these terms: Personal (individual child vs adults) Permanent (always vs for awhile or for now) Pervasive (everything vs not everything)

Review Goals

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Session 6

Coping with Stress and Trauma

Turning Point • Session 6: Coping with Stress and Trauma

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Session 6: Coping with Stress and Trauma Most of what children know about people and the world comes from their environment and the people they live with. They learn what is right or wrong through experience and the response of the people they live with. The adult caregivers have the greatest influence on the child’s learning and ability to cope with events, good and bad.

Many of the coping strategies that children utilize are not consciously developed by the child, but rather impulsively engaged. For the most part, children do not have the complex reasoning skills necessary to develop intricate plans that will make them better able to endure the abuse, or better yet, escape the abuse. However, our brains have gifted us with the desire and instinct to survive.

As children create or build a repertoire of coping strategies, they most often develop a variety of coping skills. Typically, some of those skills will be useful and beneficial overall, and some that serve the purpose but are detrimental to the child’s overall well-being.

Strategies for Children Maladaptive: Minimizing, rationalizing, denial, dissociation, verbal or physical aggression, under or over eating, drugs and alcohol Adaptive: Deep breathing, stretching, personal timeout, writing, physical exercise, music, visualization, positive self-talk, regular contact with supportive adults (relatives, teachers, counselors, etc.)

Strategies for Adolescents Maladaptive: Drugs, alcohol, tobacco, rationalization, minimizing, sex, rumination, aggression, dissociation Adaptive: Talking, deep breathing, journaling, visualization, distraction, regular contact with supportive adults (relatives, teachers, counselors, etc.)

Strategies for Parents/Adults Maladaptive: Drinking, drug use, gambling, sex addiction, road rage, hanging onto anger, inappropriate boundaries, isolation, obsessions, dissociation, shopping, overspending, over or under eating, avoiding responsibilities, “yes, but…”

Adaptive: Deep breathing, talking, stretching, physical exercise/exertion, music, thought changing, positive affirmations, journaling, humor, planning, sleep, spirituality/prayer

Resilience Skill #4 Self-Efficacy Children need to believe in themselves and their ability to meet daily challenges. They develop this skill by being “good” at something and feeling confident in the experience. By providing interesting tasks and skills to master, and following up with acknowledgement and praise, parents will help children acquire the strength to move past adversity.

PRIDE Skill and/or PLAIN Talk Review Turning Point • Session 6: Coping with Stress and Trauma

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Session 7

Risk and Protective Factors in Child Abuse and Neglect

Turning Point • Session 7: Risk and Protective Factors in Child Abuse and Neglect

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Session 7: Risk and Protective Factors in Child Abuse and Neglect There is no known single “cause” of child abuse or neglect. There is also no single factor common to all families where maltreatment occurs. Child abuse occurs across all socio-economic, religious, cultural, racial, and ethnic groups. So while there is no specific cause of child maltreatment, research indicates there are a number of familial “risk factors” that are commonly associated with child abuse. Children within families and environments in which these factors exist have a have a higher probability of experiencing maltreatment.

Every child experiences adversity to some degree. While exposure to adversity can negatively impact outcomes, research is clear that protective factors can decrease their influence and impact. Protective factors positively influence outcomes regardless of race, ethnicity, or socio-economic class. However, protective factors do not create invulnerable or trauma-resistant children. The impact of adversity and trauma is real and alters the course of children’s lives every day. The presence of protective factors will not negate the impact of trauma, adversity and stress. Rather, protective factors work to increase coping skills, decrease healing time, and lessen the likelihood of long-term maladaptive behaviors.

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Risk Factors

Risk can be defined as “an elevated probability of an undesirable outcome.” It should be understood that rarely do risk factors present in isolation. There are four separate categories of risk factors facing children. They are: • • • •

Parent or Caregiver Factors Family Factors Child Factors Environmental Factors Parent or Caregiver Factors

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Personality Characteristics – including low self-esteem, poor impulse of control, depression, anxiety, anti-social behavior, and external locus of control (the belief that events are determined by chance or outside factors beyond one’s sense of control)

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Parental History and the Cycle of Abuse – Parents who had poor role models or who did not get their needs met often struggle to meet the needs of their own children. Those who were mistreated or witnessed violence in the home may use the same behavior with children, viewing it as “normal” and “appropriate”

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Substance Abuse – is a contributing factor in 1/3 to 2/3 of families involved in the child welfare system. Substance abuse interferes with a parent’s mental function, judgment, inhibitions, and protective capacity. It also influences how money is prioritized in families, either on meeting children’s needs or on drugs/alcohol.

