The Forgotten Children by Debasish Kundu , Malik A. K. Awan

The Forgotten Children By Prof.Dr.Debasish Kundu M.D.H., F.F.Hom, F.I.H.M.S., Ph.D.(U.S.A.), D.Sc.(Colombo) Fellow of International Holistic Medical Society, CA,U.S.A. Fellow of Foundation of Homeopathy, NY, U.S.A., Fellow of World E.Homeopathy System of Medical Council, Hong Kong, Faculty, International Holistic Medical Society,CA,U.S.A., Vice-President, American Nutritional Medical Association, CA,U.S.A. Visiting Professor, Khulna Homeopathic Medical College & Hospital, Khulna, Bangladesh.

Former Director General , Mooreland University, U.S.A. Author, Materia Medica for the New Age Man, Diseases of Women ,Natural Medicines,A Clinical Treatise on Cancer,Aids & Homeopathy, Pharmacodynamics, Aids & Your Sex Life, Aids & Homeopathy, Essentials of Acupuncture, etc.

Recipient, Royal Assyrian Order of Merit Laureate, Dag Hammarskjold Award for Medicine Editor In Chief, International Journal of Homeopathy & Natural Medicines, USA Editor in Chief, The Internet Journal of Herbal and Plant Medicine , U.S.A.

& Prof. Dr. Sir Malik A. K .Awan B.S.,M.S.(Psychology), M.D.(A.M.), D.C.L., D.D.(U.S.A.), Ph.D.(London) President & C.E.O., American Nutritional Medical Association, CA,U.S.A. President,International Holistic Medical Society,CA,U.S.A., President,International Homeopathtic Medical Society,CA,U.S.A., Chief Editor, Holistic Medical Hylite International,CA,U.S.A., Author, Herbology, Natural Medicines, Pharmacodynamics,etc.

Laureate, Albert Schweitzer Award for Medicine

First Edition 2006 Published by: International Holistic Medical Society P.O.Box 66005, Stockton, CA 95206

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from author/editor.

Š Copyright Reserved with Dr.Debasish Kundu

Preface

Kids remember everybody in their lives. They especially remember people they have lived with. It's a sad reality that sometimes kids have to be rescued. It's a sad fact that foster parents can't adopt all their foster children.

But why be a party to further damage by taking people out of kids â lives if a positive relationship can be salvaged? Whether that's a bio parent, foster parent, a bio sibling or a foster sibling, a grandmother, an aunt, or a cousin.

If the child can't live with these people anymore for the multitude of unfortunate reasons we all know too well, be a part of keeping the child's access to them open, not a part of closing the child's access to them. If you understood the pain the losses cause them, believe me, you wouldn't want it on your conscience. I don't want it on mine and that is why I feel so compelled to speak out. It's a barbaric practice. Please listen, not just to me, but to all of those who have taken the time to write their stories, to those who have spent their lives searching for and piecing together their histories, their life quilts. And take a hard look at those who now live on the fringes of humanity, those homeless foster kids now grown up, those in prisons, those that are too crippled by their losses to respond in acceptable ways anymore, whose hearts are forever frozen from the cold. Maybe one preserved relationship could have made the difference.

This little booklet aims to describe Foster Care and its various aspects in easily understandable manner. We hope it will inspire you and encourage you in your efforts to effectively and lovingly parent your children. You will have no other challenge so important, so taxing, or so rewarding. If you are not currently parenting, perhaps you will be motivated to help some parent who is struggling to raise a challenging child. With these practical helps you could keep a child happily and safely engaged in positive play long enough for a tired parent to catch a nap or get to a doctor‘s appointment or maybe even read this book!

Dr.Debasish Kundu Dr.Malik A.K.Awan

Index Chapter 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Contents Introduction Foster Care and our Families Foundations of Attachment Foster Children are Ours The Foster Children‘s past and his present Learning the Job Behavioral Management Parenting Needy Children Education of Foster Children How Well Do You Know Your Child Research on Children Missing from Foster Care Why Foster parents come and stay Improving Family Foster Care Child Abuse Aiming Good Educational Outcomes Health Care Rights of Foster Children Foster Care Month Campaign Reaching out to the media Writing and Placing letters to the press Adolescents Health Bibliography

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Introduction If I listened long enough to you, I'd find a way to believe it was true.

Knowing that you lied, straight-faced while I cried.

Still I look to find a reason to believe.

- Rod Stewart A major focus of foster care programming is developing public relations materials that will entice families, with "commitment," into foster parenting. According to Webster's dictionary- "a commitment is a binding promise or pledged; a responsibility, a covenant, a vow." There is something sacred about commitments; commitment seems to be a moral as well as logical choice. Also present is the implication that we must honor our commitments from the moment we make them onward through all eternity. This unwritten but unforgettable, "never-ending" clause scares many of us away from making any sort of commitment at all. As the community develops, support of children in foster care will continue to be a need. Foster parents are an integral part of the development and nurturing of our children and the health of our community. Foster parents offer children the stability and emotional support they need to experience a safe and encouraging environment.

1. What is Foster Care?

Foster care provides protective services for children. It provides 24-hour temporary placement of children outside their own homes due to neglect, abuse, or other significant family problems. The goal of foster care services is to strengthen the family of origin, so the child can be returned safely home as soon as possible.

The objectives of foster care are to: Protect the child and provide sufficient care for the child on a temporary basis in a nurturing, stimulating environment Help the child cope with the separation from the family Provide a safe environment while developing and implementing a permanent plan for the child‘s future Family foster care can offer care to children with a range of problems, depending on the experience, expertise, and resources of the foster family. Foster parents work together with the child‘s biological parents and with a variety of professionals including social workers, juvenile court officers and judges, family counselors in private and public agencies, and a variety of medical personnel, as needed by the child.

2. Who Are Foster Parents?

Foster parents come from a variety of backgrounds and experiences. We welcome anyone with a desire to provide care for children to apply as a foster parent.

3. What Do Foster Parents Do? Provide children with a safe, nurturing relationship Work as members of a professional team Support the child‘s relationship with the birth family Ensure that the child‘s basic needs such as food, clothing, shelter, medical, educational, and emotional development are met

4. Which Children Need Homes the Most?

Any child, under the age of 18, can need a foster parent. Each child‘s needs are different.

Foster parents are needed to provide homes for: Teenagers Sibling groups who need to stay together Infants and toddlers Children with emotional/behavioral needs Children with special needs 5. How Do I Become a Foster Parent?

For more information, contact your nearest Health and Human Services Center A representative will call you back and then mail you initial information regarding the process Orientation and required training will be provided at no cost to prospective foster applicants 6. How Can I Support Foster Care Program?

Distribute foster care information to your employees at your place of work Allow any Foster Care agency to hold presentations, set up display booths/tables, and distribute information to your employees or civic groups Volunteer your time by becoming involved as a mentor or working at special events to promote the foster care program Donate or sponsor specific items that are often needed by foster children – shoes, clothing, school supplies, luggage, coats, etc.

Contribute financially to aid families in their support of extra-curriculum activities.

On Family Foster Home Retention A significant amount of space has been devoted to issues of recruitment and training of foster parents. Less has been said and written about the retention of the foster families we have or increasing the longevity of the ones we recruit. Are trained and experienced people leaving the foster care system at the same rate new people are entering it?

On the road with Recruitment and Retention workshops, participants consistently ask about retention. For home recruiters it is a priority concern. I always try to suggest a number of ways to decrease the untimely loss of quality foster families: adequate preparation through pre-service training; maintenance of skill through in-service training; burnout protection measures; stress management training; foster parent participation as full partners in case planning and agency functioning; respite care; careful matching of children with families; recognition of service; support groups, and so on.

A major focus of recruitment programming is developing public relations materials that will entice families, with "commitment," into foster parenting. Guilt, it seems, is the unavoidable by-product of wavering commitment. Wavering commitments tend to turn into hollow responsibilities which tend to turn into distasteful obligations. All the passion and energy and excitement that accompanied the commitment slips away. The activity once performed with skill, grace and enthusiasm gets done with mediocrity and sometimes bitterness. The once highly committed individual gives less and does only enough to get by - serving no one's true interest.

Wavering commitment is not necessarily a function of no longer caring but of losing interest and enthusiasm for the way we have chosen to act on our commitment. Thus giving up did not mean I no longer cared about people or the children they serve, I simply

had reached my limit when it came to the activity of class advocacy. I had given all I could, and there is ample evidence I've better served my commitment by leaving than I would have had I stayed.

Sometimes people simply need to move on. They commit themselves to foster care (or any other vocation) in good faith, fully intending for their commitment to last for years and perhaps forever. They give their best and their all as they pledged they would. But for many, a time arrives when direct service in foster care just doesn't fit them anymore.

They have outgrown it; unforeseen events have altered their ability and motivation to honor their commitment; or they have found another or better way to act on their beliefs and values. In most cases they have given all they effectively could. Continuing, only because they promised they would, gives nothing of value to anybody.

When it is time for foster parents to move on, we must let them without guilting them into doing more or hanging in just a little longer. There are things we can do to ensure the activity of foster parenting remains acceptable and appealing for longer periods of time, but not forever. We must do the best we can to support and recognize the people who are willing and able to stay. However, we must look realistically and unemotionally at the fact that people do leave, and some should leave.

We must create opportunities for foster parents to serve the foster care system in ways other than direct service. The truth is parenting other peoples' children is a remarkably demanding task and it takes a toll on every foster parent. We must create alternative ways for former foster parents to act on their commitment - providing respite care, serving on recruitment committees, lobbying legislators, etc. And we must accept the fact there are only a limited number of people in the universe who can provide quality foster care; some for years, others for decades. That means we must continue to bring new people into the system as foster families: that's why we call it recruitment and retention.

Focus on Foster Home Retention II The initial essay on Retention, to summarize the responses, was helpful but misses the mark in offering practical advise on improving agency retention programing. To quote one frustrated home finder: "I spend all of my time recruiting new homes-hours on the road, speaking, promoting, doing the dog-and-pony shows, only to have the homes fretted away by some insensitive, inept or perceived slight from the agency. I have no difficulty in accepting those who retire from fostering because they want to move on, what I need is some how-to on keeping those homes who still have the commitment but seem to get lost in the day-to-day shuffle."

Let me begin by suggesting the obvious: before you can improve your agency foster home retention programing you must first have a retention program. No, an annual gettogether with the obligatory piece of mystery meat sans sauce does not constitute a retention program. True, an annual feast with certificates of appreciation and\or longevity, some door prizes and some supportive words from the agency leadership is a nice event in one's retention program but for many agencies it seems to be the retention program.

An effective retention program should begin with the recognition that fostering someone else's child is, simply put, a job-and, like every job, has its pluses and minuses. As long as the agency-foster parent relationship stays in the plus column we improve our odds to retain the home. The same job support factors that retain social workers, auto mechanics, nurses, school teachers and software engineers will retain foster care providers. In broad

terms, the retention factors include: mentally challenging work, equitable rewards, supportive working conditions, supportive colleagues, and personality-job fit.

Viewing fostering has a job as practical implications for retention programing. When we apply for a job we expect a clear job description; a list of responsibilities, obligations and tasks; a definition of the rewards/ compensations; and, a definition of where we fit in the organizational chart, i.e., from where we will get out peer support. Effective foster home retention is founded on the home's recruitment-is what the agency promotes as the job of fostering the reality of what your new homes encounter as they enter your system? When the agency promotes that fostering is a team effort are all agency staff members on the same page in defining team, and, are we conveying that definition clearly to our recruits?

And while on the issue of commonality of definitions, do the line staff, child social workers and foster home workers have a realistic understanding of the demands foster families face?

Improving your home retention programming includes instituting an exit survey system.

Without the follow-up your agency merely assumes why the Smiths left the program.

Whatever the hard facts may include (personality conflicts with staff, poor staff-home support, poor, ineffective or non-communication, and the like) most are amenable to training. The kinds of questions one should ask include: * Were their needs met? * Did they have clear understanding of their responsibilities? * Were they informed of placement goals established for the child? * Did they receive prompt notification of any goal changes for the children? * What, if any, were there placement issues? * What was their overall feelings about their fostering experience.

The point is, naturally, you cannot fix what you don't know is broken. The survey data should be quantified and used to add, amend or modify retention programming accordingly.

Retained and compared from year to year, your exit survey data will offer concrete suggestions for improving your home recruitment and both pre and in-service training.

The single most effective component of a foster home retention program is in-service training. Granted, parenting skills to manage demanding behaviors is important but don't overlook that long list of social, inter-personal and communication skills necessary to make the home-to-agency relationship more effective and less stressful for the foster parent. I suggest you also consider the disconnect between what your pre-service training promised and what is the realty of fostering. Most pre-service training packages treat demanding behavior in a vacuum, i.e., one at a time-when's the last time you encounter a youth who processed problems one at a time? Equally frustrating for foster parents is realizing that the agency pre-service or orientation packaged the agency-to-foster home support in a rather romanticized view.

Borrowing from Susan Meltsner's Burnout, here are a few stressors you may want to address: * adjustment to the placement of a new child into your home; * inadequate information * disagreeing with a caseworker * remaining non-judgmental concerning birth parents * transportation to a variety of appointments

* not having telephone calls returned * dealing with a withdrawn, hostile or disturbed child * dealing with a child and school personnel about problems the child is creating, experiencing in school * birth parents missing visits * a child with a particularly traumatic background * a child who is involved with drugs/alcohol, or sexually acting out or committing crimes * child going on overnight visits * child requiring special medical attention * new regulations * disagreements with a spouse over the discipline of children * possibility of adopting a child in your care * not knowing the agency's immediate or long term plans for a child * having to ask that a child be removed from your home * difficulty with time management * destruction of property * allegations of abuse * separation Generally the big-four issues would include: burnout, allegations of abuse, the impact of fostering on the foster parents marriage/ relationships and separation-an interesting point about the separation issue: potential foster parents focus on how difficult it must be to relinquish the child while practicing foster parents focus on the challenges of dealing with the child's separation from his family issues.

Like recruitment, retention programming is a formal, annual plan and begins with a truthin-packaging approach about fostering, a realistic description of what the demands and rewards are supported by in-service skills-building that balances the pluses and minuses in favor of retention.

Both government and non-profit child care agencies tend to face two similar realities: (1) they are viewed by John Q. Public as large, remote and defused bureaucracies, and, (2) telephone contacts leave the caller bewildered at the lack of knowledge by the receptionist, difficulty in getting the right person on the telephone and the seeming impersonal, inattentive attitude of a human service agency.

Before you garner any success at foster home recruitment you may need to invest in a personal growth program: packaging and selling your agency and its programs to your community at large, and, professionalizing and humanizing your inquiry reception and follow-up. They won't sign on if your are a stranger, and, they won't follow through if you appear disinterested.

Farming a neighborhood Develop a specialized newsletter to civic and social groups, local institutions , business or trade groups and larger employers, professional groups such as teachers, nurses, etc., sell your agency, programs and needs.

Become a cause

Focus the recruitment on the most pressing community need; speaking before local groups, responding to community inquiries--even on tangential topics; Niche marketing Develop a mailing list of trade, business and social\civic group newsletters within the community; specialized a letter to the editor campaign of providing a series of human interest stories all focusing on the need and the opportunities to help community and youth; Specializing Since your objective is to interest folk who are interested in parenting and helping other people's children, then go for those folk who by profession or advocation are already interested-- teachers and coaches, youth group leaders, youth recreational leaders, all company-civic group sponsored youth activity facilitators, etc.; Simple Integrated Marketing As you know, your current foster homes are your best recruiters (and equally true, a disgruntled current or retired foster home is your single greatest competitor for new homes). Develop and produce individual foster family home recruitment kits--brochures, informative handouts [about child in need statistics, support services offered to foster families by the agency--training, respite, sponsored activities, etc.] personalized business cards, note cards for follow-up contacts, and so on. Present a training on One on One Recruitment for your interested foster parents - give them their kits and engage. Offer incentives for home referrals, or a cash bounty for homes recruited and approved. Have the program self-sustaining with agency staff supervision.

Action Agenda: Building a Database So, you ask each of your foster families and your agency staff folk to give you two names of people that they know who are engaged in a child\youth focused occupation or activity. Remember, there are dozens of positive and supportive activities for your agency's foster home program that do not involve accepting placements. Mine your database: develop and distribute your wish list, gear a specific recruitment program for the database, ask the database for additional referrals to add to the database, personalize your program with frequent contacts-such as a specialized newsletter-with your database-truth is, your best foot forward in your community are the folk in your community.

What, your agency does not have time or resources to manage this project? So, you ask your foster families: who has a computer and can spare two hours a week?

Don't Recruit : Help Folks Join Nothing sells like success, certainly not original, but 'tis true even for foster family recruitment. Potential families may know they want infants, or toddlers, or, more frequently, that they don't want teenagers. Selling your program as opposed to a particular child or age group offers your potential families a larger comfort zone as they approach the decision to join your program as a fostering family. Certainly, be truthful in presenting the numbers and placement needs of the agency - if homes infants are not in demand, let the stats speak for you. The opportunities for the family to expand their

interests and work with different age groups and particular needs may only be actualized if they join in the first place. If you insist on telling them what they want they will join something else.

Relationship Selling Let's face it: what you are about is selling relationships. But don't be short-sighted, you should be selling two relationships: that of the foster family and the child placed in their care and the relationship between the foster family and the agency. The first is obvious, the second is often presumed but frequently mythical. You need to clearly define and package the agency's support, technical assistance and accessibility in an easy-to-read reference guide that provides the potential foster family a what's what of what can be expected from the agency. Tough and demanding tasks are made easier when there is a support relationship with the agency. Having difficulty in crafting a statement of the agency's support for your foster families? Then, any wonder you have difficulty in recruiting and maintaining families?

Action Agenda: Selling Your Agency As Albert Einstein so eloquently put it: "The definition of insanity is doing the same thing over and over and expecting a new result." If your agency has a low profile, a negative profile or even a no profile then get out there and sell, sell, sell (actually, educate, educate, educate). You develop and deploy a straight forward public education project. Lots of options: speakers bureau; pubic seminars about your agency and programs, with church and civic groups; human interest programming in the papers, on radio and TV the objective it to create a positive profile to which folk respond during your recruitment camp. Tough to have folk join and be supportive when they don't know who or what you are. Chicken and egg question, true, but, when's the last time you gave support of any kind to an activity about which you knew little or nothing?

The Beginning Every system offers resistance to new ideas, new efforts or new programming. A great starting point in analyzing your agency's response to previous foster and adoptive recruitment efforts and predicting support for your new endeavor is to apply the don't ask why, ask why not test. The test may be adapted to any number of delivery systems: interview, individual questionnaire, group sessions or even bulletin board notices. The object being to gather as much information you can about the barriers you face before you face them.

The following list certainly is not exhaustive but offers a useful and lighthearted tool to survey your peers and ferret out preconceived notions as to why your ideas won't work, benchmark specific resistance you can expect in your recruitment programming and illuminate some of the hidden agenda items at work within your agency.

Frame your approach by asking recipients to check off the answers they most often hear themselves saying when ask to solve a problem, support a project or join in a project.

Good idea, not practical.

We do alright with what we have.

Let's give that some more thought.

We did that years ago.

Not in our agency.

Not in this department.

Has anyone else tried this?

Never be tried before.

Been through this before.

You know, old dog new tricks. No way.

Why don't you write that up.

What do other agencies do?

I don't like the idea.

The administration will not agree.

Why change what we are doing?

We don't have the authority.

We've never done anything like this before.

We don't have time.

Too radical.

I am too busy.

Can't change tradition.

That's not my job.

That's beyond our control.

Materials will cost too much.

Our agency is different.

We've tried that before.

Add your own excuses to the list; make a checklist questionnaire , give your peers and associates a free pen (colored ink even) for completing the form , then, inventory the results. Even this tongue-in-cheek approach will yield truthful results. Remember, humor as a way of disarming even the most ardent opposition.

With information about the reasons why not in hand you may then tackle the task of educating your team members about the how to of your recruitment programing.

Building Your Recruitment Team Your team also comes with some preconceived, group barriers you'll need to overcome as you attempt to promote the team skills needed to implement your recruitment action plan.

The following describes three sets of barriers to skills transfer with your team members.

Team-Member Centered Barriers 1. Team-Members may not see any payoff for using the skills. For Team-Members to use

the skills you are promoting they must see that the advantages of doing it your way out weigh the disadvantages.

2. Team-Members disagree with the concepts and principles of the program.

3. Team-Members initially experience failure when using the skills - they must experience success if you expect them to sustain their participation.

4. Team-Members may not have the self-confidence to use some of the skills inherent in your programing; try to match tasks to talent, especially in the initial stages of implementation.

5. Team-Members may not see an immediate need for the skills you are attempting to develop; coordinate new skills with new programing to reduce lag time.

6. Team-Members may not be aware that they are doing good, they are more likely to be enthusiastic and supportive when the feedback acknowledges the quality of their participation.

Leader-Centered Barriers 1. You may not be the most positive role model; do you practice what you preach? Don't expect Team-Members to do if you do otherwise.

2. Are you a good coach? Your Team-Members will respond as a team directly proportional to your skills as a team coach.

Agency-Centered Barriers 1. Negative balance of consequences – Team members will not use the program skills if the agency does not value those skills.

2. Project task interference – Team members will defer from your project if the agency impedes participation through time, policies, procedures or work environment constraints.

2. No positive feedback – Team members will not use new skills and support the program if the agency does not specifically support and honor their participation.

As with the individual barriers, group barriers may be overcome with planning and attention to detail when implementing your recruitment action plan.

Assessing Recruitment Material & Methods A major and on-going challenge to your recruitment programming is assessing the effectiveness of your various methods and materials; the proverbial most bang for your buck is often a delicate balancing act. You may demonstrate that A is producing results at $$ cost while B looks good but has yet to produce any results , what is difficult to calculate in your formula is the implementation lag , the time delay , between A and B .

To aid in tracking the cost both in terms of dollar resources and in staff and talent resources I offer a simple worksheet (a sample and a blank sheet for your use). Make copies and detail each of your current and prospective methods and materials; revisit the evaluation frequently. Use the information in staffing your efforts and managing your

resources.

Some suggestions for your evaluation include: Methods Broadcast Media * Radio * Network TV * Local TV * Cable TV Print Media * Daily Newspapers; * Weekly Newspapers; * Neighborhood papers; * Free, advertiser supported papers; * Community magazines; * Ethnic or religious publications; * Local Company newsletters; * Union Bulletins; * Church, organization, special interest group newsletters or bulletins.

Print Media Tools * Media Kits * Press Releases * Fact Sheets * Feature Articles * Op-ed articles * Announcements * Letters to the Editor * Columns * Press Conferences * Photographs * Advertising * Display Ads

Retention: Fostering for the Rewards Foster parents as recruiters: it is true, one nurtured family will spread the wealth.

A simple but effective strategy for rewarding foster parents is the Thanks for Being You gift bag. I take a zip lock sandwich bag, fill with the items below and place this message on a note stapled to the back:

Thanks for Being You I have packed a little bag of things that remind me of you. * Rubber Band: reminds me of those arms around me and the times I needed hugged; * Tissue: reminds me of the tears you dried; * Toothpick: reminds me of how you "pick-out" the good stuff in me; * Band Aid: reminds me of how you heal hurt feelings; * Candy Kiss: reminds me of your occasional treats; * Gold Thread: reminds me of the ties we have formed with each other; * Eraser: reminds me that when I make mistakes, it's OK; * Lifesaver Candy: reminds me that I think of you as my "lifesaver," whenever I need to talk you are there; * Mint: reminds me that you are worth a mint to me.

I use these at appreciation dinners. I have the children that are in care pass these out to the moms or dads. It is inexpensive but a wonderful way to say thank you. The children really like being able to give something back to their families and usually not a dry eye from the moms that will treasure the little bag.

The Greatest Gift Living with history of who we are defines who we will be. A written account of memories and dreams provides credibility; add life's documents, certificates and photographs of you and family members-we have roots. Such brings our childhood to life. Lettice Stuart, noted author and speaker: Portraits in Words, The Gift of a Lifetime, said, "Another life-changing event happened . My dear, sweet mother died suddenly at the age of 74. I adored my mother, and her death broke my heart. I missed her terribly, but one of the things I grieved about the most was that I had never followed through with my promise to myself to tape record her many wonderful stories of our ancestors and her childhood in Mobile, Alabama. I had heard these stories countless times, but as soon as she died I forgot many of the names and details."

Upon searching the internet I found more than 250 websites devoted to preserving family history and an additional 180 websites on preserving family. There are numerous retailers that specialize in materials to craft memory books. Office suppliers devote significant shelf space for scrap booking materials. We even have retailers that come to your home and give a presentation to you and your guests, selling memory making products as we do tupperware.

Personal projects do take time and devotion-and consistency if the project is to prove worth the effort. Begin by developing a personal style: I use clear, plastic shoe boxes labeled with family member names. Whenever I develop a role of film, I sort through the pictures placing them in the shoe boxes. I also include invitations, certificates and any awards pertinent to each individual. This Father's Day I put together a box of photos of my husband's childhood school pictures as well as family snapshots. As he viewed each picture, he told the children about the photo; we then passed them around the table one at a time. Each young adult was so excited to compare themselves with their Dad and to relish his stories. He looked at me, because there were a few other gifts inside the package besides the box of photos, "This was enough. This is overwhelming. I love you."

We will sit down and work on his book together-never finished, because life goes on and there will be more to add.

"Stories are how we pass on family values and traditions. When people die they take their memories with them. Human beings have a deep need to tell their story and to give meaning to their experiences. Telling your story gives you perspective on your life and brings continuity, connectedness and order to the seemingly haphazard events of daily living. Personal histories tell the stories behind the names and dates on family trees and genealogical charts bring those people to life. Your personal history will give your children and grandchildren a sense of family ties and roots , something that is disappearing to today's mobile society. It's the greatest gift you can leave your family," explains Lettice Stuart.

Many children in foster and adoptive homes don't know their family history and have lost all the keepsakes and life's mementoes we take for granted. Begin by looking up their family name on the internet. This research could turn up a long lost relative. Look up the year they were born and discover what was happening in the world on the day they were born. Review magazines and cut out pictures that resemble a family event they remember can substitute for the real photo. Remember the important thing is the documentation of a memory.

"The supreme happiness in life is the conviction that we are loved , loved for ourselves, or rather, loved in spite of ourselves." A quote from Victor Hugo represents the love and thought that goes into a life book because of the time and effort. What better way to say, I love you?

Some may say that they have never done anything significant or important in their lives to document. You increase self-worth by having your life in print and it provides an opportunity to discover your past--enhancing your belief that people do care for you. We are each important and our heritage needs to be shared and protected. Family history can be handed down for generations to come in a book that stores the photographic and documented memories.

A good memory book will bring laughter, tears and love thus making it the gift of a lifetime, the greatest gift you can give or receive.

Foster Care and our Families Families are challenging today. When you have a traditional number of kids it is difficult, when you have additional kids, more than the average home, and challenging kids such as in foster care, the world you live in is a different place. Thinking about the fact that foster parents open up their homes to strangers and immediately make family members of them is something that the average family doesn't do. Your world is very unlike that of your non-fostering neighbors.

Large families are familiar with some of the problems involved with caring for a whole mob of kids. Everything you do is on a large scale- cooking, shopping, laundry, school events, doctors, illnesses and meetings. I think they have some idea of what life as a foster parent is like. But, foster parents have all this and then add the stress of a variety of behavioral problems, learning disabilities and kids just trying to push the envelope - and lots of these kids. Family dinners look like Roman feasts with all the dishes.

A parent in a melded family resulting from several marriages and each spouse bringing their own children to the family have some idea of what the family dynamics are for a foster family. But as foster parents you have a whole array of personalities that you are trying to make into a unit to function as a family. The numbers and look of the family change constantly as kids come and go. That is what makes your situation so unusual.

Most families have problems and crisis occasionally; a foster family lives it 24/7. There is usually at least one child among your brood who thinks it is his job to keep you in a constant state of anxiety. You wonder if the oldest one is doing drugs. You may worry the middle one has a very strong crush on an older girl. The next two are both experiencing school problems and one has been thrown off the bus for 'acting out'. The smallest one is not responding well to love and attention. You believe she isn't bonding with you and your husband. And those are just the beginning since problems can change hourly and new kids can arrive with their own set of problems. Older kids can move out on their own, or get put into another facility. The face of the family constantly changes.

In many regular homes, where kids are doing fine, rules established, and life somewhat normal, parent's day ends at a reasonable bedtime and begins at breakfast. Not so for the foster parent who needs to do a bed check, or wait up for kids with later curfews, or do all those things the too-short day didn't include. Maybe a new crisis breaks out or you have a suicidal teen or one that is simply too upset to sleep, your day lengthens. Maybe someone just needs to bear their soul or have finally become ready to make an important revelation. Whatever the reason, your job is not a 9-5 one.

Foster parents must know so many things to get through one day, that your world barely resembles that of most parents. You need to have more than a working knowledge of drugs. A foster parent needs to know the signs of abuse. There is a need to understand reverse psychology and the concepts of reinforcement and re-direction. You need to be great at logistics since you must be everywhere at once and also learning how to stretch a dollar or a day will add to your value.

As foster parents we must display more patience and control than other parents, because kids coming into our homes are not well-behaved usually, they are not in-control themselves, and they do not want to be there sometimes. Raising kids requires patience no matter what kind of parent you are, but a foster parent cannot lose it without fear of repercussions and possibly losing that child. They are and must always be the professionals.

The chaos and craziness that is the norm for a foster parent is hard to understand for most people. The question of why you do this along with the usual statement, "I could never do what you do" lets foster parents know they are not exactly like average people. The fact that you like it and won' t do anything else convinces the world you are different. This fact means that friends must come from the ranks of other 'crazy' people just like younamely foster parents.

So when your world seems like it is from another planet and you feel like you live on the fringe of society, when your day resembles nothing like your parents and you look in the mirror and do not recognize that wild eyed parent, you know, it is true. You live in a different world. But most times it is a wonderful world- rewarding and interesting and you do make a difference.

It seems sad that we live in a time when some parents biggest concern about parenting is what their rights are in regards to their children. They want to know at what stage are

they allowed to "wash their hands" of their own kids. They need to know if they are responsible for a runaway teen's escapades while those kids are loose in the world. Their questions indicate, they are no longer able to parent these kids. They cannot hang in there for the long haul.

When you are downtrodden daily, when county agencies make you feel like dirt because you have no money or you can't handle your kids, when you live in fear for yourselves and your children, you have lost the ability to run the full race of parenting. These parents have become ineffectual. Their children have become victims.

Parents who have become so frustrated that their only response to the situation is how does this effect me as parents, have probably lost the battle. When the focus starts to change to the parents rather than the child, we are heading for trouble. The child is the one with the problem, he needs the help. When we concentrate on the parent, we sometimes neglect the plight of the child.

It is understandable that some parents will eventually reach the "end of their rope." It is also accepted that not all parents are equipped to handle the problems of an out-of-control teenager. Many parents have not had their own needs met, so cannot continue to worry about their kids. They wonder when, it will be their turn. Years of dealing with courts, police, and probation officers can dampen the enthusiasm of any parent. When a person has tried everything they know how to try and has consulted all the so called "experts" with little result, the only answer left is to give up. These parents are worn out, their energy depleted, and their spirits plummeted to the depths of hell. They are scared and desperate. They need answers, but more important they need a vacation from the responsibilities of parenting. It should not be so, but it is the case. These parents must be relieved of their parental duties in order to not do further harm to their kids. I don't mean this as a slam to the natural parents who cannot cope, unless they have really not tried.

There comes a time when we cannot go it alone and if we have done all we can do, what is left? This is usually where foster care comes in.

When we reach this point, this is where a foster parent is most valuable. If we get involved in the family too soon, before the situation has reached this point, foster care may be effective, but the parent will still not have learned how to parent. They have acquired no coping skills. In the beginning stage of trouble with kids, the help should be from outside sources rather than removing the child from the home. Helping a father or mother learn how to parent can correct the situation before out-of-home placement becomes necessary. On the other end of the spectrum, is the scenario where we wait until it is too late. If we wait till the situation is out-of-control, the child may never return home. In all three cases, foster parenting may be effective for the time the child is in the foster home. The difference seems to be when the child returns home. Timing appears to be everything.

The exhausted parent who has tired of the battle is in no shape to go on, until a much needed respite from the problems is provided. The foster parent should be prepared to foster for the long haul, but certainly long enough for a natural family to regain their bearings. Any foster parent who feels he is unable to go the distance will probably add to the problems of that child if they take them on knowing they cannot make it to the finish line. I grant you sometimes we do not know, but most times there are signs that tell us whether this could be a long term placement or not.

The worse thing that could happen to a foster kid who has to be removed from their family and home, is to be sent to a foster home that is likely to be a short placement when they need a long term one. I believe problems perpetuate themselves when the changes keep continuing in this young person's life. These kids are most often in need of stability.

Any improvement seen in those we foster comes from consistency and stability. A child will not work on issues until he feels safe and stable. He cannot feel that way if he is constantly shuffled from placement to placement.

When a foster parent gives up on a kid, it is a re-run of what happened with his/her own family. His parents abandoned him/her ,in his mind, and now, so have these new folks that he was beginning to trust. He feels worthless, not capable of being loved. His selfesteem is lowered and his trust level is disintegrated. He knows for sure now, that no one cares about him. He is convinced he is no good. This may result in some self-fulfilling prophecy.

You never know where they are mentally, emotionally, and for that matter, physically.

When you have a child who skips school, you worry what they are doing with that time.

You fear they will never receive the education they need to provide for their own future.

Dealing with kids that are delinquent thrusts you into some very unsavory situations. You also get to know lawyers, police, and judges on a personal basis. Nothing you wish to brag about in public. The uncertainty parents live with everyday definitely takes its toll.

But, somewhere and somehow, we must be there for these children. We must be the ones whom they can count on. We must be the family they want and desperately need. We must go one step farther however, we must help those natural parents learn to parent.

I believe that being there for the long haul means getting that child ready to return home.

This requires returning to a place where parents know how to parent. Who better to help those parents than foster parents. Foster parents do not have all the answers, but they know how to parent. Their instincts can be trusted. I want to personally thank all the parents and foster parents who have gone the distance. You truly do deserve a trophy.

We like to believe love is an emotion which descends upon people in some incomprehensible way, and that the euphoric mood is due to some mysterious connection associated with the one we love. The truth, however, is not nearly so romantic. There is nothing particularly mystical about how love develops. Love develops due to the release in the brain of pleasure causing endorphins. The mechanism for releasing the endorphins can be put in place by anyone who chooses to put the effort into it. Much like runners know they will reach a "high" if they run far enough and fast enough, lovers know if they tickle their loved one's ear and whisper sweet nothings they can expect some sort of aroused reaction. The emotion, which we call love, is the result of very specific actions.

The task for adoptive parents is to figure out what actions on their part release the endorphins in their child's system, enabling the child to connect pleasure with their parents. They are not hard to discover if parents can remember when they first "fell in love". If that time can't be remembered go to any high school and watch the adolescents in the halls and classrooms. The same elements present in the flirtation and courtship dance need to be injected into the parent-child dance if the two are to "fall in love".

Eyes have been called the window of the soul, as it is through them we make our deepest connections. It would be very difficult to fall in love with someone who avoids eye contact. When people talk to each other it is extremely helpful if they are looking at each other as then deeper, more meaningful interactions occur. One of the first games

universally played with infants around the world is "Peek a boo". The baby looks expectantly in the direction of mother's face and squeals with delight when eye contact occurs. Reciprocal eye contact is therefore a pivotal part of making a connection with an adopted child.

The largest organ of the body is the skin. When people are stroked and massaged they are flooded with feelings of good will. Animals are tamed by petting them. Tamed animals are better equipped to respond to their master's voice, stay where they are put and come when they are called. They develop larger brains and are physically larger and more agile. Children who are touched and caressed in non-sexual ways are soothed and comforted by the presence of their parents. They become responsive to their parent's directives and wishes. In essence, they become "tame".

Food is another pivotal component of arousing the feeling called "love". Not just any food, however, will do. Lovers do not send each other carrots on Valentine's Day. The food of choice is chocolate, though any sugar will serve the purpose of arousing in a child a feeling of good will, which then transfers to the parent giving them the treat.

The inner ears contain tiny hairs which, when stimulated appropriately, can cause a pleasurable shiver to run up and down the spine. Infants are affected by rocking, adolescents by amusement parks. Adults jump out of planes and participate in extreme sports, anything to arouse that shiver of excitement, which keeps them coming back again and again to re-arouse the senses.

The process of getting a child to attach to new parents is, therefore, enhanced by incorporating eye contact, touch, sugar and movement in such a way that the child‘s awareness is heightened and the pleasurable feelings which result are connected to the parent. Any activity between the parent and child which is on the parent's terms and involves these elements in a fun way will be bonding. Swinging a child, playing horsey, playing tag, water games, wrestling, dressing a child silly all are ways to help the child feel pleasure in the parent's presence. Activities are limited only by the parent's imagination.

If a child avoids eye contact, it can be overcome by playing peek-a-boo with M&Ms. Everytime the child makes eye contact a piece of candy is popped into the mouth so the sweetness is associated with the parents and the resistance to making eye contact is overcome in a fun way. Key is having the sweet pass directly from the parent's hand to the child's mouth. If the child feeds himself/herself the impact is minimized.

When a child is resistant to being touched the parent needs to touch lightly and frequently until the resistance is decreased. Brushing a child's hair, quick hugs, light tickles, neck and back rubs, foot massage, rubbing lotion into the child's hands, helping the child dress, tying the child's shoes, This Little Pig, listen to the heartbeat, patty cake, patty cake with feet, wheelbarrow, thumb wrestling, fingernail polish, counting body parts, rubbing noses, face painting, feeling muscles, etc, all are quick, fun ways to get close to a child without activating resistance.

Many children arrive in the adoptive home scared and angry. Diffusing those feelings is important if attachment is to occur. Telling children in words they are safe and loved does not penetrate the armor of defenses with children who have heard it all before. It is not telling a child he or she is loved which will have the most impact. It is acting it out in joyous, yet intrusive ways, which will help parents get through the wall surrounding injured hearts.

Foundations of Attachment We like to believe love is an emotion which descends upon people in some incomprehensible way, and that the euphoric mood is due to some mysterious connection associated with the one we love. The truth, however, is not nearly so romantic. There is nothing particularly mystical about how love develops. Love develops due to the release in the brain of pleasure causing endorphins. The mechanism for releasing the endorphins can be put in place by anyone who chooses to put the effort into it. Much like runners know they will reach a "high" if they run far enough and fast enough, lovers know if they tickle their loved one's ear and whisper sweet nothings they can expect some sort of aroused reaction. The emotion, which we call love, is the result of very specific actions.

The task for adoptive parents is to figure out what actions on their part release the endorphins in their child's system, enabling the child to connect pleasure with their parents. They are not hard to discover if parents can remember when they first "fell in love". If that time can't be remembered go to any high school and watch the adolescents in the halls and classrooms. The same elements present in the flirtation and courtship dance need to be injected into the parent-child dance if the two are to "fall in love".

Eyes have been called the window of the soul, as it is through them we make our deepest connections. It would be very difficult to fall in love with someone who avoids eye contact. When people talk to each other it is extremely helpful if they are looking at each other as then deeper, more meaningful interactions occur. One of the first games universally played with infants around the world is "Peek a boo". The baby looks expectantly in the direction of mother's face and squeals with delight when eye contact occurs. Reciprocal eye contact is therefore a pivotal part of making a connection with an adopted child.

The largest organ of the body is the skin. When people are stroked and massaged they are flooded with feelings of good will. Animals are tamed by petting them. Tamed animals are better equipped to respond to their master's voice, stay where they are put and come when they are called. They develop larger brains and are physically larger and more agile. Children who are touched and caressed in non-sexual ways are soothed and comforted by the presence of their parents. They become responsive to their parent's directives and wishes. In essence, they become "tame".

Food is another pivotal component of arousing the feeling called "love". Not just any food, however, will do. Lovers do not send each other carrots on Valentine's Day. The food of choice is chocolate, though any sugar will serve the purpose of arousing in a child a feeling of good will, which then transfers to the parent giving them the treat.

The inner ears contain tiny hairs which, when stimulated appropriately, can cause a pleasurable shiver to run up and down the spine. Infants are affected by rocking, adolescents by amusement parks. Adults jump out of planes and participate in extreme sports, anything to arouse that shiver of excitement, which keeps them coming back again and again to re-arouse the senses.

The process of getting a child to attach to new parents is, therefore, enhanced by incorporating eye contact, touch, sugar and movement in such a way that the child‘s awareness is heightened and the pleasurable feelings which result are connected to the parent. Any activity between the parent and child which is on the parent's terms and

involves these elements in a fun way will be bonding. Swinging a child, playing horsey, playing tag, water games, wrestling, dressing a child silly all are ways to help the child feel pleasure in the parent's presence. Activities are limited only by the parent's imagination.

When a child is resistant to being touched the parent needs to touch lightly and frequently until the resistance is decreased. Brushing a child's hair, quick hugs, light tickles, neck and back rubs, foot massage, rubbing lotion into the child's hands, helping the child dress, tying the child's shoes, This Little Pig, listen to the heartbeat, patty cake, patty cake with feet, wheelbarrow, thumb wrestling, fingernail polish, counting body parts, rubbing noses, face painting, feeling muscles, etc, all are quick, fun ways to get close to a child without activating resistance.

Many children arrive in the adoptive home scared and angry. Diffusing those feelings is important if attachment is to occur. Telling children in words they are safe and loved does not penetrate the armor of defenses with children who have heard it all before. It is not telling a child he or she is loved which will have the most impact. It is acting it out in joyous, yet intrusive ways, which will help parents get through the wall surrounding injured hearts.

Foster Children are ours From the time of our first foster kid until the last one, as foster parents we were told, these kids belong to someone else. They are not your children. They already have parents and families. You are just a temporary substitute for their real parents. I'm sorry, but I beg to differ with that opinion.

For all intents and purposes, when these kids come into our homes, they also enter our hearts. I've had only a few I was not sad to see leave, most could have stayed on forever.

They were my children even when I reminded myself they were not. I knew they had biological parents, but I became the parent of the heart. My soul and very essence was wrapped up in that child. He was mine, at least for a time.

Biological parents or birth parents were there first. They changed those diapers and watched the first steps, but as a foster parent we are also privy to firsts. Sometimes, they are the bad firsts, like when they stole a car for the first time. Sometimes, they are the good firsts, as when the child finally gets home by curfew.

Natural parents, the ones these kids are born to, are responsible for teaching their kids many things. Some do a darn good job of it, but most of the kids we get, have not been taught well. That is where we come in. We teach them what they should already know.

We give them those lessons they never had or at the least, did not understand.

Foster parents are told, do not get too close. Hogwash! We are told don't get involved emotionally, this is just a job. Right! If you believe that you will probably be a very ineffectual foster parent. Social workers have told us to distance ourselves, don't do it.

That is what their own parents did and you see how well that worked.

This past week, my very first foster kid from years ago was shot. A neighbor with 30 guns and some literature on how to kill someone took six shots at this young man. The reason, a noisy motorcycle and some tire tracks in his yard. This was the first this kid heard of it being a problem in the two years he lived by this older man. Fortunately, he is okay, but will need operations and therapy to regain use of his hand.

I first heard the news from a foster kid who became part of my family. He heard it on the TV. I had no details and till I was able to get information, did not even know if this kid was alive. For at least a half an hour, I was unsure if he lived or died and I believe that I went through what any parent would go through in this situation.

I was terrified, memories flashed through my mind, and my heart almost stopped until I heard his voice. The after effects of this news and the subsequent hospital visits brought about feelings of grief and mourning for what he has lost, especially emotionally. His fear, distrust level has gone up. His sense of well being and belief in goodness of others has been shattered. The trauma and the fear he experienced have left their mark on all of us.

I acted like a parent, rushing to find news and going to see him with my own eyes to ascertain that he is indeed going to be okay. I was able to take a back seat while others cared for him, mostly his girlfriend, but I was there. Once, when he left, we told him we would always be there for him. He still looked surprised as we proved it again.

Looking into his eyes, I could see the disbelief and horror that came with the reality that someone wished him dead. This was always a gentle young man with a very good heart.

His problems never involved cruelty to others and he was a wonderful help to me as well as I to him. He was grateful for anything he got and had a way of being there for others.

The memories of our times together almost overcame me when I first saw him in that hospital bed. The same mothering instincts came back. For a time, he was mine, as all my foster children were while they lived with us.

Foster parents need to get involved emotionally in their foster kid's lives. They need to treat them with the same respect and consideration, with which they treat their own kids.

Fairness is vital and cannot be achieved if foster kids are not thought of as your own.

Equality will go far to helping a foster child fit in. I always say, my natural children got much less than most kids, since we shared everything we had equally with whoever was part of the family at the time. This was our way.

If you plan something, do you include your foster kids? Are there names on lists for family events? Does the extended family recognize them as part of yours? They should, because they are part of your family.

I know all about the problems of foster kids feeling disloyal to their own families if they get too close to yours. I won't deny it can pose problems. Tell them they have two families if that solves the problem. You can tell them that they need not feel the same about you as you do about them, but you cannot stop feeling that they are part of your family. Do whatever you must for your foster child's comfort level, but don't stop thinking of them as family. I think, pulling away and keeping your distance causes more problems in comparison to some you have when you accept them as your own kids.

We have always given foster kids the choice to react to our caring in their own way.

Unless, they specifically asked us to not act like family, we always did. My best results came from those who we got closest to and became part of our family. All the time we were helping them learn about family by example, we encouraged them to stay in touch with their own. We helped them reach the understanding needed to see their very own parents did not have the kind of family they should have had. We showed them what it was like to have a real family and some took that knowledge home.

I don't regret anything I've ever done for any of my kids. I do not for one minute believe I replaced their parents. When they left our house to return to their birth parents, they may

have soon forgot me, but some of them never did. To some, I still am mom or ma. Every once in awhile, a kid will track me down and leave a cryptic message on my answering machine, which says, I know I was a pain-in-the-butt when I lived with you. But I really learned a lot from you. You guys were really good to me. Or maybe they will tell me about their successes and claim it was because of something we did or said. They tell me they called because they wanted us to know they turned out good or because they respected our opinion on something. They want to please us and apologize for what they said when they were younger. They wanted to do it to you, the foster parent. The person who temporarily substituted for their own parents until they were able to parent again.

They wanted to share news with the person that changed their life while they were growing up. They wanted to thank the person who taught them important life lessons.

Now, doesn't that sound like a parent to you?

To all your foster parents who have opened your homes and your hearts, I congratulate you. To all of you who forget these kids not born to you are not your own, I commend you.

The Foster Child’s Past and his Present One proverb says: ―Those who do not know history are forever condemned to repeat it.‖ Who knew these words applied to foster care?

Whether you realize it or not, history can be a powerful player in your foster home. Yes indeed, your foster child‘s past can have an overpowering impact on your present family life. Maltreatment is a gift that keeps on giving. Although children are rescued from unsafe, abusive homes, their continued safety depends on a thorough understanding of what they‘ve been through, how they‘ve been affected, and what baggage they bring with them into your home.

Many inexperienced foster and adoptive parents assume that with the placement of the child in their home they begin the first day of the rest of their lives together. That is, that they march arm in arm with the child through the present and on to the future. However, it might be more accurate to say that when a child is placed in a foster home, the family actually takes a trip into the child‘s past. And, soon the question arises, are we—as a foster family—moving ahead or slipping backwards? And also, which is stronger the push towards the future or the drag of the past?

History is potent, and knowledge of history is important too, and yet many foster and adoptive children are placed without the foster parents knowing what the children have been through, and how they have been affected. In the worst case scenario, historic facts are either totally unknown or, if known, withheld from the parents. The lack of knowledge of history or its concealment is undoubtedly not in the best interests of the child or the foster family. Sharing thorough history with foster parents is one key to preventing disruptions which can be traumatic to both the child and the family.

Knowing the child’s past: Here is a short list of what foster parents should know and be told about the child‘s history: The specific history of maltreatment.

A complete medical history including whether the child is HIV positive.

What the child‘s routines have been, when are they used to eating, how do they accept going to bed, etc.

The details of behavior and emotional problems.

Whether they have ever previously been a danger to themselves and to others.

The parenting approaches which have succeeded or failed in past placements.

The historic role of the child in his family of origin. That is, was the child a little parent, a sexual partner, a companion to the parent, etc.

The reasons for past failed foster placements.

The types of relationship problems the child has had in the home. Is the child extremely jealous? Does the child resent mother figures? etc.

The child’s history influences how you parent: Successful foster parenting grows out of knowledge of the child and the child‘s history.

Foster parents must modify and provide parenting of their children if the child‘s history reveals specific critical problems. Here are some examples of how a child‘s history would suggest ultra sensitive parenting: Since a child who has been sexually abused may misinterpret even normal touch, foster parents would be very gingerly in how, when and where they offer affection to the child.

A child who has been locked in the crawl space of his house as punishment, would not be isolated or timed out in his room by his foster family.

A child who has been physically starved and malnourished might be treated differently at the table or around food issues. Foster parents may need to make special accommodations to reassure the child that food is plentiful and available.

A child who has been sexually active and sexually predatory would not be left alone and unattended with other children.

A child who has made allegations against previous foster fathers would not be cared for alone by the present foster father.

A child who has set fires in the past would not be allowed to roam the neighborhood unsupervised.

Sequestering foster parents: A common practice in this field is for past foster parents to be sequestered from current foster families. I think the justification commonly given for this is that the child needs a fair, fresh start. If the past foster parent talks to the prospective foster parent, she might

offer a negative point of view which would frighten off the new foster parent. However, in keeping foster parents from talking with each other, we may perpetuate problems. The next family remains unaware of critical issues of life in the trenches with the child. They have to re-invent the wheel, and they may inadvertently repeat failures. In my contacts with foster and adoptive parents, I‘ve repeatedly asked them: when should we be honest with you about the children and their problems? The answer is universally: right from the start…we‘d rather have no surprises.

The “heads up” principle: The ―heads up‖ principle that I am espousing is this: foster children should be moved into placements with not just full disclosure but more than full disclosure. Specifically, the child should be placed into care not only with documented facts but also with undocumented concerns. In my opinion, if a child has been suspected of perpetrating sexually against other children in a previous placement, the suspicions and concerns should be voiced to the new foster parents for safety‘s sake. Again, this is the ―heads up‖ principle: alerting new foster or adoptive parents to the possibilities. We are asking them to keep vigilant, so that the child, other children, and the family remain as safe as possible. I have seen too many families who have been blind-sided due to mostly wellintentioned withholding of undocumented information and of important suspicions.

Without that information the foster parents lack critical concerns which might keep the child, other children, and themselves safe.

Learning the Job Persons who decide to become foster parents have no way of knowing what adventures lie ahead. They don't begin to suspect the challenges they will face. These beautiful, loving, innocent folks are clueless when they try to imagine the different situations they will become involved in daily.

