CSAT’s
Knowledge Application Program

KAP Keys for Clinicians

Based on TIP 36
Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
www.samhsa.gov

Introduction
Key 1: Symptoms/Syndromes Associated With Childhood Abuse and Neglect
Key 2: Screening Questions: Detecting a History of Childhood Abuse or Neglect
Key 3: Behavioral Clues
Key 4: What Children’s Protective Services Agencies Should Do
Ordering Information

Introduction

These KAP Keys were developed to accompany the Treatment Improvement Protocol (TIP) Series published by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration. These KAP Keys are based entirely on TIP 36 and are designed to meet the needs of the busy clinician for concise, easily accessed “how-to” information.

For more information on the topics in these KAP Keys, see TIP 36.

Other Treatment Improvement Protocols that are relevant to these KAP Keys:

TIP 9, Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Abuse (1994, Reprinted 1999) BKD134

TIP 25, Substance Abuse Treatment and Domestic Violence (1997) BKD239

TIP 27, Comprehensive Case Management for Substance Abuse Treatment (1998) BKD251

Key 1 Symptoms/Syndromes Associated With Childhood Abuse and Neglect

Common

• Excessive feelings of
• Helplessness
• Low self-esteem
• Guilt
• Shame
• Anxiety
• Depression
• Anger
• Suicidal behavior
• Posttraumatic stress disorders
• Substance abuse disorders
• Difficulty in close or intimate relationships

Less Common

• Symptoms of dissociation
• Dissociative (traumatic) amnesia
• Dissociative identity disorder
• Borderline personality disorder
• Antisocial personality disorder
• Somatization
• Compulsive/indiscriminate sexual activity
• Bingeing, chronic overeating, eating disorders
• Self-mutilation or other self-harm

Key 2 Screening Questions: Detecting a History of Childhood Abuse or Neglect

The following questions can be used to help screen for a history of childhood abuse or neglect. They can be asked as written, or they can be asked in relation to developmental stages. To do so, ask the same question with an introductory phrase that reflects different time periods or developmental stages. For example, the question “Were you treated harshly as a child?” can be rephrased as, “When you were 5 to 10 years old…” or “When you were 11 to 15 years old….”

Screening Questions

1.    Were there any significant traumatic events in your family while you were growing up? For example, did any of the following events occur in your family:

• Death?
• Prolonged hospitalization of a parent/sibling?
• Incarceration of a parent or sibling?
• Divorce?
• A chronic disease?

2.    Were you treated harshly as a child?

3.    Did you ever experience physical abuse as a child?

4.    Did you ever experience sexual abuse as a child?

5.    Did you ever experience emotional abuse as a child?

6.     Did you experience inappropriate physical or sexual contact with an adult or person at least 5 years older than you while you were growing up?

7.     When you were a child, was there violence in your household, such as battering involving siblings or a parent and his or her partner?

8.     Do you feel that your parents neglected you while you were growing up?

9.     Were there ever periods during which you did not have adequate food, clothing, shelter, or protection?

10.   Did your parents use alcohol or drugs frequently when you were growing up?

11.  Did you ever use alcohol or drugs with them?

12.   Have you or has anyone in your family ever been involved with the children’s protective system?

13.  Did you ever live away from your parents?

14.  Were you or your siblings ever in foster care?

15.   When you were a child, were there any periods when you felt unsafe or in danger?

16.   When you were growing up, did anyone in your family use alcohol or drugs? How did his or her alcohol or drug use affect you as a child?

17.   Have you ever felt that abuse or neglect was justified based on your misbehavior or shortcomings?

18.   Did you feel that the abuse was your fault and that you deserved it?

Adapted from TIP 36, Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues, page 24.

Key 3 Behavioral Clues

The following behavior may indicate that a parent or caregiver is abusing or neglecting children:

• Name calling or negative or belittling labeling of children.
• Telling stories that suggest children are living in unsafe conditions (e.g., being left alone, traveling in unsafe neighborhoods)
• Blaming children or directing misplaced anger at them that may mask guilt about poor parenting.
• Inappropriately describing children in terms of their development (e.g., having expectations for a 4-year-old that should be reserved for a 12-year-old).
• Giving children too many responsibilities and too much autonomy for their age.
• Sexualizing the child.
• Imposing inappropriate disciplinary measures: an inability to distinguish between discipline (guiding) and punishment (hurting).

Adapted from TIP 36, Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues, page 80.

Key 4 What Children’s Protective Services Agencies Should Do

• Respond to reports of child abuse and neglect, and identify children who are being maltreated or at risk for maltreatment.
• Assess the situation—the safety of the child or children, the risk of further maltreatment, the resources and needs of the parents and extended families, and their willingness and motivation to receive help.
• Assemble the resources and services needed to support the family and protect the children.
• Provide settings for alternative or substitute care for children who cannot safely remain at home.
• Evaluate progress and assess the need for further attention by children’s protective services.

Adapted from TIP 36, Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues, page 88.

Ordering Information

TIP 36
Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues

Easy Ways to Obtain FREE Copies of All TIP Products

• Call SAMHSA’s National Clearinghouse for Alcohol and Drug Information (NCADI) at 800–729–6686, TDD (hearing impaired) 800–487–4889
• Visit CSAT’s Web site at www.csat.samhsa.gov

Do not reproduce or distribute this publication for a fee without specific, written authorization from the Office of Communications, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

DHHS Publication No. (SMA) 01-3605
Printed 2001