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Attitude and Knowledge – Negative attitudes about a child or the child’s attributes can influence the way the child is treated. Inaccurate information regarding normal child development may result in the parent having unrealistic expectations, and inappropriate discipline strategies.

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Age – is a factor primarily in physical abuse. Generally, younger mothers tend to more abusive than older mothers due to lower economic status, lack of social support, and high stress.

Turning Point • Session 7: Risk and Protective Factors in Child Abuse and Neglect

Family Factors • Family Structure – Children living in a single parent household have a higher rate of abuse and neglect. Single parent families are more likely to be below the poverty line, have increased stress due to the higher burden of responsibility, and fewer family supports.

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Family Chaos – Chaotic households may have a parent with mental illness, a large number of household members, and inconsistent or absent parenting.

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Marital Conflict and Domestic Violence – it is estimated that in over 50% of families where there is partner violence, there is also child abuse and neglect. Sometimes the abusive adult is also violent toward the children, and the adult victim is focused on the abuser or their own survival.

Even if the children are not battered directly, exposure to violence has harmful emotional consequences.

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Stress – plays a significant role in family functioning overall. When stress increases, maladaptive coping strategies may come into play. Those strategies in turn have harmful effects which increase the stress factor. It can be difficult to exit this cycle.

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Parent-Child Interaction – abusive and neglectful adults tend to focus on the negative behaviors of their children and ignore or discount positive behaviors. These parents are less supportive, affectionate, playful and responsive to children’s needs. They also tend to use harsher discipline practices including hitting and prolonged isolation.

Child Factors • Age – Infants and young children (birth to three) are particularly vulnerable due to their small physical size, early developmental status, need of constant care, and inability to understand and utilize possible safety measures.

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Disabilities – children with cognitive, physical, and emotional disabilities experience higher rates of abuse and neglect. Their needs can be overwhelming for caregivers, attachment is more likely to be disrupted, and social support for parents is often much lower.

Environmental Factors • Poverty and Unemployment – these factors have a strong connection to child maltreatment, especially if there is prolonged unemployment. The stress of not being able to find work leads to parental depression, low self-esteem, and a feeling of hopelessness. When combined with poverty, parents can be overwhelmed and resort to abusive behaviors toward their children.

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Social Isolation and Social Support – it is unclear whether social isolation and lack of social supports lead to abusive behaviors, or if it is abusive behaviors that lead parents to socially isolate themselves and resist social support.

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Violent Communities – children who live in dangerous neighborhoods experience more violence at home. Some risk is due to the fact that dangerous neighborhoods tend to also be impoverished; however, there is also a connected relationship between those who see violence as an acceptable behavior and abuse in the home.

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Protective Factors

The presence of protective factors doesn’t negate the realities of abuse and neglect. Rather, they are elements that aid the child and family in moving past the trauma and building healthy relationships and successful life. Rarely do protective factors appear in isolation. When there are protective factors present, they usually occur in tandem.

• • •

Personal Factors Relationships Community Resources Personal Factors • Temperament – children who are even tempered and optimistic are better equipped to view negative experiences as external and limited in scope and duration.

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Impulse Control and Emotional Regulation – the ability to regulate emotions, behaviors, and impulsivity reduces children’s misbehavior, which in turn decreases parental anger and frustration. Also, children with these factors are better liked by peers and adults.

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Problem Solving Skills – increase children’s ability to find a workable solution to the problems they face.

Relationships • Supportive and Available Parent or Adult Caregiver – when children have other caring and supportive adults in their life, they learn that while some adults are dangerous or apathetic, others provide positive interactions and pro-social skills.