It is not their fault that they are naive, or uninformed, or do not anticipate the many events that will soon be part of their lives. It is natural to only know well those things you have first hand knowledge of and what you have studied. Before becoming foster parents, most people are simply parents and want to help other children as well as their own kids.

We really do not offer them enough training in advance as to how to parent this high risk kids, so the majority of us learn on the job.

Learning on the job should not strike fear in your hearts or even worry you too greatly; it is a natural function. Do you remember when you first brought your own newborn baby home from the hospital? Do you recall the feelings that ran through you as you looked at that helplessly tiny infant and realized it's total dependence was upon you? It was frightening at first to take on such a great responsibility, but you did it. You learned how to recognize all the different sounds that baby made along with their meanings. You eventually mastered diapering the still untrained toddler as they tried to escape.

Recognizing the signs of childhood diseases became second nature to you, you even knew the immunization schedule by heart. Later, you became an expert in everything from school science projects to football plays. You did it all because you had to; it was necessary to better parent your kids. It is the same with foster parenting.

Understand I still believe foster parents need so many skills that much more training should be offered and required. I think there are so many subjects we must excel at and

thousands of topics we must be familiar with that good training makes sense. I am also a proponent of not reinventing the wheel if someone has already worked out the best methods why not share those. But my independent and creative nature also forces me to advise parents to follow their instincts and get creative in their approaches when it is not a life or death matter.

Learning on the job is the only sensible way to learn some things. Book learning and being shown are not the same as doing it yourself. If your natural kids were all "A" students and never suffered from learning disabilities, you are probably not an expert in that field. Don't worry, you soon will be if you parent kids like this. You will soon learn to adjust your methods and expectations for kids who cannot do well in school without lots of assistance. You will bring teaching and requests down to their level without being patronizing. You may learn to use simpler words, one task commands, and talk more slowly and deliberately. With some kids you may see a need for much more patience than you ever thought you had. Others may require a lot of handholding throughout every step of a process to complete some task. You will learn what is needed.

Before I fostered, I had no experience with chemical abuse. It took some time to realize what all the signs of abuse were and what those signs indicated. I had to learn about many different drugs, how they were used, what they cost, where they could be obtained, and what the long-term effects were from abusing them. I'd like to say I learned all this from training and when I first started foster care, but that is untrue. By the time I received the training I had been living with chemical abusers for more than a year. I had learned by being nosy and asking questions. I picked up street names of drugs, and places where they sold these things from the kids themselves. Often just overheard remarks were an education.

This learning on the job also took place when it came to sexual abuse. I never was so close to that problem before. Of course, I knew it existed, but it never makes an impact on you until you experience it firsthand or witness the aftermath of its victims. After hearing the revelations from kids, that sometimes occur when they start to feel comfortable with you, you soon become an expert. It is tough to imagine what these children had to live through. There experiences were horrible and sometimes so disgusting it is hard to fathom that one person can treat another in such a way. You may have no experience, but your instincts tell you to be cautious and to be empathic. You learn to recognize the different ways this abusive past manifests itself in youth. You start to know the reasons behind the behaviors. Like the eating disorders, the choice of clothing, the awful sleeping habits, or the mistrust of everyone. You learned this by working with these kids and being observant. Yes, training may have better prepared you for the symptoms and signs of past abuse, but you learned how to react by living with these kids. You learn to take relationships slow and lower your expectations about any affectionate return from these kids. You realize you must first build up self-esteem and trust in the world before they will believe and accept you. It is a long procedure with few quick results.

Illnesses, disorders, and all those acronyms for disabilities and syndromes are learned when necessary, you don't usually have too much previous knowledge of those things.

Learning on the job is how I learned about diabetes and many more unpleasant things like venereal diseases and what drugs those required.

So don't worry about what you don‘t know. Just open your mind to learning, be observant, and let your instincts take over. You know when someone hurts they need comfort. You know when someone is confused; they need patience and understanding.

And you know that every child that comes through your door needs love, so give it. The rest you can learn. Don't ever stop learning. Thanks to all foster parents who took this amazing job and now are learning more than they ever dreamed possible.

Behavioural Management Foster kids rarely have just one area where problems exist. Most kids, in fact, have several bad behaviors to correct, issues they must overcome, and goals they must reach.

The foster parent sees their job as mender, fixer, or repair person. We are never content to just let these issues resolve themselves, and rightly so. We arm ourselves with ideas, solutions, and prayer to battle the various problems.

One thing wrong with this strategy is the fact that we attack on all fronts, instead of focusing on just one enemy at a time. Foster parents must pick their battles carefully.

There are two basic reasons that this is best. Number one is the fact that kids can not usually successfully work on a whole array of problems at one time. The second reason is for the sake of the foster parent. You will burn out too quickly if you don't reserve your strength.

But you say, these kids have soooo many problems. They need so much help. You count off the problems on your fingers, but before you get to your toes, slow down. Try to remember it took many years for these problems to develop. You cannot fix this kid by Friday. You will need to pick your battles.

This assessment to decide which war you wage may take a bit of time. It is also hard to do when you still don't know the child well. Until you truly connect with a kid, you must rely on first impressions and what you have actually witnessed.

It is necessary to prioritize this child's needs when deciding which behaviors to conquer, and help him meet challenges necessary for a functional life. We developed a system.

First, list all the major problems. Put things in perspective, this is usually not going to include things like he does not make his bed, or he forgets to brush his teeth. If these are this kid's most pressing problem, pat yourself on the back, give him a big hug, and be content that you are so lucky. I m thinking more in the terms of items like he is violent toward others, he uses pot, he steals, or he cannot stay in school. You know- the kinds of issues foster parents deal with every day.

Next, start to prioritize them. I tend to divide them into the following categories.

Behaviors, activities, or problems that are dangerous to other's well being.

Behaviors, activities, or problems that are dangerous to the foster child's physical well being.

Behaviors, activities, or problems that are dangerous to other's mental/emotional well being.

Behaviors, activities, or problems that are dangerous to the foster child's mental/emotional well being.

Behaviors, activities, or problems that are against the law.

Behaviors, activities, or problems that interfere with the foster child's education.

Behaviors, activities, or problems that interfere with the running of the household.

All other negative behaviors, activities, or problems that you need work on.

Start at the top and work your way down. Work on one problem to its solution before tackling another one. The only time you should break this rule is when you are getting nowhere after months and months of work then focus on another problem for awhile, going back to the first after the new one is solved.

You may see this list differently than others do and change the arrangement of priorities.

Even foster parents have pet peeves, pet projects, or their own things that drive them crazy. I remember one foster mom who took really tough kids. The only ones she would refuse were those with blue hair. Drove her crazy. We can laugh about such a silly thing, but if the child is where you can see them, day after day and a little thing sets you off, you will be unable to parent that kid effectively. I believe foster parents should always have the option to decide if a child will fit into their home and lifestyle. There are so many kids out there; we should be able to accommodate most parents. I also believe their requests should be reasonable, blue hair is probably not a real valid excuse, but I can understand it just the same.

I feel any behavior that can lead to death or injury for anyone must be number one on your list. That battle has a high chance of casualties if you do not attack there. One battle at a time, unless the problem will prove to be a small, little skirmish. Kids can work effectively on correcting one behavior. They will be more successful if they believe this is the one thing that will please you (and shut you up). When you approach with a long list in hand, they don't fight, they don't surrender, and they just play dead. They don t hear you or even care what you are saying. It is impossible to redirect them. It is impossible to implement a plan or develop a procedure. They have turned you off , and they will not be part of your little war since they are sure they cannot win. Make it easier on them by giving them one front to battle at a time. Then, everyone wins.

An estimated 1 in 20--or as many as 3 million children--may have a "serious" emotional disturbance". This is a mental health term that refers to mental, emotional, and behavior problems that severely disrupt a person's ability to function socially, academically, and emotionally. It is a problem that is real, painful, and costly; a broad range of services is often necessary to meet the needs of children with emotional problems and their families.

Children with emotional problems behave in a variety of ways, some more noticeable and severe than others. Just as there are a variety of types and severity of physical disorders, there are many different categories of emotional and behavioral disorders. The following are some examples of the types of problems affecting SED Youth: Anxiety Disorders affect an estimated 9% of youths, They include phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. The youngsters experience excessive fear or worry that interferes with tier daily lives Major depression shows up in about 6% of youths, and is marked by profound changes in emotion, motivation, physical well-being, and negative or self-destructive thoughts.

Bipolar Disorder, also known as manic-depressive illness, is marked by exaggerated mood swings, and often begins in the teenage years and recurs throughout the lives of these individuals.

Learning Disorders affect approximately 5% of youths, and include difficulties in spoken or written language, coordination, attention, or self control.

Conduct Disorders, which estimated to affect 4% to 10% of youths, causes children to act out their feelings or impulses towards others in destructive ways, such as lying, stealing, truancy, aggression, setting fires and committing vandalism.

Eating Disorders, more common in girls, include anorexia (self-starvation) and the binge and purge cycles of bulimia.

Autism, which appears before a child's third birthday, shows up in 7 to 14 of every 10,000 children. Children with autism have problems interacting and communicating with others. Often they methodically repeat the same behavior over long periods of time.

(Autism is a separate classification in special education.)

Schizophrenia, marked by psychotic periods, hallucinations, loss of reality, and withdrawal, occurs in about 3 out of every 1,000 adolescents.

Without treatment, some youths with such problems may become dangerous to themselves or others. When left untreated, over half (56%) drop out of school, and nearly three out of four (73%) who drop out are arrested within five years. But, with proper treatment, they can become healthy, productive members of society.

Possible warning signs of a serious emotional disturbance in children can include: constant feelings of sadness or hopelessness sever anger, overreaction, or crying feelings of guilt, worthlessness anxious or worried more than other children unable to get over a loss of death of loved one unexplained fears over-concern about appearance feeling out of control Family doctors, counselors, social workers, teachers, nurses, local hotlines or clergy members can point you toward help, which may include: counseling family or group therapy crisis care medications tutoring school, camp, or residential programs Situational, Emotional & Behavioral Warning Signs of Depression & Suicide - How Parents Can Reduce Risk The following is a list of situational warning signs that may indicate a risk of depression and suicide. Because a child experiences a stressful situation does not necessarily mean that he or she will become depressed or suicidal. The ability to cope with stress differs from child to child. However, if a child epxeriences too many of the following stressful situations for an extended period, the risk of depression or suicide increases.

Academic problems Arrest Association with a subculture that romaticizes suicide Break-up with a friend Death of a family member Death of a friend Dislike of school Emotional abuse Emotional neglect Family crisis

Family financial problems Family health problems Family history of depression Family history of suicide Family tension Family violence Institutional placement Lack of friends Loss of an important friend Loss of a valued possession Loss or death of a pet Moving or changing schools Parental divorce Parental separation Personal health problem Personal setback, disappointment, or embarrassment Physical abuse Physical handicap or deformity Physical neglect Sexual abuse Suicide among friends Suspension or expulsion from school The following is a list of emotional warning signs that may indicate a risk of depression or suicide. Because a child displays one or more of these emotions does not necessarily mean that he or she is depressed or suicidal. Children can be very emotional as a "normal" part of growing up. However, if a child experiences too many of the following emotions for an extended period, the risk of depression or suicide increases.

s -esteem

The following is a list of behavioral warning signs that may indicate a risk of depression and suicide. Because a child displays one or more of these behaviors does not necessarily mean that he or she is depressed or suicidal. Children exhibit changes in behavior for

many reasons. They lack maturity and tend to act out feelings through their behaviors.

However, if a child exhibits too many of the following behaviors for an extended period, the risk of depression or suicide increases. ness

Drug abuse

s of interest in sports or hobbies Rebelliousness

-destructive behavior

Are Young Children At Risk Of Suicide?

Yes. Children as young as four can have self-destructive wishes. Young children tend to view death as temporary and reversible. suicidal gestures and attempts are not rare among children under 12. In fact, children under age 10 represent a group in which there is a growing suicide rate. Experts believe the number of suicide attempts among young children is under-reported because they are often "masked" as accidents or are not recognized by doctors.

What Roles Do Age & Sex Have In Suicide Risk?

Adolescents are the group of children most at risk of suicide. Children in their early teens are at risk of suicide because of the many changes and stresses that oocur in them socially, emotionallly, and physically. More females than males attempt suicide; however, more males than females die from suicide.

Why Do Children Commit Suicide?

There are five popular theories which attempt to explain why children commit suicide.

Experts agree that behavior as complex as suicide probably cannot be explained by one theory. DEVELOPMENTAL THEORY emphasizes how stressful it is to grow up in our modern society. Children already under social stress may become suicidal when faced with a difficult adjustment, such as the divorce of parents or the death of a loved one.

COGNITIVE THEORY states that children are too immature to understand the finality of death. They many have romantic ideas about death and do not realize it is permanent.

SOCIOLOGICAL THEORY accents the importance of social belonging. Suicidal children lose faith in society and see themselves as worthless and unimportant.

PSYCHODYNAMIC THEORY asserts that suicide results from a loss of love and attachment, such as neglect or rejection by family and friends. BIOLOGICAL THEORY proposes that when something goes wrong with the chemistry of the brain, severe depression and suicidal thoughts may occur.

What Methods Do Children Use To Commit Suicide?

The most common methods children use to commit suicide are: shooting, hanging, drug overdosing, running into traffic, and breathing gases or vapors. Other methods include: cutting or stabbing, wrecking a motor vehicle, drowning, and jumping from a high place.

Firearms are the most commonly used device in suicide by boys. Girls are more likely to use drugs (including prescription, over-the-counter, and illegal drugs).

What Time of The Day & Year Are Suicide Rates Highest?

Most suicides occur between 3 P.M. and 6 P.M. Studies show that suicide rates tend to rise during spring (peaking in April and May) and decline in winter (dipping lowest through December and January).

How Parents can reduce depression and suicidal tendency The following is a list of ways parents can reduce the risk of depression and suicide.

Children usually become depressed or suicidal when they are overwhelmed by problems, do not know how to cope with stress, or feel alone in their struggles. Parents/Caregivers should consider these facts and determine how they relate to their children.

Find ways to help children develop and maintain a positive self-image. Children who feel good about themselves are less likely to become depressed or sucidal.

Teach and encourage children to communicate openly. Children who can discuss their problems and concerns are less likely to suffer from trapped feelings and more likely to find solutions.

Teach children "healthy" ways to handle stress. Children who learn that stress is a part of life, and develop healthy ways to deal with it, are better able to handle problems throughout their lives.

Allow children to help make personal and family decisions. Children who learn how to make decisions, and be responsible for them, are better equipped to deal with stress and other problems they must resolve.

Develop and maintain a stable home environment with healthy family relationships.

Depression and suicide risk are highly associated with family problems.

Devote time and attention to each child so that he or she will feel like a special individual. Children who feel loved and cared for are less likely to become depressed or suicidal.

Be aware of sudden or dramatic emotional or behavioral changes in children. children often express their frustrations through emotional outbursts or altered patterns of behavior.

Know each child's friends and their behaviors. Children sometimes become depressed or suicidal as a response to what is happening within their peer group.

Set a good example for children in how you handle stress. Children lend to copy the behaviors of their parents and other significant adults.

Keep alcohol, drugs and medications, guns, knives, and other potentially dangerous objects locked away from children. Some children attempt suicide as an impulsive response to depression or other problems.

Help children to realize that death is permanent. Many children, especially those under 12, believe that death is temporary and reversible.

Seek professional hlep if it appears your child is depressed or suicidal. Therapy can uncover the cause of the problem, develop an approach to resolve it, help the child overcome his or her depression, and reduce the risk of suicide.

Parenting Needy Children we live in a time when some parents biggest concern about parenting is what their rights are in regards to their children. They want to know at what stage are they allowed to "wash their hands" of their own kids. They need to know if they are responsible for a runaway teen's escapades while those kids are loose in the world. Their questions indicate, they are no longer able to parent these kids.

They cannot hang in there for the long haul.

When you are downtrodden daily, when county agencies make you feel like dirt because you have no money or you can't handle your kids, when you live in fear for yourselves and your children, you have lost the ability to run the full race of parenting. These parents have become ineffectual. Their children have become victims.

Parents who have become so frustrated that their only response to the situation is how does this effect me as parents, have probably lost the battle. When the focus starts to change to the parents rather than the child, we are heading for trouble. The child is the one with the problem, he needs the help. When we concentrate on the parent, we sometimes neglect the plight of the child.

It is understandable that some parents will eventually reach the "end of their rope." It is also accepted that not all parents are equipped to handle the problems of an out-of-control teenager. Many parents have not had their own needs met, so cannot continue to worry about their kids. They wonder when, it will be their turn. Years of dealing with courts, police, and probation officers can dampen the enthusiasm of any parent. When a person has tried everything they know how to try and has consulted all the so called "experts" with little result, the only answer left is to give up. These parents are worn out, their energy depleted, and their spirits plummeted to the depths of hell. They are scared and desperate. They need answers, but more important they need a vacation from the

responsibilities of parenting. It should not be so, but it is the case. These parents must be relieved of their parental duties in order to not do further harm to their kids. I don't mean this as a slam to the natural parents who cannot cope, unless they have really not tried.

There comes a time when we cannot go it alone and if we have done all we can do, what is left? This is usually where foster care comes in.

When we reach this point, this is where a foster parent is most valuable. If we get involved in the family too soon, before the situation has reached this point, foster care may be effective, but the parent will still not have learned how to parent. They have acquired no coping skills. In the beginning stage of trouble with kids, the help should be from outside sources rather than removing the child from the home. Helping a father or mother learn how to parent can correct the situation before out-of-home placement becomes necessary. On the other end of the spectrum, is the scenario where we wait until it is too late. If we wait till the situation is out-of-control, the child may never return home. In all three cases, foster parenting may be effective for the time the child is in the foster home.The difference seems to be when the child returns home.Timing appears to be everything.

The exhausted parent who has tired of the battle is in no shape to go on, until a much needed respite from the problems is provided. The foster parent should be prepared to foster for the long haul, but certainly long enough for a natural family to regain their bearings. Any foster parent who feels he is unable to go the distance will probably add to the problems of that child if they take them on knowing they cannot make it to the finish line. I grant you sometimes we do not know, but most times there are signs that tell us whether this could be a long term placement or not.

The worse thing that could happen to a foster kid who has to be removed from their family and home, is to be sent to a foster home that is likely to be a short placement when they need a long term one. I believe problems perpetuate themselves when the changes keep continuing in this young person's life. These kids are most often in need of stability.

Any improvement seen in those we foster comes from consistency and stability. A child will not work on issues until he feels safe and stable. He cannot feel that way if he is constantly shuffled from placement to placement.

When a foster parent gives up on a kid, it is a re-run of what happened with his own family. His parents abandoned him ,in his mind, and now, so have these new folks that he was beginning to trust. He feels worthless, not capable of being loved. His self-esteem is lowered and his trust level is disintegrated. He knows for sure now, that no one cares about him. He is convinced he is no good. This may result in some self-fulfilling prophecy.

I sympathise with parents and foster parents alike who live with these kids. It is not easy to be around kids who swear at you, call you names, and are abusive. It takes great amounts of stamina to deal with children that have been sexually abused or neglected or abandoned. They take every ounce of strength and seem to require every fiber of your being to care for them. I have lived with chemically dependent teens and rode that seesaw of emotion with those kids. You never know where they are mentally, emotionally, and for that matter, physically. When you have a child who skips school, you worry what they are doing with that time. You fear they will never receive the education they need to provide for their own future. Dealing with kids that are delinquent thrusts you into some very unsavory situations. You also get to know lawyers, police, and judges on a personal

basis. Nothing you wish to brag about in public. The uncertainty parents live with everyday definitely takes its toll. But, somewhere and somehow, we must be there for these children. We must be the ones whom they can count on. We must be the family they want and desperately need. We must go one step farther however, we must help those natural parents learn to parent.

I believe that being there for the long haul means getting that child ready to return home.

This requires returning to a place where parents know how to parent. Who better to help those parents than foster parents. Foster parents do not have all the answers, but they know how to parent. Their instincts can be trusted. I want to personally thank all the parents and foster parents who have gone the distance. You truly do deserve a trophy.

Good foster parents make a point to become knowledgeable about the issues that their foster children face. So many times, foster children have a multitude of issues such as ADHD, attachment disorders, psychological problems, or developmental issues. The longer that a child is with us, the more educated we should become about their issues.

Many times, it is the foster parent that has the most complete knowledge of the child‘s needs. But because these children come into care with so many issues, it sometimes becomes painfully obvious that there is usually no clear-cut plan to help our foster children. Also, each professional specializes in only one, or maybe two issues. A teacher would pick up on educational or developmental issues way before an attorney would. The attorney, however, would know much more about the child‘s legal issues than a pediatrician. Because of this, it becomes even more important that the foster parent act as the connecting block between all members of the team who are looking after the needs of the child.

But how do you deal with team members that don‘t see you as knowledgeable about your foster child‘s needs. What about the attorney that refuses to speak with you, or the school administrator that will not allow you input into your child‘s individual education plan?

How do you handle a professional that believes they know more than you do about the child?

It‘s difficult to alter another person‘s belief from thinking you are just a caregiver to understanding that you are an important, knowledgeable, and vital part of the professional team. What we can do as foster parents is control how we present ourselves to the other members of the team. The following is a list of suggestions that all foster parents should remember when dealing with other members of the professional team: 1. Keep detailed documentation of the foster child‘s behaviors, eating patterns, and the child‘s likes and dislikes. Also, record all doctor appointments, dental visits, educational milestones and difficulties, contact with child welfare personnel, and visits with biological family. Be assured that the other members of the team are keeping records, so it only makes sense that you should too.

2. Research the issues that your foster child has and become as knowledgeable as you can

about them. The internet can be a valuable tool to use to research things. Read books that deal with the special issues foster children face. Knowledge is power! If you think the information you find can help your foster child with a particular issue, pass that information along to the other members of the team.

3. Join your local and state foster parent associations and be active in them. You can gain a wealth of knowledge about the foster care system by talking with other foster parents.

The support from others who are in the trenches with you can be invaluable.

4. Find out what your rights are as a foster parent. Get to know what information in the case file you are privy to. Know in many cases, foster parents are allowed to make input into educational plans, case plans, review hearings and court reports. Find out what you are allowed to do and how to exercise your rights. Attend every meeting you are allowed to participate in and don‘t be afraid to ask questions about things you don‘t understand.

5. When having to deal with more narrow-minded member of the team, be calm, but persistent. Don‘t be afraid to step up the chain of command in order to get the services and attention that the child needs. Everyone has a boss! Attorneys have to abide by a code of ethics outlined by their state bar association. They also have to ultimately answer to the presiding judge on the case. Doctor‘s have a code of ethics that they have to follow as well. Don‘t be afraid to seek out a second opinion, if you don‘t like how the child‘s needs are being met.

6. If during a meeting or hearing, you get rattled or off-track, don‘t be afraid to excuse yourself to regroup. Always maintain a proper level of professionalism in your speech and demeanor.

Above all, don‘t be afraid to stand up for the rights of your foster child. Be tough, be tenacious, be diligent in your quest. You have a vital role in the professional team. Stand firm with the knowledge and understanding that you are important in the life of that child.

Show the other members of the team that you are more than ―JUST A CAREGIVER‖.

When you become a parent, you have a period of time, usually several months to a couple of years, where you are obsessed with parenthood. After that, things mellow out a bit and you feel more comfortable with the fact that you can release those babies into the care of others for a short time. Babysitters, daycare, and family members are brought into play.

This is not as common with foster kids.

Family members may tell you how wonderful what youÕre doing is, but seldom offer to supervise your foster kids. Requests to baby-sit them are heard infrequently. Even offering to spell you a few hours so you can get away never happens. Foster parents must often deal with tougher kids for more hours a day with less breaks.

Foster kids are almost always troubled kids. They are often children with a variety of learning disorders, behavioral problems, and health issues. We see many with disabilities and many with emotional problems that mean regular care is just not enough. This situation is wearing for most folks and can result in early burnout.

Respite, the scheduled breaks given to foster parents, never comes often enough and sometimes is delayed for weeks. This is a dangerous situation if you want your foster parents to be effective.

We had a way of trading help in one agency I worked for, where foster parents would help one another when they needed to be away. This worked great for most foster parents. We had teen boys, mainly, the last chance ones. The group would be offering help to one another, when I would request help. The answer- anyone, but your boys was replied. I had tough kids, but still needed to get away for personal things occasionally.

This made it difficult.

If other foster parents are in this same boat or get too few respite times off, you need to bring this matter to your county or agency. Everyone needs adequate breaks to remain fresh enough to function and do this most difficult job.

When counties or agencies hire respite workers for the foster parents who just come in and take over that is one way of handling this problem. Some parents find this intrusive in their own homes and others would like to be able relax in their own home without the extra children. Of course a lot of this depends on how you view your foster children. If this is family to you, this problem may be a moot point. You wish them to be with you at all times. You do not need a break from them because for all intents and purposes they are yours. But, some kids in a home of many foster kids may not fit this description.

I have worked in homes where the foster parents left, and the respite workers came in. I also have been involved where kids were taken to a respite workers home. Either way has some problems, so I guess it is a matter of preference.

The main point is to receive the opportunity to take respite. When you are given the opportunity to get a break, take it. Some folks I knew almost never took the respite, which was very unhealthy. If, however, you must pay to go to a hotel or other place to get away, then money becomes an issue. Agencies or counties should supply a fee for respite so it doesnÕt come out of the foster parentÕs pocket. We knew one agency that provided a place to use, which eliminated that problem.

Whatever the plan, there must be respite for parents who do such a challenging, difficult job. Coming to each otherÕs rescue is a wonderful plan, if all can participate.

Remember that foster parents find their own best friends among their ranks and should all help one another. If you can spell each other for much needed break, that is the easiest solution. But houses with several kids can have numbers double when that happens and not be able to provide adequate coverage.

Choosing respite when kids are on home visits sounds ideal, except they never all go on home visits at the same time. This is also a good plan if that could be arranged, but that is a long shot.

Foster parents need respite, ask for it, and find ways to get it, and use it. Foster parentsyou deserve it.

When a kid comes into your home and you are suddenly in charge of helping to shape his life, it is very easy to get caught up in the moment. You want to do great things for them and with them. You want significant changes to appear before your eyes. If you are too impatient, this unfortunately can mean you also have unrealistic expectations of that child.

Before they reached your home, they were taken out of theirs. Most times, they were not given a choice if they wanted to stay or not, just told they must go. They are going to live

with strangers( hopefully you won't be that for long, but you are now.) They are going to need to sleep and eat with people they don't know. The house is strange, the rules are different, even the food may be different. We're talking significant changes in their lifestyle.

These kids lost all control of what happens to them. They may have very little say in what they do or don't do. Suddenly everyone is making decisions for them.. Up to this point, they may have made their own decisions or maybe no one cared enough to make any decisions. No matter how you slice it, you may be the bad guy and cannot expect them to immediately warm up to you, much less work the program you have in mind for them.

No matter how many heart to hearts, or home-baked brownies, this is going to take time.

Your first few days, possibly weeks need to be used to get to know each other and gain trust. They won't work with you or for you until they trust you. Often, kids are not given enough adjustment time. The foster parents give up too soon if they see no promising signs or results in a very short time. Foster parenting is about staying in there for the long haul. It teaches one patience, endurance, and what I refer to as stick-to-it-ive-ness.

Remember, don't ever give up on these kids. That's often what the parents did and now their children live with you. Think of the honor of being the only adult in their lives who ever stuck it out. The only person they could take at their word and count on.

When starting to work with these kids, remember where they came from. They may never have had to do chores. Saying grace at the table may scare them. Doing homework before they receive nasty demands may be foreign to them. We had one kid whose mom loved him so much she would not make him do homework. She believed he should just play.

Maybe these kids are not well versed on hygiene and good personal habits. Manners may mean nothing to them.

Keeping your expectations reasonable may mean learning to choose your battles. We always started with the tough ones. For example, most of our kids had chemical problems of one sort or another. We worked on that issue rather than worried about whether their room was clean or not. We always prioritized. We did not let go of trying to accomplish other goals with that child. Instead, we worked on those things most important. Years ago, we even allowed our almost grown boys to smoke, that issue has been settled for foster parents now. At the time our thinking was I really need to keep him from abusing drugs or shooting up. Yes, smoking is not good for your health, but it is was of very little concern if he overdosed and died.

I have known foster parents to do the white glove test to check rooms. Personally, I find that ridiculous. Our house ran on, "Clean enough to be healthy, dirty enough to be happy." Sometimes even that was a challenge when the house was filled with 8 oversized boys.

Most kids, once they connect , want to please you. If they don't connect, the battle is more difficult and will require more time. Even when they wish to please you, they may not know how. Remember the mom who thought homework was not something her child had to do. The kids we get come from anything but traditional situations. The relationships in some of their families are so confused with roles being muddled and boundaries blurred that it is difficult to even understand your foster family. They don't even recognize the family concept.

Expecting these kids to come from losing their parents, siblings, home, and all their important stuff, and to immediately fit right in and "get it" is too much. To expect

perfection when their abilities are too few is hopeless. If you think they will be perfect kids in two weeks just cause they live in your house, you are lying to yourself. It took some of them 15 years or more to get this messed up, it will not change overnight, no matter how wonderful you are or what you do.

Sit back. Take a deep breath. Realize this may be the challenge of a life time. Accept the fact that you can do it. Ask for guidance from a higher power and recognize the fact that you are human. And so is this kid. Give him what he needs most- like love, attention, guidance, patience, a chance to succeed. Reserve the bad stuff- like judgement, impatience, intolerance, and anger.

Adjust your expectations and you will both be happier. Good Luck and God Bless You for fostering. arenthood is wonderful, huh? Yes, it can be magical, fulfilling, and even stimulating. But, it has its ups and downs like anything else. And, while raising any child can be stressful at times, foster parenting needy children certainly can be draining. Foster parenting of children who have insatiable needs can wear down the best of parents and ultimately destroy the placement, if you‘re not on top of it. One foster mother told me, ―I should call my foster son, ‗Barnacle Bill,‘ since he gloms onto me and won‘t ever let go…I don‘t know if he‘s needy or anxious, fearing that he‘ll lose me, if he‘d let go for a minute.‖ Whether they‘re anxious or needy, I guess what I‘m saying here is that there are certain foster children who take much more time than others. Some could figuratively suck the life out of you, one breath at a time. God love them, these children are needy and demanding for good reason. Many of them have been sorely neglected by your predecessors, their original parent figures. The result is they feel chronically empty, and take a guess about who they expect to fill the emptiness? One father said, ―Even after spending an entire evening with James one-on-one, when I try to peel him off me to send him to bed, he throws a fit.‖ How exhausting is that? It‘s punishing to foster parents when you spend that much time with the child to see it end in tears and temper tantrums.

The stress, wear-and-tear, and drain in the foster home can start out almost in detectably at first. And, later parents are hard-pressed to describe what it is about their child that they find so exhausting or difficult. They can‘t pinpoint why they are so weary. When asked what‘s wrong, their tired explanation often goes, ―It‘s not one thing, it‘s everything!‖ The bottom line here is: raising a neglected child often leads to neglecting everyone else in your home.

There is a law that children are neediest when you are busy, preoccupied, in a hurry, sick, tired, in the bathroom and/or on the phone. Many youngsters are exquisitely tuned into any change in parent‘s moods and emotional availability. A flashing light goes off if you are somehow engaged in activities that don‘t center on them. And, then follows a barrage of demands. Other children only know they need you when they see that someone else needs you first, e.g. if you are giving someone else a hug, they have to butt in. Your attention directed at another family member or even a visitor to your home triggers a feeding frenzy on the part of the needy child.

The Impact Upon Other Children In Your Home The impact of raising a needy child on other children in your home can be deleterious.

When a child‘s needs are all-consuming and/or when they demand constant attention, reassurance, and parental time, the rest of the family suffers. I have talked with many biological children of foster parents who are the ―invisible‖ victims of life with the needy child. These youngsters may have initially bought into the notion of fostering with some excitement and esprit de corp. However, if the foster child is difficult, abrasive, naughty, demanding, and hard to interact with, soon the excitement wanes. The biological children have to become experts at patiently waiting their turn for time with mother or father.

Does that time ever come? If their turn never arrives, some biological children feel embittered and can develop problems at home and school related to the loss of their parents‘ attention.

Suggestions I have some suggestions for foster parents who are raising very needy children. These ideas may not fit your family, but at least please think about them. As a foster parent, you are a precious resource for needy children.

1. Set aside time for yourselves individually, as a couple and with the nuclear (original) family. Without that you may succumb to the stresses of raising the all-consuming child.

2. Get your rest. Exhaustion can lead to frayed nerves and short temper. It can result in sub-par parenting and feelings that you are not up to one more day with this child.

3. Use approved respite care and try not to feel guilty about it.

4. Keep your goals reasonable with your children. Many of the children have had problems for years; you cannot expect those things to change over night. One thing that runs people ragged is the delusion/belief that we can totally control our children‘s behavior. As parents, we may nurture, protect, guide, suggest, advise, reinforce, met out consequences, and warn, but we rarely control. Thus, the belief that we must control everything that the children do can set us up for exhaustion.

5. Put limits on the needy child. If you don‘t place some limits on the time they demand, you may burn out. Try ―tag team‖ parenting where the child develops a relationship with both parents. If you are single parenting, get the child a mentor.

6. Seek advice from a therapist who knows foster children. Ask for strategies which might mollify the child‘s anxieties and reduce the child‘s neediness.

If we could give only one word of advice to parents that word would be consistency. A consistent parent gives the child a gift of always knowing what to expect. Neither, the rules, nor the consequences change daily.

There are foster kids who called this "nagging", but they knew what they could or could not do and what would happen if they made the wrong choice. They would come in the door and before they knew we knew what they had been up to, they were discussing the consequences. They knew them in advance. I knew I had hit home with a message when the kids started to finish the sentence. No kid, upon learning they were in trouble, could claim ignorance because I had heard them repeat that very rule.

They claim the average attention span for teens being talked to is about 30 seconds, so that is the time you have to get messages across. If that is the case, a complete message needs to be broken down into small, short bits, and repeated often.

Teens dislike sermons so these short bursts are best. But more important than length is what you say. Being consistent means telling them the exact same thing in the exact same way. It is kind of like when you hear an advertising jingle for a product on TV. You begin to remember the exact words; the phrase goes together without even thinking about it. Have you noticed the new trend in advertisements? The first few weeks, or months, you get the complete ad with every gruesome detail. Later on, just the punchline, so to speak, is the entire ad, but in your mind you have already filled in the blanks. It is the same with these little messages.

Consistency would mean nothing to kids if it were only reserved for what and how we say it. You must follow through in practice. This means a parent should be very sure of what policies they want to implement. Consistency implies, no change without a good reason. I have been a foster parent in organizations where every day saw policy changes.

As foster parents, we were confused. Now, consider a foster child who has never had stability. Suddenly, the pattern is repeating itself and he does not know what the rules are anymore. Most foster kids came from families that were very inconsistent. For the first few years of parenting, these parents were often so lenient, set few rules, and never expected kids to pay consequences for their action. Suddenly, they decide it is time to be firm and go so far the other direction as to almost be abusive. They certainly are not realistic. It takes months before they admit this approach is not working and midstream; they change direction once again. Their kids are confused, and by this time probably dizzy.

Another scenario is the parents who say if you do this, you will be punished in this way.

When the kids do (let's say use drugs), the punishment for that is grounding for a month.

Unfortunately, the kids are driving them crazy being inside and whining all the time so they let them out in two weeks. These kids have just learned not to believe what you say.

They figure they should not worry about rules or consequences since you will weaken or they can get around you. It is always better to keep grounding to a minimum that you can live with, but be consistent. I must admit this does not always work since I had one young man who was grounded for two weeks every time he got drunk. He had the pleasure of my company every two weeks. He would pay his consequence without complaining, then immediately go out and do it again. It eventually took treatment to help the situation, but, we did not back down. This young man has since attached himself to our family and for all intents and purposes, he is our son. We all lived through it. I also in some rare instances allowed kids to work their way out of grounding for both our sanity's sake. But the work was in addition to regular chores, time-consuming, and hard.

Consistency is important in scheduling for the same reasons as in rules. These kids never knew if they would eat or when, what time they would finally go to bed, if they would actually see this parent that day etc. We tried to keep to a reasonable schedule in our foster home. It is difficult, but not impossible. Crisis and a tremendous workload makes it a challenge, but keep to a schedule as best you can, if you want calm kids. A factor in the lives they led which may have added to their problems was nothing was predictable.

They might complain to you, but they tend to thrive on set times for everything. I am talking within reason here.

Kids learn to associate certain things with certain other events. such as homework being done directly before or after supper. The bus coming for school exactly ¸ hour after their morning shower. Lights out or quiet time at specific times, followed by sleep.

Consistency should also carry over to love. No matter what those kids do, they still need attention and love. That should never be withheld from them as a punishment when they screw up, they need it most of all.

Education of Foster Children INTRODUCTION In 1975,U.S. Congress passed a comprehensive law which mandates that every student is entitled to a free and appropriate education (FAPE). A student can no longer be denied admission to a school or be regulated to an isolated location.

SURROGATE PARENTS Can Anyone Be a Surrogate Parent?

No. If a surrogate parent is needed, the school must first determine if there is a relative caretaker, foster parent or Court Appointed Special Advocate. If so, the school must appoint this person. (CA Government Code, Section 7579.5(e)).

If the foster parent is the legal guardian, they are considered to be a "parent" for all special education purposes.

SPECIAL EDUCATION DEFINITION Special education means a specially designed instruction, at no cost to the parent, to meet the unique needs of a child with disabilities. This can include classroom, home, hospitals, institutions, physical and vocational education.

SPECIAL EDUCATION ELIGIBILITY CRITERIA The following list qualifies students as individuals with disabilities if the assessment demonstrates that the degree of the student's impairment requires special education and related services: A. Deaf and Hard of Hearing B. Hearing and Vision Impairment C. Speech and Language Disorder (must meet one or more of the following) Articulation Disorder - Displays reduced intelligibility or an inability to use the speech mechanism witch significantly interferes with communication and attracts adverse attention.

Abnormal Voice - Characterized by persistent, defective voice quality, pitch or loudness.

Fluency Disorders - The flow of verbal expression including rate and rhythm adversely affects communication between student and listener.

Language Disorder - Scores at least 1.5 standard deviations the mean or 7th percentile for age or student displays inappropriate or adequate usages of expressive language.

D. Physically Handicapped E. Health Impaired - Cronic or acute health problems adversely affect the educational performance.

F. Autism G. Mental Retardation H. Seriously Emotionally Disturbed I. Learning Disabilities

J. Traumatic Brain Injury - Not injuries that are congenital or degenerative, or injuries induced by birth trauma.

RELATED SERVICES The term "related services" means transportation, and such developmental, corrective, and other supportive services as may be required to assist a child with a disability to benefit from special education. It includes the early identification and assessment of disabling conditions in children.

The following includes some of these services that must be provided without any charge to the parent: Language and speech development and remediation Psychological services, including counseling and guidance (other than assessment and development of the IEP) Physical and occupational therapy Recreation, including therapeutic recreation and social work services Medical, health, nursing and counseling services, including rehabilitation counseling (except such medical services shall be ~or diagnostic and evaluation purposes only) Audiological services Orientation and mobility instruction Instruction in the home or hospital Adapted physical education Physical and occupational therapy Vision services Specially designed vocational education and career development STEPS TO BE TAKEN If you think your child/foster child needs help in school, the following must be done: Write a letter to the school principal with a copy to the school psychologist. In the letter state your concerns and request a complete learning evaluation for your student. Use as much documentation as you have. The more the better.

Keep a copy of the letter.

After a few days, call the principal and restate your concerns and request for an evaluation and thank them for their assistance.

The assessment must be completed within 50 days.

If your student falls 40% below standards, he is eligible for special education services.

If your student does not qualify for special education services, have him diagnosed by a doctor for A.D.D., emotionally disturbed, etc.

After you have this evaluation, request a 504 IEP hearing.

REFERRAL FOR ASSESSMENT FOR SPECIAL EDUCATION SERVICES Every student with a disability is entitled to a FAPE. This means "special education specifically designed at no cost to the parents to meet the unique needs of this student.

(Title 20, U.S. Code, Section 14112, CA Ed. Code, Section 56031).

The following are steps that must be followed for a student to be identified as disabled and in need of special education: Referral for a complete assessment. A parent or surrogate parent initiates the request, in writing to the school principal and school psychologist. This assessment must be completed within 50 days of receiving the signed Permission to Assess form. The letter

should include the reason that an assessment is being requested. Give as many reasons as possible. The more evidence you include, the better.

The assessment process. The district has 15 days to develop and give the proposed assessment plan to the parent. The parent then has 15 days to consent to the assessment plan.

Determining eligibility. An individual assessment of the student's educational need should be conducted by qualified persons. A speech and language specialist should perform the speech test. Psychological assessment should be conducted by a credentialed school psychologist; health assessment be a credentialed school nurse or physician, behavioral problems by a behavioral specialist. (CA Ed. Code Sections 56324 and 56320).

A psycho-educational assessment is performed to determine eligibility for special services. It focuses on a student's abilities, learning capacities, and social-emotional behavior in an education contest. It should include a comprehensive evaluation of the student's functioning in all areas of concern. including, when appropriate, health and development, vision, hearing, motor abilities, speech and language, self-help, orientation and mobility, academic performance and social and emotional status. (CA Ed. Code, Sect. 56320).

If a student has communication (speech language) problems, tests that do not require a verbal response should be used in the assessment (i.e., pointing, gesturing, signing).

Pupils with visual or hearing handicaps should be assessed with tests specifically designed for them.

Tests used to assess specific areas of education need should be diagnostic and curriculum based. Often schools will opt for an "all purpose" test that is quickÓ to administer; these tests only give a global score and are not valid for goals and objectives.

Screening tests such as WRAT (Wide Range Achievement Test) must be followed up by in depth tests. A test of written language can only be used to determine a problem in writing just as a suspected reading or math problem should be assessed with reading and math diagnostic tests.

Students under 5 and those with very special needs and delays can best be assessed by developmental scales, tests of developing language, interviews and observation forms.

When a student exhibits a serious behavior problem that interferes with his academic progress a functional analysis assessment must be conducted by a qualified behavior specialist.

REFUSAL OF NEEDED SERVICES If an assessment indicates a student needs a particular type of service, the school may not refuse this service on the grounds they do not have that service available at that school.

They must find the means to provide it.

PARENT RIGHTS IN THE ASSESSMENT AND EVALUATION PROCESS The following is a list of rules when applying for initial evaluations, assessments, and to assessments for revisions of an IEP Parent consent must be given prior to assessment (CA Ed. Code Sec. 56321 (c)).

The assessment is in all areas related to the child's suspected disability (CA Ed. Code.

56320(e), (f).

Tests must be validated for the specific purpose used and given by trained personnel. (CA Ed. Code Secs. 56320(b), (c), (d), (e)).

The assessment must be given in the student's native language and/or other mode of communication (CA Ed. Code Sec. 56320(b)(1)).

Testing and evaluation materials cannot be racially, culturally or sexually discriminatory (CA Ed. Code Sec. 56320(a)).

The school must provide the parents a copy of the assessment finding is the parent requests one. It is best to request a copy before the IEP meeting to help you in the meeting. (CA Ed. Code Sec. 56329).

If you disagree with the assessment, you can either challenge it through the fair hearing procedure or obtain an independent assessment. This independent assessment must be considered by the district when decisions about the student are made. The district, when requested, must pay for the private assessment unless it can show, through a hearing that it requests, that the district's assessment was accurate, complete and met the legal requirement described above (CA Ed. Code Sec. 56329).

A complete reevaluation must be completed at least every three years. If the parent or teacher requests, this can be done more frequently.

A copy of notice of parent rights must be attached to the assessment plan. (CA. Ed. Code Sec. 56321 (a)).

PARENTS RESPONSIBILITY State and federal law give parents a voice in the fundamental decisions regarding provision of special education and related services to their children with disabilities. This includes a responsibility to be knowledgeable and concerned about the child's educational needs and to participate in the assessment and IEP. You are the child's champion. You can call for an IEP anytime you feel the goals of an old IEP need changing. Your signature is required. Do not let school personnel dictate what your child needs.

DEVELOPING AN IEP The following should be in an IEP: The student's present level of performance in all problem areas.

Individualized annual goals, short term objectives and the responsible personnel for implementing the goals.

Specific special education services to be provided.

Specific related services and the amount of time provided for them.

Any specialized materials or methods to be used.

The category for eligibility based on the assessment results.

Behavioral Intervention plan (if this assessment was performed).

Transition Services -Secondary students 16 and older. (Age 14 if appropriate). A plan is designed to give pupils the skills they need to transition from school to work and/or post secondary education.

Note: The IEP meeting should be conducted by the special education teacher.

PARENT RIGHTS IN IEP PROCESS Your rights in the IEP process are: To receive written notice in your native language of the time, location, participants and have the meeting scheduled at a mutually agreed time and place.

Attend the meeting and be accompanied by other persons (advocates).

Present information and participate equally in the development of the IEP. Have a language or sign interpreter present if needed.

Obtain a copy of the IEP. Have the IEP reviewed annually. Sooner if needed.

Have the IEP implemented as soon as possible, except where legitimate circumstances require a short delay.

To only sign off on the parts of the IEP you agree with. Only these parts will be implemented.

MENTAL HEALTH SERVICES If a student needs mental health services, request the IEP team refer the student to County Mental Health for an AB 3632 assessment Mental health services that are available at no cost are: A. Individual Therapy B. Group Therapy C. Family Therapy D. Day Treatment E. Residential Treatment BEHAVIORAL INTERVENTION PLAN A behavioral intervention plan is a written document which is developed when a special education student exhibits a serious behavior problem that significantly interferes with the implementation of the goals and objectives of the student's IEP. (CA Ed Code Section 56520 and Title 5 CA Code of Regulations, Section 3052).

Behavioral interventions that may be included in the plan are: Teaching adaptive behaviors (choice-making, self-management, relaxation techniques, general skill development, etc).

Positive reinforcing acceptable behaviors.

Changing the setting, Offering variety in the curriculum and removing excessive noise and other approaches.

Behavioral interventions that are prohibited: That which involve the infliction of pain or trauma Verbal abuse, ridicule, humiliation.

Infliction of emotional trauma.

Denial of adequate sleep, food, water, shelter, bedding, comfort, or access to bathroom facilities.

Impediments to adequate student supervision Interventions which involve locked seclusion, toxic or unpleasant sprays or mists released near the student's face Deprivation of one or more of the student's senses Any device, material or object that simultaneously immobilizes all four extremities (except in unanticipated emergency situations, prone containment may be used by trained staff only for that period of time necessary to abate the emergency) IEP APPEAL If you do not agree with the results of the IEP, you have the right to appeal. You should be given a copy of the Ă’Notice of parent rights and procedural safeguards.Ă“ This will explain the appeal process.

SUSPENSION/EXPULSION Students with disabilities may be suspended for up to ten days if their presence at school would be dangerous. Otherwise the suspension cannot be for more than 5 days.

Students with disabilities cannot be expelled from school for misconduct that is directly related to their disability.

NEW SCHOOL DISTRICT The new school district must immediately provide an interim placement for not more than 30 days. This placement must conform to an IEP. Within this 30 days, the IEP team must review the program and make a recommendation. Records and reports from the old school district may be used.

WHAT WE CAN REQUEST IN AN IEP You can set up any number of goals you can justify (needed for student to learn): Tutoring Transportation - Home to school Aide on bus Change of classrooms and/or teachers Change of school Calculators for math work Tape teacher lessons All tests given orally with readers Use word finder for spelling A study period with a tutor No more than 1/2 hour of homework per night Do fewer math problems - learn concepts Leave any class when overwhelmed - go to special ed classroom to unwind and talk to the teacher Have pass/fail classes instead of letter grades.

Student to be watched from time arrives at school until on bus to return Speech/language assistance Fine motor therapy Gross motor therapy NCR paper - another student takes notes Any needed related services stated earlier Any other services or special assistance not listed that is needed.

SECTION 504 AMERICANS WITH DISABILITY ACT ELIGIBILITY Students with disabilities who are not eligible for special education are still entitled to receive supportive services necessary to enable them to benefit from their school program under State and Federal laws. (Government Code 11135, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act).

Students with ADD/ADHD fall under this act.

SERVICES Students receive the same services as special education students, but these services are provided in regular classes, not special education classes.

IEP MEETING

The only difference between this IEP meeting and a special education IEP meeting is this meeting is conducted by the counselor.

504 ENFORCEMENT The Office of Civil Rights administers and enforces this. If you believe your child has not been afforded his rights, you may file a complaint with this office at: U.S. Department of Education Office of Civil Rights, Region IX Old Federal Building 50 United Nations Plaza, Room 239 San Francisco, CA 94102 HINTS FOR WORKING WITH SCHOOL ADMINISTRATORS Keep a diary of events, including dates, times, persons involved and a brief overview of what happened.

Confirm all meetings, telephone conversations and new information from outside sources in writing. (a) Handwritten information is fine. (b) Write legibly. (c) Write briefly and, wherever possible, in phrases which can be written in numbered order. (d) At the end of every letter, state the following: please do not hesitate to contact me if my understanding of these issues is not accurate."

Put all questions, concerns and frustrations in writing. You can never ask too many questions, have too many concerns, or eliminate all your frustrations.

If you don't receive results from your first letter, copy your first letter and send it with a cover letter asking for a response. If you don't receive results from your second letter, copy it with a new cover letter, copy first and second letter, send it with a new cover letter and copy to his or her supervisor, and be sure to put their cc: name at the bottom of the letter.

When meeting with any professional, whenever possible bring a friend, advocate or if necessary, a lawyer to take notes of what was said by all persons in attendance. Introduce your companion as an advocate for the person with disabilities.

Ask for all policies and decisions to be put in writing. If you don't receive it in writing you put it in writing and ask for confirmation.

Before you enter a meeting, research all laws, rules, and regulations about your issues of concern.

Be sure you obtain a copy of appeals process or grievance procedures prior to any meeting. Study it, and bring it with you to the meeting.

Join an advocacy group in your area. If there isn't one form one yourself.

Never lose your temper. Remain calm at all costs. If you feel yourself losing your cool, ask for a five minute rest break or ask for a glass of water. Never just give up.

