Child Emotional Neglect — The Failure to Nurture

Howard Dubowitz, M.D.

Howard Dubowitz, MD, is a Professor of Pediatrics and the Director of the Center for Families and Children at the University of Maryland His medical training includes the University of Cape Town, South Africa; an internship in Israel at the Tel Hashomer Hospital, Ram Gan, Chaim Sheba Medical School;
a pediatric residency at Boston City Hospital; and a fellowship in child abuse and neglect at the Children’s Hospital, Boston. He also worked as a general practitioner in London and has a Master of Science degree in epidemiology from the Harvard School of Public Health. Dr. Dubowitz serves in a wide variety
of professional capacities in teaching, research, and administration, and has received numerous professional honors and awards including, most recently, the American Academy of Pediatrics’ Special Achievement Award. Widely published in scientific journals and books, Dr. Dubowitz is one of the principal investigators on the LONGSCAN study, a prospective research project involving five independent centers in the U.S. that examines the antecedents and consequences of maltreatment of children.

Over the past 10 years the shattered bodies and psyches of our wounded warriors have come to the clinical staff at WRNMMC on a daily basis. Most of us have evaluated and treated patients who have suffered the onslaught of trauma and its impact on the psyche and soma. Many of us subscribe to assessing and responding to our patients with a biopsychosocial approach but in doing so we have often ignored the topic of genital injury because of the taboo associated with talking about this type of injury. As a result of this symposium, we hope to learn more about and discuss the psychiatric and medical risks associated with genital injuries in order to better care for patients, their spouses and families. To accomplish these goals many thoughts and questions must be addressed.

What does it mean to have a genital injury? What is it like? How do we talk to patients with genital injuries? How do we instill hope in those with devastating genital injuries? How do we address sexual function and fertility? How do we provide the education and tools to allow wounded warriors to direct their own healing? When and how can we develop therapeutic alliances so the patient and family feel they have an advocate? How do we collaborate more effectively with our colleagues to insure more effective treatment outcomes? How can we have a voice to help our veterans who need support once they leave WRNMMC?

With these questions and others in mind we have organized this ground breaking symposium and invited experts from the fields of Psychiatry, Psychology, Urology and Congress to learn from each others’ experiences and insights and to initiate and facilitate dialogue to help patients, families, and children. The following pages are a summary of the thoughts and discussion at this important conference.

Understanding how people react to tragic events and the roles leaders play in recovery is critical to effective leadership. In the aftermath of traumatic events, many children and their parents, even those not living in close proximity to the event, want to hear guidance from their community’s leaders. In this acute phase, leaders must communicate effectively to people who have questions, seek reassurance, and want to take action.

As shock and horror turn to sorrow and mourning, leaders are responsible for identifying the timing of when a community is ready for the next step forward and how best to speak the language of each community to help individuals, families, and care providers.

Wide arrays of communication technologies have evolved to now become integral components of modern healthcare delivery. A number of tools and applications are poised to change the way physicians and patients interact, and in that way potentially change the nature and quality of the doctor-patient relationship. The internet, social networking and smart phones can complement, and even extend, healthcare communications that once ceased at the end of an office encounter. Now, with ever expanding ways to share, military and civilian populations alike are expanding access and have the potential for ongoing communication, support and information sharing beyond the traditional medical settings.

“Educating Civilian Social Work Professionals about Military Culture and Care”

Mary Ann Forgey, PhD

Mary Ann Forgey, PhD, is an associate professor at Fordham University Graduate School
of Social Service. Dr. Forgey received her BA
and MSW from Boston College, and her PhD
from Columbia University. She teaches a range
of practice courses in the foundation and
advanced years including electives that she
developed on intimate partner violence (IPV)
and most recently military social work. She has
been the principal investigator on two research
projects related to IPV within the military, the
results of which have been published in the
Journal of Family Violence, Violence and Victims and the Journal of Social Work Education. Prior
to entering academia, Dr. Forgey was employed
as a civilian social worker for the Department
of the Army in Wiesbaden, Germany. She also
worked as a child protection social worker in
Boston, Massachusetts.

For youth between the ages of 10 and 24, suicide is the third leading cause of death. Nearly 14 percent of high school students report seriously considering suicide – which equals three students in an average classroom size of 20. Research also shows the estimated cost of youth suicide to be more than $6 billion a year in medical costs and work loss, in this country alone.

An important step in preventing suicide is ensuring people have access to the best available knowledge and tools to prevent suicide. Equally important is to make certain this information is also actionable, so it can be put into practice.

Suicide Prevention Tools

·       Gatekeeper Training Implementation Support System (GTISS)
Created by the Tennessee Lives Count initiative, this is an online resource that provides tools to support successful selection, implementation, and evaluation of gatekeeper training programs.

·       Family Brochure
The Native American Rehabilitation Association’s Life is Sacred Native Youth Suicide Prevention Program is built upon the unique role culture plays in prevention of youth suicide.

·       MYSPP Early Identification and Referral Data Toolkit
The Maine Youth Suicide Prevention Program (MYSPP) developed an online resource that provides guidance and actionable tools for collecting early identification and referral data on students at risk for suicidal behavior in schools.

Suicide Prevention Research

Through this collaboration, DVP created a series of actionable knowledge briefs to help integrate research into suicide prevention efforts in local communities:

·       Putting Knowledge into Action to Prevent Violence
Details on the actionable knowledge process and how communities can put science into action to prevent suicide and other forms of violence.

·       Suicide Prevention: A Public Health Issue
Why suicide is a public health issue and the unique role that public health plays in preventing suicide in communities.

·       Preventing Suicide Through Connectedness
How connectedness between individuals, families, and organizations can help prevent suicide and increase well-being.