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Close Relationships with Competent Adults – competent adults teach life lessons, provide opportunities for learning and sharing, and pass on wisdom. These children also have the benefit of a confidant; someone with whom they can share their hopes, dreams, and fears.

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Connection to Peers with Positive Social Skills – every moment of a child’s life is spent learning something. Peer relationships teach a skill-set that can only come from that common group.

Children learn about sharing, equity, and differences from a group that is near their age and developmental level.

Turning Point • Session 7: Risk and Protective Factors in Child Abuse and Neglect

Community Resources • Involvement with Pro-social Organizations - including sports teams, faith groups, academic clubs, scouts, etc. The organizations foster independence, self-control, personal responsibility, fairness, ethic of hard work, and cooperation. The maltreated child benefits from these experiences, especially when they are not occurring in the home.

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Safe Neighborhood – the opposite, living in dangerous or violent areas, requires children to have a persistent fear response. They must stay alert and maintain a “fight or flight” state of hypervigilance. These children already maintain a state of hypervigilance in their abusive home, which alters their perception of the world. Living in a safe neighborhood allows them to drop their armor, so to speak, when they leave the confines of their home.

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Access to Social Services – having access to social services increases the chance that a child or family will make use of them. Children find it nearly impossible to arrange for consistent transportation, make appointments, or navigate complex systems on their own. When services and service providers make themselves accessible to the children they are designed to serve, positive change is more likely to occur.

Building on Parents’ Strengths No matter how unorganized, chaotic, or troubled a person’s life is, there are inherent strengths within that keep them going day to day. Courage, tenacity, a sense of humor, hope, intelligence, and having friends are examples of strengths parents can call on when things are difficult or in the midst of crisis.

It’s really about reframing personal perception to find good even in the worst situation.

It is beneficial to identify a set of core strengths held by the abusive or neglectful parent. These strengths can be examined, expanded, and called upon when the parent decides to change their parenting style.

Having this list on hand can be helpful in times of despair.

Resilience Skill #5 Reduce Risk Factors It is important that abused and neglected children have an environment with minimal risk for additional harm. Parents and caretakers can review the list of risk factors and work to decrease the number and severity of those in the child’s life. Just as important, the list of protective factors should be reviewed and attempts be made to add some of them to the child’s everyday life. These can include supervision, clear limits and boundaries, and immediate intervention when harsh or inappropriate behavior occurs.

PRIDE Skill and/or PLAIN Talk Review

Turning Point • Session 7: Risk and Protective Factors in Child Abuse and Neglect

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Session 8

Discipline Strategies

Turning Point • Session 8: Discipline Strategies

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Session 8: Discipline Strategies Discipline We often think of discipline as being what parents do when a child misbehaves. However, discipline is not the same as punishment. Discipline should be a combination of teaching, guidance, attention, and consequences, given to a child on a regular basis, to help them grow to be healthy, independent and competent adults.

Effective discipline should be a combination of positive daily interactions and timely consequences.

Teaching and guidance should come before and after a child misbehaves. Consequences should be natural, logical and should always fit the misdeed.

Common Punishment (discipline) Practices There are many common punishment techniques used by parents and adults worldwide. From timeout to spanking, shaming to shunning, these and other methods have been used to get children to do what parents expect of them. Some practices are cultural, some generational, others weave in and out of popularity as societal standards and norms shift. Overall however, discipline practices tend to be traditional passed from parent to child through time.

Examples: •

Yelling

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Threats

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Shaming

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Time-out

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Negotiation

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Restrictions

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Taking away privileges

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Corporal (physical: spanking, slapping, hitting)

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Ignoring

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Giving up and doing nothing

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Understanding why children do what they do can help to alleviate some parental stress arising from children’s misbehavior. A child is not simply a “bad kid” – but they may get into the habit of bad behavior.

Most behavior falls into one of four categories; Attention, Power, Revenge, and Displays of Inadequacy.

We’ll look at each of these separately.

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Attention: This can also be called interaction. Children need attention from and interaction with the adults around them, and they’ll do whatever they have to do to get it. Positive attention takes the form of talking, listening, playing, walking, singing, reading, cooking and other similar activities done with the child. There is shared interaction, usually combined with caring words and gestures, learning, and feelings of happiness. The child’s need for attention is fulfilled and the adult feels good about what has taken place.