IEP CHECK LIST The following checklist has been developed by TASK (Team of Advocates for Special Kids) 100 Cerritos Ave. Anaheim, CA 92805, to help you think of items that should be considered in preparing you child's IEP. TIME PERIOD yes____ no____ Should your child attend school for the standard school year? yes____ no____ An extended school year? yes____ no____ CURRICULUM

Do the goals correspond to the areas of need mentioned in the assessments? yes____ no____ Are the goals and/or objectives specific enough to easily recognize that they have been attained? yes____ no____ Does your child require a structured setting? yes____ no____ Is there a need for special equipment or materials to work effectively with your child? yes____ no____ a. Braille? yes____ no____ b. Tape Recorder? yes____ no____ What might be appropriate methods of rewarding your child? ______________________________ ________________________________________________________________________ __ What are appropriate disciplinary methods? __________________________________________ ________________________________________________________________________ __ Does your child require special classroom support, i.e. sign language or interpreter? yes____ no____ Have you been given a copy of your child's proposed daily schedule? yes____ no____ RELATED SERVICES Are the related services your child needs specified in the IEP? yes____ no____ How will they be provided (Pull-out or in class)? __________________________________ Will any of them require additional transportation? yes____ no____ Which of the following are appropriate related services? a. Transportation yes____ no____ b. Speech Therapy yes____ no____ c. Occupational Therapy yes____ no____ d. Physical Therapy yes____ no____ e. Adaptive P.E. yes____ no____ f. Group or individual counseling yes____ no____ g. Parent training yes____ no____ h. Other _______________________________________________________________ SPECIAL REQUIREMENTS/ACCESSIBILITY Does your child need special physical accessibility? yes____ no____ a. Assistance to move about? yes____ no____ b. Books on tape? yes____ no____ c. Materials in large print yes____ no____ Does your child have any special diet or medication requirements? yes____ no____ a. Allergies? yes____ no____ If medication is needed during the school day, who administers it? _________________________ a. When? ___________________ INTEGRATION/MAINSTREAMING WHAT IS THE "LEAST RESTRICTIVE ENVIRONMENT" FOR YOUR CHILD?

a. With children who do not have disabilities? yes____ no____ b. Separate from children who do not have disabilities? yes____ no____ c. The same school he/she would attend if not disabled? yes____ no____ d. Are special classes and programming spread throughout the school? yes____ no____ Does your child participate in (the same extent as other students)?: a. School assemblies? yes____ no____ b. Graduation exercises? yes____ no____ c. Clubs? yes____ no____ d. Regular art, music and/or P.E.? yes____ no____ e. Homeroom? yes____ no____ f. Study halls? yes____ no____ g. Field trips? yes____ no____ SPECIAL ASSISTANCE Does your child require therapeutic intervention? yes____ no____ Does he require structure even in his spare time? yes____ no____ Because of his disability, does your child require an alternative to playground recreation? yes____ no____ Does your child require special support during free time? ie eating, toilet yes____ no____ TRANSPORTATION How long will your child be on a bus? ______________________________________________ a. Will an aide or special equipment be necessary for safety? yes____ no____ b. Does the child need to be escorted to and picked up at the classroom? yes____ no____ What provisions for transportation are necessary, and written into the plan? yes____ no____ a. If transportation must be contracted for, do you have a copy of contract? yes____ no____ SPECIAL CONSIDERATIONS FOR SECONDARY EDUCATION Have you discussed the suspension/expulsion policies of your district? yes____ no____ Are appropriate career/vocational plans included in your students IEP? yes____ no____ MONITORING Who will be working with your child: where, and on what specific goals? _____________________ ________________________________________________________________________ __ Are all the child's teachers mentioned in the plan appraised of it? yes____ no____ Are the goals and objectives written in the IEP measurable and observable? yes____ no____ Does the IEP indicate who is directly responsible for its implementation? yes____ no____ Will you receive a written report on your child's progress? yes____ no____ How will the regular classroom teacher and the special education teacher coordinate work? _____________________________________________________________________

What date will the plan begin? ___________________________________________________ When, how and by whom will the program be evaluated? ________________________________ ________________________________________________________________________ __ TECHNOLOGY Has your child been tested for the value of computers in his education? yes____ no____ Does your child need a computer to benefit from education? yes____ no____ What adaptations are necessary for your child to use a computer? (i.e. switches, head gear, touch windows, etc.) __________________________________________________ ________________________________________________________________________ __ What specialized software will be used? ____________________________________________ ________________________________________________________________________ __ Who will be responsible? _______________________________________________________ WHAT TO INCLUDE IN YOUR CHILD'S HOME FILE Keep records chronologically, with the most recent on top.

Each year list your child's Teacher Special Education Teachers School School District Superintendent Principal School Board Members Psychologist Special Education Administrator Related Services Personnel List the chain of command within the school system, beginning with local, and ending with state and federal. Include addresses and telephone numbers of easy reference.

Composite of Special Education Laws, Part 30 of Education Code for the State of California.

Copies of all of your child's school records including the cumulative file, health file, confidential file, psychological file and any other papers or records containing your child's name or pertaining to your child that may be in the possession of anyone in your child's school district or SELPA (Special Education Local Plan Area).

Report cards.

Copies of test results and recommendations from independent assessments.

All written (including handwritten) letters and notes to and from school personnel.

All written communication with outside professionals regarding your child's unique needs.

Dated notes you have taken in conversations with you child's physician or other professionals who see your child.

Dated notes on parent/teacher conferences.

Dated notes on all telephone conversations with school personnel or others regarding your child.

A list of medications being given to your child at home and at school as authorized by your child's physical. Include the kind of medication, times and dosage information. In addition, note the Rx numbers, as well as any changes in dosage or reaction.

This list has been developed by TASK (Team of Advocates for Special Kids) 100 Cerritos Ave. Anaheim, CA 92805

Assistive Technology Assistive Technology is the use of technological devices to help your child succeed in school. This technology must be considered for each individual with a disability. Medical equipment does not fall under assistive technology. When talking about assistive technology devises, ask for a 2-4 week trial period to see how the devices work at school and home. Some questions to consider are: Does it take too much effort for the child? If so, there could be frustration and the device is poor. You should have the child involved in determining the equipment to be used. If the student does not use the equipment, it will not help them.

Assistive Technology Checklist Writing Mechanics of Writing Pen/pencil with adaptive grip Adapted paper (e.g. raised line, highlighted lines) Slant board Type writer Portable word processor Computer Other Alternate Computer Access Keyboard w/easy access Key guard Arm support Track ball/tack pad/joystick w/on screen keyboard Alternate keyboard Mouth stick/head pointer w/standard/alternate keyboard Head mouse/head master/tracker w/on screen keyboard Switch with Morse code Switch with scanning Voice recognition software

Word prediction to reduce keystrokes Other Composing Written Material Word cards/word book/word wall Pocket dictionary/thesaurus Electronic/talking electronic dictionary/thesaurus/ spell checker Word processor w/spell checker/grammar checker Word processor w/word prediction to facilitate spelling and sentence construction Talking word processor for multisensory typing Voice recognition software Multimedia software for expression of ideas (assignments Other Communication Communication board/book with pictures/objects/ letters/words Eye gaze board (eye gaze communication) Simple voice output device Voice output device w/levels Device w/speech synthesis for typing Other Activities for Daily Living (ADL) Adaptive eating devices (e.g. foam handle on utensil) Adaptive Dressing equipment Other Reading, Studying, and Math Reading Changes in text size, spacing, color background color Use of pictures with text Book adapted for page turning (e.g. page fiuffers, 3-ring binder Talking electronic device to pronounce challenging words Scanner w/talking word processor Electronic books Other Learning/ Studying Print or picture schedule Low tech aids to find materials (i.e. index tabs, color coded folders) Highlight text (e.g. markers, highlight tape, ruler, etc) Voice output reminders for assignments, steps of task, etc.

Software for manipulation of objects/concept development input devices (e.g. switch touch window) Software for organization of ideas and studying Recorded material (books on tape, taped lectures with number coded index, etc.)

Math Abacus/math line Calculator/calculator with print out

Talking calculator Calculator w/large keys and/or large LCD print out On screen calculator Software with templates for math computation (may use adapted input methods) Tactile/voice measuring devices (e.g. clock, ruler) Other Recreation & Leisure Adapted toys and games (e.g. toy with adaptive handle) Use of battery interrupter and switch to operate a toy Adaptive sporting equipment (e.g. lighted/bell ball, velcro mitt) Universal cuff to hold crayons, markers, paint brush Modified utensils (e.g. rollers, stampers, scissors) Arm rest to support arm for drawing/painting Drawing/graphic program on computer Playing games on the computer Music software on computer Other Mobility Walker Grab rails Manual wheelchair Powered mobility toy Powered wheelchair w/joystick, head switch or reacher) Other Environmental Control Light switch extension Use of universal link and switch to turn on electrical appliances (e.g. radio, fan, blender, etc.)

Radio/ultra sound/remote controlled appliances Other Positioning & Seating Non-slip surface on chair to prevent slipping Bolster, rolled towel, blocks for feet Adapted/alternate chair, side layer, stander Custom fitted wheelchair or insert Other Vision Eye glasses Magnifier Large print books Screen magnifier (mounted on screen) Screen color cornets Screen magnification software CCTV (closed-circuit television) Screen reader Braille keyboard and note taker

Braille translation software Braille printer Other Hearing Hearing aid Classroom amplification Captioning Signaling device (e.g. vibrating pager) TDD/TTY for phone access Screen flash for alert signals on computer Other NOTE: This list is intended to provide examples of assistive technology and should not be misconstrued as a mandate for payment by any agency.

There is a major difference in the equipment used. It is classified into Low-tech and High-tech equipment.

Low-tech equipment and other supports are readily available in schools, including off the shelf items to accommodate the needs of students, which can be provided by general/special education through the Student Study Team (SST)/IEP process. Examples include: Calculators, pencil grips, large pencils and tape recorders.

High-tech equipment supports students who may need more specialized equipment and support services beyond basic assistive technology, often students with low incidence and/or significant/severs disabilities, which requires more in-depth assessment. Examples include: Closed circuit television (CCTV), Augmentative communication devices, alternative computer access, FM systems, sound field systems, and specialized software.

In many instances low technology equipment would be better because it is easier to use, has less chances of breaking down, is portable, does not need electric outlets to operate, and is readily available.

How Well Do You Know Your Child?

The majority of adoptive parents have a moral code which precludes lying as an acceptable behavior. They abhor it. They avoid it at all costs. They admire integrity and honesty. With the huge mandate and model in the home that telling the truth is essential and lying is forbidden, why then do so many adoptees lie? When they lie, the children are subjected to consequences and disciplined in various ways. Parents beg, implore their children to tell the truth, even promising the consequence will be lessened if they just come clean. Yet, the lying persists. Some children lie when they want to not take responsibility for their behavior. Some lie when they want something. Some lie to manipulate and triangulate others around them. Some lie in the face of the truth - with frosting on their face and fingers they will state, unequivocally, they did not have a piece of cake. Some do all of the above and simply lie about everything all the time. What internal workings of the brain tells children that lying is an acceptable form of speech?

By looking at the workings of the brain, some answers can be obtained. The first two years of life are pivotal to brain development and personality growth. It is during these critical months foundations are laid which determine, to a great extent, future patterns of behavior. The way a child learns to think about life, himself, and others in these first

years will affect how he behaves during his life and the nature of the relationships he establishes. He will learn to trust or not, love or not, fear or not, think or not. tell the truth or not.

Babies learn to tell the truth or to lie with their first breaths. During the first year of life a baby is a bundle of needs. He needs to be fed, kept warm, comforted, held, rocked, cuddled and attended to. He is totally dependent on others for his survival and emotional growth. When that care is consistent with his needs he learns to trust. When that care is not consistent with his needs he learns to not trust. He begins to tell himself the first lies.

The infant signals he is hungry and no one comes. He cries and no one comes. He cries some more and no one comes. He stops crying and the internal messages he must give himself in order to survive are, "I am no longer hungry. I am not cold." The internal lying messages continue, "I am not worthy of being kept warm, comforted, held, cuddled, rocked. The world is unsafe. No one cares" The lies enter his psyche and embed themselves in his brain. The distinct line between truth and falsehood begins to blur.

During the second year of life a child begins to focus on wants in addition to needs. He wants his mother to stay with him. He wants to play with toys. He wants to laugh and giggle in the face of someone who cares. Yet, despite his wants, his mother leaves, there are no toys and no one giggles and coos in his face. He cries and no one comes. He cries some more and no one comes. He stops crying and the internal messages he must give himself in order to survive are, "I don't want my mother to stay. It is OK she is gone."

The internal lying messages continue. "I don't want toys and stimulation. I don't want anyone to coo and giggle in my face. Life is fine exactly the way it is. The difference between the truth and the lies becomes even fuzzier. The pathway in his brain gets deeper.

In subsequent years a child learns to distinguish feelings and emotions. These are confirmed by those around him. His mother says, "I love you" and follows that up with a safe home, nutritious food, and warm clothes. It is not the words which convey a feeling of love, it is the actions which give meaning to the words. Contrast that to the child whose mother says, "I love you" and then proceeds to neglect him, perhaps beat him. The actions make a lie of the words. The actions make a lie of the emotion. The child questions, "If this is love, then why does it hurt so bad? What is the truth here?" As a predictable, safe, caring world crumbles about him he gets angry, enraged. However, such strong feelings in so small a person is very frightening to him. In order to protect himself from his own fear, grief and rage he must tell himself that he is a strong little boy, capable of taking care of himself. He denies he is angry, scared or grief stricken. To give himself permission to feel these feelings, to even acknowledge their existence, is to make himself vulnerable to an uncaring world. The lies he tells himself in order to survive continue. "I am happy. I am not angry. I am not scared. I am not sad." Truth becomes a taboo topic for him to consider. Truth becomes irrelevant. Survival is all that matters. The rut in his brain deepens and lying becomes habitual. It has no good or bad connotations.

Like the moon and the stars, it is just there.

The child enters a home where truth is very relevant. The concept is so foreign to him it is rejected. The truth has never mattered before, why should it suddenly become important? He has blocked out the difference between truth and lies to the point where he does not even consider it worth his while to pay attention to which is which. Parents and the rest of society however, tend to feel differently so it must be addressed. Central to

helping a child deal with lying behaviors is a message which runs counter to prevailing thought. Most people develop relationships with people they can trust and have been known to say something like, "I could never love someone I didn't trust." Obviously, that is not the message a child who lies needs to hear. Parents can be extremely therapeutic when they change that to, "I can love you even when I don't trust you." And, "I am such a great mom that you are not going to keep me from loving you just because you lie."

Another important concept when dealing with lying behaviors is to not ask a child who lies a question when you know the answer, in hopes the child will tell the truth. It is a set up for the child. He lies. You pounce triumphantly on his lie. He feels betrayed. If you know the answer, don't ask. By the same token, never ask when you don't know the answer as the answer cannot be trusted anyway. In other words, never ask a child who lies a question. It simply entrenches the lying and adds a layer of guilt which further damages the relationship. Instead, act on what you believe to be the truth and leave it go at that. A sample conversation: Parent - Greg said you hit him.

Child - Well, I didn't.

P - What do you think I believe?

C - You think I hit him.

P - Right. You know you can't hit Greg so your consequence is....

C - But I didn't.

P - Would a jury of your peers convict you? Is the evidence there to indicate you did? Did you have opportunity? Did you have motive? Does Greg say you did?

C - Greg lies.

P - In this household, who tells the truth more? You or Greg?

C - Greg. You never believe me. You don't trust me.

P - Right. Fortunately I am such a great mom I can love a boy I do not trust.

C - But its not fair.

P - Have you ever lied to me and not gotten caught?

C - Yes. P - Well, then this makes up for it. Over the course of time it will all work out.

C - You don't love me as much as Greg.

P - Nice try. Now scoot to (whatever the consequence is) Parents abhor calling anyone, particularly their child, a liar. Far better to say, "I don't believe you" and make an "I message" around it. After all, there often truly is no way to determine if the child is telling the truth. Saying, "I don't believe you" diminishes the controlling effect a child has when he lies.

Lying becomes a way to take control. By distorting the truth the child can cause the parents' world to spin. The child can then take the chaos in his own brain and impose it on someone else. Children can also use lying as a means to test the parent-child relationship. How truthful are the parents being when they say this is a forever home? If the child's behaviors are disruptive enough can they force the issue and contribute to having the child moved? Maybe the child wants to be moved and is using the lying as a means to push his parents away to the point where they give up on him and ask that he be moved.

The old adage of, "You canĂ­t push a river upstream," can be applied to lying. Parents cannot control lying. All they can control is whether or not they believe the child and

how to impose an appropriate consequence. Several parenting techniques can be used with success. One is to predict for the child when he is going to lie and then give permission for him to do it. For many children lying is so habitual they lie before they even think about what else they could say. A parent can say, "I want to talk to you and I know you don't tend to tell the truth when I ask you questions. So, I want you to know I expect you to come up with a really good lie in answer to my question. Ready? (then ask the question) This accomplishes several things. One, it gives a child time to make a decision of whether to lie or not instead of letting the first words, which are usually lies, fall unthinking out of his mouth. Two, it removes lying from the control battle realm.

Three, since the parent has given the child permission to lie, it doesn't make sense to get angry or upset about it. Just praise the child for a great lie and go on with life. Or, if perchance the child happened to tell the truth, cover him with glory. Pop a piece of candy in his mouth so he connects telling the truth with sweet goodness. Remember, whenever a habit needs to be broken it requires that the brain be "rewired" around the new behavior.

"Treats" accomplish that as well with children as with puppies. Parents can practice with a child around the truth. Play a lying/truth game. Have the child tell the answers to obvious questions which have no emotional content. For example, "How old are you.

What is your teacher's name. Etc." Everytime the child tells the truth he gets a treat. Key to giving treats is it must pass from the parent's hand to the child's mouth while they are looking into each other's eyes. Do not let the child take the candy and put it in his own mouth as part of the meaning becomes lost. The connection must be clearly made that the parent is the source of all goodness and light and pleasing the parent makes good things happen for the child.

Because lying is often habitual for kids, parents can make an attempt to get in touch with how difficult it is to change a habit by changing one of their own. Explain to the child that everyone has habits, some good and some bad. Changing a habit takes thought and effort. Do you put on both your socks and then both your shoes or do you put on one sock and shoe and then the other sock and shoe? Do you mix everything up on your plate when you eat or eat one thing until it is gone and then eat the next item? Parents can find something they do habitually - even if it is something like storing the car keys in a different place - and make a commitment to change it. Challenge the child to change a habit, other than lying, and then compare notes as to each other's progress. Sympathize with your child as he struggles to change an innocuous habit so you can be sincerely appreciative of whatever efforts he makes to change a deeply entrenched habit, like lying, that has emotional overtones. Accept that changing any habit, particularly one that has been so useful to survival, is going to take a long time. A very long time. Years and years later parents will still be left wondering exactly what of all their child said was the truth.

Expecting it to change any more quickly than that sets parents and child up for disappointment and anger - two emotions which get in the way of instilling a sense in the child that he is loved and cherished exactly as he is. The message is that he needs to change his lying in order to make it in the world - not to make him more lovable to his parents.

Have fun with the lying. For example, when you know a child habitually lies ask him if wants a bowl of ice cream. When he says, "Yes", give him a bowl of cold cereal. When he asks what happened to the ice cream, happily remind him that since he always lies you never know what the truth is. When he said he wanted ice cream you knew he never told

the truth so that must mean he doesnĂ­t want ice cream. Since you didn't know what he really wanted you just guessed and thought cold cereal would be OK. This works well in restaurants when you lightly order something other than what he said he wanted and in clothing stores when you smilingly buy him a different shirt than the one he indicated was his favorite.

Parents can look for other ways to confound the child's thinking about the value of his lying. One way is to lie to the child. The child asks to go to the movies and the parent says, "Yes". Later, the parent does not take the child to the movies and when the child asks why the parent lightly says, "Oh, I thought the truth didn't matter. It was easier to tell you yes at the time, but I really didn't mean it. I thought that was how you wanted us to talk to each other in this family. Are you telling me it is important for me to tell the truth, but it is not important for you to tell the truth? Is that fair?"

The goal in dealing with lying is to put the child in conflict about his lying. When a child lies and the parents get upset and angry then they are in conflict about the childĂ­s lying and the child is not. The child says to himself, "No point in both of us getting upset about this," and continues lying. When parents get emotionally involved with the lying the child gets the message that says, "When I lie my parents are hurt. When I lie others suffer."

When a child does not have a conscience around lying, knowing that others are hurt may be irrelevant or even please the child. The lying behaviors will not change until the child sees, in non-angry situations, that the lying is not working for him. He needs to see that he is the one who suffers when he lies. It is not getting him what he wants. Alcoholics do not cease acting out their alcoholic behaviors because they think it through and decide it is rational for them to change. They stop drinking when they see their lives are going down the tubes because of it. They have an emotional connection to the negative results of their behavior and then have to act themselves into a new way of thinking. They don't think their way into a new way of acting. In the same way, a child must feel and experience the negative results of his behavior in the presence of non-angry and nonemotionally involved people. Thinking about how lying doesn't work for him doesn't work. Experiencing the results and feeling the pain is the only way to drive home that he, not anyone else, is the one who suffers the most when he lies.

Many parents can handle the lying at home by applying the mentioned techniques, however, they are at a loss when the child lies outside the home and is believed.

Commonly children who are habitual liars lie to their therapists and caseworkers. It is imperative that lying children not be seen alone by either. Parents should not take their child to any therapist who insists on seeing the child alone. The potential for triangulation and manipulation are too great. Additionally, it is too easy for a child who lies to divert attention away from the therapeutic issues which need to be addressed and focus attention on an issue which is irrelevant. Too often it is a waste of parent time, energy and money when they are not present to keep the therapy on track and focused on the behaviors which the child is exhibiting which are dangerous or anti-social. When therapists let the child direct the therapy and choose the topic it is too easy for the time to be wasted and the child empowered in blaming his parents or others for his behaviors. The situation becomes even dangerous for the parents when a lying child uses his private time with the therapist or caseworker to lodge accusations of abuse and the parents are not there to counter them.

The most insidious lie occurs when a child falsely accuses his parents of abuse. Society and public policy are often supportive of the child when he does it. A child can have a file three inches thick detailing his anti-social, pathological behaviors, while the parents do not have so much as a traffic ticket on their record, and a well meaning caseworker can still be suckered. One way to turn the tables when confronted by an official is to state, "If the child is telling the truth, he is not safe with me. If the child is lying then I am not safe with him. Either way it is not in anyone's best interest for him to come home."

Then, have him placed outside of the home while the legal processes wrangle. To do less is to compromise the entire family's well being and to send home the message to the child that there are no limits to the lies he can get away with. Loving a child and living with a child may not always be possible at the same time. Sometimes you have to feed a child with a long handled spoon.

Lying at school and in other situations can also be problematic for parents. Taking to heart the adage, "It takes a village to raise a child" many people outside of the home believe a lying child and rush to rescue and save. It is imperative that the treatment team stand behind the parents and defend them to the world if the placement is to not disrupt.

Lying can be addressed in meaningful ways, both by the parents and by professionals outside of the home. However, it takes a unified effort to get a child who lies in conflict about his behavior. If he is not in conflict, if he is not feeling the pain, if he thinks others are more in pain over his behavior than he is, he will not change. Regardless of whether or not the child lies, he must grow up knowing he is loved and cared for, even when he can't be trusted. Life has a way of imposing natural consequences on those who are habitual liars. Sometimes the best parents can do is take care of themselves so they are not hurt by the lies, give it their best shot and leave the rest to the universe.

Lets take the questionnare What really makes your child angry?

Who is your child's best friend?

What color would your child like his or her room to be?

Who is your child's hero?

What embarrasses your child most?

Would your child prefer a vanilla milk shake, a hot fudge sundae or strawberry shortcake?

In gym class, would your child rather play basketball, do exercises or run relays?

What is your child's favorite subject in school?

What is the subject your child dislikes most?

What names is your child called in school?

What is your child's favorite music?

What is your child's favorite Bible verse?

What is your child's biggest complaint about the family?

If you could buy your child anything in the world, what would be his or her first choice?

What is your child's favorite television show?

Of what accomplishment is your child proudest?

What has been the biggest disappointment in your child's life?

What is your child's favorite sport?

Which of these chores does your child dislike most: drying dishes, cleaning his or her room or taking out the trash?

What is your child's favorite book?

Does your child feel too small or too big for his or her age?

What gift from you does your child cherish most?

What person outside the family has most influenced your child's life?

When does your child prefer to do homework....after school, after supper, before bed, or in the morning before school?

Keeping an open line of communication with your child is important to their health, safety, self-esteem, trust of adults and ability to take responsibility for their actions.

If you want your child to take an interest in him or herself, you must take an active interest in your child.

If you do not know the answers to most of the above questions, it is never too late to sit down with your child and use the above questions as a guide to start a conversation. Do not ask each question at once, but pick one and expand a conversation from that one question. Do that daily or several times a week and you will see how enjoyable it can be to communicate with your child. Remember to give your undivided attention and keep tv and radio off.

Why Foster Parents Come and Stay Coming In: A Positive Experience • Recruitment response: Agencies respond to foster parent inquiries in a timely manner, providing information that fully explains the initial application and training process.

• Family assessment process: Foster parents participate in a mutual family assessment process that allows them to examine their own competencies, abilities, and qualifications in light of the type of children they hope to foster.

• Relevant basic training: Foster parents receive competency-based pre-service training that clearly defines the requirements and challenges of foster care.

• Awareness: Agencies convey a message of the positive effect foster parents can have on the children and their families (exercising caution in using ―rescuing‖ messages).

Staying on: A Satisfying Experience • Communication: Foster parents experience a relationship with the agency that is typified by: information sharing, easy access to supportive workers, and within the framework of mutual respect, and positive regard.

• Clear role definition: Foster parents are clear and confident about their rights, responsibilities and agency expectations. A good foster parent goes through many hours of training every year. You are required to educate yourself on a number of pertinent issues. Every year, new information, concepts, programs, and issues are brought forth. A foster parent is required to study these just to do their job. If training makes one a professional, an expert, than surely the foster parent should be considered so. When others are heard to say, but they are just foster parents, I start to lose control.

Lots of foster parents have worked with kids for decades. How many "professional" people do you know that study that long to be a doctor, lawyer, or teacher. We consider these people professionals, however.

What people tend to forget is the fact that in addition to training, required and otherwise, foster parents must learn on the job everyday. It becomes a necessity for new topics to be mastered with every new foster child. You may be immediately forced to learn about specific learning disabilities, behaviors, and illnesses.

A foster parent searches out information needed and begins to study the facts until they are well versed on the subject. An older, more experienced foster parent will already have studied hundreds of topics, while a beginning foster parent will need to learn everything and quickly.

As a new foster parent I knew little about drugs, but as an experienced foster parent I knew much more than I cared to know. I learned the general symptoms of a child on drugs and also the symptoms of each individual drug. Eventually I recognized many drugs by sight, knew the street names, and what they sold for. I even knew by whom and where they were being sold sometimes. The point is by necessity I became an expert on the subject.

Foster care requires a proficiency in behaviors and the accompanying acronyms that describe these disorders. Most foster parents develop an amazing medical knowledge since you regulate the health and monitor the medication of those children placed in your home. You must know CPR and first aid and be able to qualify in the Red Cross testing of these skills. A foster parent knows about a variety of medications and how to determine if they were really taken or not.

Today's foster parent must be pretty aware of all the educational options for kids. It is imperative that they know what the rights of the children are in the expectation that they receive an adequate education. You must understand Personal Education Plans and often act in the place of a parent when making educational decisions.

When foster kids challenge the law, they usually lose. The foster mom or dad is probably the one to make sure they have an adult present when being interrogated. They know a great deal about court proceedings since they attend hearings so often. They must learn the process and often know as much as lawyers about possible resources for the children.

Community service spots, restitution possibilities, programs with available space, and even which judge is best for which kid is common knowledge to the foster parent. They may have researched facilities and can advocate for their kids when the decision is being made as to where to put them.

You add to this that foster parents must understand, be able to function in, or least have knowledge of youth culture and you start to see how versatile these folks are.

The foster parent is an efficiency expert feeding large amounts of people and running a huge household on a limited budget. An expert at scheduling, they balance more meetings, appointments, and activities than a business executive does. The foster care chauffeur has figured out how to drive everyone, everywhere in different directions and get them all to their respective places on time. The schedule some foster parents keep would wilt the toughest person.

Together, foster parent couples have studied enough topics to earn several degrees, but where is their diploma. Some certification is now available, but it is still a far cry from the degree.

Yes, the lawyer, doctor, and teacher have a great deal of knowledge and do deserve the professional designation. Usually, they are only experts in one general area. Foster parents need to be master of many areas. • Ongoing training: Foster parents have access to training opportunities that prepare them for dealing with more difficult behaviors often exhibited by children in care • Ongoing support: Foster parents have access to a supportive network of caseworkers

and other more experienced foster parents to guide them through challenging moments and crises as they occur. They also have opportunities for participating in social events with other foster parents such as picnics, holiday parties and award banquets. Other suggested supportive services include: liability insurance, planned respite care and quality training events. • Inclusion: Foster parents are regarded as part of the team that is responsible for making decisions about the child and the family.

Research on Children Missing from Foster Care Despite the small body of literature dedicated to this topic, several studies and case-specific examples, as well as anecdotal evidence regarding children missing from care, are available, although no researcher has completed a comprehensive study of the incidence, causes, and strategies to address this problem in the United States.2 In reviewing the literature on children missing from care, it is useful to think of this population as one composed of three discrete groups—those who leave care voluntarily without permission, those who are removed from care (voluntarily or involuntarily) by someone without the authority to do so, and those whose presence or absence in care is unaccounted for by the custodial agency.

Children who run from care are the most researched of the three groups. Although the literature has examined the issues of familial and nonfamilial abductions of children and youth from their families, no comparable body of work pertaining to such abductions from care exists.

Conspicuously absent from a review of the literature is any notable examination of children who are lost in care, that is, those whose whereabouts are unknown to the child welfare agency, but who were not reported as missing or runaway. Thus, the majority of the discussion that follows addresses children and youth who run from care.

Children running away from public child welfare placements and institutions is not a new phenomenon (Biehal & Wade, 2000). The manner in which this issue has historically been researched and examined in the United States and Great Britain illuminates the existing gaps in our approach and identifies future research needs.

The North American literature, with its emphasis on youth who run away from home, has focused on the importance of individual and family characteristics, whereas British studies, with their institutional lens, have focused on environmental factors (Biehal & Wade, 2000). From the 1930s to the early 1970s, examinations in the United States of missing children were limited to personal pathology (i.e., the child‘s characteristics), with a sole focus on those who ran away from home. At the same time, British researchers uncovered large variations in the rates

of running behavior from institutions such as community homes, special schools, probation hostels, and assessment centers that they could not explain solely by intake procedures at the institutions. In the 1970s, British researchers turned their attention away from the individual characteristics of children who ran and sought to explain the notable variations in rates of runaway children between apparently comparable facilities in terms of the institutional environments.

Principal Research Studies and Practice Initiatives Adolescent Runaway Behavior in Specialized Foster Care (Fasulo, Cross, Mosley, & Leavey, 2002) .

This study examined the characteristics and predictors of running away for 147 adolescents between the ages of 12 and 18 in specialized foster care (SFC) in a managed child welfare agency. SFC provides a more intensive intervention than regular foster care, but adolescents in SFC may be at high risk of running away because of their more troubled histories and previous failures in foster care. Findings can guide program improvements designed to prevent future running away.

Comparing the Timing of Exits from Substitute Care (Courtney & Wong, 1996) The researchers used longitudinal data on a cohort of 8,625 children who entered substitute care to compare the timing of three types of exit from substitute care: discharge to family or guardian, adoption, and running away from care. The study involved examination of the hazard functions Research on Children Missing from Care 3 of each of the three exits, including consideration of the associations between these hazards and child, family, and service system factors. The hazards of the three exits changed over time but in dissimilar ways. Furthermore, explanatory variables had contrasting effects on the three exits.

These findings suggest that the exit process in substitute care is best understood as a combination of a number of distinct but interrelated exit processes.

Going Missing (Wade & Biehal, 1998) Going Missing was the first major study in the United Kingdom of young people who run away from residential and foster homes. Conducted over a three-year period and sponsored by the United Kingdom‘s Department of Health, it sought to understand why young people run away from substitute care and what happens when they do. In the first of the two stages of the research, the authors conducted two surveys of patterns of absences from substitute care in four English local authorities. The absences took place from July 1995 through July 1996. In the second stage, they convened 14 focus groups with young people, social workers, and residential and foster caregivers, and they conducted in-depth interviews with 36 young people, their social workers, and their caregivers. The researchers mapped patterns, motivations, and responses and examined the effect of going missing on young people.

National Incidence Studies

(Sedlak, Finkelhor, Hammer, & Schultz, 2002) The National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children (NISMART) consist of several complementary studies designed to estimate the size and nature of the United States‘ missing children problem. NISMART-2, the second such set of studies, provided national estimates of missing children based on surveys of households, juvenile residential facilities, and law enforcement agencies. The two household surveys covered all types of episodes for children living in households. The juvenile facilities study obtained information about children who ran away from the institutional settings in which they lived. The law enforcement study provided precise estimates and case characteristics for a rare form of nonfamily abduction, the stereotypical kidnapping.

NISMART–2 spanned 1997 to 1999 and presented statistical profiles of these children, including their demographic characteristics and the circumstances of their disappearance.

Operation SafeKids (Florida Department of Law Enforcement and Florida Department of Children and Families) Initiated in December 2002 at the request of Florida Governor Jeb Bush, Operation SafeKids established a 15-week partnership among the Florida Department of Law Enforcement, the Florida Department of Children and Families (DCF), and Florida‘s local law enforcement agencies, with a mission to search for and find children who were missing and under the supervision of DCF and make recommendations for improvements to enhance accountability and improve child recovery. The planners created seven regional child location strike forces throughout the state to accomplish these objectives.

Running Away in Wales (Mitchell, Rees, & Wade, 2002) Commissioned by the National Assembly for Wales, this report explored the current extent of services for young runaways in Wales. It was the first to provide reliable evidence on the incidence of running away in Wales and on the circumstances and experiences of young people who run away or are forced to leave their homes before the age of 16. Researchers undertook fieldwork for this report in six sample areas of Wales to combine agency perspectives on the strengths and weaknesses of existing services for young runaways.

Vera Institute of Justice (Ross, 2001) The New York City Administration for Children‘s Services (ACS) contracted with the Vera Institute of Justice to conduct several research studies to assist in reform efforts initiated as part of the settlement of the Marisol et al. v Rudolph W. Giuliani et al. lawsuit. Using ACS foster care data, this specific study addressed three areas: (1) children in foster care and the services they need, (2) frequency of relocation to new foster placements and types of placements between which these moves occur, and (3) characteristics of children leaving care without permission (e.g., runaways).

Findings include policy implications and potential areas of future research.

Youth in Treatment Foster Care: Predictors of Running Away

(Nesmith, 2002) This study followed 343 foster youth from Wisconsin and Minnesota, ages 11 to 18, for two years, beginning with their initial placement in care. The study identified predictors of running behavior and the timing of running once in care. Foster parents and social workers completed quarterly Child Behavior Check Lists and questionnaires regarding the youths‘ behaviors, the birth families‘ involvement, foster parenting and decision making styles, permanency planning, and running episodes. Findings identify risk factors and predictors that inform effective prevention and intervention strategies.

Young Runaways (Social Exclusion Unit, 2002) England‘s Prime Minister directed the Social Exclusion Unit‘s (SEU) to develop recommendations to ―make running away less likely and to ensure that runaways‘ short-and long-term needs are safely met‖ (SEU, 2002). In March 2001, SEU published a consultation paper on children and young people running away from home or care that outlined the characteristics of runaways and of running-away incidents, and posed a number of questions about how agencies should develop and manage future services for runaways. More than 180 individuals and organizations responded. The subsequent report (SEU, 2002) reflects the responses to the issues raised in the initial consultation paper and incorporates the viewpoints of respondents and other knowledgeable parties.

Reasons why Children Run from Care A range of factors, both internal and external to placements, may prompt children to run from care. Some factors specific to the child welfare system can increase the likelihood of running away. It is important to be aware of both the underlying reasons and immediate triggers for running behavior for each child or youth who is in the custody of the child welfare agency.

Child-Specific Reasons for Running Children leave care to feel a sense of control over their lives...it is a temporary fix of power and a need to find a place to heal themselves.

—Celeste Edmunds, former foster youth Research indicates that young people run from care placements for a variety of reasons (Biehal & Wade, 2002): • They are unhappy about separation from their families.

• They are unhappy in their placements. This may be because they do not want to be in the custody of the child welfare agency or the particular placement, their caregivers or foster parents mistreat or maltreat the children in their care, the placement fails to address the child‘s individual needs, or the placement creates a mix of children that is not conducive to the well-being of all or the management of the household.

• Running away is a strategy they developed at home or in past placements to respond to difficulties, trauma, and victimization.

• They are encouraged or intimidated by other residents in the homes or foster care, leading them to run with others to gain acceptance by peers or to run away alone to escape.

• They run as a reaction to feeling angry or upset.

• They run as a reaction to restrictions imposed by foster parents, particularly for those children unused to any boundaries being set for their behavior in the past.

• They run to return to families in the hope that they might be able to remain with them.

• They run to spend time with friends.

• They are drawn to the apparent attractions of street life including, but not limited to, criminal activity and prostitution.

Awareness and understanding of young people‘s motivation for running from care is a vital element of any strategy to deter them from repeating this behavior.

System-Specific Reasons for Running: The Effects and Consequences of Placement and Staffing The environment of foster care can, by itself, have a significant effect on the likelihood of a child running away (SEU, 2002). The number of children who run from individual foster homes vary widely—some homes have no children who run away, whereas other have several. If agencies or foster families handle the same types of children and report radically different AWOL rates, this should prompt investigation. Such a disparity may suggest different interpretations of reporting requirements or underlying problems in the quality of care (Ross, 2001).

Research suggests that the culture of individual homes is likely to have a strong effect on rates of running. In homes with little evidence of structure and authority, children feel that they can come and go as they please. In contrast, children in homes with a sense of well-supported foster parents who demonstrate nurturing leadership tend to have lower rates of running away (SEU, 2002).

Reasons Children Run from Care Sometimes running away is the most functional response to a specific living arrangement.

—Robin Nixon, Director, National Foster Care Coalition, Connect for Kids Wade and Biehal (1998) found that in residential care with high rates of going missing, senior management in the units failed to offer clear leadership, staff morale was low, and staff appeared overwhelmed by a sense of fatalism about their ability to protect children or control their behavior (Biehal & Wade, 2000). Likewise, the regimes and cultures in homes where running away was less of a problem shared certain characteristics (Biehal & Wade, 2002):

• Heads of households had a clear view of how the home should operate and provided strong leadership.

• Staff felt well supported and morale was reasonably high.

• Staff had the opportunity to discuss and agree on a consistent approach to individual children.

• Young people were involved in negotiating acceptable boundaries and patterns of behavior.

Wade and Biehal (1998) also found that residential staff often feel demoralized and powerless to intervene when young people run away.

Clear leadership and staff teams involvement in developing plans for each child is needed to reinforce staff‘s confidence in their ability to intervene effectively, with the knowledge that their intervention will occur with mutual support from their colleagues. This strategy should also facilitate a consistent response within the agency when children go missing.

Finally, the case management role of many practitioners, along with workload pressures, can result in little opportunity for direct work with young people in care (Biehal & Wade, 2002). If a case management approach is used, youth do not have a trusted professional to rely on if they are unhappy in their placements. Workload pressures can compromise the essential planning required to ensure necessary service interventions are performed. Both aspects can have the indirect effect of encouraging youth in care to leave (Wade & Biehal, 1998).

The motivations that prompt young people to go missing are complex.

Both individual and environmental factors influence and explain this phenomenon. Both have broad implications for the development of preventive services for children, teens, and families; interagency approaches to supporting young people; and the nature of foster care provision. The following sections on the prevention, response, and resolution of missing from care episodes discuss these implications.

Perhaps the single best place to dedicate prevention efforts is in improvement of the current quality of foster care services. A multidimensional approach can address the child‘s needs before he or she begins the journey along the ―missing continuum‖—from the time a child is at risk of running through the time that a child has run repeatedly.

Developing and implementing an array of organizational, managerial, supervisory, and front-line practices, and ensuring that workers use them, can lessen the risk of running and keep the child safe, supported, and nurtured in care.

Quality assurances include, but are not limited to the capacity and ability to: • provide adequate preparation for placement; • offer sufficient placements to allow for ample selection that, optimally, is mutually acceptable;

• conduct quality risk assessment; • triage problems as they arise and promote placement stability; • provide regular opportunities for visitation with family members and increase visit frequency as indicated by assessment; • visit and photograph the children regularly; • develop and provide formal guidance to foster parents and workers on strategies to prevent unauthorized absences from placement; • provide personal safety training for all children in foster care; • inform children and youth of risks of and alternatives to running; • address need for and availability and provision of services for children in care; and • conduct a periodic census by the agency of children in placement.

Adequate preparation of children and youth, and their birthparents and foster parents, can provide a foundation for placement that can improve the goodness of fit, ease the transition, and reduce the numbers of unanticipated problems that can lead to high stress, poor coping, and placement disruption. Workers should give the child, birth family, and foster family thorough information about placement plans, and they should have an opportunity to fully discuss the placement with staff (CWLA, 2003, p. 23).

Preparing Children and Youth for Foster Care Placement Once a child is removed from home, they are missing—missing from someone‘s life. And their soul ages 10 years, but their body, development, and age don‘t catch up.

—Celeste Edmunds, former foster youth CWLA (2003) indicated that workers can help children and youth during the initial transition into foster care by providing them with information about a range of issues, including: • the range of feelings, such as anger, depression, denial, loss, and confusion that children and youth may experience when placed outside their families; • the changes and challenges facing children and youth placed outside their homes; • the roles and expectations of foster parents, agency workers, and birthparents in supporting their placement; • information about the family they may be placed with, such as lifestyle, description, pictures; • the process of case planning and permanency decision making; • the reasons for their placement, the issues that must be addressed for reunification to occur, and the services and supports that will be offered to them and their families to support the reunification process;

• the importance of communicating their feelings and needs to foster parents and agency workers; and • effective ways to negotiate and resolve conflicts in foster care.

This information should be delivered in the context of an ongoing supportive relationship with a worker who will be available to support the child through the placement process.

When [caseworkers] make more promises to foster kids that [they] can‘t keep, [they] are doing more harm than good.

—Celeste Edmunds, former foster youth Supports to and Education of Children in Care The high incidence of running away demonstrates the need for comprehensive discussion of the problem—both universal and targeted— to generate greater awareness and understanding of running behavior among young people, of their birth families and foster families, and of the practitioners and available services that maximize the safety of children in foster care.

As previously stated, all children in care should be provided with personal safety training and given clear information about and have understanding of • expected times of going out and returning; • who to tell about where they are going; • how to notify their foster family and the agency if they are unable to return in the expected timeframe; • how to seek help if they are unable to get back for the agreed time, whether this has happened accidentally or on purpose; and • risks of and alternatives to running from care.

Additional supports that can bolster positive development and insulate youth from the risks of running include regular visitation with parents, siblings, and other kin; nurturing of other relationships, such as mentors, who will remain in youth‘s life for a sustained period of time; and provision of appropriate medical, psychological, and educational services. Providing ongoing, enhanced supports to young people can help prepare for youth for adulthood and assist them once they cease to be in the state‘s care and custody. Older youth in care need services to help them cope with fears about impending discharge at age 18 that include ways to feel emotionally prepared as well as prepared in terms of skills.

Placement Selection and Stability A range of placement options is essential to meet the child‘s individual needs. Workers should select placements that meet the unique needs of each child to lessen the likelihood of running away. A shortage of placement options can only heighten risks if vulnerable young people are inappropriately placed with foster families, sometimes alongside other young people already engaging in dangerous behavior

(Biehal & Wade, 2002). Running away from care is strongly associated with not having a stable care placement. Children who run from care are often in placements that fail to meet their needs, oftentimes due to an insufficient pool of resource families. Where placement stability is lacking, youth are less likely to establish a stable pattern of attachments. Such stability enables the development of trust of a caregiver that can, in turn, dissuade the child from running behavior.

Prevention of Missing-from-Care Providing young people with a greater choice of placements, and offering them a stable and positive placement experience and a chance to build secure attachments is likely to be protective. Likewise, placement stability enables the development of strategies to address the underlying difficulties that may have influenced running behavior in the past and has the potential to affect future behavior.

Caseworkers often put kids in a placement that is convenient for the worker, not necessarily best for the youth. We have to stop taking care of ourselves and start taking care of the kids.

Do what is best for them. —Judith Dunning, Statewide Coordinator for Missing Children, Illinois Department of Children and Families The most effective way to reduce the number of children who run from care is for those responsible for caring for young people to develop approaches to caring for children that reinforce placement stability.

A trusting relationship with a caregiver based on mutual respect is likely to be the best safeguard for a young person (Department of Health, 2002). Ross (2001) indicated that an initial unauthorized absence appears to be a strong indicator that a child may need additional attention. The child welfare agency can use this event to examine whether there are difficulties with the care the child is receiving or with the home or placement in which the child resides.

Supports for and Training of Foster Parents Wade and Biehal (1998) found that foster parents often feel isolated and unsupported when their foster children go missing. They understandably need support to enable them to deal consistently with these challenging situations, and they are also likely to appreciate regular advice and reassurance regarding their management of the event and its subsequent effects.

Prior to the placement of a particular child, workers should provide information to the foster family regarding any risks of running away or abduction and how best to prevent them. To safeguard children in their care, foster parents must be aware of risks associated with running away and strategies to prevent both running and abduction.

Child welfare agencies should have clear written procedures for foster parents and child welfare staff to follow if children leave their placements without permission. They should train staff and care providers

on appropriate internal and interagency protocols. Foster parents need to have a keen understanding of the procedures to be followed when children go missing, as well as ongoing support in working with children at risk of runaway and abduction.

The child welfare agency must offer foster parents the support, supervision, and training to develop skills that enable them to deter children from unauthorized absences and must provide foster parents with the understanding and competence to follow prescribed agency procedures when children leave care without permission. In addition, the agency should promote and assist in the development of foster parent support groups. These mutual support networks can be an invaluable resource to foster parents while extending the capacity of the agency to empower foster parents with knowledge and skills.

Risk Assessment Given that research has consistently shown that there is no developing pattern, in which successive running episodes become progressively riskier or more protracted, it is the particular circumstances in which young people go missing and what they do on any particular occasion that are the key factors in risk of harm, rather than the number of previous episodes. Research also suggests that the duration of absences should not be taken as an indicator of the level of risk to the young person. Absences of short duration may be as risky as longer absences, and workers should view them with equal seriousness (Biehal & Wade, 2002). These findings demonstrate the importance of identifying those factors that place children at risk of running.

Every time a child is absent from placement without permission, agency staff need to complete safety and risk assessments, hold them on file, and review them regularly. The assessment and management of safety and risk need to be grounded in a thorough knowledge of the individual young person. Careful assessment of youths‘ past absences, their motivations, the types of places they go, and the people they contact should help practitioners gauge risk and appropriate responses with increased certainty. This kind of knowledge, combined with an early response to each individual youth who is missing from care, may help manage risk and improve young people‘s life chances.

Factors to be considered in assessing risk may include (Biehal & Wade, 2002): • the previously assessed level of vulnerability, • age of the child, • time of day or night, • history of self-harm, • physical or learning difficulties, • a previous history of going missing (where to, who with, how long away), • any agreement reached regarding staying out beyond the

usual time, • where the child is believed to be, • his or her likely associations while missing, • state of mind at the time of going missing, • group behavior, • any guidance in the child‘s care plan, and • any other particular circumstances at the time of the incident.

Likewise, agencies must integrate safety into all aspects of the child welfare system, both internal and external to the child welfare agency. Safety assessments and plans must become a way of life for the entire child welfare agency, and the broader child welfare community must embrace them to include community providers of services, the courts, and educational, medical, and law enforcement communities.

Virtually anyone who potentially comes in contact with a child protection case needs to understand the concept of ensuring safety and their role in it, particularly in the case of children missing from care.

Provision of Necessary Services We need to educate our child welfare workers on the cost of removal. A lot of children are removed [from home] when it‘s a service, not a safety, issue.

—Jerry Regier, Secretary, Florida DCF Young people in care often experience serious behavior problems or struggle to cope with the trauma of abuse or rejection. Often, only limited therapeutic help is available to address these issues, either in or outside their placements (Biehal & Wade, 2002). Evidence of the mental health problems of children in care must be reconciled with the lack of community-based therapeutic resources for them and the customary delays in gaining access to child and adolescent psychiatric and psychological services.

Fasulo et al. (2002) found that the amount of therapy an adolescent received was significantly related to runaway behavior. In particular, 28% of adolescents who received less than 10 sessions ran away, whereas only 9% of adolescents who received 10 or more sessions ran away. With other variables held equal, the odds of running away with 10 more sessions of psychotherapy were .56 of the odds of running away without those sessions. Thus, increasing the availability and frequency of psychotherapy sessions may have a variety of effects that prevent running away. The study by Wade & Biehal (1998) suggested that a closer liaison between health and social services is needed to ensure the flexible delivery of a range of services appropriate to the diverse needs of this population of children. A greater focus on holistic service planning may also have a beneficial effect on running away. Children and youth are more likely to run when they have little structure to their day and if their underlying needs are not being satisfactorily addressed, including any needs for therapeutic services.

Prevention of Family Abduction Although not specifically addressed in the literature on children missing from care, researchers have written much about the prevention of abduction from birth families. Children who are taken by someone without the authority to do so are most likely to be abducted by someone they know and trust. The abductor is most likely to be a parent, a family member, or an individual once involved in a romantic relationship with the parent. Workers and parents can take steps to help minimize the possibility of abduction (Hilgeman, 1999): • Take threats of abduction seriously.

• Inform the child‘s school, day care center, or child care provider about concerns.

• Consider previous abductions or significant delays in returning the child.

• Determine if the potential abductor has difficulty separating his or her needs from those of the child.

• Consider continuous allegations made by potential abductors of inappropriate activities of the child‘s caregiver.

• Defuse the potential abductor‘s hostility.

• Pay attention to changes in the potential abductor‘s behavior.

• Maintain good relationships with people the potential abductor sees as a support system.

• Listen to the child for cues of a planned abduction.

Children Missing from Care • Note behavior or attitude changes in the child.

• Teach the child what to do and how to get help if an abduction is attempted or in progress.

All of these items are relevant to varying degrees in abductions of children from foster care. Issues of access to and visitation with the child by the birthparent are the most important areas of vigilance when any one of the items is a harbinger of a potential missing episode.

Research indicates that when a child and birthparent have ongoing contact, both the child and the parent benefit. The child will adjust better to the disruption of his or her family. The parent is more likely to maintain a feeling of connection to the child and therefore provide ongoing emotional support. A parent who has contact is more likely to work toward overcoming barriers to their being a responsible parent.

Once contact is lost, the child experiences a feeling of abandonment, and the parent loses much of his or her motivation.

