How can a traumatic experience influence childrens behaviour

How can a traumatic experience influence childrens behaviour How can a traumatic experience influence children’s behaviour? The issues surrounding children’s behaviour after a traumatic experience are complex, multifactorial and often hugely controversial. Having considered the literature on the subject, one could be forgiven for believing that there are as many opinions on the issues as there are people considering the issues. In this review we have attempted to cover as many of the major areas as possible in order to present a reasonably comprehensive overview of the subject. The definition of a traumatic experience is subjective from both the point of view of the child concerned and also form the observer. Some commentators have suggested that the only workable definition of a traumatic experience is one that, by definition, produces demonstrable psychological sequelae. (Abikoff 1987) This may be the case, but as other commentators observe, some psychological sequelae may not surface for years, if at all. This does not mean that the original triggering episode was not traumatic. There is also the view that that the worst kind, or most extreme type of trauma may be the most likely to be actively suppressed at either a conscious or subconscious level. (Haddad Garralda. 1992) Literature Review With an area of literature as vast as the one that we are considering here, it is often difficult to find a place to start. In this instance we will consider the paper by Prof. Harry Zetlin (1995) who starts with a short monograph on the screening of a television programme which dealt with arguably the most catastrophic of stresses to befall a child, that of the loss of a parent through murder or violence. He makes several thought provoking comments which are worthy of consideration as they are germinal to the thrust of this article. The first is a plea that the diagnostic label of post-traumatic stress should not be a catch-all basket for all emotional and behavioural problems that can occur after a traumatic experience. (Gorcey et al.1986) The second is the realisation that in the particular circumstances portrayed on the television where a parent is murdered have two consequences. The first is the obvious catastrophic trauma that the child experiences with the violent loss of a parent, but the second is the much less obvious fact that the child has, at a stroke, also lost a valuable, and normally available resource, of the protective family environment, which is often one of the most useful therapeutic tools available to the therapist. He adds to this two further insights. The first is that the surviving parent has their own trauma to deal with and that is invariably transmitted to the child and that, because such events are mercifully comparatively rare, only a comparatively few professionals are ever able to build up any significant expertise and experience on the subject. The main issue of the piece is, however, the very relevant point that considering the apparent obsession of the media with intrusive fly-on-the-wall documentaries and the almost equally insatiable public hunger for sensation, the very fact that such a programme is made at all, almost inevitably adds to the trauma felt by the victims. (Koss et al 1989) One could argue that actually confronting and talking about such issues is part of the healing process. Such considerations may be of value in the adult who is more able to rationalise the concepts involved, but to the child this may be very much more difficult and being forced to relive the episodes in a very public and unfamiliar arena, may do little more than add to the psychological stresses and damage already caused. (Mayall Gold 1995) This paper offers a wise and considered plea for sense and moderation, not to mention reservation and decency. It is written in calm and considered moderate tones which makes the impact of its message all the more powerful. The next few papers that we would like to analyse deal with the thorny issue of Attention deficit hyperactivity disorder (ADHD) in children. It has to be commented that there is a considerable body of literature which argues on both sides of the debate about whether ADHD is the result of childhood trauma. One side is presented, quite forcibly, by Bramble (et al. 1998). The authors cite Kewley (1998) as stating that the prime aetiology of ADHD is a genetic neuro-developmental one. They challenge the expressed views that it is a manifestation of early childhood abuse or trauma which can have occurred at some time previously with the words: ..early abuse and trauma later manifest as symptoms and that the detection of these symptoms in children clearly illustrates early trauma is a prime example of the logical fallacy that underpins all psychoanalytical theory and practice. The authors argue that to state because psychotherapy is often effective it must reflect the fact that a traumatic episode must have been responsible because it addresses directly the original emotional trauma (Follette et al.1996), is completely unsound. The natural progression of this argument, they assert, is the reason why many parents of children with ADHD have such difficulty in finding child psychiatrists who can actually help them rather than the many who would seek to blame them for the childs behaviour in the first place. (Breire 1992) The authors take the view that the reason that psychoanalytical practitioners have held so much influence on the profession over the years is that it is only recently that the glare of evidence based medicine has fallen on their discipline. The authors argue that far from using psychotherapeutic tools to try to achieve resolution, the evidence suggests that psycho-stimulant treatment is far more effective (Abikoff 1987) if only because it enhances the therapeutic effect of other forms of treatment such as family therapy and special educational provision. The converse argument, or perhaps an extension of the argument, is presented by Thambirajah (1998) who takes the view that many papers on ADHD (and by inference he is referring to the one reviewed above), regard the syndrome as being a diagnosis made simply by checking an appropriate number of boxes on a check-list. He asserts that factors such as biopsychological circumstances should be weighed equally strongly