When there is a shortage or lack of positive attention, negative attention will fill the void. The child will behave in ways that annoy or bother the adult in order to get some kind of reaction (attention and interaction) from the adult. The child’s attention seeking behaviors may include running, yelling, cursing, hitting, pushing, or destruction of property. These behaviors will illicit a response (attention) from nearby adults. That response may include talking, yelling, threatening, hitting, chasing, time-out or other “discipline” methods. In this scenario, the child again has the need for attention fulfilled, but the adult ends up feeling bad about what has taken place.

The conclusion can be drawn that when adults fulfill a child’s need for attention through positive interaction, everyone ends up feeling good about it, and there is shared joy and happiness in each other’s company.

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Power: Power is a form of control and there are times kids want to be in control; or to be in charge. They want to be in charge of you, of themselves, of the situation, of their lives and your life and everything that happens during the day. The one with the *power* is usually the one who gets to make all the decisions – and who doesn’t want to be in that position? The problem with kids being the ones with the power? They (usually) don’t have the age, wisdom, or experience to adequately make decisions that are best for everyone.

Power is displayed through anger, physical or verbal aggression, active or inactive refusal to comply, or by ignoring those in authority and doing “whatever they want to do.” The child’s behavior evokes feelings of anger or frustration, and sometimes fear, in adults because their authority has been threatened or challenged. Adults tend to respond either by arguing and fighting (which intensifies the child’s misbehavior), or by giving in (which teaches the child to fight against authority to get their way).

In responding to children’s desire for power, a two-part approach should be taken. The first is to be pro-active by giving children choices when appropriate. “Would you like cereal or eggs for Breakfast?” “You can wear your blue shirt or the green shirt today.” “We’re going to do the dishes.

Would you like to wash or dry?” Offering children choices, when appropriate, gives them a feeling of control in what they do. It also gives them skill in evaluating options and making good decisions. The second part is to avoid power struggles all together. Once a decision is made or a direction given, and the child begins to argue or refuse, avoid the temptation to negotiate, explain, argue or further discuss the issue. These are manipulation techniques that indicate the “power” is up for grabs. Instead, verbally withdraw from the conflict. Physically withdrawing – walking away from the situation – can be done as well. Just remember to be consistent, and stand by your decisions.

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Revenge: Revenge behavior often happens when the child believes he has been treated unfairly or mistreated in some way. The child tries to get back at the adult with words or actions that are hurtful. “I hate you!” “You’re stupid!” “I don’t want to live here any more!” These words are powerful, and the hurt can go deep. The response for parents is simple yet can be difficult.

First, choose NOT to let the words hurt. Let them flow off like water, letting none of them be absorbed. Second, DO NOT retaliate or punish by slinging insults and hurtful words back at the child. Children are still learning the ways of the world, and this is the perfect opportunity for parents to respond with positive, caring and loving words and actions, to build and reinforce the parent/child relationship.

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Displaying Inadequacy: Early in the process, it can be difficult to identify displays of inadequacy in children as true misbehavior. These children quietly refuse to do what is required of them.

They may play deaf, ignore, conveniently “forget” what they were told to do, or become engaged in another activity. Whatever the strategy, the end results are that someone else ends up doing the task for them. These children are generally discouraged or have a negative self-image.

Adults can best help them by providing abundant encouragement and opportunities for success. There also must be consistent follow-through on the part of the adults, ensuring that the child is completing required tasks.

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Discipline Techniques Goal: Extinguish and Replace (extinguish negative behaviors, replace with positive) •

Positive Reinforcement: Acknowledge and praise your child for things they do right. When you praise something a child does, they will want to do it again. (e.g.: “Nice job of walking to the table.”

“Thank you for keeping your bottom in the chair during dinner. You have such nice manners.” )

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Diversion and Distraction: At the early stage of a child’s misbehavior, their attention can often be diverted to something positive. The trick is to catch it early, and distract them with something they’ll find interesting, fun or entertaining. (example: It’s bedtime, and the child begins whining to stay up longer. Parent responds with, “I wonder which book I should read to you tonight. I think I’ll see if I can find The Cat in the Hat. I wonder what book you’ll choose.”)