Supervised visitation, contact between a birthparent and one or more children in the presence of a third person responsible for observing and ensuring the safety of those involved, becomes an important vehicle to maintain connections with birth families (Supervised Visitation Network, 2002). Supervised visits are designed to ensure that a child can have safe and appropriate contact with an absent

parent. It is the child‘s need for safety that is paramount in making any decisions regarding the need for such supervision. Thus, workers should preserve continuity of and connections with family relationships whenever possible.

Role of Information Technology in the Prevention of Missing Episodes Quality management information systems are essential to agency infrastructure in all aspects of operation, particularly in the prevention of having children go missing from care, as well as in interventions with children missing from care. Such state and local data systems can be extremely complex and costly. The quality of these systems varies considerably in their ease of use, ability to capture desired data, and capacity to conduct and produce meaningful analyses of the collected data. Such systems are in various stages of development, implementation, and institutionalization and have received different degrees of acceptance by agency personnel from front-line workers to state-level administrators.

Los Angeles. The Board of Supervisors unanimously approved Supervisor Michael D. Antonovich‘s motion directing the Department of Children and Family Services (DCFS) to report on the number of children missing from the foster care system, the steps taken to locate these children, and a proposal to upgrade the computer tracking system. ―It is imperative that priority be given to locating missing children and ensuring their safe return and protecting them from further abuse and neglect,‖ said Supervisor Antonovich.

DCFS has over 50,000 children under its care, a substantial number of which are either abducted,...AWOL...or simply cannot be accounted for. A recent audit report concluded that data problems with the child welfare computer system precluded the Department from locating a foster child approximately 8% of the time (emphasis added).

—Michael D. Antonovich (2002), Board of Supervisors, Los Angeles, CA Effective interventions targeted to young people who are missing from care are likely to be based on good local information systems. It is difficult to envision how, without accurate information about the children at risk, workers can appropriately plan, monitor, and resource services. The careful recording and monitoring of all incidents therefore represents a first essential building block (Biehal & Wade, 2002).

States often vary, however, in the degree to which they monitor missing and runaway children.

For instance, Florida agencies relay the number of missing children to their central office on a daily basis, and Florida requires workers to document their efforts to locate the child in the information system each week for the first three months. Texas reviews the status of children in unauthorized placements and on runaway status on a quarterly basis, including the suspected location of the child and

date of last contact with the child and others in an effort to locate the child. In Pennsylvania, the county agency is responsible for monitoring the runaway status of children in custody, and information is only relayed to the state level at the time of AFCARS submissions. In some states, the child welfare agency will petition the court to discharge the youth when they determine the child is unlikely to return. Otherwise, the child may remain on runaway status until his or her 18th birthday. The responsibility of the child welfare staff to record and update the agency‘s information system with accurate data regarding the child‘s whereabouts and current status is a linchpin in the acquisition and storage of quality data on children missing from care.

In addition to this initial building block, child welfare agencies‘ information systems must have the capacity to adequately track the location of all youth in care and workers‘ visits with youth in care. This includes cross-checks to detect that the location currently identified for each child in care is accurate and the provision of reports that identify which children or youth are not being visited on a regular basis.

According to the CWLA survey (2004), most states use their information systems to document and monitor children whose status is runaway, and about half the states do so for children identified as missing. States identified several challenges in tracking children and youth that are missing or on runaway status: • Notification to the state agency that a child is missing or has run away is not always timely.

• Updating the data system of the child‘s status is frequently delayed.

• Definitions of missing and runaway are not clear, or the data system cannot distinguish between the terms.

Prevention of Missing-from-Care Episodes • Data systems need to be improved to properly track missing or runaway children, including interfaces with other data systems.

• Better policies and protocols are needed to guide agency staff.

Information system issues can be particularly burdensome in dealing with children who cross state lines when they go missing. Not all states use the same definitional criteria in categorizing children as missing. Moreover, even if definitional consistency exists, the state in which the child is located may not be aware that a child in its care or residence is missing from another state. Just about half of the 24 reporting states routinely record the location of children and youth whose whereabouts are known when they cross state borders. The ability to exchange information and photographs between states could help alleviate this problem (FDLE, 2002). A national system would enhance the abilities of both law enforcement and child welfare agencies to locate missing children who have crossed state lines.

This would make available information from all states and would go

far to ensure joint cooperation (FDLE, 2002).

This research highlights the need for detailed recording and monitoring of all unauthorized absences and for improved coordination between child welfare and law enforcement to develop more effective reporting, response, and tracking procedures. With attainment of definitional clarity, agencies can and should develop the capacity and methods to support data collection and management information systems that capture, analyze, and share the individual, environmental, and systemic factors that increase and diminish the risks of children going missing from care.

Keep Children Safe Like all other aspects of quality child welfare practice, workers may possess the skill and know-how to develop a plan to prevent running away and abduction or to assess and respond to the risk of running away, but implementation can be readily compromised if they do not have sufficient time to devote to the task. Thus, it is the responsibility of the child welfare agency to ensure that child welfare workers have manageable caseloads so they have time to arrange appropriate visitation and services, regularly visit the child and youth, and support the caregivers. Likewise, workload constraints must allow for the provision of requisite training of child welfare staff on appropriate internal and interagency protocols and ensure that child welfare staff have manageable caseloads to enable them to follow protocols on missing and runaway children.

Future Considerations The struggle to understand the genesis of children who run from care is as real today as it was in the mid- to late 1900s. Much of the ideology, and the accompanying controversy, is the identification of the origins of children missing from care. Some attribute the issue to child specific behavioral disorders. Others believe that children ―vote with their feet‖ (Ross, 2001). Thus, runs are an indictment on the quality of care or the system in which it exists. An assessment of facilities or placements in which children leave care without permission could be paired with interviews of child welfare workers, children, and other key informants to delineate and balance these two explanations. This investigative work could lay the foundation for the establishment of programs, policies, procedures, and tools to be deployed as we embrace the inevitable challenge to prevent and respond to runs, and recover and return children who go missing from care.

Almost without exception, scholars, researchers, and experts have examined only one category of children missing from care—those who run voluntarily. This leaves an enormous vacuum in the evidence base both in terms of familial and non-familial abductions from care and child welfare systems that are unable to account for the whereabouts of every child in their custody. In the case of children lost in the system

due to the agency‘s inattention, issues of the child welfare agency management and liability remain unattended without remedial measures, and children can be at great peril unbeknownst to the agency.

Much like the absence of a child from care, this issue briefly raises an array of questions by virtue of the absence rather than presence of that which is addressed. It begs a fundamental question: How can we expect to be effective in safeguarding the vulnerable entrusted to government care without a systematic and comprehensive study and understanding of the issue, the effects on children, and resultant recommendations for change in practice, policy, and legislation across the spectrum of three discrete groups—those who leave care voluntarily without permission; those who are removed from care, voluntarily or involuntarily, by someone without the authority to do so; and those whose presence or absence in care is unaccounted for by the custodial agency. Clarity and insights begin when we claim the absence unacceptable and embrace the opportunity to discover why it occurred.

Child Abuse According to the available data on Child Abuse and Neglect , three million children were reported in 2001 as victims of maltreatment. More than 903,000 of these children were substantiated or indicated abuse and neglect victims. And of these, 18% were determined to be victims of physical abuse. Further, an estimated 1,300 children died in 2001 as a result of child abuse and neglect. This figure is conservative due to the potential for misdiagnosis of cause of death.

What is child physical abuse? Defined as non-accidental trauma or physical injury caused by punching, beating, kicking, biting, burning, or otherwise harming a child, physical abuse is the most visible form of child maltreatment. Many times, physical abuse results from inappropriate or excessive physical discipline. A parent or caretaker in anger may be unaware of the magnitude of force with which he or she strikes the child. Other factors that can contribute to child abuse include parents‘ immaturity, lack of parenting skills, poor childhood experiences, and social isolation, as well as situations of frequent crises, drug or alcohol problems, and domestic violence. What should you look for if you suspect a child is being physically abused? While injuries can occur accidentally when a child is at play, physical abuse should be suspected if the explanations do not fit the injury or if a pattern of frequency is apparent. The presence of many injuries in arious stages of healing makes it obvious that the injuries did not all occur as a result of one accident. Physical indicators of abuse include bruises; lacerations; swollen areas; and marks on the child‘s face, head, back, chest, genital area, buttocks, or thighs. Wounds like human bite marks, cigarette burns, broken bones, puncture marks, or missing hair may indicate abuse. A child‘s behavior might also signal that something is wrong.

Victims of physical abuse may display withdrawn or aggressive behavioral extremes, complain of soreness or uncomfortable movement, wear clothing that is inappropriate for the weather, express discomfort with physical contact, or become chronic runaways.

What you can do Discipline effectively. Remember that kids will be kids. Children can be

loud, unruly, and destructive. They will break things, interrupt telephone conversations, track mud through the house, not pick up their toys or clean their rooms, struggle over eating their vegetables, or pester routinely. Children will inevitably do things that may make their parents feel irritated, frustrated, disappointed, and mad. Changing a child‘s behavior is not easy. However, children should not be disciplined through violence. It is better to deny children privileges when they do something unacceptable, as well as reward them when they do something good. This teaches children that there are consequences for their actions. Regain control. Child abuse is a symptom of having difficulty coping with stressful situations. If you feel you are losing control, ask someone to relieve you for a few minutes.

Then try these tips: • Count to 10.

• Take deep breaths.

• Phone a friend.

• Look through a magazine or newspaper.

• Listen to music.

• Exercise.

• Take a walk (first make certain that children are not left without supervision).

• Take a bath.

• Write a letter.

• Sit down and relax.

• Lie down.

Get help. Support is available for families at risk of abuse through local child protection services agencies, community centers, churches, physicians, mental health facilities, and schools. Your county or state. Professionals who work with children are required by law to report reasonable suspicion of abuse or neglect. Furthermore, in 20 states, citizens who suspect abuse or neglect are required to report it. ―Reasonable suspicion‖ based on objective evidence, which could be firsthand observation or statements made by a parent or child, is all that is needed to report.

Emotional Abuse What is emotional abuse?

Emotional abuse of a child is commonly defined as a pattern of behavior by parents or caregivers that can seriously interfere with a child‘s cognitive, emotional, psychological, or social development . Emotional abuse of a child — also referred to as psychological maltreatment — can include: Ignoring. Either physically or psychologically, the parent or caregiver is not present to respond to the child. He or she may not look at the child, and may not call the child by name.

Rejecting. This is an active refusal to respond to a child‘s needs (e.g., refusing to touch a child, denying the needs of a child, ridiculing a child).

Isolating. The parent or caregiver consistently prevents the child from having normal social interactions with peers, family members, and adults. This also may include confining the child or limiting the child‘s freedom of movement.

Exploiting or corrupting. In this kind of abuse, a child is taught, encouraged, or forced to develop inappropriate or illegal behaviors. It may involve self-destructive or antisocial acts of the parent or caregiver, such as teaching the child how to steal or forcing a child into prostitution.

Verbally assaulting. This involves constantly belittling, shaming, ridiculing, or verbally threatening the child.

Terrorizing. Here, the parent or caregiver threatens or bullies the child and creates a climate of fear for the child. Terrorizing can include placing the child or the child‘s loved one (such as a sibling, pet, or toy ) in a dangerous or chaotic situation, or placing rigid or unrealistic expectations on the child with threats of harm if they are not met.

Neglecting the child. This abuse may include educational neglect, where a parent or caregiver fails or refuses to provide the child with necessary educational services; mental health neglect, where the parent or caregiver denies or ignores a child‘s need for treatment for psychological problems; or medical neglect, where a parent or caregiver denies or ignores a child‘s need for treatment for medical problems.

While the definition of emotional abuse is often complex and not precise, professionals agree that, for most parents, occasional negative attitudes or actions are not considered emotional abuse. Even the best of parents have occasions when they have momentarily ―lost control‖ and said hurtful things to their children, failed to give them the attention they wanted, or unintentionally scared them by their actions.

What is truly harmful, according to James Garbarino of the Family Life Development Center at Cornell University and a national expert on emotional abuse, is the persistent, chronic pattern that ―erodes and corrodes a child.‖ Dr. Arthur Green, director of the Family Center at the Columbia Presbyterian Medical Center in New York City, concurs that emotional abuse is not an isolated incident. ―We‘re talking about the kind of things that a good mother may do 10% of the time, but a troubled mother does 80% or 90% of the time.‖ Why does it happen?

Emotional abuse can, and does, happen in all types of families, regardless of their background. Most parents want the best for their children. However, some parents may emotionally and psychologically harm their children because of stress, poor parenting skills, social isolation, lack of available resources, or inappropriate expectations of their children. They may emotionally abuse their children because the parents or caregivers were emotionally abused themselves as children.

What are the effects of emotional abuse?

Douglas Besharov states in Recognizing Child Abuse: A Guide for the Concerned that ―Emotional abuse is an assault on the child‘s psyche, just as physical abuse is an assault on the child‘s body.‖ Children who are constantly ignored, shamed, terrorized, or humiliated suffer at least as much, if not more, than if they are physically assaulted.

Danya Glaser (2002) finds that emotional abuse can be ―more strongly predictive of subsequent impairments in the children‘s development than the severity of physical abuse.‖ An infant who is severely deprived of basic emotional nurturance, even though physically well cared for, can fail to thrive and can eventually die. Babies with less severe emotional deprivation can grow into anxious and insecure children who are slow to develop and who have low self-esteem.

Although the visible signs of emotional abuse in children can be difficult to detect, the hidden scars of this type of abuse manifest in numerous behavioral ways, including insecurity, poor self-esteem, destructive behavior, angry acts (such as fire setting and animal cruelty), withdrawal, poor development of basic skills, alcohol or drug abuse, suicide, difficulty forming relationships, and unstable job histories.

Emotionally abused children often grow up thinking that they are deficient in some way.

A continuing tragedy of emotional abuse is that, when these children become parents, they may continue the cycle with their own children .

Identifying and preventing emotional abuse While some children may experience emotional abuse only, without ever experiencing another form of abuse, emotional abuse typically is associated with and a result of other types of abuse and neglect, which makes it a significant risk factor in all child abuse and neglect cases. Brassard, Germain, and Hart (1987, as cited in Pecora et al., 2000) assert that emotional abuse is ―inherent in all forms of child maltreatment.‖ Emotional abuse that exists independently of other forms of abuse is the most difficult form of child abuse to identify and stop. This is because child protective services must have demonstrable evidence that harm to a child has been done before they can intervene.

And, since emotional abuse doesn‘t result in physical evidence such as bruising or malnutrition, it can be very hard to diagnose.

Researchers have developed diagnostic tools to help professionals who work with children and families identify and treat emotional abuse. Professionals are taught to identify risk factors for emotional abuse, ask appropriate questions about a family‘s history and the family‘s present behaviors, and provide appropriate resources (such as financial resources, mental health services, or parenting classes) to help parents and caregivers create safe, stable environments for their children and themselves.

What you can do All children need acceptance, love, encouragement, discipline, consistency, stability, and positive attention. What can you do when you feel your behavior toward your child is not embodying these qualities but is bordering on emotional abuse? Here are some suggestions: Never be afraid to apologize to your child. If you lose your temper and say something in anger that wasn‘t meant to be said, apologize. Children need to know that adults can admit when they are wrong .

Don‘t call your child names or attach labels to your child. Names such as ―Stupid‖ or ―Lazy,‖ or phrases like ―Good for nothing,‖ ―You‘ll never amount to anything,‖ ―If you could only be more like your brother,‖ and ―You can never do anything right‖ tear at a child‘s self-esteem. A child deserves respect.

Address the behavior that need correcting and use appropriate discipline techniques, such as time outs or natural consequences. Be sure to discuss the child‘s behavior and the reason for the discipline, both before and immediately after you discipline. Discipline should be provided to correct your child‘s behavior, rather than to punish or humiliate him or her.

Compliment your child when he or she accomplishes even a small task, or when you see ―good behavior.‖ Walk away from a situation when you feel you are losing control. Isolate yourself in another room for a few minutes (after first making sure the child is safe), count to 10

before you say anything, ask for help from another adult, or take a few deep breaths before reacting.

Get help. Support is available for families at risk of emotional abuse through local child protection services agencies, community centers, churches, physicians, mental health facilities, and schools.

Child Neglect Child neglect is the most prevalent form of child maltreatment in the United States.

According to the National Child Abuse and Neglect Data System (NCANDS), of the approximately 903,000 US children who were victims of abuse and neglect in 2001, 59.2% suffered from neglect alone, including medical neglect. According to the NCANDS, 35.6% of child maltreatment fatalities in the United States in 2001 occurred as a result of neglect, 21.9% as a result of physical abuse and neglect, and 3.3% as a result of neglect along with another type of maltreatment. In an independent study, Prevent Child Abuse America estimated that 1,291 children in the United States died in 2000 as a result of maltreatment, and that 45% of these child maltreatment fatalities were attributable to neglect (Peddle et al., 2002).

What is neglect?

The NCANDS defines neglect as ―a type of maltreatment that refers to the failure by the caregiver to provide needed, age appropriate care although financially able to do so or offered financial or other means to do so.‖ Neglect is usually typified by an ongoing pattern of inadequate care and is readily observed by individuals in close contact with the child. Physicians, nurses, daycare personnel, relatives, and neighbors are frequently the ones to suspect and report neglect in infants, toddlers, and preschool-aged children. Once children are in school, school personnel often notice indicators of child neglect such as poor hygiene, poor weight gain, inadequate medical care, or frequent absences from school.

Types of neglect Professionals define four types of neglect physical, educational, emotional, and medical.

Physical neglect accounts for the majority of cases of maltreatment. NCANDS estimates that 7.1 of every 1,000 US children experience physical neglect. Physical neglect generally involves the parent or caregiver not providing the child with basic necessities (e.g., adequate food, clothing, and shelter). Failure or refusal to provide these necessities endangers the child‘s physical health, well-being, psychological growth, and development. Physical neglect also includes child abandonment, inadequate supervision, rejection of a child leading to expulsion from the home, and failure to adequately provide for the child‘s safety and physical and emotional needs. Physical neglect can severely impact a child‘s development by causing failure to thrive; malnutrition; serious illness; physical harm in the form of cuts, bruises, burns, or other injuries due to lack of supervision; and a lifetime of low self-esteem.

Educational neglect involves the failure of a parent or caregiver to enroll a child of mandatory school age in school or provide appropriate home schooling or needed special educational training, thus allowing the child or youth to engage in chronic truancy.

Educational neglect can lead to the child failing to acquire basic life skills, dropping out of school, or continually displaying disruptive behavior. Educational neglect can pose a serious threat to the child‘s emotional well-being, physical health, or normal

psychological growth and development, particularly when the child has special educational needs that are not met.

Emotional neglect includes actions such as engaging in chronic or extreme spousal abuse in the child‘s presence, allowing a child to use drugs or alcohol, refusing or failing to provide needed psychological care, constantly belittling the child, and withholding affection. Parental behaviors considered to be emotional child maltreatment include Ignoring (consistent failure to respond to the child‘s need for stimulation, nurturance, encouragement, and protection or failure to acknowledge the child‘s presence), Rejecting (actively refusing to respond to the child‘s needs [e.g., refusing to show affection]), Verbally assaulting (constant belittling, name calling, or threatening), Isolating (preventing the child from having normal social contacts with other children and adults), Terrorizing (threatening the child with extreme punishment or creating a climate of terror by playing on childhood fears), and Corrupting or exploiting (encouraging the child to engage in destructive, illegal, or antisocial behavior).

A pattern of this parental behavior can lead to the child‘s poor self-image, alcohol or drug abuse, destructive behavior, and even suicide. Severe neglect of an infant‘s need for stimulation and nurturance can result in the infant failing to thrive and even infant death.

Emotional neglect is often the most difficult situation to substantiate in a legal context and is often reported secondary to other abuse or neglect concerns.

Medical neglect is the failure to provide appropriate health care for a child (although financially able to do so), thus placing the child at risk of being seriously disabled or disfigured or dying. According to NCANDS, in 2000, 3% of substantiated cases of child maltreatment in the United States (25,450 children) were victims of medical neglect.

Concern is warranted not only when a parent refuses medical care for a child in an emergency or for an acute illness, but also when a parent ignores medical recommendations for a child with a treatable chronic disease or disability, resulting in frequent hospitalizations or significant deterioration.

Even in non-emergency situations, medical neglect can result in poor overall health and compounded medical problems.

Parents may refuse medical care for their children for different reasons religious beliefs, fear or anxiety about a medical condition or treatment, or financial issues. Child protective services agencies generally will intervene when medical treatment is needed in an acute emergency (e.g., a child needs a blood transfusion to treat shock), a child with a life-threatening chronic disease is not receiving needed medical treatment (e.g., a child with diabetes is not receiving medication), or a child has a chronic disease that can cause disability or disfigurement if left untreated (e.g., a child with congenital cataracts needs surgery to prevent blindness).

In these cases, child protection services agencies may seek a court order for medical treatment to save the child‘s life or prevent life-threatening injury, disability or disfigurement.

Although medical neglect is highly correlated with poverty, there is a distinction between a caregiver‘s inability to provide the needed care based on cultural norms or the lack of financial resources, and a caregiver‘s knowing reluctance or refusal to provide care.

Children and their families may be in need of services even though the parent may not be intentionally neglectful. When poverty limits a parent‘s resources to adequately provide

necessities for the child, services may be offered to help families provide for their children.

What you can do If you suspect child neglect is occurring, first report it to the local child protective services agency (often called ―social services‖ or ―human services‖) in your county or state.

Professionals who work with children are required by law to report reasonable suspicion of abuse and neglect. Furthermore, in 20 states, citizens who suspect abuse or neglect are required to report it. ―Reasonable suspicion‖ based on objective evidence, which could be firsthand observation or statements made by a parent or child, is all that is needed to report.

Guidelines for Helping Children Experiencing Abuse or Neglect Everyone who has a relationship with a child plays an important role in maintaining the child‘s safety. It is important to recognize your vital role and learn how to help a child you suspect is abused or neglected.

If you suspect that a child is a victim of abuse and you are unsure whether the child‘s situation has been reported to child protective services (CPS), you should report your suspicions to your local CPS agency. Refer to the Fact Sheet Reporting Child Abuse and Neglect to learn about reporting suspected child abuse or neglect.

What Happens Once a Report Is Made?

After receiving a report of child abuse or neglect, CPS likely will begin an investigation.

Occasionally, CPS will determine that a report is not child abuse, or that there is not enough evidence or information to investigate the report. In these instances, CPS will usually refer the family to another agency that will provide them with necessary services (e.g., counseling, parenting skills classes, substance abuse programs). Depending on the laws in your state and your relationship with the child, you may have the opportunity to communicate with the CPS worker regarding the child‘s progress. Educators and school personnel, in particular, are an excellent resource and may be asked to share additional information to help determine the facts of a case and develop a treatment plan for the child and family. Any party discussing a child abuse case must ensure confidentiality, since details of a case may be shared only with appropriate parties as designated by law.

This precaution protects both the child and family from rumors, judgments, and stereotyping that may further isolate and alienate them, and thus negatively affect efforts to help.

Should You Still Have Contact With the Family?

Most likely, you will continue to have regular contact with the family after a report has been made. Keep in mind that you are just as important to the family‘s recovery as you are to the child‘s. Appropriate interactions with parents who are suspected of child abuse or neglect will have a positive influence on the family‘s ability to recover. Following are guidelines for interacting with the child‘s family.

Be objective and supportive. Remember that most parents want to be good parents but may need additional help, encouragement, and guidance.

Listen. Do not blame, accuse, or make judgments about the family.

Offer help or assistance to the family (e.g., babysitting, grocery shopping, carpooling).

Limit conversations to the activities that involve you; it is not your responsibility to investigate suspected child abuse or neglect.

Address the family in a manner that is consistent with your role or relationship with the family. If you are an educator, be professional and objective. If you are a friend, family member, or neighbor, be friendly, helpful, supportive, and understanding. Do not allow yourself to be placed in an adversarial role if the parents become defensive, argumentative, accusatory, or upset.

Encourage parents and provide them with resource information about educational programs on parenting, job skills, and child development; programs and activities for children; and counseling, alcohol/drug abuse, or adult education and enrichment programs. (You can even offer to join them and take advantage of the opportunity to learn new skills.)

Remember, families experiencing abuse or neglect issues are often under a great deal of stress in multiple areas of their lives. Your interaction, involvement, or support can be an important stress reducer to the child and parents.

The following tips can help you develop a nurturing relationship with any child who may be suffering from negative self-concepts or especially abuse or neglect. Remember, children need positive adult role models. Your warmth, empathy, and interest will enable the child to see adults in positive, supportive, and caring roles.

Listen Be an approachable, patient, and supportive listener. Listen without being critical or negative toward the child or the child‘s parents.

Show that you understand and believe what the child says, even if it is difficult. Make sure to not blame, punish, or accuse the child of doing anything wrong.

Encourage the child to talk freely, but do not pressure the child to self-disclose or reveal his or her experiences of abuse or neglect.

Empathize Validate the child's feelings, emotions, and experiences. Do not belittle or minimize the child‘s feelings.

Affirm the child‘s decision to confide in you. Tell the child that he or she is doing the right thing by talking to you. Let the child know that you are there for him or her and want to help.

Assure the child often that he or she is not to blame. Child victims may believe that the abuse or neglect is their fault.

Don‘t overreact. Stay calm. Fear and anger are normal reactions, but you may frighten the child and prevent him or her from confiding in you in the future.

Do not talk negatively about the abuser in front of the child. Remember that abused children may be very loyal to their abusers; underneath other feelings they may have, they love their parents and want to be loved and wanted by them.

Be a positive role model Help improve the child‘s self-esteem. Give a lot of positive feedback and reinforcement.

As often as possible, tell the child how he or she positively contributes to your life, the child‘s family, and the world. Tell the child about his or her potential and what he or she has to offer, and sincerely tell the child that he or she is good, smart, and kind.

Teach conflict resolution. Abused or neglected children may be unfamiliar with nonviolent ways of dealing with conflict.

When a child acts in ways that seem strange, remember to look for the feelings behind the actions. Children may try to protect themselves from their negative feelings by

pretending those feelings do not exist. Also, they may seek your attention through negative behaviors because they do not know how to gain your attention using positive ones. Look for opportunities to encourage and reinforce positive behavior.

Promote positive interaction Do not display pity, over-focus attention, or treat abused children differently from others.

Children who have been the victims of abuse or neglect want to be normal and feel like other children.

Foster the child‘s relationships with peers by encouraging extracurricular and schoolrelated activities.

Build confidence. Allow children to have possessions of their own (e.g., desk or work space, books, backpack, toys) and give them resources and opportunities to be successful at taking care of their responsibilities.

All these acts can reinforce a child‘s resiliency and sense of well-being. Keep in mind, however, that these acts do not replace informing CPS if you suspect a child is being abused or neglected. You may still need to make a report if you feel a child‘s safety is at risk.

Child Physical Abuse According to the National Child Abuse and Neglect Data System (NCANDS), three million children were reported in 2001 as victims of maltreatment. More than 903,000 of these children were substantiated or indicated abuse and neglect victims. And of these, 18% were determined to be victims of physical abuse. Further, an estimated 1,300 children died in 2001 as a result of child abuse and neglect. This figure is conservative due to the potential for misdiagnosis of cause of death.

What is child physical abuse?

Defined as non-accidental trauma or physical injury caused by punching, beating, kicking, biting, burning, or otherwise harming a child, physical abuse is the most visible form of child maltreatment.

Many times, physical abuse results from inappropriate or excessive physical discipline. A parent or caretaker in anger may be unaware of the magnitude of force with which he or she strikes the child.

Other factors that can contribute to child abuse include parents‘ immaturity, lack of parenting skills, poor childhood experiences, and social isolation, as well as situations of frequent crises, drug or alcohol problems, and domestic violence.

What should you look for if you suspect a child is being physically abused?

While injuries can occur accidentally when a child is at play, physical abuse should be suspected if the explanations do not fit the injury or if a pattern of frequency is apparent.

The presence of many injuries in various stages of healing makes it obvious that the injuries did not all occur as a result of one accident.

Physical indicators of abuse include bruises; lacerations; swollen areas; and marks on the child‘s face, head, back, chest, genital area, buttocks, or thighs. Wounds like human bite marks, cigarette burns, broken bones, puncture marks, or missing hair may indicate abuse.

A child‘s behavior might also signal that something is wrong. Victims of physical abuse may display withdrawn or aggressive behavioral extremes, complain of soreness or uncomfortable movement, wear clothing that is inappropriate for the weather, express discomfort with physical contact, or become chronic runaways.

What you can do Discipline effectively. Remember that kids will be kids. Children can be loud, unruly, and destructive. They will break things, interrupt telephone conversations, track mud through the house, not pick up their toys or clean their rooms, struggle over eating their vegetables, or pester routinely. Children will inevitably do things that may make their parents feel irritated, frustrated, disappointed, and mad. Changing a child‘s behavior is not easy. However, children should not be disciplined through violence.

It is better to deny children privileges when they do something unacceptable, as well as reward them when they do something good. This teaches children that there are consequences for their actions.

Regain control. Child abuse is a symptom of having difficulty coping with stressful situations. If you feel you are losing control, ask someone to relieve you for a few minutes. Then try these tips: Count to 10.

Take deep breaths.

Phone a friend.

Look through a magazine or newspaper.

Listen to music.

Exercise.

Take a walk (first make certain that children are not left without supervision).

Take a bath.

Write a letter.

Sit down and relax.

Lie down.

Get help. Support is available for families at risk of abuse through local child protection services agencies, community centers, churches, physicians, mental health facilities,and schools.

Report, report, report. If you suspect child abuse is occurring, first report it to the local child protective services agency (often called ―social services‖ or ―human services‖) in your county or state. Professionals who work with children are required by law to report reasonable suspicion of abuse or neglect. Furthermore, in 20 states, citizens who suspect abuse or neglect are required to report it. ―Reasonable suspicion‖ based on objective evidence, which could be firsthand observation or statements made by a parent or child, is all that is needed to report.

Reporting Child Abuse and Neglect Deciding whether to report suspected child abuse can be a difficult and confusing process; yet, it is the crucial first step in protecting a child who might be in danger.

In most states, professionals who work with children in any capacity are identified as ―mandated reporters‖ and are required by law to report suspected child abuse or neglect.

And, in approximately 18 states, any citizen who suspects that a child is being abused or neglected is mandated to report.1 No matter your state laws, it is the responsibility of all individuals and community members not just mandated reporters to report suspected maltreatment of any child.

Why don‘t some people report child abuse and neglect?

Among the most frequently identified reasons for not reporting are lack of knowledge about child abuse and neglect and lack of familiarity about state reporting laws. Other reasons people don‘t report include: Fear or unwillingness to ―get involved‖ Fear that a report will ―make things worse for the child" Reluctance to risk angering the family Concern that making a report will negatively impact an existing relationship with the child Belief that someone else will speak up Although these feelings are understandable, they are not grounds for not reporting. Lack of action on your part could lead to dire consequences for the child and the child‘s family. It even could result in serious harm or death of the child that might otherwise have been prevented.

What can you do if you believe a child is being abused or neglected?

Report, report, report. Everyone has the right and responsibility to report any incidence of suspected child abuse at any time. Actual knowledge of abuse is not required; all you need is ―reasonable cause, suspicion, or belief‖ based on your observations. Information to support your concern may include your firsthand observations or beliefs, your professional training or experience, or statements made by the child or parent.

Having only limited information about your suspicion should not prevent you from making a report. Remember, you do not have to be ―right‖ in your suspicions; you simply need to have a heightened and rational concern for the safety and well-being of a child.

Also, all states have laws that protect reporters from legal liability as long as reports are made in ―good faith.‖ Who do you call? And then what happens?

To report suspected abuse or neglect, contact your local child protective agency, which, depending on where you live, might be called Social Services, Children and Family Services, or Human Welfare. If you feel that the child is in an emergency situation, however, call your local law enforcement agency immediately.

The person who responds to your call will ask you several questions in order to provide the investigative team with sufficient information. Keep in mind, you do not need to know all the answers to make a report;you just need to be as comprehensive, specific, and clear as possible. Following are a few questions you may be asked: What is your name, address, and telephone number?

What is your relationship to the child?

What is the child‘s name, age, and address? If you don't know the answers to this question, you can provide descriptive information that will enable investigators to locate the child.

What is the suspected abuser‘s name, relationship to the child, and address or license plate number?

What is the child‘s parents‘ names, address, and telephone number?

Describe the type of abuse, when it occurred, and your reasons for suspecting abuse.

What is the current location of the child?

What is your assessment of the child‘s current level of safety?

What can you tell us about the child‘s siblings and any related safety concerns?

What are the names, addresses, and telephone numbers of other witnesses?

Has the child presented with other suspicious injuries before?

Although anonymous reports can be made in every state, child welfare agencies generally discourage anonymity for many reasons. One, knowing the identity of the reporter can help the child welfare worker gather information during the investigative process to ensure the child‘s safety. Two, if the case goes to trial, the child welfare worker may need to rely on the reporter to be a crucial evidentiary witness.

Unfortunately, many child welfare agencies are severely underfunded and understaffed.

Typically, reports of child abuse and neglect are prioritized based on whether the child is in immediate risk or danger. Be patient. You may have to call more than once.

Who investigates complaints of child abuse and neglect?

The state or county agency that provides child protective services has the legal authority and obligation ―to explore, study, and evaluate‖ reports of child abuse and neglect and to provide services when needed. During the early investigation stage, child welfare workers are responsible for determining: Whether abuse or neglect has likely occurred Whether there is immediate danger or risk to the child What the motivation, capacity, and intent of the alleged perpetrator is What the ability of a non-offending caregiver is to protect the child in the immediate future If the child is in immediate danger, the child welfare worker may place him or her under emergency protective services, which may include in-home support and supervision or the temporary removal of the child to a safe alternative environment (e.g., with other family members or in foster care). If the child is removed from the home under these circumstances, the court and family must be notified and an emergency/temporary custody review hearing must be held, typically within 48 to 72 hours.2 If the child welfare worker determines that there are safety concerns yet it is safe to leave the child in the home the worker is responsible for creating a plan to keep the child safe in that environment and for organizing or providing any needed support for the child and the family. Support may come from a variety of sources, including extended family, local community organizations, and child protective services.

What happens to the child and family if a report is substantiated?

After a more comprehensive assessment, the child welfare worker must determine whether abuse or neglect occurred. If the allegations of abuse or neglect are substantiated, the child protection agency and/or courts will evaluate the case and determine what level of intervention is necessary. Interventions are dependent on the severity of the circumstances and may include voluntary assistance and services, court-ordered supervision and services, out-of-home placement, and as a last and complicated intervention termination of parental rights.

If a court orders the child to be removed from the home and placed under the supervision of the child welfare agency, two important federal laws come to bear. Both the Adoption and Safe Families Act of 1997 (P. L. 105-89) and the Adoption Assistance and Child Welfare Act of 1980 (P. L. 96-272) legally mandate child welfare workers to make ―reasonable efforts‖ to reunite the family whenever possible and establish timeframes for achieving this goal or another permanency solution. If, after a thorough investigation, it is determined that the child is in need of substitute care, the child may go to live with other

relatives or in an alternate care arrangement (e.g., foster care), until it is determined that the child is no longer in danger in the home or until services can be provided for the child and family to ensure the child‘s safety.

In some cases, it is necessary for law enforcement to file criminal child abuse charges, depending on the nature and severity of the abuse or neglect. The range of legal penalties for child maltreatment varies from therapy for the perpetrator to incarceration.

Will you be able to find out what happens to the child?

One difficult conflict arises with the reporter‘s desire or need to know the outcome of the report, versus the family‘s right to privacy and confidentiality. Usually, if you are a family friend, neighbor, or relative, and not part of the child welfare professional community, you will not receive detailed information about the report.

The child welfare agency may let you know whether the circumstances have been evaluated and whether the case has been opened for further investigation. Many times, however, child welfare agencies are overburdened with high caseloads and too many time demands and thus are unable to report whether the allegations were substantiated. You may request information regarding the status of your report if the agency does not provide it voluntarily.

In some states, professionals who are mandated to report are provided greater detail due to their continued legal obligation, role in assisting or treating the child, and ability to monitor conditions that might further endanger the child. Thus, most state laws entitle mandated reporters to be informed of the findings of the investigation and the services being provided to protect the child.

What happens if you report and the case is unsubstantiated?

While only a small percentage of reports turn out to be deliberately false, some cases become classified as ―unsubstantiated,‖ which means there was not sufficient information regarding the allegation or the identity of the family to confirm abuse or neglect based on the state‘s legal criteria. Some cases are classified as unsubstantiated if no court action was taken and voluntary services were provided to the child. Criteria for substantiation vary among states because there is no uniform national system for case reporting.

If you are unsure of the legal and societal definitions of abuse or neglect in your community, contact your local child welfare agency for information.

Knowing how, when, and what to report about child abuse and neglect may make a life or death difference for a child.

Child Sex Abuse Abstruct:Prevalence of sexually transmitted infections and mental health needs of female child and adolescent survivors of rape and sexual assault attending a specialist clinic Objectives: To determine the prevalence of sexually transmitted infections (STIs) and the mental health needs of female child and adolescent survivors of rape and sexual assault who were referred to a specialist genitourinary medicine (GUM) clinic.

Method: Retrospective case notes review of 98 females aged 16 or less, who attended over a 5 year period (1996–2000).

Results: The overall prevalence of STIs was 26%. Among the girls who were aged 0–12 years (n = 16), one had gonorrhoea and another had Trichomonas vaginalis infection.

Prevalence of STIs in those aged 13–16 years, who were not sexually active before the

index assault, was 24% and in those who gave a history of previous consensual sexual activity it was 39% (p = 0.17). Chlamydial infection was more common among the girls who disclosed previous consensual sexual activity than in those did not disclose previous sexual activity (p = 0.012). The overall prevalence of vaginal candidiasis was 17% and bacterial vaginosis 13%. More than one third of the study population gave a history of previous sexual, physical, or other abuse. 81% reported having current psychological difficulties. Mood changes and sleep disturbances were reported more frequently than other psychological symptoms; 15% attempted self harm. All types of psychological difficulties, except mood changes, were not affected by the time interval between index assault and first presentation to the clinic and the type of assailant. 29% had no involvement with social and mental health services before their attendance at the clinic Conclusions: The prevalence of STIs among female child and adolescent survivors of rape and sexual assault attending a specialist clinic was high. The range of mental health and social difficulties was wide and multiple. The importance of an early assessment for the presence of STIs and mental health difficulties was demonstrated.

1 Sexual abuse of children and adolescents is widespread. In one UK study, 27% of 2 reported rapes were perpetrated against girls aged 15 years or less. There are serious physical, social, and mental health consequences for those experiencing sexual violence whether non-penetrative assault, single episode rape, or reoccurring sexual relationships 3 of a non-consensual nature. Early victimisation is associated with an increase in further victimisation and risk taking behaviour in adolescence and adulthood—for example, 1,4,5 unprotected sex with multiple partners and teenage pregnancy.

This may also impede 6 risk reduction intervention efforts to implement safer sex strategies. Victims who have been assaulted at a younger age have a high prevalence of psychological morbidity, later 7,8 psychiatric disorder, and substance misuse. Multiple symptoms within the first few weeks after an assault may reflect the "normal" response to such a stressful event or perhaps an adjustment disorder. Severe, persistent single symptom profiles at a later time may reflect more serious psychopathology such as post-traumatic stress disorder and depression.

The aim of this study was to determine the prevalence of sexually transmitted infections, mental health, and social difficulties in female child and adolescent survivors of sexual assault/rape attending a specialist sexual assault service in an inner London genitourinary medicine (GUM) clinic.

METHODS The study population comprised all females aged 16 years or less, who were referred over a 5 year period (1996–2000) to a specialist service for victims of sexual assault based in a specialist GUM clinic in London. Ethical approval was obtained from the East London and the City Health Authority research subcommittee. Data were collected retrospectively from the case notes using a standardised study proforma. Sexual and medical history, psychosocial problems, history of mental health difficulties, and current mental health issues of all survivors were routinely documented on clinic proforma.

Genital examination was offered in all cases. This includes screening for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Candida species, and bacterial vaginosis, performed using standard methods. Pre-pubertal girls and those who

were intolerant of or declined a speculum examination had external genital or vulvo9 vaginal swabs taken. Oral and/or rectal samples were taken in those declaring attempted or full penetration or in those who had symptoms suggestive of infection at these sites. A first voided urine (FVU) sample was taken for chlamydial EIA or nucleic acid amplification (NAAT) test when it became available if other tests were declined. Blood tests for syphilis, hepatitis B, hepatitis C, and HIV serological markers were offered at presentation and at 3 month follow up, where appropriate. Culture for herpes simplex virus (HSV) was taken if clinically indicated. Pelvic inflammatory disease (PID), genital warts, and Pediculosis pubis were diagnosed clinically.

Antibiotic prophylaxis against bacterial STIs and hepatitis B vaccination was offered to all survivors of sexual assault/rape. The study period was defined as follow up over 3 months from first presentation to the clinic. An assessment of STIs and risk of mental health problems was made on each visit. Blood tests and genital swabs were repeated if clinically indicated.

Statistical analysis Prevalence of STIs, including chlamydial infection, in post-pubertal girls (13–16 years) who were sexually active before the index assault and those who denied previous consensual sexual activity and in those who had full genital examination and those who declined speculum examination was compared using the 2 test. Relation between the presence of an STI and psychological disturbance, current mental health symptoms against age, type of assailant, and the time interval between assault and attendance was also compared using the 2 test. A statistical package, SAS version 8.2, was used for all the calculation of p values.

RESULTS Demographic details A total of 126 females aged 16 years or less were referred to the clinic over the 5 year period, of whom 15 did not attend for assessment by a genitourinary physician. Twelve girls were seen at a different venue arranged by the paediatric team and were not included in the study; 99 girls were reviewed in clinic and 98 case notes were retrieved for analysis. The age range of the sample was 3–16 years, of whom 16 girls were aged less than 13 years. Assailants were all male; the youngest assailant recorded as aged 15 years.

Assault by multiple assailants was reported in 15% (n = 15) of the sample (range 2–7 assailants). Other demographic details of the study population are presented in table 1 .

Table 1 Detail of study population (n = 98) Demographic data No (%) Median age (years) Ethnicity White European Black Afro-Caribbean Bangladeshi Other Details of assault Referral pattern Police including CPT* and CID

14.5 44 (45) 27 (28) 17 (17) 10 (10)

62 (63)

Self referral Pediatrician General practitioner Social services and others Not recorded Location of assault UK Abroad Time between assault and attendance <7 days 1–4 weeks 1–3 months 4–6 months >7 months Not recorded Assailants Stranger Acquaintance Family member Friend Unknown by patient Nature of assault Vaginal penetration (attempted/actual) Oral penetration only Digital penetration only More than one site including anal penetration Unknown by patient Family and social history Accommodation Living with parent (s)/care Local authority Not recorded Family problems Studying School based difficulties/truancy Learning difficulties Previous mental health problems Alcohol and other substance misuse Smoking Previous abuse Sexual Physical/emotional Previous STIs Previous pregnancy

9 (9) 8 (8) 7 (8) 4 (4) 8 (8) 96 (97) 2 (3) 17 (17) 35 (36) 22 (23) 10 (10) 12 (12) 2 (2) 28 (29) 26 (27) 22 (22) 15 (15) 7 (7) 67 (68) 1 (1) 4 (4) 21 (22) 5 (5)

77 (79) 19 (19) 2 (2) 20 (20) 85 (87) 24 (25) 6 (6) 30 (31) 31 (32) 31 (32) 37 (38) 13 (13) 4 (4) 4 (4)

*Child Protection Team.

Criminal Investigation Department.

Majority involving vaginal penetration.

Contraception In those girls aged 13â&#x20AC;&#x201C;16 years who gave a history of consensual sexual activity before the assault/rape (n = 28) four used condoms, five took the oral contraceptive pill, one received medroxyprogesterone acetate (Depo-provera), and 18 girls did not use any method of contraception.

Twenty four girls received emergency hormonal contraception; seven girls obtained it at presentation within our clinic, the remainder being prescribed it elsewhere. Seven individuals became pregnant and four of these may have been a direct consequent of the assault. Six girls underwent termination of pregnancy.

Caring for A Pregnant Teen There are foster parents out there who specialize in parenting pregnant teens. This is a distinct type of parenting that I greatly admire since in reality you are caring for two children at once.

Usually, with young girls not ready for relationships much less babies, there is some passing of time between the discovery of pregnancy and the announcement to parents. If this time is short, a few days or a week, not little harm will be done unless the teen is far along and has just discovered it herself. Hopefully, parents will not need to wait months before they are told since this could be dangerous to the mom and baby.

Parents need to acquaint themselves with the way each foster daughter carries herself.

They should be aware of her basic body outlines and general health. Foster parents must know this girl's habits so that they recognize when things change. This is important for all kids, not just "possibly pregnant teens."

Once you learn to recognize the changes in your kids, you will parent more efficiently.

Changes in attitude, appearance, and habits usually announce an important step in your foster child's development. It can be signs of a positive change, but more often it is a negative change these signs herald.

When the discovery is made either independently by the parents or the child shares the joyful news, then the hard decisions need to be made. Before absolutely anything, get that girl to a doctor. Make sure the pregnancy is confirmed before everyone loses their mind over it. This is a common state of affairs that occurs whenever there is a teenage pregnancy. Slow down, relax and get the facts.

The doctor appointment needs to take place regardless of any previous one by the teen.

Confirmation should take place even if the teen assures you she did a home or other pregnancy test. Because this is such an emotion filled issue, teens may tend to stretch the truth, hide the facts, or "game" about this subject.

Laws are designed to give young people many privileges including one of privacy, but your teen can wave that and allow you to be part of the whole process. If you have a good relationship with your teen, this will be easier to gain admission to information and doctor visits. Try to make your teen understand that there will be lots of stress and trauma surrounding this early age pregnancy and that she will need support. You may need to bow out if the young parents are at the highest end of the age spectrum or if a natural

parent chooses to be involved. Try to stand up for your rights as to inclusion if you are to continue to parent this girl. Some foster parents also help care for the new baby as well so I believe they must be involved in the process. Not wishing to slam the natural parent, but if there were reasons to remove that foster daughter from the birth parent home, then they are ill equipped to help that daughter raise a child.

One of your most important jobs as a foster parent of a pregnant teen is to make sure that the girl is getting good prenatal care. This means either dropping her off at the doctor's office, going with her, or confirming by phone that the visit took place. A young lady who skips appointments may develop serious medical problems and not even be aware of the problem.

Pregnancy requires proper eating, taking vitamins, enough sleep, and a watchful eye as to potential problems as the body changes to accommodate a baby. It requires a clear understanding of the doctor's orders and suggestions so you can follow them religiously.

Certain tests may be required in order to plan an appropriate delivery. These things must be dutifully reported and understood. Some teens as well as others of all ages lack common sense and someone who has more maturity needs to oversee the pregnancy.

Of course, the biggest step will be what decision is to be made concerning the babies future. Most foster parents I know, by nature just love children, so the abortion issue will probably not be one they would entertain. We won't even go there. There is the decision as to whether or not this young girl or parents can raise this child by themselves or if they should consider adoption. Although the foster parents are in a good position to influence these girls, I would not recommend it. I would recommend you give them all the information, resources, and help you can. Stay away from offering opinions. Your relationship is so sensitive as it is with this child, you could alienate them by telling them what to do. This is a vitally important decision that can change their entire life.

It is okay to offer friendly advice in the way of information and where to find resources or who to call etc. It is a very bad move to advise the teen to either keep the baby or adopt. This is one time I really advise foster parents to keep their mouths shut. Difficult, I know. This is no time to be judgmental or say I told you so. This is not the right time to get into religious and moral debates. There may come another time, but now is not it.

Attempt to be supportive, no matter what choices this girl or young parents make.

Remember, if the father is in the picture and intends to be part of this girl's life, he needs to be treated like an adult member of this relationship. It goes without saying, so should the girl. This does not indicate you should not be painfully aware of their tender age, just do not constantly focus the discussion on that aspect. If you do, things may backfire and your relationship will suffer. Instead focus on the realities of jobs, school, diapers, no social life, friends moving on with their lives without you etc.

I've recently read that more girls are choosing abstinence; I hope that is true. But until the majority makes that decision, we will need to deal with teen pregnancies. We need to fight for laws that involve foster parents as much as possible while preserving the young girls' privacy and dignity. This means we may only get information second hand and may not be in the examining room. This is not a problem if we are dealing with a truthful teen.

It is a problem when we have one who may not tell us she now needs a new medication or pretends to take it, but does not. This is a whole other situation. You may be able to develop some sort means of communication with the doctor that protects her privacy, but keeps you in the know. Ask.

If this girl has no other person to help her, offer to go to child -birth classes. I have done that and it was another bonding experience on a much different level. You can be a good support, but only if no one else in the situation is interested or willing.

One special problem you may encounter is with a pregnant teen who was previously sexually abused. This can result in a whole slew of additional problems. I experienced this when I took a girl for a gynecology examination. She was fine until the doctor touched her and then she almost became uncontrollable. I stood by her, holding her hand throughout the entire exam. It can be a time when all those monstrous past memories come to light. This often occurs anyway at puberty, but surely is likely when a girl is focusing on her body and what it is becoming. Be prepared if your girls have a history of sex abuse. It may pose several problems.

One last problem will need to be dealt with if you are to help parent this young mom and her baby. This problem will be a need to be helpful, but not overbearing. Teach, but do not scold or belittle this girl's efforts. Motherhood should come natural, that ability should be passed down from mother to mother and generation to generation. That is also where the lack of training and skill is passed down. Foster kids are often born to moms with little or no understanding of parenting. Their own needs have not been met so they do not know how to care for their own child. There is no skill to be passed down. They don't know how to parent.

Last, look into all those resources available. There are organizations that provide food products for moms who need financial help. Many offer medical help and advice. Some places specialize in lending out maternity clothing or baby equipment at no cost to the mom. There are many school programs in place for moms who want education while they are raising their babies. Search out what is available in your area and I'm sure your teen will have a better chance of successfully surviving this unplanned pregnancy.

For foster parents who take in these special girls in such a delicate condition as it was once referred to, I take my hat off to you. For all foster parents, thanks for being the kind of people you are to do the job you do.

Screening for STIs Of the sample (n = 98), 10 females (10%) declined any examination including urine test; 44 girls had a full genital screen including speculum examination, and 40 had external or vulvo-vaginal swabs without speculum examination. FVU was tested for Chlamydia trachomatis in four cases who declined genital examination; 16 of 72 (22%) post-pubertal girls aged 13â&#x20AC;&#x201C;16 years declined speculum examination.

Thirteen of 98 (13%) cases had antibiotic prophylaxis against bacterial STIs. Eight girls (8%) had hepatitis B vaccination; none had HIV post-exposure prophylaxis; 69 (70%) girls attended at least one appointment during follow up period.

