1. Our Babies: Safe &
Sound
WV Asthma Coalition
Spring Quarterly Meeting
– May 14, 2013
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2. Connecting the Dots
Asthma appears to be a greater risk for
children who have experienced traumatic and
stressful events including child maltreatment.
Importance of screening for asthma among
victims of childhood abuse, and awareness of
the possibility of physical or sexual abuse
among children with asthma.
Healthy lung development is key to
preventing SUIDs and SIDS.
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3. Child Abuse Increases
Asthma Risks
The risk of developing asthma is doubled
in children who have suffered physical or
sexual abuse, new research in Puerto
Rico shows.
Survey of 1,213 children and their chief
caregivers found that nearly 40 percent
had been diagnosed with asthma at some
point.
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4. 2008 Puerto Rico Study
Study found that victims of sexual or
physical abuse were 2.52 times more
likely to have asthma currently, and 2.35
times more likely to be taking asthma
medications.
http://www.atsjournals.org/doi
/abs/10.1164/rccm.200711-1629OC
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5. Epigenetics
Follow-Up Study published this year linked
Asthma In Puerto Rican Children and
Exposure to Violence to Genetic Changes
“Most asthma studies have focused on
environmental factors such as air pollution.
This is one of the first to look at the impact of
stress on epigenetics, which can cause
differences in gene expression.”
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6. Boston University Study Linked Abuse
in Childhood Linked to Adult Asthma in
African-American Women
African-American women who reported
suffering abuse before age 11 had a
greater likelihood of adult-onset asthma
compared to women whose childhood and
adolescence were free of abuse,
according to a new study from the Slone
Epidemiology Center at the Boston
University School of Public Health.
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7. Boston University Study
The study followed 28,456 African-American
women from 1995 to 2011.
Results indicate incidence of adult-onset
asthma was more than 20% higher among
women who had been abused during
childhood.
Evidence was stronger for physical abuse
than for sexual abuse.
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8. Adverse Childhood Experiences
(ACEs) have long-term effects.
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9. The Adverse Childhood
Experiences (ACE) Study
• The largest study of its kind ever done to
examine the health and social effects of
adverse childhood experiences over the
lifespan (18,000 participants)

10. The Adverse Childhood Experiences
(ACE) Study
Summary of Findings:
• Adverse Childhood Experiences (ACEs)
are very common
• ACEs are strong predictors of later
health risks and disease
• This combination makes ACEs the leading
determinant of the health and social well-being of
our nation

11. Categories of Adverse
Childhood Experiences
Category
Prevalence (%)
Abuse, by Category
Psychological (by parents) 11%
Physical (by parents) 11%
Sexual (anyone) 22%
Household Dysfunction, by Category
Substance Abuse 26%
Mental Illness 19%
Mother Treated Violently 13%
Imprisoned Household Member 3%

13. Evidence from ACE Study
Suggests:
These chronic diseases in
adults are determined
decades earlier, by the
experiences of childhood.
Affective
Response

14. Adverse Childhood Experiences
vs. Current Smoking
0
2
4
6
8
10
12
14
16
18
20
0 1 2 3 4-5 6 or more
ACE Score
%

15. ACE Score vs. Smoking and COPD
0
2
4
6
8
10
12
14
16
18
20PercentWithProblem
0 1 2 3 4 or more
ACE Score:
Regular smoking by age 14 COPD

16. Implications
Research findings highlight importance of
screening for asthma among victims of
childhood abuse, and awareness of the
possibility of physical or sexual abuse
among children with asthma.
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17. Facts about Child Maltreatment
In West Virginia (2010)
32,244 CPS referrals.
4,133 substantiated cases.
3,961 child victims.
8 children died.
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18. Child Abuse is Declining in WV
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19. What are some potential
warning signs and indicators?
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20. What are some physical indicators of
possible physical abuse?
Physical Indicators
Questionable bruises
Questionable burns
Questionable fractures (in various stages
of healing)
Questionable cuts and scrapes (to mouth,
eyes, external genitalia)

21. What are some behavioral indicators
of possible physical abuse?
Behavioral Indicators
Uncomfortable with physical contact
Wary of adult contacts
Behavioral extremes
Afraid to go home
Wears inappropriate clothing for season to
hide injuries
Self destructive

22. What are some physical indicators of
possible child neglect?
Physical Indicators
Consistent hunger, poor hygiene,
inappropriate clothing
Consistent lack of supervision
Unattended physical or health problems
Abandonment

23. What are some behavioral indicators
of possible child neglect?
Behavioral Indicators
Begging, stealing food
Constant fatigue, falling asleep
States there is no caregiver
Frequently absent
Shunned by peers
Self destructive

24. What are some physical indicators of
possible sexual abuse?
Physical Indicators
Difficulty walking or sitting
Torn, stained or bloody underwear / diaper
Bruises or bleeding in external genitalia
Massive weight change

25. What are some behavioral indicators
of possible sexual abuse?
Behavioral Indicators
Withdrawal, chronic depression
Overly compliant, passive behavior aimed at
maintaining a low profile.
Hostility or aggression.
Unusual sexual behavior or knowledge.
Unusually seductive behaviors with peers
and adults.