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Positive Communication: When a child misbehaves, tell them what TO DO, rather than what NOT TO DO. When a child is behaving defiantly, they will naturally refuse what you tell them not to do. Phrasing the direction positively lets them know what you expect of them, and allows them to comply quickly and earn your praise. (example: Child is yelling. “Please use your quiet voice.” Child responds in a quieter voice. “Thank you for using your quiet voice. That sounds so much better when we’re inside.” Child is jumping on the bed. “Please put your head on your pillow.” Child puts her head on her pillow. “Thank you for putting your head on your pillow. Now I can read you a story.”)

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PRIDE Skills: Praise, Reflect, Imitate, Describe – all with Enthusiasm •

Praise: State something the child is doing right.

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Reflect: Repeat (or paraphrase) the child’s words back to them. This lets them know you were listening, increases communication, and increases their sense of self-awareness.

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Imitate: Copy the child’s (positive) actions. This lets them know when they’re doing something right, boosts their self-esteem, and allows them to teach the parent something new.

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Describe: Talk about what the child is doing (positively). This lets the child know they have the parent’s attention, again lets them know what they are doing right, and increases a child’s vocabulary and language skills.

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Enthusiasm: Have fun with the child, and let them know you’re enjoying their company!

These skills are positive forms of communicating with a child. They are designed to let a child know they are heard, know when they are doing something “right,” build their self-esteem, and build a positive relationship with the parent.

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Turning Point • Session 8: Discipline Strategies

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Consistency: This is the key to any discipline strategy. From birth they experience the relationship between action and reaction. “When I cry, somebody holds and comforts me.” They learn to connect scents with voices and faces. As their experience with action/reaction grows, they become secure and develop a sense of safety and well-being. The quickest way for a child to learn is through repetition – another term for consistency. Rules should be the same today as they were yesterday and will be tomorrow.

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Selective / Strategic Ignoring: Consistently ignoring a behavior that is simply annoying can be an effective way to get a child to discontinue it. When ignoring, it is important that as soon as the child stops the annoying behavior, the parent immediately responds with positive attention and interaction for something else. (example: Child is whining. Parent ignores child completely.

The child gets bored with it and moves on to playing with Legos®. The parent immediately responds with, “Wow, you’re building something really cool with those Legos®. You’re the best builder I’ve ever seen!”) Remember, a child is looking for attention and interaction with the parent. Give lots of it when they are doing something good!

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Time-out: The secret to a successful time-out is that it be boring to the child. It is done best in a chair placed in a corner of a room that has no TV, toys, or other children. No one should talk to or make eye-contact with the child in time-out. All attention should be directed to something or someone other than the child. A good measure of time is one minute per year of age. If the child was sent to timeout for not doing (or refusing to do) a task, the task must be completed by the child as soon as time-out is completed. If the task is still not completed, full time-out should be done again.

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Natural and/or Logical Consequences: Parents need not come up with a punishment for every misdeed or wrongdoing. Most often, the most effective “punishment” is the natural consequence that occurs following the misbehavior. (example: Parent tells the child to bring their library book in from outdoors. The child says OK, but forgets to do it. It rains, and the library book is ruined. Parent says, “You’ll have to pay for the library book with your own money.” Parent reminds the child to bring money when they go to the library so the book can be paid for.) No arguing, yelling or punishment needed. The results of the child not following the direction results in having to spend their own money on a ruined book.

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Age-Appropriate Discipline Strategies Infants: Infants should not be disciplined.

They have no self-awareness or self-control, and have no way of expressing their needs. Babies can cry for hours, seemingly inconsolable. Combined with a lack of sleep, irritating, annoying or difficult behaviors can make some parents angry, frantic, disappointed, or resentful. The first defense is to check to see if baby is wet or hungry, too hot or too cold, or in an uncomfortable position. If their needs appear to be met, there are some simple techniques that can be used to help soothe a fussy baby, such as swaddling, infant massage, back-rubbing or patting, dimming lights, etc.