Prevalence of STIs Twenty three girls had at least one STI and the overall prevalence of STIs including nonspecific PID was 26% (n = 88). Multiple STIs were diagnosed in two cases; one girl had gonorrhoea, Trichomonasvaginalis, and chlamydial infections; the other was diagnosed with genital warts and PID. Two of 16 (13%) girls who were aged 12 years or less had an STI; one had gonorrhoea and another had Trichomonas vaginalis infection. Ten of 42 (24%) girls aged 13â&#x20AC;&#x201C;16 years who did not disclose any consensual sexual activity before the index assault and 11 of 28 (39%) girls who gave a history of previous consensual

sexual activity, had at least one STI (p = 0.17). No STI was found in two girls aged 13–16 years whose sexual activity before the index assault was not recorded. Chlamydial infection was found in eight of 28 (29%) girls who were involved in consensual sexual activity before the index assault compared to two of 42 (5%) girls who were not involved in consensual sexual activity (p = 0.012).

Of the girls who had a full genital screen and examination (n = 44), 18 (41%) were found to have at least one STI. Of those who had FVU, external genital, or vulvo-vaginal swabs (n = 44), five (11%) girls had at least one STI (p = 0.0016). Ten girls in the "full examination" group and none in the other group were diagnosed with chlamydial infection (p = 0.008).

Overall, 15 (17%) girls had vaginal candidiasis and 11 (13%) had bacterial vaginosis (n = 88). There were no cases of syphilis, hepatitis B or hepatitis C virus (n = 57), or HIV infection among those tested (n = 33).

Mental health and social difficulties Fifty eight of 98 (59%) females aged 16 years or less described psychosocial difficulties before the index assault. These included previous sexual abuse, other abuse, family problems, poor school attendance, learning difficulty, and alcohol misuse (table 1 ).

Thirty (31%) had one or more mental health difficulties before the assault. These included deliberate self harm 13 (13%), depression 13 (13%), behavioural problems eight (8%), and eating difficulties four (4%).

Ninety one out of 93 girls aged 10–16 years were included in the analysis of current mental health problems; five girls below the age of 10 years were excluded for developmental reasons. Two girls aged 10–16 years were also excluded from the analysis because of the absence of documented current psychosocial information in the case notes; 74 of 91 (81%) girls reported current, often multiple, symptoms at presentation, including mood changes in 50 (55%), sleep disturbance in 36 (40%), anxiety in 30 (33%), appetite change in 14 (15%), and psychosomatic symptoms in seven (8%). Thoughts of self harm occurred in 32 (35%) and 14 (15%) made attempts after the assault. Attempted self harm included overdoses in nine cases, cutting in two cases, and attempted hanging and jumping in three cases, with the majority presenting in the first 6 months of the assault.

Details of the recorded symptoms were compared to age at presentation, time interval between assault and first presentation, and the type of assailants (table below). Both younger (aged 10–12 years) and older adolescents (aged 13–16 years) reported a wide range of current mental health problems during the follow up period: 32 of 91 (35%) girls reported more than three psychological symptoms and 30 of them were aged 13–16 years.

Mood changes were higher in those presenting after 1 month of the index assault (p = 0.001).

Mood changes No (%)

Age at presentation

Sleep disturbance No (%)

Anxiety No (%)

Thought of self harm No (%)

Attempted self harm No (%)

Appetite changes No (%)

Psychosomatic symptoms No (%)

10–12 years (n = 12) 5 (42) 13–16 years (n = 79) 45 (57) Time interval since assault <1 month (n = 46) 17 (37) 1–6 months (n = 32) 25 (78) 7 months (n = 13) 8 (62) Assailants Stranger/unknown 17 (52) (n = 33) Acquaintance/friend 27 (71) (n = 38) Family (n = 20) 6 (30)

3 (25) 33 (42)

5 (42) 25 (32)

1 (8) 31 (41)

1 (8) 13 (16)

1 (8) 13 (16)

0 7 (9)

20 (43) 13 (40) 3 (23)

18 (39) 9 (28) 3 (23)

18 (39) 11 (34) 3 (23)

6 (13) 6 (19) 2 (15)

9 (20) 2 (6) 3 (23)

3 (7) 1 (3) 3 (23)

14 (42)

9 (27)

10 (30)

5 (15)

3 (9)

2 (6)

17 (45)

16 (42)

17 (45)

7 (18)

8 (21)

2 (5)

5 (25)

5 (25)

5 (25)

2 (10)

3 (15)

3 (15)

Table 2 Symptoms recorded after assault compared to time interval, age at presentation, and type of assailant(s)

Further analysis of the results showed no significant relation between the presence of an STI and psychological disturbance (p = 0.84). Twenty six (29%) of these young people aged 10–16 years had no involvement with social services or child and adolescent mental health services at the initial presentation to our clinic and these girls were referred to the appropriate services for further assessment and follow up.

DISCUSSION The reported prevalence of STIs in girls and boys where sexual abuse was suspected were low in the United Kingdom. However, the risk of infection depends upon the prevalence of STIs in the abusers and abused population, the organism, and the type and site of the assault. Recent data suggest a continued rise in the number of new cases of STIs diagnosed within GUM clinics in the United Kingdom. The largest increase in cases of gonorrhoea and genital chlamydial infection was seen among teenagers of both sexes, and they remain key groups in STI transmission. More recently, Creighton et al demonstrated higher rate of STIs in females aged 16 years or less attending a London clinic. However, the authors did not report on the number of girls who were sexually assaulted/raped in their study.

Our study showed that the overall prevalence of STIs in female child and adolescent survivors of rape and sexual assault attending a specialist GUM clinic was high.

Chlamydial infection was significantly more common in post-pubertal girls who were involved in consensual sexual activity before the index assault. The study also demonstrated that the prevalence of STIs was lower in those who declined a speculum examination than in those who underwent the examination. This may reflect differences in the methods used or true population differences between the two groups. Prospective studies are needed to explain this. Furthermore, this study supports other published studies in emphasising the importance of screening for STIs in survivors of rape and sexual assault whether or not they disclose a history of previous consensual sexual activity. Ten per cent of the study population declined screening for STIs because of its perceived invasive nature. School based screening programmes for chlamydia and/or gonorrhoea in the United States and, more recently, pilot studies for genital chlamydial

infection in England, have demonstrated that less invasive techniques such as urine ligase chain reaction (LCR) test were more acceptable to young people. Non-invasive DNA amplification tests to identify C trachomatis and other sexually transmitted organisms, would also be more acceptable for STI screening in these young survivors. Before these assays could be used for medico-legal purposes, studies comparing these techniques with the more established methods would need to be undertaken as they are largely untested in this age group. There were a number of risk factors within the study population, which could increase the likelihood of further abuse and future unwanted pregnancies, STIs, and psychological difficulties. More than one third of girls reported previous sexual abuse. A history of mental health problems, substance misuse, and learning difficulty indicated further individual vulnerability. Environmental factors including school attendance difficulties, leaving the family home, family dysfunction, lack of social and mental health support were frequent in the study population. The prevalence of mood, sleep and appetite disturbances was also high. Deliberate self harm was a common problem in these young survivors as reported in other studies.

Key messages Prevalence of STIs was high among female child and adolescent survivors of sexual assault/rape Genital chlamydial infection was more common in post-pubertal girls who were involved in consensual sexual activity Psychosocial difficulties were common and multiple in young survivors of sexual assault/rape An early assessment of both physical and mental health is important in these survivors.

There were some limitations in this retrospective study. Those attending the clinic were a self selected group. The findings cannot be generalised to survivors not making contact with services. A significant proportion of adolescent survivors of sexual violence may not be able to disclose their history unless specifically asked. Inquiring about mental health problems requires specialist training and expertise, being dependent upon the young personâ&#x20AC;&#x2DC;s recall of events. In addition, the method for eliciting mental health symptoms was not standardised in this study. Furthermore, different types of assessment used and poor follow up may have contributed to an underestimation of the true prevalence of STIs among these survivors.

In conclusion, our study demonstrated a high prevalence of STIs, mental health, and social difficulties among female child and adolescent survivors of sexual assault/rape, reinforcing the importance of early physical and mental health assessment of these young people. The development of specialist services, within the United Kingdom, where the needs of child and adolescent survivors of sexual assault/rape can be addressed, is urgently required.

Sexual assault is a broad-based term that encompasses a wide range of sexual victimizations, including rape. Since the American Academy of Pediatrics published its last policy statement on this topic in 1994, additional information and data have emerged about sexual assault and rape in adolescents, the adolescent's perception of sexual assault, and the treatment and management of the adolescent who has been a victim of sexual assault. This new information mandates an updated knowledge base for pediatricians who

care for adolescent patients. This statement provides that update, focusing on sexual assault and rape in the adolescent population.

DEFINITIONS Understanding the definitions of the terms sexual assault, rape, acquaintance rape, date rape, molestation, and statutory rape are important in the identification, treatment, and management of the adolescent victim. Sexual assault is a comprehensive term that includes multiple types of forced or inappropriate sexual activity. Sexual assault includes situations in which there is sexual contact with or without penetration that occurs because of physical force or psychological coercion. This includes touching of a person's "sexual or intimate parts or the intentional touching of the clothing covering those intimate parts."

The term molestation is applied when there is non-coital sexual activity between a child and an adolescent or adult. Molestation can include viewing of sexual materials, genital or breast fondling, or oral-genital contact.

From legal and clinical perspectives, rape is defined as "forced sexual intercourse" that occurs because of physical force or psychological coercion. Rape involves vaginal, anal, or oral penetration by the offender. This definition also includes incidents in which penetration is with a foreign object, such as a bottle, or situations in which the victim is unable to give consent because of intoxication or developmental disability. The terms acquaintance rape and date rape are applied to those situations in which the assailant and victim know each other.

Statutory rape involves sexual penetration by a person 18 years or older of a person under the age of consent. Statutory rape laws are based on the premise that, until a person reaches a certain age, he or she is legally incapable of consenting to sexual intercourse.

The age of consent varies from state to state. In some states, there are new statutory rape laws mandating that sexual intercourse and sexual contact must now be reported if certain age differences exist between a minor (usually defined as younger than 18 or 21 years) and his or her sex partner (whether minor or adult), even if the sexual act was voluntary and consensual. There is concern that the new laws and mandated reporting statutes can have a significant impact on the interaction between the health care provider and the patient. Adolescents and health care providers may have concerns regarding medical or social history, access to care, and confidentiality, and some adolescents may refuse to seek care or refuse to disclose personal risk information because of possible reporting of sexual partners.

U.S. National data show that adolescents continue to have the highest rates of rape and other sexual assaults of any age group. Annual rates of sexual assault per 1000 persons (males and females) were reported in 1998 by the US Department of Justice to be 3.5 for ages 12 through 15 years, 5.0 for ages 16 through 19 years, 4.6 for ages 20 through 24 years, and 1.7 for ages 24 through 29 years. There are significant gender differences in adolescent rape and sexual assault, with female victims exceeding males by a ratio of 13.5:1. National Crime Victimization Survey statistics reported 308 569 rapes and sexual assaults in females 12 years or older and 21 519 rapes and sexual assaults in males 12 years or older in 1998. This represents a decrease from peak rates of rape and sexual assault reported in 1992. The US Department of Justice reported that more than half of all rape and sexual assault victims in 1998 were females younger than 25 years. Studies have demonstrated that two thirds to three quarters of all adolescent rapes and sexual assaults

are perpetrated by an acquaintance or relative of the adolescent. Older adolescents are most commonly the victims during social encounters with the assailants (e.g., a date).

With younger adolescent victims, the assailant is more likely to be a member of the adolescent's extended family. Adolescents with developmental disabilities, especially those in the mildly retarded range, are at particular risk for acquaintance and date rape.

Adolescent rape victims are more likely than adult victims to have used alcohol or drugs and are less likely to be physically injured during a rape, as the assailants in adolescent rape tend to use weapons less frequently. Adolescent female victims are also more likely to delay seeking medical care after rape and sexual assault and are less likely to press charges than adult women. Male victims are less likely to report a sexual assault than are female victims. Studies of sexual assault of males have demonstrated that up to 90% of perpetrators are male. Sexual assault of males by females is more commonly reported by older adolescents or young adults, compared with children or young adolescents. Male perpetrators of male sexual assault more commonly identify themselves as heterosexual than homosexual, and there is lack of clarity in the literature whether adolescent and young adult victims are more commonly heterosexual or homosexual. The rate of perpetration by an acquaintance of the victim is similar for male and female victims, but multiple assailants, use of a weapon, and forced oral assaults are more common in assault of males than females. Alcohol or drug use immediately before a sexual assault has been reported by more than 40% of adolescent victims and adolescent assailants. The recent increase in the rate of adolescent acquaintance rape has been associated with the illegal availability of flunitrazepam (Rohypnol, manufactured by Roche Pharmaceuticals Inc, outside of the United States). This so-called "date rape drug" is a benzodiazepine sedative/hypnotic. The effects of flunitrazepam begin 30 minutes after ingestion, peak within 2 hours, and can persist for up to 8 to 12 hours. Drug effects include somnolence, decreased anxiety, muscular relaxation, and profound sedation. There may also be amnesia for the time that the drug exerts its action. This drug can go undetected if added to any drink, thus increasing the risk of sexual assault, especially in the adolescent population.

Exploring the perceptions and attitudes of adolescents regarding rape and other forced or unwanted sexual encounters is important. The acquaintance rape phenomenon raises issues of victim credibility, because there may have been voluntary participation until the assault occurred. Aggressive behavior on the part of a male perpetrator may be seen by some adolescents as normative in this context. One study demonstrated that male and female adolescents who viewed a vignette of unwanted sexual intercourse accompanied by a photograph of the victim dressed in provocative clothing were more likely to indicate that the victim was responsible for the assailant's behavior, more likely to view the male's behavior as justified, and less likely to judge the act as rape.

Exploration of unwanted sexual experiences and rape from the adolescent's perspective can lead to additional insight into health behaviors and outcomes. A large survey of unwanted sexual experiences among middle and high school students indicated that 18% of females and 12% of males reported having had an unwanted sexual experience. In one study, this led to unexpected gender-reversed patterns of behavior, including the internalizing behavior, bulimia, in males and externalizing behaviors, such as fighting, in females. Other studies of female adolescents have found rape during childhood or adolescence to be associated with younger age of first voluntary intercourse, lower

internal locus of control, higher depression scores, increased seeking and receipt of psychologist services, increased rate of pregnancy, and greater amounts of illegal drug use as well as evidence of physical abuse and negative mental health states.

TREATMENT AND MANAGEMENT The pediatrician who is involved in the management of adolescents who are the victims of sexual assault should be trained in the forensic procedures required for documentation and collection of evidence or should refer to an emergency department or rape crisis center where there are personnel experienced with adolescent rape victims. New colposcopic procedures allow examiners to better document genital trauma, including microtrauma, seen in rape cases, with a growing body of literature demonstrating the patterns of genital injury in sexual assault victims.

It is essential that the forensic examination be performed by a person who can ensure an unbroken chain of evidence and accurate documentation of findings. Details of the required examination and documentation are presented in a handbook by the American College of Emergency Physicians, Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient. Pediatricians who treat sexually abused or assaulted patients need to be aware of the legal requirements, including completion of appropriate forms and reporting to appropriate authorities, specific to their locale.

Pediatricians should also be aware that the availability of DNA amplification technology now used to more accurately identify assailants allows for performance of a forensic examination beyond the 72-hour period that was previously considered the cutoff for such examinations. The diagnosis and management of sexually transmitted diseases (STDs) is an important component of treatment of the assault victim. Blood and tissue specimens should be obtained from appropriate sites (as identified in the history) to detect Neisseria gonorrhea and Chlamydia trachomatis. Vaginal secretions should be microscopically examined for Trichomonas species. Specimens should be tested for herpes virus if there is a clinical indication (eg, vesicles). Serum samples should be obtained to test for syphilis, hepatitis B virus (HBV), and human immunodeficiency virus (HIV). These tests serve as a baseline indicating the presence of any STDs in the victim before the assault but are considered controversial by some authorities who prefer performing the initial STD tests 2 weeks after the assault. All authorities agree that the syphilis and HBV tests should be repeated in 6 weeks and that the HIV test should be repeated in 3 to 6 months.

Pregnancy prevention and postcoital contraception should be addressed with every adolescent female rape and sexual assault victim. This discussion should include risks of failure and options for pregnancy management. A baseline urine pregnancy test should be performed. This is important because the adolescent could be pregnant from sexual activity that occurred before the assault.

Current recommendations are to provide prophylactic treatment for Chlamydia infection and gonorrhea to adolescent sexual assault victims and to provide prophylaxis for pregnancy prevention. HIV prophylaxis is not universally recommended but should be considered when there is mucosal exposure (oral, vaginal, or anal). Factors to consider include the risks and benefits of the medical regimen, whether there was repeated abuse or multiple perpetrators, if the perpetrator is known to be HIV-positive, or if there is a high prevalence of HIV in the geographic area where the sexual assault occurred. HBV

vaccination is recommended for those who have not received a complete HBV series or who have a negative surface antibody despite previous vaccination.

ADOLESCENT REACTIONS TO RAPE Posttraumatic stress disorder occurs in up to 80% of rape victims. Rape trauma syndrome is described as consisting of an initial phase lasting days to weeks during which the victim experiences disbelief, anxiety, fear, emotional liability, and guilt followed by a reorganization phase lasting months to years during which the victim goes through periods of adjustment, integration, and recovery. Counseling designed to specifically address these issues as well as additional psychological trauma that results from date or acquaintance rape should be available. Psychotropic medications may be required in some instances. The pediatrician should be knowledgeable about services available in the community to address these issues and should provide initial psychological support.

Other victim reactions to rape can include the feeling that his or her trust has been violated, increased self-blame, less positive self-concept, anxiety, alcohol abuse, and effects on sexual activity (including younger age at first voluntary sexual activity, poor use of contraception, greater number of abortions and pregnancies, STDs, victimization by older partners, and sexual dissatisfaction). Adolescent victims may feel that their actions contributed to the act of rape and have confusion as to whether the incident was forced or consensual.

Because responses to rape can vary, it is important for pediatricians to not only manage the physical needs of the victim but also be sensitive to the psychological needs of the adolescent. Pediatricians should be aware that self-blame, humiliation, and naivetĂŠ may prevent the adolescent from seeking medical care. Effective screening, referral, and follow-up allow for support of the adolescent rape victim and appropriate delivery of health care services. Because patients treated in emergency departments often do not return for follow-up care, it is important that the emergency treatment team refer the assaulted adolescent back to his or her medical home. Thus, pediatricians should be prepared to provide such services as follow-up STD testing, completion of the HBV vaccination series, treatment of injuries, screening for mental health problems, and management of substance use issues.

SEXUAL ASSAULT AND RAPE PREVENTION STRATEGIES Adolescent rape exists in a sociocultural context in which issues of male dominance, appropriate gender behaviors, female victimization, and power imbalances in relationships are highly visible. Prevention messages for adolescents need to be designed for males and females. Adolescents need to be able to identify high-risk situations and should be encouraged to seek medical care after a rape. Factors that may increase the likelihood of assault (e.g., late night use of drugs or alcohol) and strategies to prevent rape should be discussed, and associated educational materials should be distributed.

Screening of adolescents for sexual victimization should be part of a routine history.

Adolescents should be asked direct questions regarding their past sexual experiences.

These questions should include those that explore age of first sexual experience, unwanted voluntary or forced sexual acts, and a description of events. Exploration of gender roles and relationship parameters (e.g., exploitative, nonconsensual vs. healthy) are critical. The patient needs the opportunity to describe the experience in his or her own words.

RECOMMENDATIONS Pediatricians should be knowledgeable about the epidemiology of sexual assault in adolescence.

Pediatricians should be knowledgeable about the current reporting requirements for sexual assault in their communities.

Pediatricians should be knowledgeable about sexual assault and rape evaluation services available in their communities and when to refer adolescents for a forensic examination.

Pediatricians should screen adolescents for a history of sexual assault and potential squeal.

Pediatricians should be prepared to offer psychological support or referral for counseling and should be aware of the services in the community that provide management, examination, and counseling for the adolescent patient who has been sexually assaulted.

Pediatricians should provide preventive counseling to their adolescent patients regarding avoidance of high-risk situations that could lead to sexual assault.

The Evaluation of Sexual Abuse in Children Introduction Few areas of pediatrics have expanded so rapidly in clinical importance in recent years as that of sexual abuse of children. What Kempe called a "hidden pediatric problem in 1977 is certainly less hidden at present. In 2002, more than 88000 children were confirmed victims of sexual abuse in the United States. Studies have suggested that each year approximately 1% of children experience some form of sexual abuse, resulting in the sexual victimization of 12% to 25% of girls and 8% to 10% of boys by 18 years of age, Children may be sexually abused by family members or nonfamily members and are more frequently abused by males. Boys are reportedly victimized less often than girls but may not be as likely to disclose the abuse. Adolescents are perpetrators in at least 20% of reported cases; women may be perpetrators, but only a small minority of sexual abuse allegations involve women.

Concurrent with the expansion of knowledge, education about child abuse became a mandated component of US pediatric residencies in 1997.4 Pediatricians will almost certainly encounter sexually abused children in their practices and may be asked by parents and other professionals for consultation. Knowledge of normal and abnormal sexual behaviors, physical signs of sexual abuse, appropriate diagnostic tests for sexually transmitted infections, and medical conditions confused with sexual abuse is useful in the evaluation of such children. All child health professionals should routinely identify those at high risk for or with a history of abuse. Because the evaluation of suspected victims of child sexual abuse often involves careful questioning, evidence-collection procedures, or specialized examination techniques and equipment, many pediatricians do not feel prepared to conduct such comprehensive medical assessments. In such circumstances, pediatricians may refer children to other physicians or health care professionals with expertise in the evaluation and treatment of sexually abused children. Because the scope of practice of some non-physician examiners is limited to assessment, documentation, and collection of forensic evidence, close coordination with a knowledgeable physician or pediatric nurse practitioner is necessary to provide complete assessment and treatment of physical, behavioral, and emotional consequences of abuse. In other circumstances, the

community pediatrician may be asked to evaluate a child for sexual abuse to determine if a report and further investigation are warranted. In some circumstances, pediatricians may conduct comprehensive assessments of suspected victims of child sexual abuse when no other resources are available in their community.

Because pediatricians have trusted relationships with patients and families, they may provide essential support and guidance from the time that abuse is detected and subsequently as the child and family recover from the physical and emotional consequences of abuse. Because of this trusted relationship, the pediatrician may also gain information from the child or family that is valuable to the investigation, evaluation, and treatment of the victim. However, a close relationship between the pediatrician and the family may pose potential tension, prompting the pediatrician to refer the child to a specialist to avoid conflict with the family. Furthermore, although pediatricians must care for sexually abused children in their practice, many report inadequate training in the recognition of red flags for sexual abuse and a lack of a consistent approach to evaluating suspected abuse.7 Consultation with a pediatric specialist who has extensive training and professional experience in the comprehensive assessment of victims of sexual abuse may be necessary. These guidelines are intended for use by all health professionals caring for children. Additional guidelines are published by the American Academy of Pediatrics (AAP) for the evaluation of sexual assault of the adolescent.

Sexual abuse occurs when a child is engaged in sexual activities that he or she cannot comprehend, for which he or she is developmentally unprepared and cannot give consent, and/or that violate the law or social taboos of society. The sexual activities may include all forms of oral-genital, genital, or anal contact by or to the child or abuse that does not involve contact, such as exhibitionism, voyeurism, or using the child in the production of pornography. As many as 19% of adolescents who are regular Internet users have been solicited by strangers for sex through the Internet; built-in filters and monitoring are less effective than parent-child communication in preventing online predation. Sexual abuse includes a spectrum of activities ranging from rape to physically less intrusive sexual abuse.

Sexual abuse can be differentiated from "sexual play" by determining whether there is a developmental asymmetry among the participants and by assessing the coercive nature of the behavior. Thus, when young children at the same developmental stage are looking at or touching each other's genitalia because of mutual interest, without coercion or intrusion of the body, this is considered normal (i.e., nonabusive) behavior. However, a 6year-old who tries to coerce a 3-year-old to engage in anal intercourse is displaying abnormal behavior, and appropriate referrals should be made to assess the origin of such behavior and to establish appropriate safety parameters for all children involved. Among nonabused children 2 to 12 years of age, fewer than 1.5% exhibit the following behaviors: putting the mouth on genitals, asking to engage in sex acts, imitating intercourse, inserting objects into the vagina or anus, and touching animal genitals. Children or adolescents who exhibit inappropriate or excessive sexual behavior may be reacting to their own victimization or may live in environments with stressors, boundary problems, or family sexuality or nudity. Some sexually abused children will display a great number of sexual behaviors and a greater intensity of these behaviors. However, there is a significant proportion of sexually abused children who do not display increased sexual behavior. Research has shown that there are two responses to sexual abuse: one that

reflects inhibition and the other that reflects excitation, and it is in the latter group that more sexual behavior is observed.

Sexually abused children are seen by pediatricians in a variety of circumstances such as: (1) the child or adolescent is taken to the pediatrician because he or she has made a statement of abuse or abuse has been witnessed; (2) the child is brought to the pediatrician by social service or law enforcement professionals for a non-acute medical evaluation for possible sexual abuse as part of an investigation; (3) the child is brought to an emergency department after a suspected episode of acute sexual abuse for a medical evaluation, evidence collection, and crisis management; (4) the child is brought to the pediatrician or emergency department because a caregiver or other individual suspects abuse because of behavioral or physical symptoms; or (5) the child is brought to the pediatrician for a routine physical examination, and during the course of the examination, behavioral or physical signs of sexual abuse are detected.

The diagnosis of sexual abuse and the protection of the child from additional harm depend in part on the pediatrician's willingness to consider abuse as a possibility.

Sexually abused children who have not disclosed abuse may present to medical settings with a variety of symptoms and signs. Because children who are sexually abused are generally coerced into secrecy, the clinician may need a high level of suspicion and may need to carefully and appropriately question the child to detect sexual abuse in these situations. The presenting symptoms may be so general or nonspecific (e.g., sleep disturbances, abdominal pain, enuresis, encopresis, or phobias) that caution must be exercised when the pediatrician considers sexual abuse, because the symptoms may indicate physical or emotional abuse or other stressors unrelated to sexual abuse. More specific signs and symptoms of sexual abuse are discussed under "Diagnostic Considerations." Most cases of child sexual abuse are first detected when a child discloses that he or she has been abused. Children presenting with nonspecific symptoms and signs should be questioned carefully and in a non-leading manner about any stressors, including abuse, in their life. Pediatricians who suspect that sexual abuse has occurred are urged to inform the parents of their concerns in a calm, non-accusatory manner. The individual accompanying the child may have no knowledge of or involvement in the sexual abuse of the child. A complete history, including behavioral symptoms and associated signs of sexual abuse, should be sought. The primary responsibility of the pediatrician is the protection of the child; if there is concern that the parent with the child is abusive or nonsupportive, the pediatrician may delay in informing the parent(s) while a report is made and an expedited investigation by law enforcement and/or child protective services agencies can be conducted. Whenever there is a lack of support or belief in the child, this information should be provided promptly to child protective services.

Interviewing the Child The pediatrician should try to obtain an appropriate history in all cases before performing a medical examination. Although investigative interviews should be conducted by social services and/or law enforcement agencies, this does not preclude physicians asking relevant questions to obtain a detailed pediatric history and a review of systems. Medical history, past incidents of abuse or suspicious injuries, and menstrual history should be documented. When children are brought for evaluation by protective personnel, little or

no history may be available other than that provided by the child. The medical history should include information helpful in determining what tests should be done and when, how to interpret medical findings when present, and what medical and mental health services should be provided to the child and family.

The courts have allowed physicians to testify regarding specific details of a child's statements obtained in the course of taking a medical history to provide diagnosis and treatment, although exceptions may preclude such testimony in some cases. Occasionally, children spontaneously describe their abuse and indicate who abused them. When asking young children about abuse, line drawings, dolls, or other aids are generally used only by professionals trained in interviewing young children. The American Academy of Child and Adolescent Psychiatry and American Professional Society on the Abuse of Children have published guidelines for interviewing sexually abused children. It is desirable for those conducting the interview to avoid leading and suggestive questions or showing strong emotions such as shock or disbelief and to maintain a "tell-me-more" or "and-thenwhat-happened" approach. When possible, the parent should not be present during the interview so that influences and distractions are kept to a minimum. Written notes in the medical record or audiotape or videotape should be used to document the questions asked and the child's responses as well as their demeanor and emotional responses to questioning. When audiotaping or videotaping is used, protocols should be coordinated with the district attorney's office in accordance with state guidelines. Most expert interviewers do not interview children younger than 3 years.

Physical Examination The physical examination of sexually abused children should not result in additional physical or emotional trauma. The examination should be explained to the child before it is performed. It is advisable to have a supportive adult not suspected of involvement in the abuse present during the examination unless the child prefers not to have such a person present. Children may be anxious about giving a history, being examined, or having procedures performed. Time must be allotted to relieve the child's anxiety.

When the alleged sexual abuse has occurred within 72 hours or there is an acute injury, the examination should be performed immediately. In this situation, forensic evidence collection may be appropriate and may include body swabs, hair and saliva sampling, collection of clothing or linens, and blood samples. Body swabs collected in prepubertal children more than 24 hours after a sexual assault are unlikely to yield forensic evidence, and nearly two thirds of the forensic evidence may be recovered from clothing and linens.

When more than 72 hours have passed and no acute injuries are present, an emergency examination usually is not necessary. As long as the child is in a safe and protective environment, an evaluation can be scheduled at the earliest convenient time for the child, physician, and investigative team. The child should have a thorough pediatric examination performed by a health care provider with appropriate training and experience who is licensed to make medical diagnoses and recommend treatment. This examination should include a careful assessment for signs of physical abuse, neglect, and selfinjurious behaviors. Injuries, including bruises incurred on the arms or legs during selfdefense, should be documented in victims of acute sexual assault. Sexual maturity should also be assessed. In the rare instance in which the child is unable to cooperate and the examination must be performed because of the likelihood of trauma, infection, and/or the need to collect forensic samples, an examination under sedation with careful monitoring

should be considered. Signs of trauma should preferably be documented by photographs; if such equipment is unavailable, detailed diagrams can be used to illustrate the findings.

Specific attention should be given to the areas involved in sexual activity: the mouth, breasts, genitals, perineal region, buttocks, and anus. In female children, the examination should include inspection of the medial aspects of the thighs, labia majora and minora, clitoris, urethra, periurethral tissue, hymen, hymenal opening, fossa navicularis, posterior fourchette, perineum, and perianal tissues. The thighs, penis, scrotum, perineum, and perianal tissues in males should be assessed for bruises, scars, bite marks, and discharge.

Any abnormalities should be noted and interpreted appropriately with regard to the specificity of the finding to trauma (eg, nonspecific, suggestive, or indicative of trauma).

If the interpretation of an abnormal finding is problematic, consultation with an expert physician is advisable.

Various examination techniques and positions for visualizing genital and anal structures in children and adolescents have been described. Such techniques are often necessary to determine the reliability of an examination finding; for example, different techniques may be used to ensure that an apparent defect or cleft in the posterior hymen is not a normal hymenal fold or congenital variation. In addition, instruments that magnify and illuminate the genital and rectal areas should be used. Speculum or digital examinations should not be performed on the prepubertal child unless under anesthesia (e.g., for suspected foreign body), and digital examinations of the rectum are not necessary. Because many factors can influence the size of the hymenal orifice, measurements of the orifice alone are not helpful in assessing the likelihood of abuse.

Laboratory Data Depending on the history of abuse, the examiner may decide to conduct tests for sexually transmitted diseases (STDs). Approximately 5% of sexually abused children acquire an STD from their victimization. The following factors should be considered in deciding which STDs to test for, when to test, and which anatomic sites to test: age of the child, type(s) of sexual contact, time lapse from last sexual contact, signs or symptoms suggestive of an STD, family member or sibling with an STD, abuser with risk factors for an STD, request/concerns of child or family, prevalence of STDs in the community, presence of other examination findings, and patient/parent request for testing. Although universal screening of postpubertal patients is recommended, more selective criteria are often used for testing prepubertal patients. For example, the yield of positive gonococcal cultures is low in asymptomatic prepubertal children, especially when the history indicates fondling only. Vaginal, rather than cervical, samples are adequate for STD testing in prepubertal children. Considering the prolonged incubation period for human papillomavirus infections, a follow-up examination several weeks or months after the initial examination may be indicated; in addition, the family and patient should be informed about the potential for delayed presentation of lesions. Testing before any prophylactic treatment is preferable to prophylaxis without testing; the identification of an STD in a child may have legal significance as well as implications for treatment, especially if there are other sexual contacts of the child or perpetrator. The implications of various STDs that may be diagnosed in children are summarized in Table 1 ; guidelines are also provided by the Centers for Disease Control and Prevention and the AAP. The most specific and sensitive tests should be used when evaluating children for

STDs. Cultures are considered the "gold standard" for diagnosing Chlamydia trachomatis (cell culture) and Neisseria gonorrhoeae (bacterial culture). New tests, such as nucleic acidâ&#x20AC;&#x201C;amplification tests, may be more sensitive in detecting vaginal C trachomatis, but data regarding use in prepubertal children are limited. Because the prevalence of STDs in children is low, the positive predictive value of these tests is lower than that of adults, so confirmatory testing with an alternative test may be important, especially if such results will be presented in legal settings. When child sexual abuse is suspected and STD testing is indicated, vaginal/urethral samples and/or rectal swabs for isolation of C trachomatis and N gonorrhoeae are recommended. In addition, vaginal swabs for isolation of Trichomonas vaginalis may be obtained. Testing for other STDs, including human immunodeficiency virus (HIV), hepatitis B, hepatitis C, and syphilis, is based on the presence of symptoms and signs, patient/family wishes, detection of another STD, and physician discretion. Venereal warts, caused by human papillomavirus infection, are clinically diagnosed without testing. Any genital or anal lesions suspicious for herpes should be confirmed with a culture, distinguishing between herpes simplex virus types 1 and 2. Guidelines for treatment are published by the Centers for Disease Control and Prevention.

TABLE 1. Implications of Commonly Encountered STDs for the Diagnosis and Reporting of Sexual Abuse of Infants and Prepubertal Children STD Confirmed

Sexual Abuse

Suggested Action

Gonorrhoea*

Diagnostic

Report

Syphilis*

Diagnostic

Report

HIV infection

Diagnostic

Report

C trachomatis infection*

Diagnostic

Report

T vaginalis infection

Highly suspicious

Report

C acuminata infection* (anogenital warts)

Suspicious

Report

Herpes simplex (genital location)

Suspicious

Report||

Bacterial vaginosis

Inconclusive

Medical follow-up

* If not perinatally acquired and rare nonsexual vertical transmission is excluded.

Although the culture technique is the "gold standard," current studies are investigating the use of nucleic acidâ&#x20AC;&#x201C;amplification tests as an alternative diagnostic method in children.

To the agency mandated in the community to receive reports of suspected sexual abuse.

If not acquired perinatally or by transfusion. || Unless there is a clear history of autoinoculation.

If a child has reached menarche, pregnancy testing should be considered. A negative pregnancy status should be confirmed before administering any medication, including

emergency contraception ("morning after" pills). Guidelines for emergency contraception have been published; the AAP is in the process of developing its own guidelines.

Diagnosis The diagnosis of child sexual abuse often can be made on the basis of a child's history.

Sexual abuse is rarely diagnosed on the basis of only physical examination or laboratory findings. Physical findings are often absent even when the perpetrator admits to penetration of the child's genitalia. Many types of abuse leave no physical evidence, and mucosal injuries often heal rapidly and completely. In a recent study of pregnant adolescents, only 2 of 36 had evidence of penetration. Occasionally, a child presents with clear evidence of anogenital trauma without an adequate history. Abused children may deny abuse. Findings that are concerning include: (1) abrasions or bruising of the genitalia; (2) an acute or healed tear in the posterior aspect of the hymen that extends to or nearly to the base of the hymen; (3) a markedly decreased amount of hymenal tissue or absent hymenal tissue in the posterior aspect; (4) injury to or scarring of the posterior fourchette, fossa navicularis, or hymen; and (5) anal bruising or lacerations. The interpretation of physical findings continues to evolve as evidence-based research becomes available. The physician, the multidisciplinary team evaluating the child, and the courts must establish a level of certainty about whether a child has been sexually abused.

Table 2 provides suggested guidelines for making the decision to report sexual abuse of children based on currently available information. For example, the presence of semen, sperm, or acid phosphatase; a positive culture for N gonorrhoeae or C trachomatis; or a positive serologic test for syphilis or HIV infection make the diagnosis of sexual abuse a near medical certainty, even in the absence of a positive history, if perinatal transmission has been excluded for the STDs. The differential diagnosis of genital trauma also includes accidental injury and physical abuse. This differentiation may be difficult and may require a careful history and multidisciplinary approach. Because many normal anatomic variations, congenital malformations and infections, or other medical conditions may be confused with abuse, familiarity with these other causes is important.

TABLE 2. Guidelines for Making the Decision to Report Sexual Abuse of Children Data Available

Response

History

Behavioral Physical Diagnostic Symptoms Examination Tests

Level of Report Concern Decision About Sexual Abuse

Clear statement None or vague

Present or absent Present or absent

Normal or abnormal Normal or nonspecific

Positive or High negative Positive test High for C trachomatis, gonorrhea, T vaginalis, HIV, syphilis, or

Report Report

None or vague

Present or absent

Vague, Present or or absent history by parent only None Present

Concerning or diagnostic findings Normal or nonspecific

Normal or nonspecific

herpes* Negative or positive

High

Report

Negative

Indeterminate Refer when possible

Negative

Intermediate

Possible report, refer, or follow

*

If nonsexual transmission is unlikely or excluded.

Confirmed with various examination techniques and/or peer review with expert consultant.

If behaviors are rare/unusual in normal children.

Physicians should be aware that child sexual abuse often occurs in the context of other family problems, including physical abuse, emotional maltreatment, substance abuse, and family violence. If these problems are suspected, referral for a more comprehensive evaluation is imperative and may involve other professionals with expertise needed for evaluation and treatment. In difficult cases, pediatricians may find consultation with a regional child abuse specialist or assessment center helpful.

After the examination, the physician should provide appropriate feedback, follow-up care, and reassurance to the child and family.

Treatment All children who have been sexually abused should be evaluated by a pediatrician and a mental health professional to assess the need for treatment and to assess the level of family support. Unfortunately, mental health treatment services for sexually abused children are not universally available. The need for therapy varies from victim to victim regardless of abuse chronicity or characteristics. An assessment should include specific questions concerning suicidal or self-injurious thoughts and behaviors. Poor prognostic signs include more intrusive forms of abuse, more violent assaults, longer periods of sexual molestation, and closer relationship of the perpetrator to the victim. The parents of the victim may also need treatment and support to cope with the emotional trauma of their child's abuse; parents who are survivors of child abuse should be identified to ensure appropriate therapy and to optimize their ability to assist their own child in the healing process. Treatment may include follow-up examinations to assess healing of injuries and additional assessment for STDs, such as Condylomata acuminata infection or herpes, that may not be detected in the acute time frame of the initial examination. The pediatrician may also provide follow-up care to ensure that the child and supportive family members are recovering emotionally from the abuse.

Legal Issues

The medical evaluation is first and foremost just that: an examination by a medical professional with the primary aim of diagnosing and determining treatment for a patient's complaint. When the complaint involves the possible commission of a crime, however, the physician must recognize legal concerns. The legal issues confronting pediatricians in evaluating sexually abused children include mandatory reporting of suspected abuse with penalties for failure to report; involvement in the civil, juvenile, or family court systems; involvement in divorce or custody proceedings; and involvement in criminal prosecution of defendants in criminal court. In addition, there are medical liability risks for pediatricians who fail to diagnose abuse or who misdiagnose other conditions as abuse.

All pediatricians in the United States are required under the laws of each state to report suspected as well as known cases of child abuse. In many states, the suspicion of child sexual abuse as a possible diagnosis requires a report to both the appropriate law enforcement and child protective services agencies. Among adolescents, sexual activity and sexual abuse are not synonymous, and it should not be assumed that all adolescents who are sexually active are, by definition, being abused. Many adolescents have consensual, age-appropriate sexual experiences, and it is critical that adolescents who are sexually active receive appropriate confidential health care and counseling. Federal and state laws should support providing confidential health care and should affirm the authority of physicians and other health care professionals to exercise appropriate clinical judgment in reporting cases of sexual activity. All physicians need to know their state law requirements and where and when to file a written report; an update on child abuse reporting statutes is given below.

Mandatory Reporters of Child Abuse and Neglect State Statutes Series 2003 Author(s): National Clearinghouse on Child Abuse and Neglect Information Year Published: 2003 Current through June 2003 Each State and U.S. Territory designates individuals, typically by professional group, who are mandated by law to report child maltreatment. Any person, however, may report incidents of abuse or neglect.

Individuals Typically Mandated to Report Individuals typically designated as mandatory reporters have frequent contact with children. Such individuals include: Health care workers School personnel Child care providers Social workers Law enforcement officers Mental health professionals Some States also mandate animal control officers, veterinarians, commercial film or photograph processors, substance abuse counselors, and firefighters to report abuse or neglect. Four States- Alaska, Arkansas, Connecticut, and South Dakota--include domestic violence workers on the list of mandated reporters. Approximately eighteen States require all citizens to report suspected abuse or neglect regardless of profession.

Standard for Making a Report Typically a report must be made when the reporter suspects or has reasons to suspect that a child has been abused or neglected.

Privileged Communications Approximately 34 States and Territories specify in their reporting laws when a communication is privileged. Privileged communications, which is the statutory recognition of the right to maintain the confidentiality of communications between professionals and their clients or patients, are exempt from mandatory reporting laws.

The privilege most widely recognized by the States is that of attorney-client. The privilege pertaining to clergy-penitent also is frequently recognized, but limited to situations in which a clergy person becomes aware of child abuse through confessions or in the capacity of spiritual advisor. However, five States, New Hampshire, North Carolina, Rhode Island, Texas, and West Virginia, deny the clergy-penitent privilege.

Very few States recognize the physician-patient and mental health professional-patient privileges as exempt from mandatory reporting laws.

These guidelines do not suggest that a pediatrician who evaluates a child with an isolated behavioral finding (nightmares, enuresis, phobias, etc) or an isolated physical finding (erythema or an abrasion of the labia or traumatic separation of labial adhesions) is obligated to report these cases as suspicious. If additional historical, physical, or laboratory findings suggestive of sexual abuse are present, the physician may have an increased level of suspicion and should report the case. In both criminal and civil proceedings, physicians must testify to their findings "to a reasonable degree of medical certainty. Pediatricians are encouraged to discuss cases with their local or regional child abuse consultants and their local child protective services agency. In this way, families may be spared unnecessary investigations, agencies are less likely to be overburdened, and physicians may be protected from potential prosecution for failure to report. Statutes in each state immunize reporters from civil or criminal liability as long as the report was not made either without basis or with deliberate bad intentions. On the other hand, although no known physicians have been prosecuted successfully for failure to report, there have been successful malpractice actions against physicians who failed to diagnose or report child abuse appropriately.

Because of the likelihood of legal action, detailed records, drawings, and/or photographs should be maintained soon after the evaluation and kept in a secure location. Protected health information for a minor who is believed to be the victim of abuse may be disclosed to social services or protective agencies; the Health Insurance Portability and Accountability Act (HIPAA; Pub L No. 104â&#x20AC;&#x201C;191 [1996]) does not preempt state laws that provide for reporting or investigating child abuse. Physicians required to testify in court are better prepared and may feel more comfortable if their records are complete and accurate. Physicians may testify in civil cases concerning temporary or permanent custody of the child by a parent or the state or in criminal cases in which a suspected abuser's guilt or innocence is determined. In general, the ability to protect a child may often depend on the quality and detail of the physician's records.

A number of cases of alleged sexual abuse involve parents who are in the process of separation or divorce and who allege that their child is being sexually abused by the other parent during custodial visits. Although these cases are generally more difficult and time consuming for the pediatrician, the child protective services system, and law enforcement agencies, they should not be dismissed simply because a custody dispute exists.

Whenever a careful and comprehensive assessment of the child's physical and behavioral symptoms yields a suspicion of abuse or the child discloses abuse to the physician, a

report to protective services should be made. If symptoms or statements are primarily reported by the parent but not supported during an assessment of the child, the physician may wish to refer the family to a mental health or sexual abuse expert. A juvenile court proceeding may ensue to determine if the child needs protection. The American Bar Association indicates that most divorces do not involve custody disputes, and relatively few custody disputes involve allegations of sexual abuse.

Conclusions The evaluation of sexually abused children is increasingly a part of general pediatric practice. Pediatricians are part of a multidisciplinary approach to prevent, investigate, and treat the problem and need to be competent in the basic skills of history taking, physical examination, selection of laboratory tests, and differential diagnosis. An expanding clinical consultation network is available to assist the primary care physician with the assessment of child abuse cases.

Child Sexual Abuse It can be very difficult to talk about sexual abuse and even more difficult to acknowledge that sexual abuse of children of all ages including infants happens every day. Sexual abuse of children has become the subject of great community concern and the focus of many legislative and professional initiatives. This is evidenced by the expanding body of literature on sexual abuse, public declarations by adult survivors, and increased media coverage of sexual abuse issues.

According to the National Child Abuse and Neglect Data System (NCANDS), an estimated 9.6% of confirmed or substantiated child abuse and neglect cases in 2001 involved sexual abuse. This figure translates into nearly 1.2 child sexual abuse victims for every 1,000 children under the age of 18, or 86,830 victims in 2001 alone. Other studies suggest that even more children suffer abuse and neglect than is ever reported to child protective services agencies. A survey of 1,712 college students revealed a 17% rate of occurrence of sexual abuse before age 18 (Epstein & Bottoms, 1998).

What is child sexual abuse?

At the extreme end of the spectrum, sexual abuse includes sexual intercourse or its deviations. Yet all offences that involve sexually touching a child, as well as nontouching offenses and sexual exploitation, are just as harmful and devastating to a child‘s well-being.

Touching sexual offenses include Fondling, Making a child touch an adult‘s sexual organs, and Penetrating a child‘s vagina or anus no matter how slight with a penis or any object that doesn‘t have a valid medical purpose.

Non-touching sexual offenses include Engaging in indecent exposure or exhibitionism, Exposing children to pornographic material, Deliberately exposing a child to the act of sexual intercourse, and Masturbating in front of a child.

Sexual exploitation can include Engaging a child or soliciting a child for the purposes of prostitution and Using a child to film, photograph, or model pornography.

These definitions are broad and general. In most states, the legal definition of child molestation is an act of a person adult or child which forces, coerces, or threatens a child to have any form of sexual contact or to engage in any type of sexual activity at the perpetrator‘s direction.

What are the effects of child sexual abuse?

The effects of sexual abuse extend far beyond childhood occurrence. Sexual abuse robs children of their childhood and creates a loss of trust, feelings of guilt, and self-abusive behavior. It can lead to antisocial behavior, depression, identity confusion, loss of selfesteem, and other serious emotional problems. It can also lead to difficulty with intimate relationships later in life. The sexual victimization of children is ethically and morally wrong.

Proving sexual abuse When sexual abuse occurs the child victim may be the only witness and the child‘s statements may be the only evidence. In such cases, the central issue sometimes becomes whether the child‘s statements can be trusted. Some child welfare experts feel that children never lie about sexual abuse and that their statements must always be believed.

According to Douglas Besharov in The Future of Children (1994), ―Potential reporters are not expected to determine the truth of a child‘s statements. As a general rule, therefore, all doubts should be resolved in favor of making a report.‖ He continues, ―A child who describes being sexually abused should be reported unless there is clear reason to disbelieve the statement.‖ Child sexual abuse cases can be very difficult to prove largely because cases where definitive, objective evidence exists are the exception rather than the rule. The first indicators of sexual abuse may not be physical, but rather behavioral changes or abnormalities. Unfortunately, because it can be so difficult to accept that sexual abuse may be occurring, the adult may misinterpret the signals and feel that the child is merely being disobedient or insolent. The reaction to the disclosure of abuse then becomes disbelief and rejection of the child‘s statements.

Sexual abuse is usually discovered in one of two ways: Direct disclosure (e.g., the victim, victim‘s family member, or parent seeking help makes a statement) Indirect methods (e.g., someone witnesses the abuse to the child, the child contracts a sexually transmitted disease, or the child becomes pregnant) Sometimes the child may be so traumatized by sexual abuse that years pass before he or she is able to understand or talk about what happened. In these cases, adult survivors of sexual abuse may come forward for the first time in their 40s or 50s and divulge the horror of their experiences.

What should you look for if you suspect a child is being sexually abused?

Children who are sexually abused may exhibit behavioral changes, based on their age.

Children up to age three may exhibit Fear or excessive crying Vomiting Feeding problems Bowel problems Sleep disturbances Failure to thrive

Children ages two to nine may exhibit Fear of particular people, places, or activities Regression to earlier behaviors such as bed wetting or stranger anxiety Victimization of others Excessive masturbation Feelings of shame or guilt Nightmares or sleep disturbances Withdrawal from family or friends Fear of attack recurring Eating disturbances Symptoms of sexual abuse in older children and adolescents include: Depression Nightmares or sleep disturbances Poor school performance Promiscuity Substance abuse Aggression Running away from home Fear of attack recurring Eating disturbances Early pregnancy or marriage Suicidal gestures Anger about being forced into situation beyond one‘s control Pseudo-mature behaviors What you can do Protect your children. Teach your children what is appropriate sexual behavior and when to say ―no‖ if someone tries to touch sexual parts of their bodies or touch them in any way that makes them feel uncomfortable. Also, observe your children when they interact with others to see if they are hesitant or particularly uncomfortable around certain adults.

It is critical to provide adequate supervision for your children and only leave them in the care of individuals whom you deem safe.

Support child abuse victims. Children need to know that they can speak openly to a trusted adult and that they will be believed. Children who are victims of sexual abuse should always be reassured that they are not responsible for what has happened to them.

Offer encouragement for victims by supporting organizations that help victims of incest or by simply reassuring victims of sexual abuse that they should not feel shame or guilt.

It is important to understand that troubled families can be helped and that everyone can play a part in the process.

Teach others about child abuse. Help make others aware of sexual abuse by arranging for knowledgeable guest speakers to present to your organizations or groups. Encourage your local school board to establish programs to educate both teachers and students about the problem.

Report, report, report. If you suspect sexual abuse and believe a child to be in imminent danger, report it to the local child protective services agency (often called ―social services‖ or ―human services‖) in your county or state. Professionals who work with

children are required by law to report reasonable suspicion of abuse or neglect.