as the symptom cluster of impulsivity, inattention or hyperactivity. (Tannock 1998) In direct contrast to the preceding paper he states that early traumatic experiences, current abuse or even depression of the mother may all be contributory factors in the aetiology of the condition. He argues that taking no account of these factors is to ignore much of the accumulated evidence and wisdom on the subject. He also makes a very valid point that to ignore these factors and only to use the check-list approach means that here is an over-reliance on the significance of these symptoms and, as a direct result, this leads to an overestimation of prevalence. He points to the obviously erroneous estimate of a study that was based exclusively on check list symptomatology, of 15% (although the study is not quoted). The author makes the very valid point that most psychiatrists would agree that the hyperkinetic disorder is a small sub-group within the ADHD syndrome and that these children may need treatment with stimulants but only after other aetiologies have been excluded. He makes the rather apt comparison of treating all children with ADHD the same way as calling all four legged animals with a tail donkeys. There are a great many more papers on this issue which we could usefully review but we must explore other areas of trauma in a childs life in order to try to give a representative overview. With the possible exception of the situation outlined in the first paper reviewed, there can be few experiences more traumatising to a child than to me made homeless as a refugee in a time of war. The paper by Hodes (et al. 2001) is both heart rending and informative as it explores the health needs of refugees arriving in the UK. Although the paper catalogues all of the health needs (that need not concern us in this article) of the refugees, it does not overlook the psychosocial trauma aspects of the childrens plight. They point to the fact that one way that a childs psychological trauma can be minimised is by being accepted into a peer group such as a school. While this may indeed be true, the problem is that refugee children are seldom seen by their peers as belonging and are therefore seldom completely accepted. (Lewis 1998) This is either aggravated or caused by the fact that they already have twice the rate of psychiatric disorder as found in control groups of children. (Tousignant et al. 1999). It is therefore important to be aware of these problems as they are often very amenable to psychiatric intervention (OShea et al. 2000). The authors quote a paper by Burnett and Peel (2001) who appear to be particularly pessimistic about making a diagnosis of post-traumatic stress disorder in children from a fundamentally different culture, as their recovery is thought to be secondary to the reconstruction of their support networks, which may prove particularly difficult in a different or even alien, cultural environment. They point to studies of the children who fled to the USA to escape the Pol Pot regime, who had post-traumatic stress in childhood, and even when followed up 12 years later they quote 35% as still having post traumatic stress and 14% had active depression. (Sack et al. 1999). This may be a reflection of the difficulty in getting appropriate treatment for a condition in a different culture. But, in distinct relevance to our considerations here, the authors comment that even exposure to a single stressor may result in a surprisingly persistent post traumatic stress reaction. (Richards Lovell 1999). The last article that we are going to consider here is a paper by Papineni (2003). This paper has been selected partly because of its direct relevance to our consideration, but also because on a human level, it is a riveting piece of writing. It is entitled Children of bad memories and opens with the quote Every time there is a war there is a rape (Stiglmayer 1994). The whole article is a collection of war-related rape stories and the resultant psychopathology that ensued. The author specifically explores the issues relating to childhood rape and its aftermath. She also considers a related issue and that is how the effect of maternal shame shapes a childs perception of themselves (with heartrending consequences), how the shame felt by the mother is often externalised to affect the child who is the visible symbol of the physical act. (Carpenter 2000) The catalogue of emotion and reaction described in this article by some of the subjects, would almost make an authoritative text book on the consequences of a traumatic experience in childhood. It would be almost impossible to quantify a single negative emotion that was neither articulated nor experienced by the victims, not only of the act of rape, but also of the stigma and aftermath of the act which was often described as the worst aspect of the whole thing. A constant theme that runs trough the paper is the realisation that the presence of a child conceived by a rape is a potent reminder of the trauma and therefore is, in itself a bar to psychological healing. The author also points to the fact that another, almost inevitable consequence of forcible rape, is difficulty with relationships and intimacy which can devastate a childs social development. (Human Rights Watch.1996). Such a child may not only have this burden to bear for its life, but the stigma forced upon it by society may also have untold consequences. The author quotes a child born from the Rwandan conflict, describing itself by different names which bear witness to societys perception, and more accurately and inevitably, the childs perception of itself: children of hate, enfants non-desirÃÆ'Â ©s (unwanted children), or enfants mauvais souvenir (children of bad memories) The author describes how such psychological trauma may never be successfully treated and ends with the very perceptive comment. There cannot be peace without justice, and unless the international community recognises all rape in conflict situations as crimes against humanity, there will be no peace for the victims of such atrocities. Conclusion It is clearly a forlorn hope to cover all of the aspects of trauma and its potential impact on a childs life in one short article. We hope that, by being selective, we have been able to provide the reader with an authoritative insight into some on the problems associated with the subject.