Toddlers (18 months to 3 years) Toddlers have learned that they have some (limited) choices in their behavior, and have learned how to say “No!” It’s common for them to do the opposite of what they’re told, or to respond with a resounding “No” and a shake of the head. They aren’t being purposefully willful or disobedient. Rather, they have discovered a sense of their autonomy and find great joy in expressing it. Developmentally, this is a positive step in their growth, although it can be frustrating at times. Positive reinforcement is highly effective with this age group. Children delight in pleasing those around them, and will want to repeat (over and over and over) behaviors that caused a positive reaction. During the more difficult moments (when the toddler is tired, hungry, irritable) diversion and distraction work wonders for keeping behavior in check.

Pre-school (3-5 years) Pre-school age children continue to react positively to positive reinforcement. Continue to praise behavior you want them to repeat. They love and need their parent’s attention, and will do whatever they need to in order to have it. At this age they have a good grasp of cause and effect, so strategic ignoring is also effective. Time-out is also effective with pre-school age children.

Loss of privileges is NOT effective with this age group. Pre-school age children have not yet developed a concept of time, so taking away something that will happen in the future is meaningless to them at the time it is given. When the time finally does arrive that they realize the privilege is lost, they can’t relate the cause and effect (relating the misdeed to the loss of privilege).

Elementary School (6-11 years) Early elementary age children still respond well to positive reinforcement, natural and logical consequences, and when-then statements. Time-out is effective up to about age 7 years, at which time loss of privileges becomes the strategy of choice. The secrets of making removal of privileges effective are: 1) Give the child one warning. 2) Immediately follow through. 3) Remove privilege for no more than one day. 4) The child should lose no more than 3 privileges in one day, or this method loses its effectiveness. The process looks like this: “Please turn off the TV.” Wait 5 seconds. “Turn off the TV or you will lose your video games for the rest of the day.” Wait 5 seconds. “You have lost your video games for today. Please turn off the TV or you will lose your bike for the rest of today.” Wait 5 seconds. “You’ve lost your bike for the rest of the day. Please turn off the TV or you will lose your DS for the rest of the day.” “Thank you for turning off the TV. Since you did what I told you to do, you can keep your DS for the rest of the day.” Most children will do as they were told before losing the third privilege. If a child consistently goes beyond the third loss, more work should be done to improve the parent-child relationship.

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Boundary and Limit Setting Establishing personal boundaries and learning to respect the boundaries of others are critical skills for children, and adults, to learn. Boundaries provide safety and help to provide for the physical and emotional well-being of a child. It’s important for children and adults to understand appropriate boundaries as they relate to themselves, family members, friends, acquaintances, and strangers.

Many of the boundaries we have are unspoken, but have been developed over time by our experiences, knowledge and culture. Some of the issues that have boundaries and limits are: touch, words, privacy, health, safety, and space.

There are similarities and differences in Adult vs. Child boundaries/limits. There are also differences depending on where we are, and the relationship between the people involved. There are even boundaries related to space; Bedrooms, homes, outdoor play areas, school, public places, and other people’s homes to name just a few.

Parents must set boundaries and limits for their child. During the early years, parents set all the limits, but as children grow older, they can establish some of their own.

In the physically or sexually abused child, personal boundaries are blurred or distorted. It takes time and practice to relearn appropriate boundary setting.

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Discipline in Practice Establish Family Rules (boundaries and limits) Family Rules can include expectations as well as things that are not allowed. (example: The family will eat dinner together every Sunday night. It is never OK to physically hurt another person.)

Reward Positive Behavior (positive reinforcement, PRIDE Skills) Rewards can be immediate; for example praising a child when they begin their homework at the preagreed upon time. Or rewards can be cumulative; for example letting the child rent a video Friday night after they have done their homework at the pre-agreed upon time every day that week. Rewards can be planned or done as a surprise, and they don’t need to be purchased items. One of the best rewards can be time spent with the child.

Restrictions or Disciplinary Action (extinguish and replace) Sometimes the appropriate and effective response to deliberate misbehavior is to restrict or remove the child’s privileges. For example, if the child is physically or verbally aggressive toward a friend or sibling, the privilege of TV or video games can be lost for a specific amount of time. Just remember: Whatever restriction you set, you must be willing and able to follow through with it!! So if the parent tells the child, “You can’t play outside for a week!” they must be willing and able to prevent the child from playing outside for the entire 7 days – no matter how difficult or inconvenient it is for the parent (or the child)!