Furthermore, in 20 states, citizens who suspect abuse or neglect are required to report it. ―Reasonable suspicion‖ based on objective evidence, which could be firsthand observation or statements made by a parent or child, is all that is needed to report.

Remember that you may be the only person in a position to help a child who is being sexually abused.

Children and Prostitution – Introduction The stars were still out in the field, and the child prostitutes plied their trade, the only happy ones, having learned how unhappiness sticks and will not risk being traded in for a song or a balloon.

John Ashbery, And the stars were shining Background and Context of this Review In spite of international commitment to the eradication of all practices associated with the sexual exploitation of and sale and traffic in children, there is little comprehensive data on the extent, mechanisms or root causes. Research has thus far been largely exploratory, to a great extent using data generated from secondary sources, most frequently from journalism and non governmental organisations, whether these have a campaigning or welfare orientation. There is an urgent need for more systematic and global knowledge of the nature and incidence of the problem, including an understanding of the cultural, social and economic contexts in which it arises and flourishes and the development of typologies and categories that can be of use not only in developing appropriate conceptual frameworks and methods of research but also eventually in policy formulation and programme development by national and international bodies. It is also clear that there is a critical need to develop operational definitions that will capture the phenomena involved in the commercial sexual exploitation of children, so that they can be measured, monitored and combatted.

Structure of the research The research on which this review is based took place at the request of UNICEF Headquarters, New York, Children in Especially Difficult Circumstances Section as a background document for the Congress against the Commercial Sexual Exploitation of Children, held in Stockholm 25-31 August, 1996. Researchers were based at the Centre for Family Research, University of Cambridge. The researchers were thus able to take advantage of an existing structure of monthly child research seminars and the expertise of a number of children's rights, child labour and child sexual exploitation researchers working in the university as well as of the Childwatch International Indicators for Children's Rights Project, which is also based at the Centre for Family Research; The research team members were from Nepal, UK, India, West Africa, South Africa, East Africa, Latin America and the Caribbean, Thailand, Vietnam, Papua New Guinea, Netherlands, Sri Lanka, Norway, Poland and Egypt.

The review includes materials developed during three days of workshops immediately preceding the Congress Against the Commercial Sexual Exploitation of children, in

which the team members were joined by Mark Connolly of UNICEF Headquarters, New York, Children in Especially Difficult Circumstances Section.

Objectives and scope The objectives of the research were to: Map the discourse of the commercial sexual exploitation of children, showing the main ideas in operation and the main organisational and geographical contexts in which they arise; Map the data showing what data are available, their strengths and weaknesses, together with a critique of methods and assumptions; Describe the context of the production and reproduction of knowledge in this field; Discuss the implications of the current state of discourses and data and their potential for future work, particularly in the area of measurement.

In order to develop the most useful and systematic research typologies and methods, the literature review team considered in the first instance the widest possible range of reported occurrences of the sexual exploitation of and sale and traffic in children for sexual purposes. These included: prostitution pornography marriage broking sex tourism cultural practices such as devadasi adoption and fostering of older children sexual abuse in institutional settings sexual abuse of domestic servants Further major lacunae in the research process were materials from Francophone countries and information about Islamic nations.

Children and Prostitution - Part I: Literature review 1. Current Literature and its Consequences The research began with a review of available literature, organised on a regional basis.

This had two justifications. In the first place, there appears to be no universal structure of ideas informing discussions on the commercial sexual exploitation of children, which is dispersed among a variety of agencies with a number of disparate objectives and activities varying from law and advocacy to welfare, and even arguments in favour of paedophilia. In the second place, it was clear that certain aspects dominate the discourse in specific regions of the world. The research thus began with a twofold purpose, examining existing discourses for what they might provide in the way of well argued, internally-consistent structures of ideas. In this respect, it has to be made clear from the outset that by 'discourse' we mean clearly distinguishable sets of ideas, publications, speeches and other social products that inform and construct the way people think and act. Any discourse on child commercial sexual exploitation will be related to other discourses -- on childhood, sexuality, exploitation and prostitution, for example. It will

produce and reproduce these ideas in ways that tend to reinforce current structures of power and hierarchy. The first task for this review, therefore, was to examine not simply the evidence about the commercial sexual exploitation of children but, more importantly, how it is being produced, reproduced and presented.

1.1. The regional approach South East Asia, particularly Thailand and the Philippines, is the key to any discussion of the commercial sexual exploitation of children because it was the situation in this area in the past two decades that raised public awareness of the commercial sexual exploitation of children and mobilised public opinion against 'child sex tourists'. The discourse derived from these two countries has set the parameters and tone of the debate. The issues debated with respect to Thailand and the Philippines have become key to the global discussion of child prostitution to the extent that it is impossible to talk about commercial sexual exploitation without reference to them. Thailand and the Philippines have provided much of the mythology and iconography of the commercial sexual exploitation of children so that it is important to look at these two countries in detail in order to understand the origins and the boundaries of the issue.

The role of non-governmental organisations (NGOs), in particular End Child Prostitution in Asian Tourism (ECPAT), in raising awareness cannot be underestimated. It is they who first brought the issue to public attention, set the agenda and have continued to dominate the debate. Although the countries for which they mainly campaign are Thailand and the Philippines, they are also concerned with Sri Lanka, Taiwan and Korea.

Their work is widely disseminated through both the Western media and national English language press. These NGOs also publish articles widely in the popular press and ECPAT is responsible for two influential books, The Child and the Tourist (O'Grady, 1992) and The Rape of the Innocent (O'Grady, 1994), popular paperbacks designed to appeal to a non-specialist audience. Drawing on ECPAT's success, other groups now campaign against child prostitution but ECPAT remains a central information source. It is rare to find an article on child sexual exploitation in a Western newspaper that does not make reference to ECPAT. The content of this information follows predictable formulae. A typical example would be a case study of a very young girl forced or tricked into a brothel where she is obliged to service 20 customers a night for very low remuneration. In the story she will be rescued by a welfare agency and sent back to her village, only to discover that she has contracted HIV and will shortly die. It will be stated or implied that it is demand from Western men that causes her to become a prostitute. Aspects of degradation and abuse are repeatedly emphasised, as is the youth of the girl. The language used is often emotive.

For example, one report describes 'the lifeless body of an eight year old child, left in a Saigon hotel room after a night of sexual abuse' (ECPAT Newsletter, 1995), while a campaigner told the press 'I still remember vividly the tears in the eyes of the child rescued from a Bangkok brothel who told me how she begged a customer not to harm her, only to have her pleas mercilessly rejected' (Bangkok Post 6/10/93).

In the current campaigning literature, both within South East Asia and in the West, the image of child commercial sexual exploitation is of small children being sought out and exploited by Western tourists. Much press coverage now is concerned with finding and

punishing these men (and it is assumed that all sex tourists are male in this geographical region, even though there are reports of female sex tourists in other areas). Yet around the slums of the port of Klong Toey in Bangkok, men who cannot not afford a 'real' (meaning fully grown) woman will find a young girl a reasonable substitute because she is cheaper and easier to control. While this is an aspect of child prostitution that many campaigning groups in Asia would prefer to ignore, it is likely that the majority of young prostitutes are not found in the bars of Bangkok or Manila but in the brothels in the rural areas or the back streets of cities. In many local brothels in Thailand and the Philippines, younger women are said to be prized for their innocence and freshness, while girls even younger are prized for their cheapness (Ennew, 1986; Black, 1994). Even among the better-off Thai men, there is a marked preference for younger girls. A 1994 survey conducted among students, office workers, and residents of a slum area, to assess the impact of HIV on children found that the most desirable age for prostitutes is under 18: 'Many males felt that child prostitutes between 15 and 18 were more desirable than adults, but that it was wrong to sleep with younger ones (under 14)' (Sittitrai and Brown 1994, p. 4).

In other parts of South East Asia, although the discourse is not as influential on the world stage, the issue is also often constructed on the basis of the idea of the foreign male exploiter. There is less information on Vietnam, Cambodia and China but these three countries share the language of 'social evil', which is behaviour or ideas that are contrary to and damaging for national culture. Child prostitution, like AIDS, is described as a problem imported from other cultures, not always the West, or considered in terms of trafficking so that Vietnamese girls, for example, are forced across the border to Cambodia or China without any acknowledgement of indigenous prostitution. China however, adds another component to the picture. Chinese girls are said to be the victims of traffickers, especially young girls from the Yunan region (Centre for the Protection of Children's Rights, 1991) but Chinese men, rather than foreigners, are often blamed for the problem. It is also repeatedly claimed that Chinese men will pay to have penetrative sex with a virgin because this is believed to be a cure for AIDS (Muntabhorn, 1992; O'Grady, 1992; 1994). This is a common assertion in the literature worldwide, even though there is no ethnographic evidence to prove it. In Vietnam and Cambodia in particular, antiChinese feeling leads to the repetition of this notion (Thang, 1996).

In addition to the accounts of NGOs and journalists, a relatively small amount of information is produced by anthropologists and sociologists who have worked on limited research projects (Truong, 1982; 1986; 1990; Hantrakul, 1983; Muecke, 1992; Mccaughy & Hou, 1994; Care, 1994; Lie, 1995). The resulting articles and books are concerned with the cultural background, particularly religion and societal norms that can be predisposing factors in encouraging or discouraging children to become prostitutes. In this respect a major issue is the apparent religious sanction given to prostitution by Buddhist values, which stress models of duty and sacrifice for children especially for girls. One argument is that by supporting her family through prostitution a girl gains merit rather than bringing shame on herself and her family, a justification that is frequently manipulated in some areas of the literature. However, these texts are usually published in the academic Western press, with a relatively small circulation among other academics.

One problem in the NGO literature is that the academic literature seems to be largely ignored or unknown. In addition, within the mainstream, campaigning literature, certain categories become blurred. Thus it is a feature of the reporting that:

child prostitutes are often by implication only girls; pre-pubertal and post-pubertal children are often included in the numbers given for child prostitutes along with young women over the age of 18 years; numbers given for Western tourist clients are confused with numbers of Western tourists as a whole, with no account given of local clients; within the undifferentiated category of child prostitute, the origins of child prostitutes are hidden, obscuring aspects of origin, such as ethnic or socio-economic factors.

A second major geographical focus is South Asia - India, Nepal, Sri Lanka and, to a lesser extent, Bangladesh and Pakistan. This has three components, the girl child, religious prostitution and trafficking for sexual purposes. The idea of the girl child arose largely through Indian attempts to assign a special space in social philosophy and policy to girls (Williams, 1991). 1990 was named The Year of the Girl Child by the South Asian Association for Regional Cooperation (SAARC) and the UNICEF India Office. Two main themes of the year were prevention of child marriages and rehabilitation of child prostitutes. One Indian woman's comment on the material published in the Year of the Girl Child shows the reproductive nature of the information purveyed in the resulting 'spurt of publications': Many of the papers are clones of earlier ones. The self-perpetuations occur through citations being made circular, until a body of knowledge is assumed to have been created.

The sum and substance of much of this writing concern the low status of the girl, her limited opportunities for education and the gender bias in the home. The television screen has also sensitized people to the plight of the girl child as a drudge (Aanandalakshmi, 1991, p. 29).

This was not the intention of 'girl child' campaigners such as Sheela Barse, who makes it clear that she is opposed to the 'feminist method of carving out the female persons' group out of the human race and examining it in isolation, on the presumption that females are always wronged' (Barse, 1991, p. 99). Barse states that it is more important to establish that girlhood cannot be the entire province either of womanhood in the women's rights movement, or of childhood in the children's rights movement.

Nevertheless, the notion of the 'girl child' has been reified, as if there is something essential about all female children regardless of wealth or ethnicity, something that makes them more vulnerable than boys in general. This focuses on vulnerability to sexual violation, early marriage, unplanned teenage pregnancy and is a new manifestation of the old control over women's sexuality and fertility. It masquerades as concern for their vulnerability but actually implies that females cannot control their own sexuality, which should consequently be under male control. This is reflected in three approaches to development aid programming for girls: The link between female education and child survival; The emphasis on the employment of girls as prostitutes, which is a minor exploiter of girls compared to agriculture, domestic service and manufacture; The immense silence about the specificity of certain kinds of exploitation that are exclusive to boys.

In India and in Nepal the 'girl child' discourse focuses on religious prostitution (of which

devadasi is the best known form) and trafficking in children, while in Bangladesh, the rape of pre-pubertal girls hired as domestic servants is an important theme (Blanchet, 1996, p. 119) . In Pakistan, Baluchistan and the North West Frontier provinces of India, much of the literature on the girl child is legal (see for example Jahangir, 1986). A further concern is the fate of the daughters of prostitutes who on account of social opprobrium are said to be forced into prostitution (Patkar, 1991).

Religious prostitution is practised in various parts of India and Nepal. Devadasi cults are found in Southern India and also practised in other parts of the country such as Uttar Pradesh and Orissa. They derive customary sanction from oppressive upper-caste temple traditions. Pre-pubertal girls, aged between five and nine years, from poor, low-caste homes, are dedicated by an initiation rite to the deity in the local temple during full moon.

She is then employed by the temple priest. Sometimes, even before menarche, she is auctioned for her virginity; the deflowering ceremony known as udilumbuvadu becomes the privilege of the highest bidder. The market value of a girl falls after she attains puberty, when she is said to have no recourse other than prostitution. Yellama is represented as the principal goddess who is worshipped but, as recent research has shown, the practice of devadasi is prevalent in many other temple towns and other deities such as Meenakshi, Jagannath and Murugan are also propitiated. Religious prostitution is known by different names such as venkatasani, jogini, nailis, muralis and theradiyan (Bahni, 1989; Marglin, 1985; Mowli, 1992; Story, 1987).

In Nepal, particularly the western parts, religious prostitution known as badini and jhuma is also practised. Although little is known about these practices, they do not seem to vary significantly from devdasi. However, the main sexual exploitation issue in Nepal is the traffic with India, the open border between the two countries making it difficult to monitor (Human Rights Watch, 1995; O'Dea, 1993; Rozario, 1988). It is also stated that, because of corruption, official assistance is given to the sale and the trafficking of young girl (Agroforestry Report, 1990). In most accounts Bombay is given as the main destination. The international trade routes most frequently mentioned are from Nepal and Bangladesh to India, and from India and Pakistan to the Middle-Eastern countries.

In sharp contrast to the emphasis on the 'girl child' in the rest of South Asia, in Sri Lanka the discourse revolves around boys and sex tourism. ECPAT and other advocacy organisations have influenced the discourse here, claiming that male western paedophiles are targeting Sri Lanka because of the availability of boys. For instance, it is argued that, despite the civil war, the number of tourists who visited Sri Lanka increased from 102,000 in 1989 to 169, 000 in 1996, although of course this does not necessarily mean that all tourists are male, let alone sex tourists. According to the literature, the South West coast, Negombo and Hikkawuda are the main destination points. They are close to the beach and some hotels assist paedophiles in procuring boys mostly aged between six and 15 years, although most boy prostitutes in Sri Lanka appear tend to work independently of either brothels or pimps (Bond,1981; Goonesekere & Abeyratne, 1986; Seneviratne, 1991). Although there is evidence of sex tourism in Sri Lanka, the picture is not clear because of the tendency to reproduce information. One case in point is the frequent reference to the role of Spartacus guides, which provide male homosexual tourists with up to date information about the availability of sexual contacts in most countries, and were notorious in the 1980s, particularly with respect to both Sri Lanka and the Philippines, for giving locations where boy prostitutes could be encountered. Despite the

fact that the magazine no longer explicitly refers to children, and the then publisher of Spartacus has died, the magazine's role in the sex tourism business is constantly reiterated in popular literature on the commercial sexual exploitation of Sri Lankan boys as if no changes had occurred.

A third major geographical region with a characteristic discourse that influences global debates might be designated the Anglophone West and consists the United States, Canada, Australia and Western Europe. From the late nineteenth to early twentieth century there was considerable public concern about the 'White Slave Trade'. Many aspects of this earlier discourse are clearly visible in current debates. Nevertheless, modern concern about what is always referred to in the academic literature as 'juvenile' rather than 'child' prostitution resurfaced in the late 1960s alongside the issue of runaway children. Journalists were quick to use labels like baby-pros or, with respect to pornography, 'kiddie porn'. Then, the concern was for children who joined the 'hippie' culture of America's big cities, in particular San Francisco and New York (Deisher et al, 1969; Weisberg, 1985). Britain and Canada, where many of the same social problems as America were reported, but a few years later, experienced similar concerns in the early to mid 1970s (Sereny, 1984; Donovan, 1992).

The earliest indications of a juvenile prostitution 'problem' can be found in the mass media, but academics were also involved from the very beginning (see for example Deisher et al, 1969). In addition, since the late 1960s there have been a number of moral panics about child abuse in North America and Western Europe. Thus interest in juvenile prostitution has come in waves, eclipsed at times, by concerns about 'battered children' or more recently 'satanic' or 'ritual' abuse (La Fontaine, 1990; Jenkins, 1992; Joseph, 1995).

Thus, there have been few long term studies of juvenile prostitutes, but rather a flurry of papers and articles at times when interest in the issue is high. Currently, concern is focused on young male prostitutes, because they are seen as vectors for the spread of HIV and research into their lives is conducted along bio-medical models that are concerned with certain areas of behaviour and particular attitudes (National Consultation on Adolescent Prostitution, 1984; Pleak et al, 1990; Snell, 1995). Both academics and journalists have remained interested in the issue of delinquency and deviancy psychology, which it is assumed many young prostitutes share but, again, this is linked to bio-medical models with particular perspectives and limited range (Baizerman et al 1979; Davidson & Loken 1987). Western journalists have a major role in disseminating information about the commercial sexual exploitation of children. Articles on young male prostitutes, often referred to as 'rent boys' in the English language press, as well as young female prostitutes, remain an occasional feature of many newspapers and women's magazines and are presented as campaigning or investigative journalism, while revealing prurient details designed to shock and sensationalise. Popular books written on the issue of child prostitution and pornography are mostly written by journalists with a stated mission to reveal the truth. Playlands (Lloyd, 1977) and Child Pornography (Tate, 1991), two influential books on the subject were both written by journalists and one of the most famous books, H: Autobiography of a Child Prostitute and Heroin Addict, was written in collaboration with journalists from the German newspaper, Stern ('F', 1981).

Due to the ease of access and a history of journalistic interest, the material is very heavily urban based, with San Francisco (Weisberg, 1985), New York (Allsebrook & Swift, 1989), London (Sawyer, 1988), Birmingham (Donovan, 1992), Melbourne (Muntabhorn

1993),Amsterdam (Tate, 1991; Donovan, 1992) and Berlin ('F', 1981) over-represented.

Other cities with known groups of child prostitutes, such as Dallas, Washington DC, Sydney, and in the United Kingdom, Brighton and Cardiff, are not discussed in nearly the same detail. In the USA especially, there are certain centres of expertise on child prostitution such as Huckleberry House in San Francisco and Covenant House in New York, with long campaigning and advocacy histories, so that it can be easier to gain access to both children and experts in the 'treatment' of abused children through these types of organisation. In Canada, particular emphasis has been placed on Ontario, not because of the higher concentration of juvenile prostitutes there, but because the Queen's University Social Program Evaluation Group has taken particular interest in the problems facing homeless and prostitute youth (Radford et al, 1989).

In the USA, the source of a good deal of the literature is part of the university sector that specialises in 'objective' non-judgmental studies of AIDS awareness and/or delinquent psychology (Nightingale n.d.; Baizerman et al 1979; Davidson & Loken 1987; Widom and Ames, 1994). In the USA much emphasis is placed on the 'runaway' phenomenon, first noted in the 1960s and now closely tied to the prostitution discourse (Lloyd, 1977; Sereny, 1984; Schaffer & Deblassie, 1984). The current prostitution problem continues to be seen as having its roots in the alternative culture movements of the late 1960s, with a special emphasis on the hippie communities in San Francisco (Weisberg 1985). It is claimed that many children ran way to join these communes but, on leaving them, found themselves unable to make any money other than through prostitution (Schaffer & Deblassie, 1984).

In Canada, the emphasis has been on AIDS prevention and protecting children for their own good and that of society (Lowman, 1987). It is notable that the Canadian literature concentrates on Canadians of European descent (National Consultation on Adolescent Prostitution, 1984). Native Canadians are seldom mentioned, despite the fact that they tend to show higher-than-average rates of what are regarded as predisposing factors such as coming from broken homes with a history of drug or alcohol use, or having been placed in state institutional care. Yet in the rest of the literature, the multiple problems that lead children into prostitution are emphasised (Lowman, 1987). This in direct contrast to United States research, where race or ethnicity are especially important markers. No study of juvenile prostitutes in the USA is complete without a breakdown of prostitutes' racial backgrounds and a discussion of what this might mean (Weisberg, 1985; Gibsonainyette et al, 1988).

In the United Kingdom, the stress is on boy prostitutes. 'Rent boys' have become a staple of the British media and even the more serious academic studies, have tended to concentrate more on boys than on girls, despite the smaller numbers of boy prostitutes.

The West Midland Police, which covers Birmingham where there is a major red light district, commissioned a report on young male prostitutes and came up with a report based on a sample group of less than 20 (Donovan, 1992). While the police have concentrated on boy prostitutes, the advocacy groups discuss young children of both sexes, highlighting the problems they experience when they leave institutional care and the lack of support they are given. NGOs such as the Children's Society in the United Kingdom have published papers and articles suggesting that it is both lack of institutional care and the brutalising effect that many children's homes have on their inmates that

contribute to their recourse to prostitution when they are discharged or escape (Lee & O'Brien, 1995).

A further contributory factor stressed in Western literature is the role of broken homes (Finkelhor, 1979; Sereny, 1984; Weisberg, 1985; Lowman, 1987; Gibsonainyette et al, 1988; Campagna & Poffenberger 1988; Allsebrook & Swift, 1989; Widom and Ames, 1994). Many of the juveniles surveyed have suffered sexual and physical abuse within the family and many are runaways from abusive situations (Finkelhor, 1979; Weisberg, 1985; Lowman, 1987; Snell, 1995). In Britain, the emphasis is placed more on children who have been in state institutional care rather than those from abusive families, yet the literature remains framed within the discourse on dysfunctional families (Lee & O'Brien, 1995). Throughout almost all the books and articles on the subject in the West, runs the theme that these children are outside society, and that reasons have to be found for their deviancy. Their life histories are presented in terms of theories of deviancy. There is a notable absence of views of the children themselves or, when literature does include their opinions, this is often countered by an authorial voice giving reasons why they are wrong.

The particular emphasis on boy prostitutes is related to a concern with the mental health of sexually exploited children in general. In the case of boys, there is considerable discussion about whether these boys are homosexual or 'really' heterosexuals whose commercial sexual activities are focused on financial gain. One concern frequently expressed is that heterosexual boys with homosexual clients may become gay by being prostitutes, resulting in a good deal of discussion about exactly what boys will let there partners do to them and whether they take an 'active' or 'passive' role in sexual activities.

A parallel debate is entirely absent in the literature on female prostitution. Nor is there any information about young men who have female clients (Lloyd, 1977; Donovan, 1994). The only similar discussion in literature on female prostitution is whether or not girl prostitutes can become good mothers. The underlying implication is that, whether they are boys or girls, juvenile prostitutes will not have learned appropriate gender roles.

Literature on the poor psychological health of young sex workers also seems to take for granted they suffer from low self-esteem, suicidal tendencies and the inability to form relationships, generally without exploring scientifically the causal relationships involved (Finkelhor, 1979; Baizerman et al, 1979; National Consultation on Adolescent Prostitution, 1984; Davidson & Loken, 1987). The assumption is that low self-esteem results from prostitution, rather than that some juveniles become prostitutes because their self-esteem is low. One dissenting voice can be heard in the published words of a woman sex worker, I also find it very interesting that [the authorities] look at the child prostitute, and they say the problem is prostitution. They forget the problems of theft, drugs, or just general exploitation of youth on the street... It's bordering on criminal for officials to try and say that prostitution is responsible for this....Prostitution is a symptom of a greater problem that these children have experienced that put them on the street in the first place (Bell, 1987, p. 26).

Many texts stress degrading aspects of child prostitution, including being forced into being prostitutes, raped by pimps, terrorised by gang members and becoming dependent on drugs (Sawyer, 1988; Tate, 1991). There is constant reference to the apparently inevitable links between prostitution and heroin use. Yet there is little information about

the long-term effects in adulthood because there is no systematic research on the results of prostitution in childhood, simply the impression from reiterated assumptions that juvenile prostitutes end up either dead or living worthless and useless lives (Campagna & Poffenberger, 1988). Some accounts of the lives of boy prostitutes suggest that the average length of time as a prostitute is between two and seven years (Donovan, 1986; Snell 1995) but longitudinal studies seem not to be carried out.

A further concern for those writing about young girl prostitutes is the part played by males who live off their earnings, with far more attention paid to this than to the role of female adult exploiters. Pimps are almost always portrayed as vicious and evil psychopaths, and the fact that many girls speak fondly of their 'protectors' is explained as co-dependency. Even though not all prostitutes work for pimps and some men living with prostitutes are part time prostitutes themselves, the overwhelming impression given of pimps is that they are older, manipulative men (Lowman, 1987). The assumption that all girl prostitutes must be controlled in this way is, of course, a reflection of overall societal assumptions about the vulnerability of women and the need to police their sexuality.

These three discourses, from South East and South Asia and the West represent the majority of studies on the commercial sexual exploitation of children. In each case the discourse on children and prostitution is constructed within structures of ideas about society, childhood, gender and sexuality. In South East Asia the literature on children and prostitution tends to dominate current discussion of childhood. There is no developed literature on children and the social phenomenon of childhood, but a long tradition of constructing gender and sexuality on the basis of an image of passive, childlike women as well as defining cultural norms in opposition to external or foreign evils. The current debates about female children in South Asia, subsumed in the incorrect, essentialist notion of the 'girl child' have been providing a trenchant feminist critique of the unequal status of women in society. This stresses the more vulnerable aspects of female sexuality and thus not only emphasises the oppressive aspects of tradition, through concentrating on the image of girl children as temple prostitutes, but also pivots on the notion of women and girls as objects, as in trafficking. Western discourses on the commercial sexual exploitation of children, on the other hand, are more individualistic and thus concentrate on the deviant behaviour and mental health of individual cases, as well as a concern with the causal relationship between deviant, abusive families and prostitution, showing overall societal concerns only in with respect to the proper assimilation of gender roles.

In contrast, the literature on child sexual exploitation in Africa and in Latin America is far less developed and cohesive. In both areas, the literature on childhood has different emphases.

In so far as they exist at all, child studies in Africa, focus on child health and construct the idea of children as victims, without any particular focus on commercial sexual exploitation of children. Indeed, it is often claimed that this term cannot be applied in most African contexts because the distinction between sexual abuse, sexual exploitation and commercial sexual exploitation cannot be clearly drawn, not only in analytical terms within studies, but also within cultural understandings.

Africa's diversity makes the definition of childhood in itself a research issue. The African social science community, includes very few specialists on children's issues outside

traditional concerns with health, education and psychology. The main themes in academic research on children in Africa carried out by Western researchers have traditionally been socialisation and initiation or puberty rites. In the nexus between academia and programme makers, a good deal of more recent research has concentrated on medical anthropology, with an interest in traditional health practices in child care and nutrition.

African social science researchers with an interest in child studies now tend to focus on the broad area of child abuse, although, as will be argued below the definition has a particularly African texture. A further major interest in all circles, in research largely dominated by Western researchers, is HIV/AIDS. In the African context this concerns children rather more than it does in other regions of the world, partly because the pattern of infection has long been recognised to be heterosexual, thus affecting children through vertical transmission; partly because of the existence of a relatively large number of 'AIDS orphans', principally in East Africa. A number of mostly Western psychologists have also been studying children affected by armed conflict, concentrating on aspects of traumatisation and victimisation (see for example, Dodge & Raundalen, 1987).

The considerable upheavals due to wars, conflicts, natural and man-made disasters, together with mounting impoverishment among African populations, increasingly affect African children. Yet very few socio economic studies of these effects have taken place.

Research on children appears to be fragmented and there are few outlets for publication of research on children's issues. Two recent annotated bibliographies of studies of African children and childhood provide no references to published work on sexual abuse, much less on commercial sexual exploitation of children (Gueye 1995; Ross 1995).

Within this context, the topic of the sexual exploitation of children is part of an overall emphasis on children as victims, fitting within the concerns of a relatively-well developed discourse on child abuse and neglect. This latter is largely the outcome of the activities of Association for Nation Wide Action for Prevention and Protection Against Child Abuse and Neglect (ANPPCAN), the African member of the International Society for the Prevention of Child Abuse and Neglect. Based in Nairobi and with national chapters in many African countries (largely Anglophone), ANPPCAN has been active in promoting research in this area as well as advocacy for children's protection rights.

It has to be said, however, that the concept of 'abuse' used by ANPPCAN, and entering the African literature, is not structured in the same way as used in the general Western literature, which can lead to confusion between researchers from different regions. The presentation given by an ANPPCAN functionary in Nairobi cited by Dallape (1988, pp.

104-8) makes this very clear. Child abuse is seen as a feature of other social phenomena or situations, rather than as a phenomenon in its own right: 'The following are the areas where child abuse is commonly evidenced: Child labour Children in prison Handicapped children Battering of children Children under psychological stress Abandoned children Children in war situations.' (ibid, p. 104)

Sexual abuse and/or exploitation are mentioned under child labour, prisons, psychological stress and abandonment in this list. The problems this presents for arriving at even an operational definition for sexual exploitation are clear. This is possibly why, in another ANPPCAN publication, a study of child agricultural labourers (male) and prostitutes (female) makes it clear that by 'prostitute' is meant any unmarried girl who has sexual intercourse (Peltzer, n/d).

The field of sexual abuse in Africa cannot be separated from the literature of largelyNorthern, feminist campaigners against female excision and infibulation (see the bibliography by Passmore Sanderson, 1986). This is likewise implicated in the anthropological literature on initiation (see La Fontaine, 1985, for an over-view).

Although campaigners sometimes like to include these debates within the general field of sexual exploitation of children, this is conceptual nonsense. It does not advance the purposes of advocacy to obscure issues by merging disparate concerns with different root causes.

The study of child sexual exploitation in Africa cannot be separated conceptually from constructions of sexuality and sexual morality. It is notable that the literature shows a particularly marked distinction not only between the behaviours expected of boys and girls, but also the expressed attitudes towards sexual morality of both groups. A further focus of study in this area is the migration nexus, together with the contrasts drawn between rural morality and town morality, and between generations. This is also situated within the overall massive population movements within the continent in the face of natural disaster, war and impoverishment. Nevertheless, although there is considerable anecdotal evidence of child sexual exploitation resulting from these types of situation in which children are rendered particularly vulnerable to the misuse of adult power, hard facts and properly-conducted research are difficult to come by.

In terms of academic discourse, or even within NGO and IGO literature, the topic of child sexual exploitation in Sub-Saharan Africa, consists of an almost total vacuum, in which dispersed and disconnected items of journalistic and project-oriented text are floating aimlessly. The vast majority of the latter material is unpublished.

Although there is a considerable body of literature on children in Latin America it is dominated by the discourse on so called 'street children' (Rizzini, 1996). It is worth noting that the Latin American model of street children has tended to dominate work in this area in all developing countries, largely because the ideas (but not the texts) have been disseminated by Western aid agencies (Ennew, 1996). Children who live on the street often engage in sexual relationships, with each other and in the course of prostitution, which may be occasional or virtually full time for both boys and girls. Thus the literature on the commercial sexual exploitation of children often seems to be merged with that on street children. The street children discourse in Brazil and Colombia in particular is characterised by ambivalence (Aptekar, 1988). Street children are worthy of pity if young, and feared if older adolescents. In either case they are often stigmatised and the literature, frequently dominated by writers from outside the region, is often lurid and lacking in any kind of academic rigour (see for example Meunier, 1977; Agnelli, 1986; Bridel & Collomp, 1986; Dimenstein, 1991). The HIV/AIDS complex has largely overwhelmed the literature on sexuality since the late 1980s, together with a specific interest in street girls in Brazil, due partly to the influence of two charismatic female

project directors. The literature on this issue is on the one hand largely tied to project publicity and on the other to medical discourses.

More recently, psychologists in several Latin American countries have shown an interest in studying child sexual abuse, which now constitutes a proper field of study and is resulting in some interesting publications. In general, but to a less hysterical extent, Latin America is going through the same kind of discovery of child sexual abuse that occurred in the USA and Europe in the late 1980s.

Prostitution itself is enmeshed in a series of ideas about men and women. These include the idea that men's sexual appetites are uncontrollable and have to be satisfied by women who enjoy sex (prostitutes) rather than by 'good women' (mothers, daughters, wives) who do not enjoy sex. This is related to ideas of honour and family. A man's honour is tied up in the chastity or purity of the females in his family, wives, sisters and daughters. In its most macho form, masculinity entails protecting the honour of the women in your own family while proving your virility by manifestations of virility (see the papers in Pescatello, 1978). This means that female prostitutes perform an important role with respect to families. Both journalism and research tend to reproduce the same historical accounts that justify the existence of prostitution as a necessary social evil that protects the purity of mothers, daughters and wives and thus ensures the continuing existence of the family (Arnold, 1978). However, it should be noted that this role is exclusive to female prostitutes, many of whom, according to most accounts, begin this work around the age of 15 years (see for example Cairo, 1967; Alves-Milho, 1977). As the majority of street children are boys, the prostitution in which they are engaged belongs within an entirely different complex of social ideas, which does not seem to have been researched in depth. The overwhelming majority of studies of children and prostitution in Latin America is concerned with female children.

There are two resounding absences within the literature on the commercial sexual exploitation of children on the world scene: Eastern Europe and Arab/Islamic countries.

However these absences occur for different reasons. Such literature as does exist in Islamic societies is dominated by legal considerations, which is to a certain extent replacing a culture of denial. Whereas in the past the tendency was to comment that child abuse and exploitation is forbidden by the Koran and therefore does not take place, there now seems to be evidence of considerable reflection on children's issues in general and exploitation and abuse in particular. This remains within religious paradigms, but is adding considerably to understanding of the attitudes of Islam to both children and sexuality (see for example Risaluddin, 1996) In so far as any link might be said to exist between the literature on child sexual exploitation in Arab countries and Eastern Europe and the former Soviet Union is the dominance of lurid journalism on the topic of trafficking in girls and women. There is an established link in sex trafficking between Arabs and South Asian countries such as India and Bangladesh. One estimate suggests that 200,000 girls from Bangladesh were taken against their will to work in Arab brothels (International Children's Rights Monitor 5 (23); 10 (1 2)). However the data are anecdotal.

With the sudden economic and social changes of 1989 families in all the former socialist countries of Eastern Europe and the former Soviet Union have been faced with the collapse of welfare systems and the burden of child support has largely shifted to families, many of which are undergoing severe hardship. Children have been particularly

badly affected and accounts by journalists suggest that there has been a sharp increase in child sex exploitation (see for example June 21, 1993, Time). The evidence is extremely patchy and usually sensational, telling for example of the longest in the world situated between Berlin and Prague called the 'Highway of Cheap Love' managed by the 'Chechen Boys,' where 'kids are sold like a kilo of bread'.

Press view of the commercial sexual exploitation of children worldwide : AMSTERDAM, Mar 26 (IPS) - Beneath New York's endlessly high buildings, in the glare of the neon lights and fancy storefronts which carve that city's image, is a hauntingly sombre reality: thousands of children selling their bodies to survive.

Halfway across the globe, in Kenya, a police raid in a Nairobi hotel in January found West African and Japanese men frolicking with nine girls aged between 12 and 16. In Sierra Leone, a nation ravaged by conflict, few tourists come to visit these days. Those who do find themselves being solicited by legions of young victims of civil war and poverty willing to provide sex for the price of a meal.

Economic need and the insatiable appetite of a new breed of tourists are pushing downwards the age of participants in the flesh trade. No longer is sex an 'attraction' promoted through subtle messages: it has moved up front, and children play a conspicuous role.

1.2. The nature of evidence in current literature The single most important factor uniting the literature on the commercial sexual exploitation of children is the way in which information is managed. There are few examples of rigorous research or of data presented within a comprehensible cultural context. Rare examples of good research practice do exist, such as the study of girl prostitutes in Costa Rica carried out by Tatiana Treguear and Carmen Carro in which both methodology and method are laid bare and it is possible to judge the quality of the data by the way they are presented (Treguear & Carro, 1994), and the exploration of cultural understandings of child abuse in Zimbabwe, carried out by a team of researchers working with participatory methods (Loewenson & Chikamba, 1994). But these are exceptions. In general terms, the available global discourse on this theme is characterised by a poor understanding and use of quantitative information, lack of attention to research techniques, the reproduction of myths and unsubstantiated facts, as well as the use of assumptions and campaigning imperatives in place of established bodies of theory. If, as is frequently stated, children indeed deserve the best we (adults) have to give, they are not receiving their just deserts in a field in which they are particularly vulnerable. Or, as has been said with respect to the discourse on street children and its effects, it is not acceptable that international organisations, policy makers, social institutions and individuals who feel entitled to intervene in the lives of children with problems, do so on the basis of obviously unclear and arbitrary knowledge about the reality of these children's lives.

(Glauser, 1990, p. 144).

Perhaps the most serious of these aspects is the way in which numerical data are manipulated and reproduced. International interest in children gained momentum in the United National International Year of the Child (1979) and was given further impetus through the adoption and entering into force of the United Nations Convention on the Rights of the Child (1989/90) yet, in the space of nearly two decades, little has changed

in terms of the way research is carried out and used by child welfare and advocacy organisations, despite considerable advances in theories of childhood and methods of researching children's issues within the academic community. What this amounts to is that the numbers provided for all groups of children in need of special care and protection have tended to remain the same, based on guestimates rather than research. Whereas guestimates have their place in the early stages of research, provided that they are based on sound reasoning, the role they should play is that of baseline hypotheses, to be proved or disproved so that the true scale of a problem can be understood and children protected using programmes grounded in a real understanding of their situation. In the case of child sexual exploitation, however, guestimates have become fact, partly because they have become inscribed in rhetorical discourses aimed to raise awareness. The objective appears to be to heighten public and policy interest in the issue by stressing the scale of the problem. Yet this is neither ethically acceptable nor logical. In the first place, as stated as far back as 1983 by the United Nations Special Rapporteur on the Suppression of the Traffic in Persons and the Exploitation of the Prostitution of Others, 'The important point is not the scale of the problem but its degree of seriousness as a violation of the fundamental rights of the human person' (Fernand-Laurent, 1983, p. 14). In the second place, the normal practice within the literature of providing a raw number, such as 'There are 1 million sexually abused children in Asia' (Narvesen, 1989), does not actually provide an idea of scale. To do this would require some knowledge of source, time, relative location and proportion. A correct statement of scale would be something like 'According to estimates made by A on the basis of B type of calculation, in 1996 there are 1 million sexually abused children (under 18 years of age) in Asia. This is C% more than the calculation made on the same basis in 1994, D% more than estimated by the same method in Africa in the same year, and represents E% of the total population of Asian children in this age group.' Scale can only be understood in these terms. Moreover it is a poor excuse for adult society to claim that, after nearly two decades and with information technology that can provide minute details of weather, money markets and economic cycles for every country in the world, to claim that guestimates are the only data available. Some relevant data do exist and more could be collected. We have the technology. But agencies 'who feel entitled to intervene in the lives of children' fail to use it.

The current situation on the quantification of the commercial sexual exploitation of children is characterised not only by widely differing figures but also by very different definitions. Data on children are frequently hidden within and confused with data on adults. One problem is caused by the different age groupings used. In many studies the juvenile population is defined as under 21, rather than 18, years (see for example Lowman, 1987). Combined with the vague bases for guestimation, this makes it difficult to judge the scale of commercial sexual exploitation of children even within a single national context. In the case of the USA, for example, one study provides an extraordinarily broad estimate of between 100,000 and 300,000 of young prostitutes (cited elsewhere as 'child prostitutes') on the basis of a sample of people aged 14 to 34, with a mean age of 22 years (Snell, 1995). Another study, of the USA, suggested that there are 2,400,000 child prostitutes and estimated a total of 100,000,000 sexually abused children in the world, but did not distinguish adequately between the categories of child prostitute and sexually abused children (Joseph, 1995). Gibsonainyette and colleagues

estimated that the number of prostitutes under the age of 18 in the USA in the 1980s and also stated that there had been a 242% increase in underage prostitution between 1967 and 1976 (Gibsonainyette et al, 1988). Campagna and Poffenberger claimed in the same year that 1.2 million children were being sexually exploited in the USA but did not define sexual exploitation (Campagna & Poffenberger, 1988 ). Combining these figures results in a highly confusing picture (Table 1; see also Box 2).

Table 1: (Gu)Estimates of child abuse and prostitution in the USA, various sources Year Estimate Definition Age Source 1967 247933

child prostitutes under 18?

Gibsonainyette et al, 1988

1976 600000

child prostitutes under 18

Gibsonainyette et al, 1988

1977 600000

boy and girl prostitutes

Densen-Gerber (Lloyd)

1988? 1200000

abused children ?

1995? 100,000 to 300,000

young prostitutes

1995? 2400000

child prostitutes ?

?

Campagna & Poffenberger

14-34? Snell Joseph 1995

Creation of a statistic ...even the best estimates of the numbers of juvenile prostitutes may have poor statistical foundation. Nevertheless, because they are the only figures available, they enter official records and become facts which may be quoted confidently by anyone. One example of this is the figure of one million child prostitutes in the United States, which was given in evidence to the House of Representatives in 1977. The expert in question was Dr Judianne Densen Gerber, Director of the Odyssey Institute which operates rehabilitation programmes for children with various kinds of deviancy problem. The figure was a guestimate based on the number of 300,000 boys prostitutes given in what Dr DensenGerber refers to as 'the research of Robin Lloyd'. Because she assumed that there would indubitably be more girl prostitutes, she added 600,000 to this figure without providing any evidence to support her claim. Indeed, historical evidence about man-boy preferences, and some figures given by other authorities in other countries, might contradict her assumption. But the real problem is that Lloyd is not a social scientist working on any established methodology for gathering statistical information, but a journalist researching a book for the popular market. Here is his own account of how he arrived at the figure Dr Densen-Gerber quoted: In the early stages of research for this book, I approached police officers and leaders of the gay community with a working figure of 300,000 boy prostitutes in the United States alone. Deputy District Attorney James Grodin, in Los Angeles said, 'You wont get any

argument from this officer for that figure'. During a television interview I offered the same figure to Morris Kight, the West Coast gay activist. Said Kight, 'It might well be double that amount'.

But what Kight and Grodin were agreeing to was -- at its best -- a gut hunch. (Lloyd 1979, p. 202).

None of these experts ever consider the alternative premise that the figure 'might well be' considerably less.

Similar difficulties occur in other parts of the world, both the figures themselves and and the range of the guestimate tend to be large (Table 2). As many figures for child Table 2: (Gu)Estimates of child prostitution in the Philippines (various sources) Date of Number Source publication not given

3,000 to 20,000 Gearin in Manila

1993

100000

ECPAT

n/d

20000

Salenlahi

1989

30000

Moorehead

1995

60000

Sachs

prostitution are based on either female or male populations, depending on the discourse involved, and the gender of the 'category' is not always made explicit, it would be difficult to compare information from different countries. Thus, given that the emphasis in India is on the 'girl-child' and in Sri Lanka on boy prostitutes, juxtaposition of figures from these two countries would be fairly meaningless.

One characteristic of the manipulation of numbers is that they are always large and always said to be 'increasing', despite the fact that the same numbers are repeated year on year, a manipulative technique that would not work with company accounts. Sources are rarely provided, the credibility of an organisation being sufficient verification (Figure 1).

Figure 1 This map appears in a widely distributed report on the activities of ECPAT and has been reproduced in various publications. The dates of the estimates are not provided, nor are the definitions and age groupings standardised. The sole source of information cited is the Government of Vietnam, presumably because this provides extra credibility.

Source: The international campaign to en child prostitution in Asian tourism, special edition of ECPAT Newsletter, NO. 9, July 1993.

Even greater difficulties become apparent in attempts to disaggregate data on child prostitutes by ethnicity. Most studies give percentages of whites, Asians, AfroCaribbeans and so forth but with no commentary and little additional information. The reader is not told what is meant by the category 'White'. Does this include Hispanics or not? Are Chinese and other East Asians placed in a different category to South Asians or are they all simply classed as Asian? If the reader is told that, for example, 60% of a sample of prostitutes are 'Non-white' this might imply (especially in a journalistic account) that Caucasians are under-represented. Yet, if the 60% were disaggregated one might discover that 15% were Afro-Caribbeans, 15% South East Asian, 15% Latino and 15% South Asian, which would mean that Caucasians were over represented in comparison with other designated 'racial' groupings. Blurred categories provide perfect fodder for stigmatisation, particularly if the discourse involved focuses on ethnicity without taking into account other markers of social status and bases of exploitation, such as age, gender and socio-economic class (Ennew, 1986, pp. 9-10).

Reproduction and repetition of myths Numbers are an important part of any campaign because they endow it with urgency and a overwhelming sense of importance. Campaigns, journalism and academic literature tend to use the same unreliable statistics, either without reference to the source or citing one of the texts that have attained credibility. A case in point is Narvesen, The Sexual Exploitation of Children in Developing Countries (1989), which claims that there are one million sexually exploited children in Asia, although other texts take this to mean one million prostitutes. It is normal for the highest figures to be given. They are always 'increasing', usually at an 'alarming' rate, reaching 'epidemic' proportions. Yet no reason is given for this except for the 'fact' that customers are turning to ever younger prostitutes because they believe them to be AIDS free. There is no evidence either way for this claim, but it has been endlessly repeated (Jubilee Action Trust, n.d.; Lee-Wright, 1990; Muntabhorn, 1992; O'Grady, 1992; 1994) until it has become a 'fact'. This reproduction of inauthentic or innacurate information is a characteristic of the literature on the commercial sexual exploitation of children. Even before the AIDS pandemic, the literature on child prostitution from all parts of the world repeated, without evidence, that

child prostitutes were sought after because they were believed to be free of sexually transmitted diseases (STDs), including the apparently worldwide belief that penetrative sex with a virgin is a cure. Other commonly repeated myths include female customers injecting boys' penises (sometimes with an unspecified substance, sometimes with a variety of named but unlikely liquids) in order to produce or maintain erections. The evidence for these myths is may simply not be provided, or given as a citation to another text that itself provides no evidence, or take the form of hearsay evidence, the unverified statement of someone who knows somebody who knows these things are true.

Many of these myths are employed in order to demonise the clients of child prostitutes, as if the violation of children's rights involved were not sufficient condemnation. At other times myths are used as distancing devices as part of the construction of the client as outside the society in question, a foreigner, or a tourist. Unresolved question raised by this literature review include how to explain the conditions of production of these myths.

What explains the prevalence of particular myths and figures and the dominance of oral over written discourse in this area? What are the 'politics of hype' that result in repetitive, shocking (and titillating) information in this field?

Tourism, xenophobia, construction of the other Just as ECPAT dominates the overall discourse, so the single idea of sex tourism, with which ECPAT is associated, captures media and other attention (Lorayes n.d., Salinlahi et al, n.d; Asia Partnership for Human Development, 1985; 1992; Miralao et al, 1990; Lee, 1991; Hall, 1992; Anglican Synod of Australia, 1993; O'Grady, 1992; 1994). ECPAT began as a sub division of ECTWT (Ecumenical Coalition on Third World Tourism) apparently perceiving child prostitution as an inevitable consequence of tourism (ECTWT, 1983; 1990). One of the leading anti-tourism campaigners once wrote "too much tourism is the rape of culture, the environment, women and children" (Srisang et al, n.d). The success of the campaigns now apparent in the growing interest in sex tourism in other parts of the world, but is particularly acute in Asia, where it often takes on an expressly anti-Japanese tone. ECPAT's original statement of intent makes this clear: The conduct of the tourists destroys all attempts to heal the wounds incurred during the Second World War. We would prefer to forget Japanese military imperialism, but, instead of the uniform, the Japanese come today in suits and violate the dignity of the people of Asia with a particular malicious form of socio-economic imperialism.

(ECTWT, 1983, p. 14) Particularly in the Philippines, memories of the Second World War run deep, Japanese are still disliked and much of the blame of child sex tourism is laid at their door. One study of child prostitution in the Philippines has an entire section on Japanese involvement in the trade (ECPAT Philippines, 1994).

Although the language of women's rights and children's rights is sometimes used, child prostitutes are seen as a symptom of the wider problem of foreign (often Western) influence, as in the use of the term 'social evils' in countries such as Vietnam. Although legislation to combat social evils came into force in Vietnam in February 1996, even the Ministry of Social Affairs, which is responsible for implementation, does not have an

official definition of the term, which is used as a blanket phrase to mean all that is contrary and harmful to Vietnamese culture, yet associated with gambling, theft and prostitution, none of which are exclusive to non-Vietnamese. As in other 'sex tourism' countries, this mechanism parallels the distancing mechanism in the West that places the emphasis on 'stranger danger', so that sexual abuse within the family is played down in favour of fear of child rape by unknown, asocial men. As Jean La Fontaine states in her seminal study of child sexual abuse in the United Kingdom, If people do think of the possibility of sexual assaults on children they see them as a risk from casual encounters in the street. The belief in the natural relationship between parent and child is the basis for the firm conviction that if danger threatens any child, it can only come from 'outside' the family. When the damage inflicted is sexual, the offending person must be an unknown, a shadowy and frightening stranger, not anyone with whom one has daily contact, let alone someone who is part of the familiar circle of family and friends....Newspapers report the rarer and more dramatic cases of children who disappear and in doing so reinforce the general idea that strangers carry a risk to children involving acts of the greatest perversion, serious damage and even death (La Fontaine, 1990, p.

109).

Similarly, the image of the foreign tourist (Figure 2) has been constructed as both a sexual threat to children and the root cause of child prostitution in certain countries.

Figure 2

Demonisation of the figure of the foreign, male tourist.

Distinguished by his camera and with his eyes hidden behind dark glasses, the tourist confronts children on a wasteland far from the high rise buildings of the modern city. The bicycle is presumably a bribe. One campaign slogan in the Philippines was 'He may look like a friend but he could abuse your child.'

Source: The international campaign to end child prostitution in Asian tourism, special edition of ECPAT Newsletter, NO. 9, July 1993.

Campaigners discuss child prostitution using the language of the market place and talk about it as if it is a question of supply and demand (Good Shepherd Sisters 1994).

Foreign men want children therefore they are supplied (O'Grady 1992; 1994; O'Connell Davidson & Brace, 1996). If the demand could be stopped, then there would be no prostitution, an idea that unhelpfully confuses moral and economic discourses (see for example ECTWT, 1990).