Clinical Decision Support

A state of irritability, exhaustion, or bewilderment triggered in clinicians who have been exposed to too many alerts which cause the user to ignore some or all the alerts. American National Standards Institute (ANSI) ; coordinates for the development of Health bevel Seven's Arden Syntax Standard. Bar Code Medication Administration (ABACA) ; An inpatient CADS to assist nurses with the five rights of medication administration. ; Provides warnings if any of the five rights are violated. ; It also requires the nurses to enter an override reason if he/she chooses to proceed.Bar Code Medication Administration Health Level Seven (HAL) ; A standards development organization for health information technology (HIT) Look-Alike, Sound-Alike (ALAS) ; Drugs with similar spelling or pronunciation. ; Refers to providing clinicians or patients with clinical knowledge and patient-related information, intelligently filtered or presented to appropriate times, to enhance patient care. ; Integrate patie nt-specific data with an available knowledge base in order to assist the clinician in selecting and delivering the safest and most effective therapies.Clinical Decision Support System A system intended to provide CDC to clinicians, caregivers and health care consumers. ; An Automated CADS includes: 1. A Knowledge base 2. An Event monitor 3. A Communication system Take Note: ; CADS may be a stand alone system ; CADS may be integrated into other technology solutions (ex. Bar code scanning technology and e-Prescribing) General Attributes of CADS 1. Designed for three purposes: Improve the quality of clinical decisions Notify of potential change in patient status ;. Prevent errant action at the point of care a.Error of commission b. Error of omission 2. Patient specificity 3. Context sensitive- relates directly to the work at hand 4. Integrated into workflow- convenient to use. 5. Timely- executes in real time 6. Pushes information to the clinician, care-giver or health care consumer 7. Intelligently filtered clinical information ; Information, advice or warning is relevant and meaningful ; CADS uses patient data to infer that the message is actually needed. ; CADS is customizable to clinical preferences. Types of Clinical Decision Support A. Patient-specific CADS B.Non-patient specific CADS ; This type of CADS consist of three types f alerts 1 . Commercial drug-interaction alerting system 2. Commercial dose and dose-range checking alerts 3. Commercial clinical rules engine Commercial drug-interaction alerting system ; Most common in COPE and Pharmacy Information systems. ; Provides alerts for drug-allergy, drug-drug, drug-pregnancy and other interactions. ; Limitation is that severity levels Of drug interaction is pre-assigned by the vendor based on the anticipated adverse reaction and cannot be customized.Four Possible Results from deterioration alerting system Alert Result Produces alert? Relevant? Clinician deeds to see? True Positive Yes True Negative NO No P ositive False Yes but never gets the chance Commercial dose and dose-range checking alerts ; Currently, this is rudimentary using few patient data, usually only age. Therefore this systems only loosely fit paternalistic category. Commercial clinical rules engine ; These allow local development or customization of clinical content and programming logic. 2. 3. 4.Data mining Informational notice Order sets Knowledge retrieval systems ; Provides population specific relationships and information. ; Encompasses numerous methods used to identify patterns and relationships in data. ; Usually just-in-time, product specific information. ; Examples: 1 . Provides alert for possible ALAS 2. In COPE, it might be order specific information such as the cost off lab test, or formula status of a drug. ; An organized set of patient care orders that are usually population, procedure or disease specific. It may be evidence-based such as clinical guideline. ; The KIRKS ; It could be: 1. Primary KIRKS ex. Google and 2. Secondary KIRKS (Harridan's online) 3. Tertiary KIRKS (ASAP, Thomson Health care and How to maximize the benefits Of CADS? Maximizing the benefits 1. Ensure that the data available for decision-making is as comprehensive as possible. Data should be current and urge Larry updated. 