Choose Your Battles Parents can’t expect children to have perfect behavior every minute of every day. Parents should choose their battles wisely – especially since there must be consistency in rules, rewards and consequences.

How important is it that some of the crayons were put back in the box upside down? Is it worth the battle to have them all facing the same way? Or is it enough that the child did put them all back in the box, just as they were told to do?

Consistency Again, consistency is the key to establishing or modifying any behavior.

Give Clear Directions When telling a child what to do, it’s important that the directive be clear, concise, and that the child have the ability (skill and maturity) to succeed. State the directions positively, telling the child what TO DO.

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Power Struggles Parents should always try to avoid power struggles with children. Simply put, it makes the parent stoop to the level of the child, and diminishes the authority of the parental role. Instead, parents should have a clear idea of the individual and family rules, limits, and boundaries, and then abide by them.

Parental Anger vs. Child Misbehavior

Studies indicate that parental anger is strongly related to the use of physical punishment. One study concluded that parents who yell often are the ones most likely to hit their children often. In another study it was found that parents are twice as likely to hit their children when they experience high levels of anger. As parents learn new discipline styles and techniques, it is important to review anger and stress levels to give them an accurate understanding of them.

Ineffective Punishment / Discipline Tools: Yelling Threats Shame Physical discipline (hitting, slapping, flicking, kicking, biting, holding, imprisoning) Giving up and doing nothing Triggers Everyone has triggers (buttons, hot spots, breaking points) when it comes to personal interactions, especially with children and adolescents. Some triggers include name calling, disrespect, foul language, threats, and certain words. When a child says or does whatever the parents’ trigger is, it magnifies the parental negative emotion and the parent may instinctively lash out – physically or verbally – with anger fueled rage.

It is the parent’s responsibility and DUTY to identify their own triggers, and learn to respond in a manner that is not harmful to the child in any way. Harming a child does NOT improve their behavior. On the contrary, harm begets rage and violence, and the cycle of abuse will continue for another generation.

PRIDE Skill and/or PLAIN Talk Review Resilience Skill Review

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Session 9

Getting Kids to Do What You Tell Them to Do

Turning Point • Session 9: Getting Kids to Do What You Tell Them to Do

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Session 9: Getting Kids to Do What You Tell Them to Do This series reviewed a lot of material; from basic child development to factors impacting the infant and toddler brain, from child abuse to understanding the needs of the child, from risk factors to protective factors, and from positive communication to effective discipline strategies.

The one thing parents may still be looking for is an answer to this simple question.

How do I get my child to do what I told him/her to do??

Several weeks ago parents were given the handouts for PRIDE Skills and PLAIN Talk with Adolescents.

Using and mastering these positive communication tools is effective in reducing oppositional and defiant interactions from kids. The key to success is USING the skills on a consistent basis.

The following suggestions are also simple but effective. An experienced or hardened parent may disregard this information as being nonsense, but these tools work time and time again. The key to success is: CONSISTENCY, PREDICTABILITY, and FOLLOW THROUGH 1. Tell the child exactly what you want them to do. (Tell, don’t ask) 2. State the direction positively. (What TO DO instead of what NOT TO DO) 3. Make certain the direction is age appropriate for this specific child.

4. Give one direction at a time.

5. Be specific if you expect something specific.

6. Be polite and respectful. Be the example.

7. Avoid giving kids too many directions/commands in one day.

8. Offer choices when possible.

9. Always provide a consequence for COMPLIANCE as well as non-compliance.

PRAISE YOUR CHILD WHEN THEY, GOT IT RIGHT. Praise them for trying when they didn’t get it quite right, but they made effort.

DON’T EXPECT MIRACLES FROM CHILDREN – THEY ARE THE MIRACLE PRIDE Skill and/or PLAIN Talk Review Resilience Skill Review

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Session 10 View Goals

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Session 10: Review Goals Program Goals •

Explain the difference between discipline and abuse.

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Identify at least two normal developmental milestones for the children in your care (or previously in your care).