Thailand and the Philippines do have some of the best recorded cases of actual commercial sexual abuse by foreigners. Despite the sensationalism of some of the reports, there has been considerable documentation of individual cases. The Jubilee Campaign for example, published full trial transcripts of the trial of a paedophile accused of the rape and grievous bodily harm of a 12 year old girl who later died, giving a full account of the injuries she had suffered (Jubilee Campaign 1992). In this case the transcripts were presented without commentary and this restraint makes the account more shocking than might be the case with the use of emotive writing, which is more usually the case (Figure 3).

Figure 3

Newspaper headlines, collected by ECPAT and typical of the genre, show the emotive language commonly used to report child sex tourism.

Source: The international campaign to end child prostitution in Asian tourism, special edition of ECPAT Newsletter, NO. 9, July 1993.

Other writers have described the situation of young prostitutes within the overall social and economic contexts of their lives, which contextualises the life choices and survival strategies that children use (see for example Black, 1991; Black, 1995) In contrast to this, there is some first hand information from Cambodia that examines child prostitution in terms of local clients and a video made by the Cambodian's Women's Association video examines the role of local men. While acknowledging that certain foreigners, in particular members of the United Nations Transitional Force in Cambodia,

were clients, the organisation sees this primarily as an issue of exploitation of the girls involved and is less interested in the nationality of the abusers. In Cambodia, the role of Vietnamese child prostitutes is given special attention as Vietnamese prostitutes are reported to make up over 50% of the prostitute population. Working illegally and not speaking the local language makes these children vulnerable to abuse (Care International, 1994; Cambodian Women's Development Association 1994; Cambodian Women's Association 1994; Thang, 1996).

The concentration on child prostitutes who service foreign clients raises the concern that other child prostitutes catering for local customers are being neither counted nor provided for within current policies and programmes. The concern with sex tourism may well be obscuring a large part of the child prostitute population, just as focus on street children forces attention away from the far larger numbers of deprived and marginalised children living and working in urban and rural areas. By presenting information in the way they do, many organisations committed to the eradication of the commercial sexual exploitation of children make it appear that child prostitution to has a single root cause and a single solution -- foreigners, the external enemy. This means that questions about national structural causes of poverty and marginalisation need not be asked. The approach taken by Treguear and Carro in their study of girl prostitutes in Costa Rica is thus all the more refreshing (Treguear & Carro, 1994). Even though Costa Rica is a major tourist destination and gender relations are implicated, they lay the blame for child prostitution on structured, economic and political violence against the poor, who are defined not simply in terms of lack of access to employment, goods and services, but also more specifically through their lack of access to power. These authors end their theoretical analysis by quoting Schibotto (1990, p. 163): 'each one of these girls is a reflection of the violence, not only of her lovers or her clients, but also the entire social formation. Because, in the last analysis, everyone of us -- at some time or in some way -has gone to bed with them' (our translation).

How evidence is gathered Perhaps the most disquieting aspect of the literature is the generally poor quality of research. The overwhelming majority of publications and 'grey literature' in the field of the commercial sexual exploitation of children is characterised by muddled, low level or misunderstood theories, badly thought out and applied research methods, poor data and inadequate analysis. Most of the literature consulted for this review was so poor that it was not worth including in the annotated bibliography and, indeed, inclusion should not be taken as a sign of high, or even adequate, quality material. It seems that, in this field, the burden of proof about the truth of a statement does not rest with the research witness who is thus enabled to make a priori claims about the existence and extent of facts that people in general find so desperately uncomfortable that they would rather accept the incredible than ask questions.

It is worth listing the more common errors of research method and analysis, because they contribute to the reproduction of unreliable or mythological information within the literature:

€Much so-called research is carried out by lawyers or activists with no background in the social sciences, whose activities are best described as 'fact-finding' and who accept as fact what would be thrown out of court as hearsay evidence; €Data are probably biased when (as frequently happens) researchers gain access to research subjects by means of institutions, projects and programmes. Information may thus reflect what the children and others think the project would like them to say, fear of reprecussions from institutional staff, or exaggeration in order to attract greater project advantages. €Samples are also likely to be skewed because they are drawn from what might be called the 'unsuccessful' prostitutes whose activities have attracted the attention of helping or controlling agencies. €Researchers seldom use control groups when designing their research. €Samples tend to be small, yet the information is frequently stretched extremely thin by being subjected to inappropriate quantitative analysis. €Results of research with small-scale samples are generalised to represent large populations. €Research is often divorced from local and cultural contexts. Little or no detail about research subjects is given. €Researchers rely on single-method studies, often on anecdotes that are passed off as case studies. Information gathered is seldom cross-checked (sometimes called 'triangulation') by using other methods, or by comparison with other studies and secondary data. €Far too often the only social science method employed is the questionnaire survey, which is at best a poor method when used alone, at worst a bad tool to use with children, particularly where sensitive subjects such as sexuality and abuse are concerned.

The language of evidence One factor in the reproduction of inadequate information in the literature of commercial sexual exploitation of children is the style of language used. Language is the means by which ideas are reproduced. The way it is used in any one context reflects the structure of the paradigm or overall theory that has given rise to these ideas. Language is never neutral. If a structure of ideas is repetitive, so the words and phrases that it gives rise to will bear the same repetitive characteristics. Literature on the commercial sexual exploitation of children is characterised by assertiveness. Uncertain verb forms such as the conditional or the subjunctive mood are seldom used. Thus writers seldom say that something 'might be the case' or 'it is reported that...'., preferring to present their case in the positive indicative, 'is', 'was, 'were'. Thus sentences often begin 'There is evidence...', or 'It is claimed..' or 'It has been found...' although the nature and source of such evidence, findings and claims are not presented. A further immediacy is given to texts by the use of what is called 'the ethnographic present' which is the device of writing about past events in the present tense. A pastiche might be: 'Caroline stands outside the nightclub waiting for a client. She is shivering with the cold and hopes that the next man will not be violent like the man who blacked her eye yesterday. She is twelve years old, but she has the eyes of a much older woman.' This often obscures the fact that the case study was gathered long ago by someone else and that Caroline, if she ever existed, for it is common for writers to invent a composite or typical person, probably is a much older woman by the time the reader encounters her in the text.

Further linguistic devices are implicated in the repetitions and confusions of quantitative data. For example, in the chapter that is devoted to child exploitation in a highly respectable publication on children's rights, the author writes: Undoubtedly most international trafficking is in women over the age of 16, but some children get swept up in the tide. Specific ages are rarely reported, but it seems reasonable to infer that at least some under-16s are included (Kent, 1992, p. 325).

Leaving aside the rather loose use of metaphor in the phrase 'swept up in the tide' with its implications of the passive, helpless role of women and children, less obvious, but equally powerful, words and phrases in this passage move it to a position in which what is said is unlikely to be questioned because of its authoritative tone. 'Undoubtedly...' puts the writer beyond question, without having given any support for his certainty. He does not qualify what he means by 'most'. Likewise, 'it seems reasonable to infer', when placed alongside 'at least' appears to be 'reasonable' without giving any grounds, while 'at least' in this context appears to imply something of an underestimate. Similar, frequently employed phrases aiding the uncritical repetition of inaccurate statistics are: 'children as young as...' which usually refers to one exceptionally young child in a larger sample of children considerably older; 'up to 20 times a night'.. when referring to numbers of clients, which gives no idea of the average number of clients or the type of sex work under discussion.

Journalists tend to take even greater liberties with language, stressing the emotive aspect of the juvenile's situation and appealing to the readers' sense of outrage. The tone of journalists' coverage of sexual exploitation is often deliberately subjective and emotional.

Repetitive use of shocking detail are justified in the public interest. Journalistic scoops are also important. There have been many children 'bought' for a night by journalists in various parts of the world to demonstrate the ease with which children can be bought or sold. Background details may be given but little analysis is presented. There is usually an emphasis in journalists' information on the personal circumstances of each child, without recourse to any wider sociological information. Broken homes and bad parenting are stressed, societal breakdown and under-funding of welfare services rarely mentioned. The failure of social services to spot children at risk or to take appropriate action when they have discovered them is rarely discussed, which is surprising when one considers the verbal lynching sometimes meted out in the Western press to social workers who fail to intervene in case of physical abuse. Instead media reports of sexual exploitation tend to explore themes such as the poverty of the family and inappropriate parental role models (alcoholic father or prostitute mother). Added to this emphasis on the guilt of bad parents is the celebration of good parental figures who help children. Charismatic individuals who rescue children from prostitution are feted and congratulated, so that ultimately it is private charities rather than the state welfare services that are seen as providing solutions.

Nevertheless, journalists do tend to quote children directly more often than academics although, when children are allowed a voice, it seems they are muted or speak according to predetermined scripts. Adult advocates are usually given much more column space, and their opinions are given far greater weigh,t so that it can sometimes seem as if journalists are merely quoting a child to prove the point that adults are making.

Within the non-governmental sector in general, data tend to be collected and/or collated in an extremely patchy and haphazard manner. There is a great reliance on newspaper reports, individual stories, other NGOs and social workers, child rescuers and other 'experts' who guess at numbers and statistics. There is almost no information from the children who work as prostitutes and little exchange of information with the academic sphere. What counts as evidence can be seen in the following passage from The Child and the Tourist, in which the author quotes 'an anonymous' Thai friend's description of 'paedophiles' he saw at a beach in Pattaya, Thailand. The 'friend's words apparently were: "I sensed an insincere, almost sinister smile on the faces of the men. Many were giggling like school children and talking in the uninhibited manner of young children. In the water, they wore skimpy swimming gear while the boys were fully dressed. Frolicking in the water they took their shorts off and bobbed up and down and removed the boys clothing. On the beach, they played with the boys in mock fighting showing their superior strength. their communication with the boys was entirely physical (much of it with sexual references and some of it genital). They had total lack of awareness of Thai customs" (O'Grady 1992: 98).

Academic literature on this topic in South East Asia is largely written by Western academics who have carried out some field research in the countries they study. In general, they conducted interviews with the children and young people and tend to be critical of middle class activists who appear to have less 'hands on' experience than the researchers (Muecke 1992; Black 1994). Some anthropologists and sociologists have been concerned with looking at underlying predisposing factors and cultural patterns that might lead to the commercial sexual exploitation of children. They rarely talk about the types of clients but look at the family background of the children involved in prostitution emphasising the burden of duty they bear, especially girls, who are expected to make sacrifices in order to look after the family and to repay the parents for their lives. They also stress the religious differences of the countries involved yet note, that although Thailand is mostly Buddhist, the Philippines Catholic and Taiwan, Confucian, all countries share these values of reciprocity and respect towards parents (Phongpaichit, 1982; Mccaughy & Hou, 1994; Lie, 1995). It is also notable that within those countries, Muslim minorities are almost never involved in prostitution although there are reported to be prostitutes in Indonesia and a small number in Malaysia (Murray, 1991).

The overall impression gained from carrying out this review of the literature on the commercial sexual exploitation of children is a permanent sense of dejรก vu, because the material is so repetitive and the methods of data collection, analysis and presentation reinforce the way information tends to be reproduced. There are interesting debates and pockets of verifiable data, but these are obscured by the overwhelming weight of sensationalism, pressurised advocacy and refusal to examine taken-for-granted assumptions. The main reason is that data in this field generally arise in the context of campaigns so that knowledge is organised around adult requirements for particular kinds of fact, rather than the actual lives and needs of sexually exploited children.

1.3 In search of a framework Facts simply do not lie around on the ground to be picked up as pigeons pick up peas. An

organisational framework of ideas is necessary in order to measure and monitor any social phenomenon. Within the field of the commercial sexual exploitation of children several clusters of ideas and theories might be considered for their usefulness as organising principles for the development of concepts and the collection of data. Each is related to a particular campaigning stance, and we have chosen to present them here in schematic form (Table 3).

Table 3: Campaign theories and related theories in the field of the commercial sexual exploitation of children Campaign Theory Feminism

Patriarchy, the 'girl-child'

Morality

Religion, sexuality, blaming perpetrators, rescuing children

Child survival and development

Psychology, medicine

International development Poverty, demand and supply aid (economics), community development Children's rights (including Power, childhood, human rights sexual rights) Although all these theoretical structures have their merits and explanatory value, the most coherent and (more importantly) children-focused framework for the purpose of measuring and monitoring the commercial sexual exploitation of children seems to us to be children's rights. This is because consideration of children's rights entails a discussion of the nature of childhood, which is inscribed in the power differential between adults and children. Discussion of this unequal relationship opens the possibility of discussing other inequalities that exist universally, while taking different cultural and historical forms. This would mean that a framework for monitoring based on these ideas would be both stable and flexible. The relationship between children and adults within families, has a parallel in the relationship between children and states, which, in their modern forms, are ultimately responsible for policing parenting, schooling and work, the main socialising institutions of childhood. Likewise, the trio of child/family/state exists within structures of regional and global domination, which include economic disparities, political inequalities and, last but not least, tourism.

Children and Prostitution - Part II: 2.Towards a Universal Framework using the Convention on the Rights of the Child One of the main conclusions of the literature review is that children's rights, as provided in the Convention on the Rights of the Child, can be used as the framework for both understanding and measuring the commercial sexual exploitation of children in the broadest possible context. The relevant articles of the Convention should not be limited to Article 34 or even to other articles relating to protection from abuse and exploitation. If eradication of sexual exploitation is the aim, then the maximum force of articles should be brought into action, in order to ensure that eradication campaigns do not consist merely of declarations of intent, legislation, prosecutions, rescue operations and

rehabilitation of victims. Protection of children from sexual exploitation requires making use of all relevant articles.

Although attempts to monitor the Convention on the Rights of the Child began with the idea of developing an article-by-article list of indicators, this has now been abandoned by most workers in this field, in favour of constructing systems of linked indicators, based on clusters of related articles. One way of clustering the articles of the Convention to produce a nationwide monitoring system is already under construction in Vietnam and Nicaragua, as part of the Childwatch International Indicators for Children's Rights project (Ennew & Miljeteig, 1996). However, in the context of particularly intractable and urgent problems, such as the sexual exploitation of children, articles could be bunched or focused, in order to provide a framework for monitoring a specific issue. Figure 2 shows one way in which this might be achieved. The fundamental articles in this figure appear in the shaded portions. These are basic to understanding not only the commercial sexual exploitation of children, but also the contexts in which it takes place. For this reason Article 34 is not the first to appear in this figure. It is preceded by articles relating to the definition of childhood, children's identity and dignity, the very aspects that are violated when sexual exploitation takes place, indeed the reasons why all 'protection' articles are necessary.

The unshaded portion of the figure contains a groups of articles that are linked to the fundamental articles in various ways, mostly related to provision. The eradication of sexual exploitation cannot take place without monitoring the impact of service provision of many kinds, including special programmes of prevention and rehabilitation.

Putting such a framework into operation first entails attention to a critical aspect of indicator development, the definition of operational concepts. It is impossible to measure a phenomenon, unless you know what it is. Thus, before rushing to count the numbers of children engaged in any activity, it is vital to spend some time thinking about the ideas involved. For this reason, the right-hand side of the figure contains lists of ideas that have to be defined so that the phenomena involved can be measured. The beauty of such a scheme is that, although the framework is universal, the definition of ideas can be culturally appropriate without violating the basic principles of the Convention.

Figure 2: Using the Convention of the Rights of the Child as a framework for measuring and monitoring the commercial sexual exploitation of children Articles

Ideas

1, 2, 8,16

Definition of child, children's dignity, nondiscrimination, identity, respect for privacy

34, 35, (11,16, 17(e), 19, 32, 33, 36)

Prostitution, traffic, pornography

12 (3,13,14,15)

Consent, power, maturity and the best interests of the child

Linked articles, relating to prevention, provision of services and rehabilitation

3, 4, 39

Reasonable expectations about service provision and rehabilitation

5,8, 19, 21,22

Family support

28, 29

Education

26, 27, 30,40

Community and state care

24

Health provision and health education

2.1. Operational definitions Although it is often claimed that measuring the commercial sexual exploitation is impossible, we would argue that this is an effect of the lack of conceptualization in the discourse as a whole. Up to this point in time, the main purpose of information gathering on this topic has been advocacy and awareness raising. In view of the fact that 133 nations were represented at the Congress Against the Commercial Sexual Exploitation of Children, each making a declaration that acknowledged the existence of a problem in their country, it can be argued that the advocates have met with considerable success.

Now is the moment for a new, more accurate form of data collection, that will provide information of sufficient accuracy to develop programmes of prevention, protection, elimination and rehabilitation. Thus the time is ripe for measurement and monitoring. The process of measurement depends less on techniques than on prior work to identify the phenomena involved, and capture their essential features in operational definitions -- not definitions for all time but ideas that can be grasped and expressed in measurable terms.

The process of 'measuring the unmeasurable' is summed up in Box 3.

The method of deriving operational definitions is: map ideas in current use; compare with the Convention; compare with national realities; decide on a pragmatic, measurable concept.

Box 3: MEASURING THE UNMEASUREABLE

Identify the phenomenon

Commercial sexual exploitation of children

'Capture' the phenomenon: operational definitions

What is commercial?

What sex acts?

Who exploits whom? How? What children? (age, gender, ethnicity)

Specify the data

List the data necessary to measure the operational definitions

Test the data

Find which data are available

Research new data

Seek data that are not currently available, using existing routine systems or setting up sites for routine measurement

Construct indicators and use for regular monitoring This review is not the place to enter into lengthy definitional debates. Nevertheless, as an example of the way in which such debates might proceed, the next part of this text will consider briefly and non-exhaustively some of the aspects necessary to defining two fundamental ideas: What the chronological definition childhood means with respect to sexuality and sexual activities; The dignity of children.

The sexual age of a child As all the reports to the Committee on the Rights of the Child make clear, although a child is defined by the Convention as a human being under the age of 18 years, this cannot encompass all the milestones of childhood, which take into consideration such aspects as criminal responsibility and minimum age for work. It is the nature of childhood to be a development towards maturity, as explicitly mentioned in Article 12, for example. Sexual maturity is perhaps the most notable milestone of childhood after learning to walk and speak. It is marked by rites of passage both formal and informal throughout the world. Yet the timing of these rites is by no means universal.

One of the earliest considerations of the research for this literature review was the influence of the onset of puberty on the commercial sexual exploitation of children, particularly with the idea of constructing a classificatory matrix to understand better the market for child sexuality (Figure 3).

Figure 3: A possible matrix for classifying the commercial sexual exploitation of children Male Female Pre-pubertal Post-pubertal However, this raised the questions 'Is puberty a useful idea to use? If so, what is the most appropriate body of literature?

It could be argued that the timing of puberty determines the beginning of sexual development, and the start of sexual behaviour, marked by psychological and physiological changes. But a biological determinist model cannot be accepted. Sexual behaviour does not emerge as inevitable result of biological changes and bodily development is also influenced by the social context of childhood and by a child's experiences. Although the appearance of secondary sexual characteristics, and changes such as the onset of menstruation may 'mean' that children are reproductively mature in a

physical sense, most social groups require further social proof of reproductive responsibility, such as the skills or means to support the next generation.

In addition, children experience the world as boys and girls and are viewed and treated by others according to their gender. In a sense they grow up in different worlds, so one cannot properly speak of child sexuality, but rather of the development of sexuality (both in the sense of sexual activity and sexual identity) in boys and in girls. The expectations of boys and girls in different societies may entail differential ages for entry into adult reproductive maturity. Thus, for example, where women and children are largely economically dependent on men, a girl's passage to womanhood may take place far earlier, at a chronological age fairly close to the average age of menarche for her social group. Boys, on the other hand, may have to wait far beyond physical maturity to become recognised as men who can build their own house and support their own wife and children. In many African societies this is explicitly recognised through a system of age sets (see Figure 4).

Figure 4: Ages and stages in the process of becoming an adult are different for boys and girls among the Sereer, West Africa Boys Name of SISSIM stage Young of the tribe Age

8 to 11 years Socialisation Education Activities about what not to do Girls Name of FU NDOG stage WE Young girls Age 7 to 10

GAYNAK Shepherds

12 to 18 years Preparation for circumcision

PES WAYABAN Young people E Youth and adults 19 to 26 years 27 to 35 years Circumcision, Marriage initiation

NOG WE Adolescents

MUXOLARE Adults

11 to 18

19 to 26 years

years years Socialisation Education Tattooing Marriage, initiation Activities through numerous prohibitions (Source: Gravrand, 1981, p. 88) This basic asymmetry in the social world of boys and girls finds religious sanction in attitudes towards menarche. For instance, in Hinduism, the advent of puberty indicates procreative power or sakti for girls, because blood is in itself seen as the immediate source of health and vitality. In addition, it is connected with unbridled sexual energy. It is believed that women accumulate so much blood (energy) that it needs to be drained regularly or it is believed that even five men cannot hold one woman down. These beliefs also inform the Buddhist tradition. Girls have to learn reticence, undergo privation and practise self sacrifice as they grow into adults.

Hinduism marks the onset of menstruation by a rite of passage consisting of an elaborate ritual of worship. A girl then also has to conform to new forms of dressing, which include the covering of breasts, application of herbs and restrictions in her movements. outside the family home. The blood of a virgin, and her general 'heated' state, on account of her purity, is regarded as more dangerous because the force of her blood has not been harmonised with the physis of a male to 'cool it down'. Thus on account of gender differences and cultural expectations, puberty marks a distinct stage in the life-cycle of a girl who is now regarded, whatever her sexual feelings or desires may be, as a woman whose body is full: a body with special procreative and sexual powers that needed to be controlled. For boys, on the other hand, the process of development is far less clearly focused and is not remarked upon (Carman & Marglin, 1985).

All these considerations, which have their parallels in every society, complicate the notion of puberty and make it a shifting notion that is less than useful for defining the age of sexual maturity, despite almost universal acknowledgement of the physical changes it brings (Richards, 1996).

It would of course be simpler to decide on an arbitrary age below which sexual activities are regarded as unacceptable. However, it would be difficult to arrive at a universally acceptable age and current national legislations varies enormously in this respect. In any case, the grounds for unacceptability might be different, based on moral, physical, psychological or economic factors. What is clear is that the decisions involved are taken by adults who decide at which age sexual activity ceases to be harmful. In the West, this is related to a tendency to distinguish between younger children as victims of sexual activity, while older children's sexual activities are likely to be viewed as delinquent.

Although this kind of pattern could be (and in many cases is) imposed on other societies in the name of children's rights, it is this kind of action that impedes implementation.

Definitional rules that do not make sense tend to be ignored.

One path worth pursuing in the search for the sexual age of children was taken by a research group in Zimbabwe. In focus group discussions with groups of youth, adults and child welfare professionals in urban and rural settings, the researchers focused discussions on the age at which children become mature, particularly sexually, and whether they are able to make their own decisions and are able to act. This approach not

only takes into account current debates about informed consent (in many areas of life including sexual activities) it also underlines the value of clustering articles to produce a framework for thought and action with respect to rights. It shows that it is difficult to define sexual maturity without taking into account power and maturity. The results of the discussions are interesting: i.Rural communities rate children as maturing at earlier ages than urban; iiProfessionals and youth rate children as maturing earlier than adults; iiiPhysical maturity is seen to happen earlier than mental maturity in urban areas, and later than mental maturity in rural areas. Rural people generally rate children as becoming mentally mature at much earlier ages than in urban areas; ivRural groups rate children as able to decide to have sex at much earlier ages than urban people (about five years difference), and youth in both urban and rural areas identify that children are able to decide to have sex at earlier ages than other groups. .....The adult groups in urban areas felt girls matured later than boys, but in rural areas the opposite applied. In urban areas signs of maturity were given as the ability to communicate, take on challenges outside the home, be independent, discriminate good from bad and make responsible decisions. In rural areas, similar signs were used, although there was also a strong aspect of the individual's ability to contribute to household work, farming and other tasks (Loewenson & Chikamba, 1994).

The researchers concluded that: 'The definition of a "child" is thus a combination of a series of physical, mental, sexual and emotional attributes, in which the family and social environment play a role. the ages given by the groups for moving from childhood to adulthood range from 10 to 24. With respect to sexual issues, the law sets 16 as the age for ability of a child to knowingly give consent to sex: while rural groups generally agree with this age, urban groups felt that 1722 (or an average of 18) was a more appropriate age' (ibid).

Dignity and Innocence Among the first considerations to be taken into account in finding operational concepts to begin the process of measuring and monitoring the commercial sexual exploitation of children are ideas of dignity and innocence, which are implicit in all discourses, but seldom examined. Without making these ideas explicit, and culturally relevant, the enterprise of combatting child sexual exploitation will continue to founder on the quicksands of repetition and the reproduction of exhausted, biased assumptions. Because the Convention on the Rights of the Child is 'the most detailed and comprehensive of all of the existing international human rights instruments' (Alston, 1994, p. 1) it has raised particular issues with respect to the application of universal standards. Thus cultural relativism has now become a particularly important issue within human rights debates, no more so than in the area of the sexual exploitation and abuse of children. It can be claimed that at a certain level, the debate over the nature of the relationship between international or 'universal' rights standards and different cultural perspectives can never be resolved' (ibid, p. 16).

But perspectives on children and childhood are the very basis of culture, because children are always in the process of developing into adults, which means they call into question, by their very existence, what it is to be a human being in terms of any social group. This

also reflects on other fundamental aspects of social life, such as sexuality. Thus the exploration of cultural meanings must be the basis of any research, advocacy or monitoring of the commercial sexual exploitation of children. To say this is not to fall into the trap of cultural relativity, which could preclude action and advocacy on behalf of children whose lives are difficult: Just as culture is not a factor which should be excluded from the human rights equation, so too it must not be accorded the status of a metanorm which trumps rights (ibid, p. 20).

The abuse, exploitation or commercial use of children's sexuality is a fundamental of their dignity as human beings. The Convention on the Rights of the Child refers to dignity seven times and it has been claimed that it is 'a concept that permeates the document' (Melton, 1991, p.344). Nevertheless, it is not defined. A former Special Rapporteur to the United Nations on Sale and Traffic points out that 'in the first article of the Universal Declaration of Human Rights, the word 'dignity' comes before 'rights'. This means that human dignity is the foundation and justification of all the rights defined later in the Declaration' (Fernand Laurent, 1992, p. 36). With respect to pornography he suggests that images published should 'take account of all aspects of the fundamental principle of respect for human dignity and which safeguards in particular the dignity of women and the innocence of children' (ibid). This raises the question of whether the dignity of children might perhaps be different from that of adults, and rest in their innocence.

There is no social science discourse on innocence, but there is a considerable body of literature on purity, which is worth exploring in this respect, much of it related to the ideas of honour and shame that appear in many of the regional discourses on child sexual exploitation. The literature from Latin America was referred to earlier, but the distinction between honour and shame is also important in most other parts of the world, although taking on a different texture in different cultures (Budhaghosa, 1923-31; Carman & Marglin, 1985; Delanay, 1991; Fernea, 1985; Gilmore, 1987; Holy, 1991; Mernessi, 1975; Peristiany, 1966; Peristiany & Pitt-Rivers, 1992; Stewart, 1994). Most anthropological writings agree that cultural notions of honour and shame both critically influence, and are informed by, the constructions of sexuality and sexual morality. They often act as the fundamental axis of evaluation. Moreover, such notions are conceptually inseparable from understanding child sex exploitation. Whatever the extent of its significance in each culture, the honour/shame nexus regulates both inter-sex and intrasex relations and is tied to power. Honour/shame, purity/innocence are mediating concepts by which people and situations are to be judged; and they also provide the terms of reference for determining the acceptable levels of behaviour in other aspects of society. Clearly, traditional beliefs influence notions of honour, shame and purity in most cultures. Further, there is an important correlation between purity and aspects of physical development, such as puberty. This furthers an understanding of puberty in epistemological terms.

There is nothing specifically sexual about the concept of 'purity' and yet it is consistently used to refer to sexuality and is inextricably linked with the concept of chastity (Douglas, 1994). Yet defining purity is problematic; does sexual purity mean virginity? Or does it mean keeping to socially sanctioned expressions of sexuality, such as marital fidelity?

Does it in fact have nothing to do with sexual purity but is linked to other factors such as

menarche? To be pure, especially when talking about either women or children, often means to be sexually untouched but it has further connotations also in that it also means sexually ignorant and passive. Both women and children are supposed to be sexually pure but it takes different forms for both of them and often has very contradictory meanings.

Where morality is derived from Christian tradition, the emphasis on purity is very strong and in these contexts, to be a 'good' woman means being a chaste or pure one. The emphasis on virginity for women is strong as are the generally negative connotations of sexuality. St Paul, for example, saw celibacy as a better and purer option than marriage and viewed sex as something to be avoided or if that did not work, to be channelled into marriage.

Orthodox Catholicism equates spiritual purity with intactness. The Virgin Mary, for example, is believed to have given birth without breaking her hymen, therefore she remained virgo intacta, even though she was a mother. While this is obviously impossible to emulate, Catholic women are expected to divorce sexuality from reproduction. Even though the only excuse for sexual behaviour is that it may lead to pregnancy, pure women are not supposed to be sexual or enjoy sexual activity.

This view is not limited to the West or to the Christian tradition. In Thailand, the same division is apparent. Pure women are mothers, impure women are prostitutes. A mother is not supposed to enjoy sex, or to initiate it or to experiment. Men go to prostitutes because they are expected to be the exact opposite of this, sex with them is for enjoyment, not reproduction.

Pure women, in these instances, are women who have sexual knowledge that is kept tightly within the socially sanctioned bonds of marriage. They are not sexually untouched but they are sexually restrained and remain sexually ignorant of any man other than their husbands (Gilmore, 1983).

However, there are contrary currents to this as well in that while women are urged to be sexually faithful, they are often mistrusted and viewed as highly sexual beings whose purity or honour must be kept by their men folk (ibid). Their sexuality is so strong and uncontrollable that it has to be constantly watched and guarded, first by fathers and brothers and then by husbands. This also links into the view that women cannot be trusted sexually and that their power is so irresistible that men must be protected form it.

Whether or not this takes the form of certain types of Islamic society, whereby a woman must remain covered so she is not a threat to men and does not tempt them, or even in certain situations in the West, where a woman is said to 'lead a man on' because of what she wears, women are seen as highly sexualized, dangerous beings who use their sexuality, knowingly or not, for male destruction. Women can never be pure because they are always sexual and always destructive.

In many ways, the sexuality of girls is viewed with the same ambivalence as that of women. On the one hand, girls are expected to be innocent and virginal, having no experience or knowledge of sex yet they are also thought to be sexually knowing. In the West, girl children of around puberty are treated with considerable ambivalence (Holland, 1991). Some are presented as still children, innocent and therefore to be kept ignorant and there is often tremendous fuss over issues such as teaching 12 year olds about sex education. However, there is also the view of girls as natural seductresses - the Lolitas or sexy school girls who know exactly how to entrap and seduce older men. The

current 'super models' capture this uncertainty well, they are getting younger and younger and more and more child like yet they are also presented as sexual (Wolf, 1991).

There is still considerable opposition to Freud's notion that children are naturally sexual and that civilisation represses them but it is fairly clear, even to those who dislike Freud and consider many of his propositions seriously flawed, that children are capable of sexual feelings and that sexual purity in children in the sense that it is something they know nothing about, is a myth. Again, this leads on to further debates about the nature of sexuality and the arguments about what children understand about their sexual feelings and whether they label them as sexual but the notion of the sexual child is still one many people are very unhappy with. There is considerable emphasis in this society on stopping children displaying any sexual behaviour in public; girls are sanctioned for sitting improperly so that they may display their underwear and both boys and girls are told off if they touch their genitals publicly (Moore & Rosenthal, 1993).

Another link between women and girl's sexuality is that of passivity. Both are considered to be passive, waiting for a man to 'discover', develop and deflower them. It is still expected that girls will be taught about sex by an older man (Moore & Rosenthal, 1993).

Purity in this case is strongly linked to being passive and waiting. The only instance in which as woman can be active is if she is fighting to preserve her purity. Under Islamic law, for example, a woman who kills while trying to prevent herself being raped is treated leniently while if she is raped the penalties on her are harsh and she is punished for impurity.

The biggest difference however between the sexual purity expected of women and girls however, is the emphasis on sexual ignorance as opposed to sexual restriction. Girls are supposed to be ignorant of sex, untouched and virginal. The distinction between adults and children is their supposed lack of sexual knowledge and it is this that gives them their innocence. Innocence for children also means ignorance and knowledge of their bodies or its functions is considered bad (Douglas, 1994). Whether or not this is the same as purity is debatable. There has undoubtedly been a conflation of purity, innocence and virginity but this is problematic (ibid). For example, if we take pure to mean sexually pure, then its opposite is sexually impure which is not exact. Sexual impurity does not simply mean not virginal - -it means breaking sexual restrictions and has heavy negative implications. A woman who has had sex is not necessarily sexually impure as long as she has remained with her husband only. However, she may not be seen as sexually pure either if she has had sexual knowledge - which category does she fit into?

The sexuality of boys is much less problematic as ideas of purity are much less relevant.

Boys' sexuality is far more integrated into their personality and sexual experience is acceptable (Moore & Rosenthal, 1993).

Despite attempts to separate any discussions of women's and children's sexuality, the history of both has meant that they have consistently been placed in the same category.

As women have become sexually liberated, children have taken the place of women as the innocent in need of protection. It is hard to generalise about purity and innocence because of the huge cross cultural variations and the need for detailed studies of individual societies' purification beliefs. However, the links between notions of purity in women and children and the fact that this concept can be discussed with much greater ease then men or boy's purity does tend to suggest that purity is a powerful concept which women and girls have to deal with in many environments in a way males do not. Purity is

central to many beliefs about children yet it is rarely discussed or defined. It is taken as a given of childhood in the same way as a term like innocence is and is so fundamental, especially to Western societies, that it is rarely questioned. Children's purity and their innocence are directly tied to their ignorance and powerlessness and all are seen as essential components of childhood. It is an area where there is little research or debate yet from the point of view of measuring and monitoring the sexual exploitation of children it is important to arrive at acceptable definitions.

2.2 Measuring and Monitoring: Challenges and Opportunities The process of measuring and monitoring children's rights requires definitional work in order to identify the data that will be needed to capture the phenomena involved and meaningfully measure the concepts derived. The data themselves must be childrencentred and disaggregated in order to distinguish the groups of children who are most at risk of having their rights violated or not achieved. Data that are gathered to serve the needs of institutions, or organised around adult centred units such as households are not adequate, nor are global national data that provide a single indicator for the entire national child population (Ennew & Miljeteig, 1996). It goes without saying that the kind of data that have been produced in general in the discourses on the sexual exploitation of children are not appropriate.

2.2.1. Asking the right questions The following is a list of some of the questions that could be asked with respect to the sexual exploitation of children, extracted from a guide for data collection on children's rights designed for Central America as part of a joint project between UNICEF and the Inter-American Human Rights Institute (Ennew & Viquez, 1996). As with the conceptual considerations presented above, these are not comprehensive, but were devised to show the paths that might be followed in the development of indicators to measure and monitor the sexual exploitation of children and its eradication.

How do cultural definitions of childhood affect conceptualisation of phenomena?

How do legal definitions of childhood affect these phenomena?

What age groupings are used in collecting and reporting data about these phenomena?

What forms of discrimination against children and between groups of children operate in this area?

What disaggregations should be sought in the collection and reporting of data about these phenomena?

Who is responsible for children's welfare in this area: parents, community or the state?

What mechanisms exist/are used by children to claim their rights?

What state welfare mechanisms exist? How effective and accessible are they?

What community (traditional) mechanisms exist? How effective are they?

At what ages and in which circumstances are children's views sought and taken into consideration in this area?

In the case of all protection rights there are additional questions to be asked with respect to each article:

What legal measures protect children in this area?

What relevant international agreements have been signed and ratified by your country?

What mechanisms are in place to ensure that these laws and agreements are implemented?

How well do these mechanisms work?

Solving the definitional problems in this area depends on examining the cultural contexts not only of sexual norms and values, but also of gender and childhood.

At what ages and under what circumstances can people under 18 legally have sexual relationships?

What evidence is there of related laws being broken?

How many convictions are there annually for sexual abuse of children by non related adults?

What kind of offences are involved?

What groups of children are involved?

Who are the abusers?

Important:Sexual abuse tends to be under-reported. Those who are convicted of abuse are not necessarily representative of child abusers in general.

How many child prostitutes are brought to the attention of welfare and police authorities each year?

What groups of adults are involved, as clients or in controlling the child prostitutes?

What groups of children are involved?

Is it related to (or believed to be related to) tourism?

Is there evidence of forced or early marriage?

How many under-age pregnancies occur each year? (This includes looking at figures for abortion and miscarriage as well as live births). Can these be linked to child sexual exploitation or abuse?

Important: Under-age pregnancies involve two children, the child-mother and her baby.

What happens to under-age mothers? (Do they miss out on schooling, for example?)

What happens to their babies?

How many children annually are treated for sexually transmitted diseases?

Important: It is important to look at the full range of sexually transmitted diseases and not to concentrate on figures for HIV/AIDS. What organisations and programmes exist for eliminating sexual exploitation?

What are their objectives?

What organisations exist for protagonism by child prostitutes?

What are their objectives?

How many children are involved in these organisations?

What welfare provisions are made for child prostitutes who live and work on the street and have no family links?

How many children are involved?

What provision is made for children who live and work on the streets to maintain or reactivate family links?

How many children are involved?

What protective measures are in place to ensure that vulnerable children are not trafficked?

Are child prostitutes able to obtain health care and to learn how to protect their own health, without discrimination?

What health services exist specifically for them?

How many and what kinds of children use these services?

Rehabilitation The first task in this group is to define the term rehabilitation.

Adult interventions on children's behalf in Latin America often seem to depend on the use of certain terms: 'situacion iregular', 'peligro social' and 'situacion de vulnerabilidad' are the most common terms in use.

Which agencies or types of organisation use these terms?

What do they mean?

Who decides when a child is in 'situacion iregular', 'peligro social' or 'situacion de vulnerabilidad'?

Conceptual issues related to this article depend on ideas about: The harm that is known or expected to have occurred to children whose rights to protection have been violated; The expected outcomes of rehabilitation schemes; Available resources; Knowledge of methods of rehabilitation.

Rehabilitation schemes can have three major aspects: Repairing physical or mental harm; Improving intellectual, social or economic skills; Providing welfare and economic resources.

What rehabilitation schemes exist (governmental, intergovernmental or NGO): For child victims of domestic violence and abuse?

For children who have been abducted, or trafficked?

For refugee and displaced children?

For economically exploited children?

For children involved in drug use?

For sexually exploited children?

How many children of each category are involved in such schemes?

What proportion of children in each category is involved in such schemes?

What are the mechanisms for ensuring that rehabilitation programmes and institutions meet acceptable standards of provision?

Is advice and support given to families of child victims?

Is information about rehabilitation schemes readily available, especially among vulnerable populations of children?

Do rehabilitation schemes include appropriate health services and special educational provision?

2.2.2. Operational definitions for measuring and monitoring the commercial sexual exploitation of children To arrive at an operational definition that can be measured, some prior conceptual work may be necessary. For example, dignity cannot be measured, nor can innocence, but if they are defined then it is possible to define and measure acts and practices that violate dignity and innocence.

With question such as this it is possible to return to the framework of the Convention on the Rights of the Child and begin to tease out some of the definitions that will lead to sepcifying the data that should be collected. Taking one of the linked groups of articles, education (Articles 28 and 29), defining this in so far as it relates to prostitution could lead to the lists of information shown in Figure 5. Likewise, finding operational definitions for the ideas encompassed by the various relationships between children and prostitution, leads to the lists shown in Figure 6, keeping in mind the following primary considerations: Define age ranges, related to the physical, psychological and social development of sexuality, as a basic tool for collecting and presenting data; Define cultural understandings of commerce, exploitation, exchange and reciprocity in the context of gender, custom and sexuality.

Remember that gender and custom/culture are fundamental to interpreting the relevant Articles of the Convention on the Rights of the Child.

Finally, the sources of necessary information can be identified, as in Figure 7. It is in this way that the unmeasurable turns out to be measurable, and the practices involved in the commercial sexual exploitation of children cut down to size, so that they can be eliminated.

Figure 5: Defining education with respect to prostitution State Budget provision (for example for sex education, per child, disaggregated by geographical parameters) Rehabilitation schemes Standards of provision Teachers (special training) Teaching materials Rehabilitation Teachers

Teachers monitoring exploitation

Teachers as early warning system Teachers identifying cases Teachers as exploiters Educational indicators as indirect indicators of commercial sexual exploitation

Drop out Absenteeism Educational achievement (all disaggregated by age, gender, ethnicity, geographical parameters)

Educational content

Knowledge of: Sexuality Sexual health Choices available How to make choices Legal and welfare structures

Figure 6: Defining Children and Prostitution within the framework of the Convention on the Rights of the Child Article (s) 34, 32, Adults giving children money/goods/favours for sex; 36 Adults selling children's sexuality; Sex and sexuality include posing for 'pornography' looking at 'pornography' touching talking looking feeling (including masturbation) penetration procuring pimping 3, 12 Children as witnesses 37 Violence, coercion, torture, cruel and inhumane treatment, punishment associated with sexual exploitation 40, 39, Juvenile justice: legal background, processing and 37 punishment of child offenders, rehabilitation 34 Adult offenders: detection, legal process, punishment, rehabilitation, recidivism 58 Families who prostitute their children, children of prostitutes, children of children who are prostitutes 30, 24 Culture and custom: Includes, early marriage, temporary marriage, practices such as devadasi, initiation, indigenous medicine,

26/27 24

circumcision (male and female), tourism, business travel..

Social welfare provision Sexually transmitted diseases Maternal mortality (child mothers) Child mortality (children of child mothers) Psychological health

Figure 7: Data available from Ministries and other government departments

Justice & Social Work prosecutions adults/children recidivism actions taken prostitutes adults children male/female offenders pimps, brothel owners, clients, parents/family,police,teachers, clergy, selling pornography, institutions Social work - 'at risk' families

Health 'rehabilitations' STDs Pregnancies: births, nonbirths maternal mortality Psychology (counselling for prostituted children)

Census Migration patterns (by age and gender) Child suicides, homicide victims Household data

Education Drop out Absenteeism School performance Special teacher education Special materials on: Prostitution Sex HIV/STD

Finance % for Sex education HIV/STD education Rehabilitation (per child)

Literacy rates

Aiming Good Educational Outcomes Teachers should understand the reasons why children are placed in Out-of-Home Care â&#x20AC;˘ Sometimes children and youth in care feel that educators believe they are in out-of home care because they have done something wrong. In fact, children in foster care are there because of circumstances beyond their control, often due to parental abuse or neglect.

Connect with Child Welfare Staff â&#x20AC;˘ Find out which students are living with foster or adoptive families, kinship caregivers or in group living arrangements. â&#x20AC;˘ Seek appropriate support from school administrators. Take the initiative to learn and then share information with administrators and school counselors about out-of-home care in general and the agency associated with your school district.

• Get clarity on what can and cannot be disclosed by child welfare staff. Stay focused on what you nee to know to help the child in school and get what information you can within the limits of confidentiality.

• Build your relationships with child welfare staff over time; learn from them about the system that they work in and how it can mesh with the one you work in.

Explore the Student‘s Academic History • Contact the student‘s former teacher and school to find out about academic status, strengths, challenges and history. Help ensure that school records and Individual Education Plans (IEPs) for students enrolled in special education are delivered to the appropriate staff at your school in a timely fashion.

• Be aware that each move a child is forced to make can delay academic progress by months. Understand that many children and youth in foster care have a harder time learning because of their experiences. They may have been in educational settings in which they were not well supported because they were viewed as transient students bound to be moved again.

• Invite the resource parents – foster parents, kinship caregivers, adoptive parents, etc. to work with you in assessing the student's current level of achievement and setting reasonable goals for the academic year.

In the Classroom • Be aware that children and youth in care generally tend to perform less well in school than their peers. Thirty to forty percent of youth in foster care are also in special education, so your student may already have an IEP or may need one. The student may have a learning disability due to poor maternal health during pregnancy or prenatal exposure to drugs and alcohol. The enormous emotional burdens of grief, loss and uncertainty about the future can also impair a child‘s ability to concentrate, learn and acquire new skills. For example, you can support the student‘s development by insuring that routines are regular and that he or she has opportunities to practice needed skill and is alerted to any schedule changes.

• Determine the student‘s academic, social and emotional level and then find ways to help him or her fit into the class by using accommodations and adaptations to support educational success.

• Respect the child‘s right to privacy. Students and teachers who do not have responsibility for teaching the child do not need to know about his or her foster care status.

• Structure materials and tasks in the classroom to help the student achieve success, even if academics are a problem. Help offset the chaos in the student‘s life by providing structure and predictability in the classroom.

• Broaden the diversity of families depicted in the books and materials in your classroom to include foster, adoptive and relative caregiving families.

• Keep in mind that a child or youth in out-of-home care or one who has been adopted may not be able to complete certain assignments. For example, constructing a family tree or bringing in a baby picture can be difficult for a child who has been frequently and suddenly moved, or has little contact with his or her birth family. Similarly, getting

permission for a special activity such as a field trip can be problematic when the current caregivers do not have legal authority to give permission. It may take more lead time than normal to get approval through the appropriate channels.

Your Relationship with the Child and Family • Like other students, a child or youth in foster care needs to be accommodated, but does not want to be treated differently. Strive to ensure that the student does not feel exposed as a ―special case‖ as he or she does in so many other settings. At the same time, be lenient when circumstances warrant it.

• Remember that many children and youth in foster care find it difficult to trust adults, often for good reason. Recognize you may have to work harder to achieve a trusting relationship over time. Behavior and attitudes intended to be caring can appear just the opposite when they have been experienced in a negative context in the past. Be patient and consistent.

• Some teachers may feel challenged by highly involved resource parents who advocate very strongly for the student. Remember that these children and youth need someone who is on their side, even if that person seems over-involved. Try to work with the energy the parents bring to their child‘s academic life.

• What children and youth in foster care need most are strong advocates in the schools.

Educators, resource parents, agency staff and birth families can all contribute to school success when they understand the challenges and have the opportunity to collaborate in providing support to these students.

Preparation for Postsecondary Education, Training and Career Goals • Prepare students for postsecondary education experiences while in middle and high school, helping them become aware of the full range of postsecondary program options.

• Train students early in self-determination and self-advocacy, so they can speak up for themselves, direct and redirect their lives, solve problems, reach valued postsecondary education and training goals, and take part in their communities.

• Help students access appropriate academic supports, high school course planning, SAT/ACT and other assessment preparation, as well as guidance and follow-up in selecting and applying to postsecondary education and training programs.

• Link students to existing community educational and career development programs such as TRIO programs and College Bridge Programs.

Foster Care Month Campaign May is observed as the National Foster Care Month in the U.S.A., Things can be done to observe this month Raise Public Awareness • Distribute information about foster care needs in your community or compelling stories to newsletters, advocacy groups, bulletin boards, public service announcements, parent/teacher organizations, community centers, web sites and special interest groups.

• Distribute information on ways members of your community can make a difference in the lives of young people in foster care. See the Change a Lifetime list in the Media

section of www.fostercaremonth.org, or see the helpful list of 40 suggestions at http://www.nfpainc.org/aboutFP/getInvolved.cfm?page=2.

• Tell a youth about Casey Family Programs and the Orphan Foundation of America‘s scholarship program wherein foster youth can receive assistance up to $10,000 for post-secondary education, including vocational/technical training. For more information about this and other scholarship programs, visit www.orphan.org.

Write, Visit, Fax, Phone or E-mail your Elected Officials • Request that your governor, state legislators and mayor proclaim the month of May as Foster Care Month. Send personalized letters (see enclosed sample letters) to your elected officials with information about the foster care system in your own community.

• Notify your U.S. Representative and Senators about activities.

Sponsor or Co-Sponsor an event • Organize an event such as a dinner, coffee gathering, picnic, auction, etc. Invite foster families, community activists, elected officials and your friends and encourage them to hold their own events.

Enlist Local Newspapers, TV and Radio Stations • Hold a press conference.

• Write a letter to the newspaper editor and encourage others to do so.

• Meet with reporters and the editorial board of your newspaper and urge them to write positive stories about foster parents, recognizing the need for more foster parents and highlighting activities built around Foster Care Month. Educate them about the challenges facing youth ―aging out‖ of care.

Recruit Volunteers • Recruit members of your organization, church, workplace, neighborhood or community center to volunteer to support foster families or to become foster parents.

• Request the assistance of your religious and business leaders in building Foster Care Month awareness in the community.

Distribute Promotional Materials in Your Community • Post information on your personal/organizational web site.

• Distribute foster care fact sheets, bumper stickers, book marks/inserts, banners and other materials with foster care information.

• Request that your local grocery stores print foster care messages on their bags.

Reach out to Businesses in Your Community. Ask them to: • Create displays in their shops that include a Foster Care Month poster and spotlights foster families.

• Offer special discounts or gifts to customers who are identified as foster families.

• Sponsor a meal, party or celebration for foster families in the community.

• Include an article in their company newsletter encouraging employees to find out how they can become involved in the lives of children and young people in foster care.

• Sponsor a scholarship for a young person who is making the transition from foster care to self-sufficiency, or contribute to an existing scholarship program • Create a training program for a former foster youth.

• Sponsor a sibling group for a week at Camp To Belong, a national nonprofit that provides reuniting events for brothers and sisters placed in different foster homes.

There are 523,000 Reasons to Get Involved • All children deserve and benefit from the love of a family. No child should ever leave foster care without a permanent connection to a nurturing adult.

• In the U.S., there are 523,000 children and youth in foster care because their own families are in crisis and unable to provide for their essential needs.

• Foster care promotes the healing process by offering a stable and secure environment until the child can either return home or establish an alternative lifelong relationship with a caring adult (such as through adoption).

• We must address the pressing needs of the foster care population now or face the consequences for generations to come. Nearly 20,000 youth will age out of foster care this year , many are only 18 years old and still need support and services. These young people are often left vulnerable to a host of adverse situations such as: homelessness, unemployment, compromised mental health, poor educational status, poverty, substance abuse, and incarceration.

You Can Change a Lifetime • It is our responsibility to ensure the safety, permanency, and well being of America‘s children.

• Nearly every community across the country is urgently seeking more foster parents to meet the needs of children and youth of all ages. Foster homes allow displaced youth to live together with their siblings, remain in their own neighborhoods, and stay in their same schools.

• Foster parenting is a significant and rewarding opportunity that helps shape brighter futures. There also are a variety of other meaningful ways for individuals, organizations and communities to get involved and make a lasting difference in the lives of young people in foster care.

Change a Lifetime: Share Your Heart, Open Your Home and Give Hope to a youth in foster care.

The Faces of Foster Care • Nearly half of the U.S. foster care population is over the age of 10.

• Youth in foster care often have special emotional, educational, and health needs related to their experiences of abuse and neglect.

• With guidance and support from a caring adult, children and youth in foster care are resilient and capable of realizing their fullest human potential.

• Everyday, people in your community are making a difference in the lives of children from your community. Foster parents, relative caregivers, mentors, advocates, social workers and other supporters are the unsung heroes of our society.