2. Optimize the method by which the decision support information is delivered to the health care provider values of CADS ; Application of CADS in different current medical technologies available: 1.COPE 2. OMAR(Getronics Medication Administration 3. Smart Pumps 4. Automated distribution cabinets CADS in COPE CADS integrated in COPE can: ; Reduce medication errors (any preventable event that may lead to inappropriate medication use or cause harm to he patient while the medication is in the control of a health care professional, patient or consumer) ; Improve compliance with recommended monitoring or adjunctive therapies. ; Improve efficiency by reducing the time spent clarifying incomplete ord ers. Screen for a variety or risks on the point of entry (ex. Duplicate therapy, drug-drug, allergic cross sensitivities) ; can reduced mathematical errors by automating weight-based and similar dosing calculations. ; can identify possible ALAS medications. Computerized Provider Order Entry CADS in Omar ; OMAR (Electronic Medication Administration Record) CADS integrated in Omar can: ; Can provide real time confirmation of the 5 rights of medication administration: 1. Right medication 2. Right dose 3. Right route 4. Right patient 5.Right time ; Can screen for recent changes in laboratory parameters, vital signs, or allergy status which may interact with a scheduled medication and alert the nurse prior to administration. ; Ex: laboratory shows critical level of potassium thereby alerting the nurse before administering dioxin to patient. CADS in Smart Pumps ; Smart pump- a computerized infusion device that can be programmed to include specific set of data. CADS integrated in Smart Pum ps can: ; Provide real time confirmation of the volume, rate and concentration of the solution being administered.Smart Pumps CADS in Automated Dispensing Cabinets ; ADS- secure storage cabinets typically located decennially on patient care units capable of handling most unit-dose and multiple dose medications. ; CADS integrated in ADS can: ; Notify nurses of potential hypersensitivity or ADAIR when certain trigger medications are withdrawn for a patient. ; In pharmacy, can provide alerts when medication is withdrawn too early or too ate based on scheduled administration time. Automated Dispensing Cabinets Unintended consequences in CADS ; A. Alert fatigue ; 8. Delay in care ; C. System performance A.Alert fatigue ; Tendency users to become overwhelmed and begin to ignore CDC messages due to a high quantity of alerts or a perception that the alerts have little perceived value. B. Delay in care ; The risk that interruptions in the workflow caused by clinical decision support alerts o r system limitations may lead to a delay in delivery of patient care. C. System Performance ; The risk that the processor resources seed by the CADS will cause the hospital information system software to perform slowly. Arden syntax standard ; A programming language designed for clinicians to build clinical rules. Streamlined computer language based on Pascal. ; Developed in Columbia University Arden Homestead in 1989. ; This standard provides a method to construct clinical rules, such as alerts, reminders and recommendations, known as Ml. ; Provides a flexible and clinically way to develop Ml. What is Ml? Ml ; Means Medical Logical Modules ; Offers a suggestion or warning (alert, recommendation or reminder) regarding a alnico decision or action, or an informational notice to report a change in a patient's clinical status.