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Name two age appropriate teaching or discipline strategies for the children in your care (or previously in your care).

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Identify two positive coping skills. Talk about one that works for you.

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Name a risk factor and a protective factor.

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Name two personal strengths.

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Give an example of the PRIDE Skills or PLAIN Talk skills.

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Name and explain two ways to build resilience.

Participant Goals Self identified (at least 3) 1.

2.

3.

System identified (CPS, Family Court) 1.

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3.

Congratulations!

This program is complete.

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7 Stages of Grief

Through the Process and Back to Life

7 Stages of Grief: Through the Process and Back to Life

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7 STAGES OF GRIEF: Through the Process and Back to Life

The Final Stage Model, “7 Stages Of Grief” Once again, it is important to interpret the stages loosely, and expect much individual variation. There is no neat progression from one stage to the next. In reality, there is much looping back, or stages can hit at the same time, or occur out of order. So why bother with stage models at all? Because they are a good general guide of what to expect.

For example, generally, a long period of “depression” (not clinical depression), isolation, and loneliness happen late in the grief process, months after the tragedy strikes. It actually is normal and expected for you to be very depressed and sad eight months later.

Outsiders do not understand this, and feel that it should be time for you to “get over it” and rejoin the land of the living. Just knowing that your desire to be alone with your sad reflections at this time is normal will help you deal with outside pressures. You are acting normally. They just don’t “get it”.



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“The 7 Stages of Grief”

1.

2.

3.

4.

Shock and Denial Paint and Guilt Anger and Bargaining “Depression,” Reflection, Loneliness

1. Shock and Denial You will probably react to learning of the loss with numbed disbelief. You may deny the reality of the loss at some level, in order to avoid the pain. Shock provides emotional protection from being overwhelmed all at once. This may last for weeks.

2. Pain and Guilt As the shock wears off, it is replaced with the suffering of unbelievable pain. Although excruciating and almost unbearable, it is important that you experience the pain fully, and not hide it, avoid it or escape from it with alcohol or drugs.

You may have guilty feelings or remorse over things you did or didn’t do with your loved one. Life feels chaotic and scary during this phase.

3. Anger and Bargaining Frustration gives way to anger, and you may lash out and lay unwarranted blame for the trauma on someone else. Please try to control this, as permanent damage to your relationships may result. This is a time for the release of bottled up emotion.

You may rail against fate, questioning “Why me?” You may also try to bargain in vain with the powers that be for a way out of your despair (“I will never drink again if you just….“) 4. “Depression,” Reflection, Loneliness Just when your friends may think you should be getting on with your life, a long period of sad reflection will likely overtake you. This is a normal stage of grief, so do not be “talked out of it” by wellmeaning outsiders. Encouragement from others is not helpful to you during this stage of grieving.

During this time, you finally realize the true magnitude of your loss, and it depresses you. You may isolate yourself on purpose, reflect on things you did with your loved one, and focus on memories of the past. You may sense feelings of emptiness or despair.

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7 Stages of Grief: Through the Process and Back to Life

5. The Upward Turn 6. Reconstruction and Working Through 7. Acceptance and Hope

5. The Upward Turn As you start to adjust, your life becomes a little calmer and more organized. Your physical symptoms lessen, and your “depression� begins to lift slightly.

6. Reconstruction and Working Through As you become more functional, your mind starts working again, and you will find yourself seeking realistic solutions to problems. You will start to work on practical and financial problems and reconstructing yourself, your life, and your family.

7. Acceptance and Hope During this, the last of the seven stages in this grief model, you learn to accept and deal with the reality of your situation. Acceptance does not necessarily mean instant happiness. Given the pain and turmoil you have experienced, you can never return to the carefree, untroubled YOU that existed before this tragedy. But you will find a way forward.

You will start to look forward and actually plan things for the future. Eventually, you will be able to think about the trauma without pain; sadness, yes, but the wrenching pain will be gone. You will once again anticipate some good times to come, and yes, even find joy again in the experience of living.

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King County Sexual Assault Resource Center 200 Mill Avenue South, Suite 10 PO Box 300 Renton, Washington 98057 www.kcsarc.org