26. What are some physical indicators of
possible emotional abuse?
Physical Indicators
Speech disorders
Lags in physical development
Failure to thrive

27. What are some behavioral indicators
of possible emotional abuse?
Behavioral Indicators
Behavior extremes: compliant, passive,
aggressive, demanding, rageful.
Overly adaptive behavior: “Parents” other
children inappropriately.
Inappropriately infantile or emotionally needy.
Self-destructive, attempted suicide.

28. Childhood Asthma and Neglect
Extrinsic Asthma
/Sensitivity to inhalent
allergens
– Dust mites
– Animal dander
– Cockroaches
– Pollen
– Mold
Intrinsic Asthma
– Emotional Stress
Medical Neglect
– Failure to maintain
asthma medication
Smoking
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29. Mandate to Report
Section 2.
All About Reporting
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30. Who Must Report
WV Code §49-6A-6
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31. New Mandated Reporters
Who Must Report
Per SB 161 (effective June 8, 2012)
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youth camp administrator or counselor
employee, coach or volunteer of an entity that
provides organized activities for children
commercial film or photographic print
processor

32. Additional Requirements Regarding
Child Sexual Abuse Reporting
Per SB 161 (effective June 8, 2012)
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Any person over 18 who receives a disclosure
from a credible witness or observes any sexual
abuse or sexual assault of a child shall report
the circumstances or cause a report to be made
to the Department or the State Police or other
law-enforcement agency having jurisdiction.
Reports shall be made immediately and not
more than 48 hours after receiving such a
disclosure or observing the sexual abuse.

33. Additional Requirements Regarding
Child Sexual Abuse Reporting
Per SB 161 (effective June 8, 2012)
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 If the reporter feels that reporting the alleged sexual
abuse will expose themselves, the child, the
reporter's children or other children in the subjects
household to an increased threat of serious
bodily injury, the individual may delay making the
report while he or she undertakes measures to
remove themselves or the affected children from the
perceived threat of additional harm.
 The individual must make the report as soon as
practical after the threat of harm has been reduced.

34. Types of Disclosure
 Indirect Hints
• "My babysitter keeps bothering me."
 Disguised Disclosures
• "I know someone who is being touched in a bad way."
 Disclosures with Strings Attached
• "I have a problem, but if I tell you about it, you have to
promise not to tell."

35. What should you do when a
parent or child discloses?
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36. Disclosure
What to do when a parent or child discloses?
1. Find a private place to talk with the person.
2. Reassure the person making the disclosure ("I believe you.”)
3. Listen openly and calmly, with minimal interruptions.
4. Write down the facts and words as the person has stated
them. (Exact words are important to investigators.)
5. Do not promise not to tell, but respect the person’s
confidentiality by not telling others who don’t need to know.
6. Tell the truth.
7. Be specific. Let the child know what is going to happen.
8. Assess the child’s immediate safety.
9. Be supportive. Report the disclosure within 48 hrs to CPS.

37. Disclosure
What NOT to Say When Someone Discloses To You
1. Don’t ask “why” questions such as:
• “Why didn't you stop him or her?”
• “Why are you telling me this?”
2. Don't say "Are you sure?"
3. Don't ask "Are you telling the truth?"
4. Don't say "Let me know if it happens again."
5. Avoid leading questions ("Did your uncle touch
you too? Was he wearing a blue jacket?”)

38. How do you make a report?
You should contact CPS whenever you
reasonably suspect a child has been abused or
neglected or is subject to conditions where
abuse or neglect is likely to occur.
CPS will accept your report and determine “Is
the child safe or does the child need protected?”
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39. To Whom Do You Report?
WV Child Abuse and Neglect Hotline
1-800-352-6513
24 hours a day - 7 days a week
For serious physical abuse and sexual abuse, also contact
the state police and local law enforcement.
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40. Responsibility to Prevent
Section 3.
What Child Abuse Prevention
Looks Like
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41. Responsibility to Prevent
“No epidemic has ever been resolved by
paying attention to the treatment of the
affected individual.”
-- George W. Albee, Ph.D.
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42. Protective Factors:
A New Prevention Framework
Suitable for universal, positive approach to
families (no “risk” factors or deficit approach)
Easily communicated to all audiences
Based on hard evidence
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44. Protective Factors
“Circles of Caring”
Knowledge of Parenting & Child
Development
Parental Resilience
Social Connections
Social & Emotional Development of Children
Concrete Support in Times of Need

45. Knowledge of Parenting & Child
Development
Information about how children
develop
How to deal with challenging
behaviors
Alternatives to how we were raised

46. Parental Resilience
Able to solve problems
Feel supported
Ability to bounce back

47. Social Connections
Relationships
Community norms
Mutual assistance networks

48. Social and Emotional
Development of Children
Positive parent-child interaction.
Appropriate adult response to challenging
behaviors or when development is not on track.
Children learn to express themselves and their
emotions.

49. Concrete Support in Times of Need
Response to crisis.
Assistance with daily needs.
Services for children and parents.

50. Remember…
WV Child Abuse and Neglect Hotline
1-800-352-6513
24 hours a day - 7 days a week
For serious physical abuse and sexual abuse, also contact
the state police and local law enforcement.

51. For More Information Contact:
The TEAM for West Virginia Children
1-866-4KIDSWV
304-697-0340
Email: pcawv@teamwv.org
Twitter: @TEAM4WVChildren
http://slideshare.net/PCAWV
http://www.preventchildabusewv.org
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