Violation of Human Rights by Police Free Essay Example, 1000 words

The case of Rodney Glen King is a classic and most prominent example of police brutality. King, a divorcee with kids, was violently harmed and beaten by police enforcers of Los Angeles Police Department (LAPD) sometime in 1991 after he was caught by authorities robbing a store and have gravely threatened and lambasted the store owner with an iron bar (Cannon, 1999). King was beaten by police badly and such incident was captured by media workers who magnified it to public eyes, and subsequently caused dissension amongst black community people who have viewed the incident as glaring proof of racial prejudice and discrimination (Cannon, 1999). Police was subjected in a court trial but whose acquittal resulted in riots at LA in 1992. Civil suits were later charged against the enforcers which jailed two officers while two others were acquitted (Cannon, 1999). In a subsequent case, King and his two other companies were arrested by police officers due to over speeding at a highway and driv ing his car with alcohol s influence (Cannon, 1999). Albeit police warning, King ignored them. He also made some resistance while authorities were about to handcuff him. We will write a custom essay sample on Violation of Human Rights by Police or any topic specifically for you Only $17.96 $11.86/pageorder now Police used a taser to subdue him but was later prompted to beat him with56 batons blows which caused him 11 skull fractures and brain damage, broken joints, bones, and teeth. Medical test further proved that King was using marijuana. He was likewise severely ridiculed by enforcers while at such state (Cannon, 1999). Out of this incident, LA lawyers sued the police officers for excessive use of violent force to King and of administrative negligence due to his inability of the supervisor to order the stoppage of further assaults to King (Cannon, 1999). The trial orbited with procedural sensitivities until the jury of Ventura Country decided for the acquittal of accused policemen (Cannon, 1999). The decision was however unacceptable for US president and other executives citing that King is a victim of police brutality.

Juvenile Crime Essay - 528 Words

One of the biggest problems which the United States is faced with is juvenile crime. The reason experts feel juvenile’s commit crimes is because of risk factors when they were younger but experts still have not found the main reason why juvenile’s commit crimes. Some risk factors associated with juvenile crime are poverty, repeated exposure to violence, drugs, easy access to firearms, unstable family life and family violence, delinquent peer groups, and media violence. Especially the demise of family life, the effect of the media on the juveniles today, and the increase of firearms available today have played a big role in the increase of juveniles crimes. nbsp;nbsp;nbsp;nbsp;nbsp;The most common risk factor is the demise of the†¦show more content†¦nbsp;nbsp;nbsp;nbsp;nbsp;Another risk factor is the effect of the media on the juveniles of today. Before the time a child has reached seventh grade, the average child has witnessed 8,000 murders and 100,000 acts of violence on the television. There is no doubt that heavy exposure to televised violence is one of the causes of aggressive behavior, crime and violence in society. Television violence affects youngsters of all ages, of both genders, at all economic levels, and all levels of intelligence. Long-term childhood exposure to television is a casual factor behind one half of the homicides committed by juveniles in the United States. nbsp;nbsp;nbsp;nbsp;nbsp;The increased availability of guns has played a big part in escalating the number of crimes committed by juveniles. In Los Angeles juvenile delinquency cases involving weapon violation grew by 86% from 1988 to 1992, which was more then any other type of juvenile offense. According to a University of Michigan study found that 270,000 guns accompany secondary school students to class daily. This is startling because it shows how many more juveniles are carrying guns and the juvenile use of guns in homicides has increased from 65 to 80 percent from 1987 to 1991. nbsp;nbsp;nbsp;nbsp;nbsp;The possession of firearms plays a big cause in the delinquency of children and is playing a bigger role in the crimes which juveniles commit. Another cause of the increase of juvenile crimes has been the effectShow MoreRelatedJuvenile Crime And Juvenile Crimes1437 Words   |  6 Pagestoday is juvenile crime. Today the juvenile involvement in crime occurs for many different reasons in many different places. Ages still in the single digits all the way through 17 are committing illegal juvenile acts each and every day. Some of these crimes are done on purpose and with an intent and some of the crimes are done on total accident. Juveniles all over America in all different places are committing crime today and as you read this there are juveniles somewhere out committing crimes. â€Å"TheRead MoreJuvenile Crimes And Juvenile Crime1620 Words   |  7 PagesJuvenile Crimes Juvenile crime occurs when a person violates the criminal law under the age of majority (in most states it’s 18). The juvenile system is way different than the adult system. When a juvenile commits a crime there are legal consequences for their actions depending on what he/she did. Sometimes the system can put them in rehabilitation or a detention center. If the offense is minor, the juvenile could be released to the custody of a parent or legal guardian. In the United StatesRead MoreJuvenile Crimes Of Juveniles1055 Words   |  5 Pagesof anyone who has been a victim of a major crime? I live near the nation’s capitol and our local news channel carries stories about people meeting this fate every day. 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