• America‘s foster care population reflects every background, culture, and age. However, because children of color comprise a disproportionate percentage of youth in care, the child welfare system must respond with more assistance and new resources that better address this disparity.

May is National Foster Care Month • Now is the time for you to come forward for a child in any way you can.

• What you choose to do today will make a lasting difference in the life of a child.

• Help honor and recognize the many caring individuals and organizations that work year-round on behalf of our nation‘s most vulnerable children.

Reaching out to the Media National Foster Care Month offers you a prime opportunity to get some positive press coverage of foster care in your community. Reporters often look for ―feel-good‖ human interest stories that profile members of the community. We offer you these 10 Recommended Steps for attracting media coverage of your event and sample press materials that you can customize to suit your specific needs.

Step One: Save the Date Send out a Save the Date (see sample below) note to all of your local media outlets. This can be done as early as March and is intended to get National Foster Care Month onto calendars of future events. If you don‘t already have an existing list of reporters, editors, and producers who cover family issues in your area, this is a good time to create one.

Make a list of all the TV and radio stations (including college- and university-affiliated stations), local newspapers (including weeklies), and magazines. Then call and ask for the name of the editor, reporter, or producer who covers foster care or family issues. Also get telephone, fax and, if possible, e-mail addresses. If you do this in March, your list should still be fairly accurate in May. Sample Date NATIONAL FOSTER CARE MONTH During the month of May, communities across the country will be celebrating the important role we can all play in the lives of children in foster care. Here in (name of community) we are planning several special events to honor foster families and encourage others to get involved in the lives of children in foster care.

We hope you‘ll work with us to develop stories about foster care during the month of May. We‘d be happy to provide you with resources, spokespersons, fact sheets and any other information you might need.

Step Two: Plan Your Event What kind of event can you hold in May to attract the attention of the press and of other targeted audiences? Here are some ideas: A breakfast to honor foster families in your community. The breakfast could include a few speeches by elected officials, child welfare advocates, and alumni and foster parents. It would be celebratory and fun.

A press conference at the Governor‘s Mansion to unveil the proclamation about National Foster Care Month.

Invite reporters to meet with some foster parents and former foster youth who have made the transition to adulthood.

Invite reporters to attend a short version of foster care training so they can see what‘s involved in becoming a licensed foster parent.

Invite reporters to a Ribbon Ceremony in your community.

Visit www.fostercaremonth.org for information about creating your own Ribbon Ceremony.

Step Three: Invite Them to Come Once you have designed your event, you may want to use the media to encourage people

to come. A sample announcement could be: Help us honor the people in (name of community) who make the world a brighter place for children in foster care. On (date and time) (name of program) invites everyone in the community to a Foster Care Month (name of event) at (location). We‘ll (give a 20 word description of event). Don‘t miss out on this great opportunity to find out how you can make a difference in the lives of children in care living in your neighborhood. For more information, call (phone number).

This announcement can be sent to all local community calendar editors of media outlets four weeks prior to your event. You can attach a short note asking the editor to run the announcement as often as possible. Be sure to include your phone number in case there are any questions.

Step Four: Tell Them Why It‘s Important Develop key messages about your program. These messages will be integrated into all your press materials and will be the primary things said by all your spokespersons. If possible you should narrow your key messages to three. In your messages, you want to convey why foster families and others who are involved in the lives of foster children and youth are important to the well-being of children and to the community, why you are participating in National Foster Care Month and what you want the community to think/feel/do about your program. If possible, use numbers that reflect how many children are in foster care in your community, how many available foster homes there are, and where people can get more information about getting involved. Here are the 3 key points we will focus on in the national campaign, but feel free to create some that truly reflect your community‘s needs.

Three Ways to Change a Lifetime: 1. Share Your Heart.

Support children in foster care and their foster parents by donating goods, services, or your time in ways such as acting as a mentor or learning how policy, legislative and budget priorities affect children and youth in foster care.

2. Open Your Home.

Become a foster or adoptive parent or a respite care provider, find out about affordable housing options for young people making the transition from foster care, or open your business or professional ―home.‖ 3. Give Hope.

Attend or organize a Foster Care Month event such as a dinner, coffee gathering, picnic, auction, etc. to raise awareness and express appreciation for foster parents, social workers and others who make a difference in the lives of children. Become a Court Appointed Special Advocate or a social worker, or help a young person in foster care.

Step Five: Appeal to the Press Plan your event with the press in mind. Some things to remember: The media – particularly television reporters – are looking for good visuals. Make sure your event has lots of color and action and signs or banners with your program

name and ―National Foster Care Month‖ prominently placed.

Choose two or three spokespersons. They might include a well-known community child welfare advocate, a foster parent, a young adult who has made the transition from foster care to adulthood, or an elected official. Make sure the spokespersons have the messages you‘ve created and are familiar with all aspects of the event.

Make sure your spokespeople can not just identify the issues, but discuss ways to address them as well. The press will want to hear about possible solutions.

Sign up reporters and identify them with badges or nametags as they enter your event so everyone knows who they are.

Step Six: Send a Press Advisory One week prior to your event, write a press advisory that will serve as an invitation to reporters. An advisory is very basic – who, what, where and when. A sample press advisory is included in this document. If you are holding a Blue Ribbon Ceremony, a sample media advisory is included in the Blue Ribbon Toolkit. If you have a news service bureau in your community (Associated Press, United Press International, Reuter‘s), be sure to fax a copy of the advisory to the ―Daybook Editor.‖ This is a person who publishes a calendar of newsworthy events for other reporters to check each day. Mail or fax it to everyone else on your press list. The day before your event, call all reporters/editors/producers to whom you sent the advisory to make sure they received it and find out if they (or someone from their media outlet) can make it to the event. If they are unable to make it, ask if you can send a news release on the day of the event. Many news outlets may be willing to print a press release word for word, but are unable to send a reporter to an event.

Step Seven: Prepare a News Release About a week before your event – or as soon as all the details are nailed down – you should write a news release (see sample.) The news release is written like a news story, but has the advantage of being written from your point of view. It contains quotes from important people, background on foster care in your community, and always contains your top messages. It should be no longer than two pages double-spaced. It is essential to list a contact person and daytime and evening numbers. Because the news release will be distributed at your event in the press kits, it should be written in the past tense.

Step Eight: Develop a Press Kit As soon as your news release is written, it‘s time to put together a press kit for distribution at your event. You won‘t need to create a lot of press kits – only as many as the number of reporters you think will show up. The kit should contain: The news release A one-page background sheet on foster care in your community Facts About Children in Foster Care, a national fact sheet included in this kit It may also contain: A list of agencies in your community that train foster parents A proclamation from your mayor declaring May to be ―National Foster Care Month‖ State or county requirements for licensing foster families Profiles of some exceptional foster families in your community Profiles of some exceptional alumni in your community Ensure that the press kit do not contain more than ten pages of paper. Make sure there is

contact information in case the reporter wants to call someone in the weeks after the event.

Step Nine: Event Management On the day of your event, set up a ―press sign-in‖ table. It should be easily recognizable to reporters and should be at the entrance to the room or location where your event will take place. A staff person or volunteer should be at the table throughout the event to assist press people. There should be a sign-in sheet with ―name of reporter‖ ―media outlet‖ and ―phone number‖ written in columns at the top. Each reporter who signs in should be given a press kit.

Step Ten: Follow-up Don‘t let the story end on the day of your event. Make copies of any stories about your event that appear in print and circulate them to your Board, funders, parents and potential foster parents. Assign people to monitor local TV news shows and tape any stories that appear about your event. Keep those tapes to show at any fundraisers, orientations or meetings you have in the future.

Stay in contact with reporters who attended your event or produce stories. You might want to contact them in the fall to see if they are interested in doing another story.

Maintaining that relationship once the event is over will help you the next time you are looking for some publicity.

National Foster Care Month is a partnership of Myra Family Programs; Myra Foundation Family Services; Black Administrators in Child Welfare; Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services; Child Welfare League of America; Connect for Kids; APHSA/National Association of Public Child Welfare Administrators; National Association of Social Workers; National CASA; National Foster Care Coalition; National Foster Parent Association; and the National Resource Center for Family-Centered Practice and Permanency Planning at the Hunter College School of Social Work, a Service of the Children‘s Bureau.

SAMPLE PRESS ADVISORY (on your letterhead) Press Advisory April 20, 2016 Contact: Myra K Awan Phone : Community-Wide Celebration of Bay City Foster Families Planned for May 8 During National Foster Care Month Bay City will join communities across the country in celebrating National Foster Care Month in May by holding a pancake breakfast to honor the 97 foster families in Bay City.

Everyone is invited to attend and to sign a giant thank-you card for the families. Among the speakers is Mayor Bill Steinberg; Kate McKenney, director of Bay City Foster Families United; and Regina St. Clair, former foster child and currently Foster Home Coordinator, Child and Family Services Division, Bay City Department of Human Services.

WHEN: Saturday, May 8, 2016

9:00 a.m. – 10:30 a.m.

WHERE: Bay City Middle School Cafeteria 4521 Maple Street NOTE: If you would like to arrange in advance to interview any of the speakers listed above, please call Myra K Awan at Phone No.xxxxxx.

If you would like information about National Foster Care Month, please call Martha at the number above.

SAMPLE NEWS RELEASE (on your letterhead) News Release May 10, 2016 Contact: Myra Awan at Phone No.xxxxxx.

BAY CITY COMMUNITY GATHERED TO HONOR FOSTER FAMILIES WHO BRIGHTEN CHILDREN‘S LIVES Local Event is Part of National Foster Care Month Bay City… On May 8, Bay City joined with thousands of communities across the country in celebrating the loving, caring adults who open their homes and hearts to children in foster care. As part of National Foster Care Month, several hundred Bay City residents attended a pancake breakfast at Bay City Middle School to thank the 97 foster families in their community. ―People who become foster parents do so out of love and compassion,‖ said Mayor Bill Steinberg, who presented a proclamation declaring May Foster Care Month. ―Take some time this month to thank these wonderful families who provide homes and love to children who need them.‖ Regina St. Clair said, ―Show you care for all children whose parents cannot care for them – find out how you can make a difference for a Bay City child in foster care.‖ Several of the foster parents who were being honored said that it was an honor simply to make a difference in the life of a child. At least two-thirds of the foster parents in attendance said that they plan to be foster parents for many more years.

Many of the people at the breakfast signed a giant thank-you card that expressed appreciation for the foster parents‘ involvement. Leslie Jones, owner of Bay City‘s Pizza Barn, gave all the foster families coupons for free pizzas during the month of May. ―Become a foster parent – it‘s one of the most rewarding opportunities available. As a trained foster parent, you could have a positive and long-lasting impact on the life of a child,‖ said foster parent Marshall Hunter. ―Bay City needs to make sure there will always be enough loving foster families.‖ REACHING OUT TO THE MEDIA: TIMELINE March • Finalize your core messages to be highlighted in all campaign materials.

• Compile a list of reporters/editors/producers in your community • Send out a Save the Date card to the above list • Begin planning your May event/s for National Foster Care Month

• Send letter to governor asking for Foster Care Month proclamation April • Begin sending newsletter article to local community newspapers, newsletters, etc.

• Finalize details of your National Foster Care Month event/s • If community is invited, send out announcement to local radio, TV, newspaper calendar editors • Determine who spokespersons will be, and ensure they have the messages • Four weeks before the event, send an announcement May • One week before event, send out press advisory • One week before event, write news release • Develop press kit and compile it before event • One day before event, call all reporters/editors/producers to ensure they know about event and will be attending .

• Day of event, send out press kits or news releases to all media outlets that don‘t attend • Monitor all media outlets after the event and collect clippings and tapes of shows to use with funders, board members and others.

After May • Maintain relationships with reporters/editors/producers who attended event or wrote stories.

CREATING A PRESS LIST As you prepare for your National Foster Care Month events and activities, be sure to develop a comprehensive list of local media outlets. This list will enable you to quickly reach out to the appropriate reporters, editors and producers at your local TV and radio stations and newspapers. It is better to plan ahead and create such a list now rather than when you frantically need to reach a reporter. The following are the steps you can take easily to create a press list that will help you obtain press attention for your event and issues surrounding foster care.

1. Figure out if a current listing of education, parenting, social issues and children/youth reporters, editors and producers for your local area already exists. It is possible that your school system‘s administrative offices, or local education association, already have such a list. If the existing list is more than six months old, it is important that you call all names on the list to make sure they are still covering issues like foster care. Reporters and editors tend to be very mobile and may have moved to another area and might be covering an entirely different issue. You can‘t count on the goodwill of reporters to pass along a story to someone more interested in covering it. Frequently, if you don‘t reach the correct person, your information will be thrown out. And it is not enough to fax materials to ―Education Reporter;‖ it is far better to get a name.

2. If a good list of reporters does not exist, it is not difficult to create one. Begin by looking in your local phone book for listings of TV and radio stations and local daily and weekly newspapers and even magazines. Call the numbers listed and ask the receptionist for the following information: name of the person(s) most likely to cover foster care, along with their address, phone and fax numbers. Sometimes the receptionist won‘t know

and will put you through to the newsroom directly. That‘s okay , state who you are and ask for the information you need. If you are put through to the reporter, ask if he or she prefers to receive information via e-mail, fax or mail. Make sure that preference is added to your list.

3. Remember to include local cable access TV, university radio stations and newspapers, and public broadcasting stations in your area on your list. If a TV station is not physically located in your community, but does serve your community, make sure to add someone from that station to your list. And, if you have a bureau of the wire services Associated Press, Reuters or UPI in your community, add them to the list.

4. Make sure to add to your list any reporters who have covered foster care in the past, even if they no longer do. For example, an anchor person who once did a story about foster care should receive information about National Foster Care Month. She might be in a position to influence a producer to get the story covered.

5. And, finally, add ―Assignment Editor‖ to your list of all stations in addition to named reporters, editors and producers. The Assignment Editor is the person who sifts through all potential news stories and assigns reporters to cover them. He or she should receive all press mailings just to make sure nothing slips through the cracks.

Once your press list is created, you will be ready when you send out announcements, advisories and news releases about National Foster Care Month. On the National Foster Care Month website, www.fostercaremonth.org, you will find some sample materials that can be tailored for your local press.

Writing and Placing Letters to the Press Most daily and weekly newspapers across the country have a special section for letters from members of the community. Sometimes these are included on the Editorial Page, and sometimes in the News section. The editor welcomes points of view from community members, as long as the letters are short, meaningful and timely.

We encourage you to write letters to the editor of your local paper about National Foster Care Month. The best time to do this is in mid-April. The letter should be no more than 10 sentences and must include your name, address and phone number. The letter should also include a sentence about your expertise/commitment/relationship to the issue of foster care.

So, for example, if you are a foster parent, be sure to mention that. In this toolkit we have included several examples of letters to the editor, written from various points of view.

You are welcome to use the letters provided here -- tailoring them to your own experience or write one yourself using these as templates. You might also want to craft your own letter from the heart, using the campaign‘s core message points .

WRITING AND PLACING OPEDS An OpEd (Opinion-Editorial) is a piece written by a member of the community with a particular point of view to express. Most daily newspapers have an Editorial or Opinion Page containing OpEds, many written by syndicated or staff columnists. A few

syndicated columnists you might be familiar with are Molly Ivins, David Broder, and Ellen Goodman.

Many newspapers welcome OpEds written by people in the community. The advantage of writing an OpEd is that it is written entirely in your own words – as opposed to having a reporter translate your viewpoint – and is usually not heavily edited unless you have exceeded the word limit. It carries your byline and title. Disadvantages are that it does not have the impact of a news article, and attracts fewer readers than do news pages.

Most OpEds are between 500-800 words. They must be topical, timely, well-written and must clearly a state a strong opinion. Before deciding to write one, read some guest OpEds to get a sense of word length, subject matter, and tone. It is also a good idea to call the Editorial Page editor to see if he or she is interested in receiving an OpEd on foster care. If the editor sounds interested, find a way to customize the template OpEd we‘ve provided. Include a little bit about your personal experiences with foster care. Include information about foster care in your community or state (how many children in the foster care system, how many foster homes, etc.) Include a contact agency or program that people can call if they want to get information about foster care.

Once your piece is written, ask some friends who are not familiar with the issue to read it.

Make sure they understand both the issue you are writing about and why it is important to them. Have several people proofread it, and then it‘s ready to send to the Editorial Page Editor. Try to submit it no later than the third week of April. Attach a brief note to it with your daytime and evening phone numbers. In the note, make sure you mention that May is National Foster Care Month so the editor understands the timeliness of your OpEd. If you haven‘t heard a response within two weeks, call the Editor and ask if he or she is interested in using it. If not, ask why.

Foundations of Attachment We like to believe love is an emotion which descends upon people in some incomprehensible way, and that the euphoric mood is due to some mysterious connection associated with the one we love. The truth, however, is not nearly so romantic. There is nothing particularly mystical about how love develops. Love develops due to the release in the brain of pleasure causing endorphins. The mechanism for releasing the endorphins can be put in place by anyone who chooses to put the effort into it. Much like runners know they will reach a "high" if they run far enough and fast enough, lovers know if they tickle their loved one's ear and whisper sweet nothings they can expect some sort of aroused reaction. The emotion, which we call love, is the result of very specific actions.

The task for adoptive parents is to figure out what actions on their part release the endorphins in their child's system, enabling the child to connect pleasure with their parents. They are not hard to discover if parents can remember when they first "fell in love". If that time can't be remembered go to any high school and watch the adolescents in the halls and classrooms. The same elements present in the flirtation and courtship dance need to be injected into the parent-child dance if the two are to "fall in love".

Eyes have been called the window of the soul, as it is through them we make our deepest connections. It would be very difficult to fall in love with someone who avoids eye

contact. When people talk to each other it is extremely helpful if they are looking at each other as then deeper, more meaningful interactions occur. One of the first games universally played with infants around the world is "Peek a boo". The baby looks expectantly in the direction of mother's face and squeals with delight when eye contact occurs. Reciprocal eye contact is therefore a pivotal part of making a connection with an adopted child.

The largest organ of the body is the skin. When people are stroked and massaged they are flooded with feelings of good will. Animals are tamed by petting them. Tamed animals are better equipped to respond to their master's voice, stay where they are put and come when they are called. They develop larger brains and are physically larger and more agile. Children who are touched and caressed in non-sexual ways are soothed and comforted by the presence of their parents. They become responsive to their parent's directives and wishes. In essence, they become "tame".

Food is another pivotal component of arousing the feeling called "love". Not just any food, however, will do. Lovers do not send each other carrots on Valentine's Day. The food of choice is chocolate, though any sugar will serve the purpose of arousing in a child a feeling of good will, which then transfers to the parent giving them the treat.

The inner ears contain tiny hairs which, when stimulated appropriately, can cause a pleasurable shiver to run up and down the spine. Infants are affected by rocking, adolescents by amusement parks. Adults jump out of planes and participate in extreme sports, anything to arouse that shiver of excitement, which keeps them coming back again and again to re-arouse the senses.

The process of getting a child to attach to new parents is, therefore, enhanced by incorporating eye contact, touch, sugar and movement in such a way that the childâ&#x20AC;&#x2DC;s awareness is heightened and the pleasurable feelings which result are connected to the parent. Any activity between the parent and child which is on the parent's terms and involves these elements in a fun way will be bonding. Swinging a child, playing horsey, playing tag, water games, wrestling, dressing a child silly all are ways to help the child feel pleasure in the parent's presence. Activities are limited only by the parent's imagination.

If a child avoids eye contact, it can be overcome by playing peek-a-boo with M&Ms. Everytime the child makes eye contact a piece of candy is popped into the mouth so the sweetness is associated with the parents and the resistance to making eye contact is overcome in a fun way. Key is having the sweet pass directly from the parent's hand to the child's mouth. If the child feeds himself/herself the impact is minimized.

When a child is resistant to being touched the parent needs to touch lightly and frequently until the resistance is decreased. Brushing a child's hair, quick hugs, light tickles, neck and back rubs, foot massage, rubbing lotion into the child's hands, helping the child dress, tying the child's shoes, This Little Pig, listen to the heartbeat, patty cake, patty cake with feet, wheelbarrow, thumb wrestling, fingernail polish, counting body parts, rubbing noses, face painting, feeling muscles, etc, all are quick, fun ways to get close to a child without activating resistance.

Many children arrive in the adoptive home scared and angry. Diffusing those feelings is important if attachment is to occur. Telling children in words they are safe and loved does not penetrate the armor of defenses with children who have heard it all before. It is not telling a child he or she is loved which will have the most impact. It is acting it out in

joyous, yet intrusive ways, which will help parents get through the wall surrounding injured hearts.

Adolescents Health Too often in the past, public policy has either ignored adolescents or focused on them only when they behave in ways that trouble their elders. Compared to very young children and to the elderly, adolescents suffer from few life - threatening conditions.

The formation in adolescence of certain health habits with long-term negative consequences (such as smoking tobacco product s , use of other addictive substances, or sexual activity without protection from STD and AIDS) often does not produce morbidity or mortality in adolescence itself.

Rather the effects, and the costs, develop over a lifetime. Thus, when societies face decisions about where to invest significant health and other supportive resources, attention to adolescents often receives short shrift, despite the fact that after early infancy, adolescence is the period of greatest vulnerability until one gets to the diseases of old age.

Need for Future Health and Productivity Adolescents aged 10-19 are a very large and significant proportion of the population of Central and South American and Caribbean countries, ranging from 17 percent in Uruguay up to almost 26 percent in El Salvador.

For all of Latin America the percentage is 21.7 percent, with figures lower than 20 percent only in Argentina, Chile and Uruguay. This compares to the much lower 13.7 percent for North America (Knaul and FlĂłrez 1996). To a large degree, the future economic development of these countries depends on having increasing proportions of the population who are reasonably well educated, healthy, and economically productive. Being both well-educated and healthy contributes to potential economic productivity, but of course does not guarantee it. It is also essential that countries create increasingly broad and rewarding economic opportunities. There is also an important interaction between economic opportunity and the readiness of today's youth to take advantage of it.

Without the realistic hope of getting ahead economically, there is little incentive for youth to invest in education or protect themselves from some of the less healthy habits they may acquire during adolescence. But without the expectation that there will be a qualified workforce to fill newly-created jobs, potential investors may be reluctant to make the necessary commitments to economic development. To the extent that a country's youth of today and tomorrow are not prepared for that future (and many are not, as will be documented below), hopes for the country's economic future become increasingly dim. Another critical issue has to do with the programs that do exist to serve adolescents, in Latin American countries and also in other parts of the world. The types of attention that adolescents usually do receive, when they receive any, too often is focused on specific problem behaviors once the behaviors are fairly well-entrenched.

Prevention programs are relatively scarce; what happens instead can be called "tertiary attention"â&#x20AC;&#x201D;trying to fix something after it is badly broken (Barker and Fuentes 1995).

Even more significant, these tertiary efforts usually focus on single issues such as early childbearing, or substance abuse, or criminal involvement . They do not take a holistic approach to youth, their families, their environments, and the overall context in which

their behavior occurs. As we will see below, these single-focus, tertiary types of attention have not demonstrated much significant capacity to change the lives of adolescents. They are, however, usually quite expensive on a per-client basis. Later, this paper will examine the evidence and look at the breadth of the growing consensus that interventions to promote adolescent health are most effective when they use a holistic framework.

Framework for Working with Adolescents The remainder of this introductory section will focus on articulating the different elements of such a framework.

In its final section, this paper will return to the framework to examine the practical issues and challenges involved in conducting work within its context.

Theories of Youth Development and Their Implications Adolescence was once viewed as a life stage that, by its very nature, involved serious conflict and upheaval as individuals tried to sever their connections with childhood dependence and struggled to achieve an independent adult identity (Blos 1962; Freud 1958). The troubles of adolescents were seen as typical or to be expected during this life stage,rather than as a sign that something was seriously wrong. However, more recent thinking sees much less necessary difficulty with the process and much more continuity between the child that was, through the adolescent that is, to the adult that will be. This view, expressed by Offer and colleagues (Offer et al. 1981; Offer 1987) and others, is that normal adolescents negotiate this period of life transition with relatively little major disruption or sustained high risk behavior, maintaining and developing their own identity and their relationships with parents as w ell as adding elements of identity and building new extra-familial relationships and skills.

Given this view of "normal" adolescence, those teenagers who do experience major disruptions and who do persistently engage in problem behaviors are in trouble now, and have a significantly greater chance of being in trouble later in life (Hamburg and Takanishi 1989). Therefore, successful interventions with these youth are likely to have important payoffs in terms of future health problems prevented and future satisfying and productive lifetimes promoted.

Developmental Tasks of Adolescence As with all stages of life, adolescence involves some key tasks that build on earlier successful development. As adolescence is the transition period between childhood and adulthood, the tasks of this period are all related to making that transition. Adolescence is the period in which individuals face the tasks of establishing a satisfying self-identity and interpersonal bonds beyond the family, including partnering; learning to handle growing sexual maturity in a responsible manner; and developing the capacity for economic viability, including education , skills, attitudes, habits. Adolescents' family, peers, neighborhood environment, school, and other associations can help them complete these tasks, or can pose significant barriers which many youth will not be able to overcome on their own. We can begin to make progress in helping adolescents once we can begin to understand how even the most undesirable of youth behaviors usually represents either: 1) the attempts of adolescents to complete these developmental tasks; 2) ambivalence about whether they want to move on to adulthood or to stay a child; or 3) the consequences of their perception that they may never complete the tasks successfully.

Addressing Symptoms, or Underlying Conditions As has already been noted, most programs serving adolescents focus on specific conditions and usually do not intervene until the conditions have reached the level of "problems." Thus we have programs

dealing with teenage childbearing, programs dealing with failure to complete secondary school, programs dealing with substance abuse among youth, and programs trying to reduce youth violence.

To a large extent this compartmentalized pattern of services reflects the narrow focus of many government agencies. However, a great deal of research on the factors contributing to the development of these problems reveals that they have common antecedentsâ&#x20AC;&#x201D;the same underlying conditions are identified time and again.

In a recent su mm ary of res earch on risk factors , Catalano and Hawkins (1995) identify the following as common antecedents for most or all of substance abuse, delinquency, teenage pregnancy, school dropout and violence: extreme economic deprivation,family conflict,family history of the problem behavior, and family management problems. Further, substance abuse, delinquency and violence all share neighborhood characteristics that suggest the neighborhood offers particular opportunities to engage in problem behaviors, and little to help youth resist them, namely: community laws and norms favorable toward d rug use and crime; availability of firearms, friends who engage in the problem behaviors, parental attitudes favorable to the problem behavior, and low neighborhood attachment and community disorganization. Under these circumstances, youth striving to achieve identity, skills, and a livelihood may have ready access to problem activities (from the societyâ&#x20AC;&#x2DC;s point of view) and little access to positive ones. Too often, public policies and programs address youth problems as if they happen in a vacuum. A more apt metaphor for youth problem behavior appears to be a volcano.

The volcano has a seething, molten inner core, and a number of potential fissures through which the pressure building up at the core may be relieved. One fissure may be risky sexual behavior; another may be involvement with drugs; a third may be criminal behavior; a fourth may be school dropout. If we focus on the symptom emerging from a particular fissure and try to fix it, say by plugging the fixture, the underlying pressure from the life conditions of high risk youth will simply find another way to escape.

Perhaps this will be as another problem behavior.

Perhaps, with proper guidance and intervention to help youth achieve developmental tasks in a constructive manner, it could be legitimate entrepreneurial activity or community service. The important point is that , to change the fate of youth in these circumstances,we have to find ways to reduce the pressure or turn down the heat at the base of the volcano. This means addressing the underlying causes or conditions of adolescent lives, at the same time we think about how to help youth toward successful completion of their fundamental developmental tasks.

Risk and Resiliency Just as there are factors in a youth's environment and background that condition the probability that the youth will get into trouble, there are also factors that may be able to protect youth from their influence. The idea of protective factors grows out of work that focuses on children who seem to do well despite living in circumstances that expose them to considerable risk (Cowen and Work 1988).

These children have been called "resilient," "invulnerable," "competent," and "stressresistant," among other appellations (Garmezy 1983, 1987; Rutter 1987; Werner 1 9 8 6 , 1 9 8 9 ; Werner and Sm ith 1982). Much recent research has focused on trying to identify such factors, and to learn how they work (that is,whether they are independent, positive factors in their own right, or whether they have effects primarily when there are

risk factors that need to be countered or alleviated). Individual, familial, and environmental protective factors have been identified to date,many of which are found to operate as independent positive factors whether or not a youth also experiences a high level of risk factors. Grossmanetal . (1992) summarize these factors . Protective individual (personality) factors include selfesteem (Garmezy 1983; Murphy and Moriarity 1976; Rutter 1979; Werner and Smith 1982), and internal locus of control (feeling confident that your own efforts will produce desired effects (Garmezy 1987; Werner 1986).

Protective familial factors include the absence of marital discord (Garmezy 1987; Rutter 1987), family cohesion having an important relationship with a significant adult figure other than one's parent(s) is a protective factor in the social environment beyond the family (Garmezy 1983; Murphy and Moriarity 1976; Rutter 1979; Werner and Smith 1982). In some studies (e.g.,Werner 1989; Werner and Smith 1982),the need for protective factors appears to increase as the risk factors to which a child or youth is exposed increase. Thus more youth will successfully negotiate circumstances of low risk without protective f actors than will successfully negotiate circumstances containing many risk factors unless they also have some protective factors working for them.

The Service Implications of Youth Development Theories The view of adolescence just presented has important implications for how we should work with adolescents.

First, it is critically important to develop coordination among different parts of the service and support system so the needs of adolescents can be addressed in a holistic and coordinated way. Even if health is the major focus of a program, it is still necessary to address the needs of youth to earn money, help their family or learn how to deal with its difficulties, and feel confident in their abilities, or these things may get in the way of youth being able to follow appropriate health regimens. Given the potential importance of protective factors, many interventions with high risk youth try to supply or strengthen them. Many programs work on improving youth self-esteem and sense of self-efficacy, regardless of what other aspects of youth experience they are trying to influence.

Programs also try to assess the problems that may be affecting adolescents' families, and offer assistance either directly to the family or to the youths as individuals in coping with their families' problems. When their family is homeless, or a parent is violent or a drug user, a youth will probably not have the ability to concentrate on schoolwork or keep up their sense of self-efficacy as long as the family problems persist, or until the youth gets some help in protecting him- or herself from negative family influences. Many programs also try to offer sympathetic and supportive adults with whom youth can bond, in order to supply this relationship as an additional protective factor. This is especially important when familiar problems and difficulties with parents are among the chief risk factors in the lives of youth. This section briefly summarizes the conditions of Latin American and Caribbean youth , to the extent that available statistics make this possible. It looks at education, employment, health and reproductive health status , and substance abuse information.

Education Educational attainment of youth varies widely among the countries of Latin America and the Caribbean basin, while within-country variations between urban and rural areas and among income groups are equally striking. Data are not available from every country.

Eleven Latin American countries report data by income strata about the proportion of

urban youth ages 20-24 who are not enrolled in school and who have less than 10 years of completed education; seven of the same countries also report data for their rural areas (CEPAL 1994, Table 47). For urban youth, the proportion achieving at least 10 years of education ranges from a high of almost 80 percent in Chile to a low of only 46 percent in Honduras. However, class differences loom large in all of the reporting countries. Chile and Venezuela have the smallest (but still substantial) class differences, with 92 percent of the highest income quartile and 62 percent of the lowest income quartile having this much education among Chileâ&#x20AC;&#x2DC;s urban youth; in Venezuela,74 percent of urban youth in the highest and 43 percent in the lowest income quartiles have completed at least 10 years of education.

Mexico reports the largest class differences for urban youth educational attainment, with 80 percent of youth in the upper income quartile completing at least 10 years of school compared to only 18 percent of urban youth in the lowest income quartile.

Parallel statistics on rural youth show much smaller between-class differences, but are much lower than the figures for urban areas in all countries reporting. Panama reports the best figures, and still only has 41 percent of rural youth completing at least 10 years of education. Figures from other countries range from 26 percent (of rural youth in Costa Rica) down to 14 percent (of rural youth in Honduras). Many indicators from around the world suggest that the way a country treats the educational opportunities of girls is a key to modernization, and also a key to avoidance of many problems specifically related to youth. When girls have opportunities to be something in life in addition to childbearers and domestic laborers, many other things also change, including family size and child spacing, and child and maternal health. Employment and Unemployment Youth employment may be a positive thing, especially for older youth. It is particularly critical for those beyond school age, for whom the inability to find a job, or to find a decent one, is usually the issue. For younger adolescents, the issue is more that their employment, which may be essential in contributing to family income, interferes with their schooling and therefore with their potential to get better jobs as they reach adulthood.

A high proportion of youth neither work, look for work, nor attend school, with the consequence that they miss opportunities for both education and training. This group of out-of-school youth who are not in paying jobs includes many whose parents are poor or indigent, who themselves are poor or indigent, and whose children are likely to be poor or indigent. There is considerable likelihood of criminal involvement among this group of youth. Also, it contains many young women who are kept at home to do unpaid household labor, and are thus unable to attend school. Little is known about the longer run effects of unpaid work in the home on the relatively high proportion of Latin American young women who perform it. Health and Adolescent Pregnancy The health problems of adolescence and youth in Latin America and the Caribbean tend to be very different from those of childhood, and are associated with the major organic and psychosocial changes that are part of adolescent development (OPS 1990). The developing countries experience significant differences in mortality rates and causes among adolescents. Infectious diseases (diarrhoea, influenza, pneumonia) still stand among the five major causes of death for 10 to 14 year olds in countries like Guatemala, but in countries like Colombia that are closer to the other end of an epidemiologic transition, accidents and violence are more import ant as causes of death among

adolescents. In some countries, violence due to police action and war is also a leading cause of death (OPS 1990).

Another issue in adolescent health is the prevalence of sexually transmitted diseases and HIV/AIDS. The highest incidence of STD is found in the age group of 20 to 24 year olds, followed by those from 15 to 19 and then those 25-29 years of age. At least half of those infected with HIV are 24 years old or younger. Teenage sexuality, pregnancy, and childbearing present major health issues to Latin and Caribbean countries, as well as to many developed countries such as the United States (European nations are considerably better at preventing unwanted pregnancies and childbearing than is the United States, Jones et al.1985.) Early sexual initiation and childbearing are associated with poor nutrition, poor or non-existent prenatal care, premature delivery, complicated childbirth, low birth weight babies and a higher proportion of babies born with additional complications, poorer infant outcomes, and the probability of less adequate parenting (Hayes 1987). The health risks to young women from illegal abortions are also great.

Estimates for Latin American countries suggest that perhaps as many as 4 in 10 pregnancies end in abortion, going as high as 6 in 10 for Chile, and as low as 2 in 10 for Mexico (Singh and Wulf 1994). To the extent that teen pregnancies result from sexual violence or abuse, they are likely to have other long - term psychological and physical health consequences that affect demand on health services (Heise, Pitanguy and Germain 1994).

Substance Abuse and Other High-risk Behaviors There are very few sources of countrylevel data reflecting the risk - taking behavior of Latin American and Caribbean youth. Those sources that do exist vary in the age range of youth studied and the ways that questions were asked. The older the age range, the more likely it is that studies find higher proportions of youth who have tried particular risky behaviors, or who habitually use addictive substances. Smoking is probably the behavior most common among youth of all ages, and most likely to affect health because of its pre valence (OPS 1990).

Significant proportions of male youth smoke cigarettes (e.g.,57 percent of 15 to 19 year olds in Peru, and 41 percent in Cuba, compared to 28 and 32 percent in the United States and Canada, respectively). In Mexico, 17 percent of an even younger age cohort, the 11 to 15 year old males, were smokers. In the United States and Canada, female youth rates of smoking are virtually the same as for males, whereas in the Latin countries studied, female youth were significantly less likely to smoke (although rates were still high, 40 percent in Peru and 28 percent in Cuba). In Mexico there was little difference in male and female rates among 11 to 15 year olds. One way to think about the importance of attending to adolescent health issues , and at tending to them in a holistic and comprehensive way, is to think about what the consequences will be if we do not make these investments . No studies of which we are aware try to assess the personal or societal costs of adolescent risk behaviors for Latin American or Caribbean youth .

However, several such attempts have been made in the United States , with respect to a variety of topics including teenage pregnancy and child bearing, educational completion and juveniles likely to become career criminals . I describe some of these studies in this section , with two purposes in mind. The first purpose is to give the reader an idea about how some analysts have tried to conceptualize the ideas of investment , pay of costs , and social and personal consequences .

There are a number of approaches , and there may be reasons for choosing one or the other of them depending on w hat you are trying to do. The second purpose is to give some concrete examples of analyses that may stimulate the reader to think about how similar investigations could be undertaken in their own countries . Toward the end of this section we describe the results from several studies that examined the effects of holistic, integrated service and support systems designed to help high risk youth .

Statements about costs that could have been prevented with appropriate interventions make very powerful argument s . For instance , the Carnegie Council on Adolescent Development (1993) recently presented some telling calculations for the United States: • Each year's class of high school dropouts will, over their lifetime, cost the nation $260 billion in lost earnings and foregone taxes.

• Over a lifetime , the aver age high school dropout will earn $230,000 less than a high school graduate and contribute $70,000 less in taxes.

• Each added year of secondary education reduces the probability of public welfare dependency in adulthood by 35 percent (with associated reductions in public costs).

• Each year, the U.S. spends roughly $20 billion in payments for income maintenance, health care, and nutrition to support families begun by teenagers.

When thinking about justifying investments in public support and services to adolescents, there is some pressure to try to quantify the results, and also to monetarize them if possible. People usually approach the job of justifying investments by asking,"What is the cost of not helping high risk youth—that is, suppose we did nothing and the youth went ahead and pursued high risk behaviors, what would be the consequences? And, are those consequences sufficiently disastrous, for a youth, for a community, or for society as a whole, that we should seriously consider putting some public resources. What Payoffs Can We Expect from Investing in Activities that Promote Adolescent Health?

The evidence is very strong that the successful programs in reality treat children and youth holistically, start young, offer many enrichment, growth and development activities, and stick with youth for a long period of time.

Teenage Childbearing During the early 1980s, several pioneering at tempts were made in the United States to estimate various aspects of the costs of teenage child bearing. Among the most sophisticated were Wertheimer and Moore (1982), who used dynamic simulation computer modeling to estimate lost earnings , lost work years , lost taxes , and probable use of public benefits such as welfare (Aid to Families with Dependent Children) and public medical care (Medicaid ) ; and SR I International (1979), who developed a 20-year projection of the public welfare , medical , housing and social services costs of a family begun by a first birth to a teenager.

Burt (1985, 1986) took the findings from these studies and developed two simple cost estimating methods that could be conducted in any jurisdiction of interest (county, st ate , or for the whole country ) . The first method calculates the money spent through the three biggest public assistance programs in the United States during a single calendar year that went to families begun by a teen first birth .

The second method follows the SRI International model, and estimates the cost to the public over a 20-year period, in welfare, medical care, housing, and social services, of each family begun by a birth to a teen younger than 15, 15 to 17, and 18 to 19. To learn the total public cost for an entire calendar year's cohort of first births to mothers 19 or you nger,these calculated costs are then multiplied by the actual number of first births to teens in those age groups as recorded in vital statistics . All out - year costs are then discounted to future value. These costs are compared to the probable public costs for families in which the mother waited until she was at least 20 before having her income assistance (Aid to Families with Dependent Children), health care (Medicaid), and nutrition (Food Stamps). first child ; the difference is the possible public savings of helping teens delay first births until the age of 20 or later. Burt and Levy (1987) used these cost analyses as the basis of a model for assessing cost-benefits and the cost effectiveness of services to adolescents. The reasoning they followed is similar to that used by Cohen (1995), described below for preventing a youth from following the path of a career criminal. That is, we can calculate, using Burtâ&#x20AC;&#x2DC;s cost methods, the public cost of each birth to a teenager,and can also estimate what the public would save if that birth were delayed until the teen was 20 or older. If the cost of the program to help each teen avoid an early birth is less than, or even virtually equal to, the cost to society of having that birth occur, then the program is cost-beneficial. If one program can accomplish the same outcomes for teens with less money, then that program is more cost-effective. There are foster parents out there who specialize in parenting pregnant teens. This is a distinct type of parenting that I greatly admire since in reality you are caring for two children at once.

Usually, with young girls not ready for relationships much less babies, there is some passing of time between the discovery of pregnancy and the announcement to parents. If this time is short, a few days or a week, not little harm will be done unless the teen is far along and has just discovered it herself. Hopefully, parents will not need to wait months before they are told since this could be dangerous to the mom and baby.

Parents need to acquaint themselves with the way each foster daughter carries herself.

They should be aware of her basic body outlines and general health. Foster parents must know this girl's habits so that they recognize when things change. This is important for all kids, not just "possibly pregnant teens."

Once you learn to recognize the changes in your kids, you will parent more efficiently.

Changes in attitude, appearance, and habits usually announce an important step in your foster child's development. It can be signs of a positive change, but more often it is a negative change these signs herald.

When the discovery is made either independently by the parents or the child shares the joyful news, then the hard decisions need to be made. Before absolutely anything, get that girl to a doctor. Make sure the pregnancy is confirmed before everyone loses their mind over it. This is a common state of affairs that occurs whenever there is a teenage pregnancy. Slow down, relax and get the facts.

The doctor appointment needs to take place regardless of any previous one by the teen.

Confirmation should take place even if the teen assures you she did a home or other pregnancy test. Because this is such an emotion filled issue, teens may tend to stretch the truth, hide the facts, or "game" about this subject.

Laws are designed to give young people many privileges including one of privacy, but your teen can wave that and allow you to be part of the whole process. If you have a good relationship with your teen, this will be easier to gain admission to information and doctor visits. Try to make your teen understand that there will be lots of stress and trauma surrounding this early age pregnancy and that she will need support. You may need to bow out if the young parents are at the highest end of the age spectrum or if a natural parent chooses to be involved. Try to stand up for your rights as to inclusion if you are to continue to parent this girl. Some foster parents also help care for the new baby as well so I believe they must be involved in the process. Not wishing to slam the natural parent, but if there were reasons to remove that foster daughter from the birth parent home, then they are ill equipped to help that daughter raise a child.

One of your most important jobs as a foster parent of a pregnant teen is to make sure that the girl is getting good prenatal care. This means either dropping her off at the doctor's office, going with her, or confirming by phone that the visit took place. A young lady who skips appointments may develop serious medical problems and not even be aware of the problem.

Pregnancy requires proper eating, taking vitamins, enough sleep, and a watchful eye as to potential problems as the body changes to accommodate a baby. It requires a clear understanding of the doctor's orders and suggestions so you can follow them religiously.

Certain tests may be required in order to plan an appropriate delivery. These things must be dutifully reported and understood. Some teens as well as others of all ages lack common sense and someone who has more maturity needs to oversee the pregnancy.

Of course, the biggest step will be what decision is to be made concerning the babies future. Most foster parents I know, by nature just love children, so the abortion issue will probably not be one they would entertain. We won't even go there. There is the decision as to whether or not this young girl or parents can raise this child by themselves or if they should consider adoption. Although the foster parents are in a good position to influence these girls, I would not recommend it. I would recommend you give them all the information, resources, and help you can. Stay away from offering opinions. Your relationship is so sensitive as it is with this child, you could alienate them by telling them what to do. This is a vitally important decision that can change their entire life.

It is okay to offer friendly advice in the way of information and where to find resources or who to call etc. It is a very bad move to advise the teen to either keep the baby or adopt. This is one time I really advise foster parents to keep their mouths shut. Difficult, I know. This is no time to be judgmental or say I told you so. This is not the right time to get into religious and moral debates. There may come another time, but now is not it.

Attempt to be supportive, no matter what choices this girl or young parents make.

Remember, if the father is in the picture and intends to be part of this girl's life, he needs to be treated like an adult member of this relationship. It goes without saying, so should the girl. This does not indicate you should not be painfully aware of their tender age, just do not constantly focus the discussion on that aspect. If you do, things may backfire and your relationship will suffer. Instead focus on the realities of jobs, school, diapers, no social life, friends moving on with their lives without you etc.

I've recently read that more girls are choosing abstinence; I hope that is true. But until the majority makes that decision, we will need to deal with teen pregnancies. We need to fight for laws that involve foster parents as much as possible while preserving the young

girls' privacy and dignity. This means we may only get information second hand and may not be in the examining room. This is not a problem if we are dealing with a truthful teen.

It is a problem when we have one who may not tell us she now needs a new medication or pretends to take it, but does not. This is a whole other situation. You may be able to develop some sort means of communication with the doctor that protects her privacy, but keeps you in the know. Ask if this girl has no other person to help her, offer to go to child -birth classes. I have done that and it was another bonding experience on a much different level. You can be a good support, but only if no one else in the situation is interested or willing.

One special problem you may encounter is with a pregnant teen who was previously sexually abused. This can result in a whole slew of additional problems. I experienced this when I took a girl for a gynecology examination. She was fine until the doctor touched her and then she almost became uncontrollable. I stood by her, holding her hand throughout the entire exam. It can be a time when all those monstrous past memories come to light. This often occurs anyway at puberty, but surely is likely when a girl is focusing on her body and what it is becoming. Be prepared if your girls have a history of sex abuse. It may pose several problems.

One last problem will need to be dealt with if you are to help parent this young mom and her baby. This problem will be a need to be helpful, but not overbearing. Teach, but do not scold or belittle this girl's efforts. Motherhood should come natural, that ability should be passed down from mother to mother and generation to generation. That is also where the lack of training and skill is passed down. Foster kids are often born to moms with little or no understanding of parenting. Their own needs have not been met so they do not know how to care for their own child. There is no skill to be passed down. They don't know how to parent.

Last, look into all those resources available. There are organizations that provide food products for moms who need financial help. Many offer medical help and advice. Some places specialize in lending out maternity clothing or baby equipment at no cost to the mom. There are many school programs in place for moms who want education while they are raising their babies. Search out what is available in your area and I'm sure your teen will have a better chance of successfully surviving this unplanned pregnancy.

For foster parents who take in these special girls in such a delicate condition as it was once referred to, I take my hat off to you. For all foster parents, thanks for being the kind of people you are to do the job you do.

Educational Completion In the United States, roughly one-fourth of youth do not complete high school; in the poorest and most disorganized sections of the country's biggest cities, this statistic can easily double. Catter all (1987) and Chaplin and Lerman (1996) present recent efforts to calculate the social costs of failure to complete at least a high school education, including private costs (those borne by the individual dropping out) and public costs (borne by the society as a whole). The primary component of private costs is foregone earnings as a consequence of being unable to get better-paying jobs and make major advancements in a career. Earnings differences are apparent early, and increase with age. Other private costs are easier to name than to place a dollar value on, and include such things as: more difficulty managing personal finances, less savings and therefore greater vulnerability to

crisis; possible lower self-esteem, greater tendency to depression; more exposure to crime and violence (as a consequence of lower incomes and therefore restricted residential choices); overrepresentation among substance abusers and homeless people known to service providers; greater likelihood of criminal involvement. Public costs include lost tax re venues (on the foregone earnings ) ,welfare and unemployment services , and possible criminal justice and health costs for the increased probability that high school dropouts will participate in criminal activities and will make greater demands on health services (either for pregnancy and child bearing, addictions ,mental health needs , greater propensity toward using or being the victim of violence , or other purposes ) .

Earnings losses have proved to be the most readily calculated element of dropout costs.

Most recent estimates (Chaplin and Lerman 1996) suggest that dropping out of high school entails earnings losses of between $90,000 and $600,000 during the course of a lifetime,with associated lost tax revenues (public costs) of between $30,000 and $200,000. Chaplin and Lerman conclude that "educated guesses suggest that additional losses to society could be equal to or even more than the earnings losses experienced by the individual" (1996, P.1). Juveniles Likely to Become Career Criminals Cohen (1995) estimates the social costs associated with a typical career criminal,a typical drug abuser, and a typical high school dropout. Rather than asking the difficult to answer question of how many career criminals, drug abusers or dropouts a program has prevented in order to justify its budget, he asks how much we are currently paying in public (government) dollars as a consequence of failing to prevent youth from taking these paths. The answers he develops suggests that if a program could prevent even one youth from becoming a career criminal it would pay for itself many times over.

For career criminals, Cohen looks at: â&#x20AC;˘ Victim costs including tangible ones (lost productivity, medical expenses), intangible ones (pain, suffering, and reduced quality of life), and probability of death; â&#x20AC;˘ Criminal justice costs, including police, investigative, court, and imprisonment costs; â&#x20AC;˘ Foregone earnings of the youth while incarcerated. He makes these calculations for each type of crime, calculates the probable number and mix of crimes perpetrated by the average career. Why Use a Holistic Approach?

In deciding what to do to assist youth, past efforts have focus ed largely on youth who have already exhibited behaviors considered undesirable by society (e.g., dropping out of school, engaging in illegal activities, engaging in violent activities, having babies without being able to support them, abusing drugs and alcohol). Programs addressing these issues typically work with youth to try to stop them from continuing these behaviors, and to reduce the consequences of these behaviors . Thus they are engaging in either secondary prevention or tertiary attention (Barker and Fuentes 1995). There is ample evidence, both from the United States and internationally, that programs of this type cannot and do not bring about a significant reduction in negative behaviors for the youth population as a whole (Barker and Fuentes 1995; Dryfoos 1990; Resnicketal. 1992). The major criticisms of, or explanations for the failure of,most programs of this type are that: (1) they are single focus (they focus only on a single problem, not on the youth's whole life circumstances, and the single problem cannot be solved without "solving" the youth's life circumstances);(2) they are too short-term;(3) they start too late (after the problems are already apparent and the behavioral patterns are set); (4) they focus only on preventing negative behavior, not on promoting positive behaviors. Dryfoos (1990) summarizes the

characteristics of single focus programs with the highest records of success; her findings are reproduced in Table 1. The evidence is very strong that the successful programs,even though nominally single-focus, in reality treat children and youth (and their families) holistically, start young, offer many enrichment, growth and development activities, and stick with youth for a long period of time. Recent research results support the importance of an integrated approach to helping youth, both in terms of the issues addressed in the youths' lives and in terms of the structure of services and activities available to them through the intervention program. In New Jersey, a high school that put in place an integrated services program described as "convenient,sensitive, non-stigmatizing, and holistic." The program offers services such as individual and family counseling, primary and preventive health services, drug and alcohol abuse counseling, crisis intervention, employment counseling, training, and placement, summer and part - time job development , recreational activities, and referrals to health and social services. In the year before the program started, students in the school experienced 20 births; in the first year of program operations this number dropped to 13, and to a remarkable 1 in the second year of program operation. Dropouts were reduced from 73 to 24 (of whom 10 received a GED3), and suspensions were reduced from 322 to 78 (Knowlton and Tetelman,1994).

The Children at Risk Program is a demonstration program operating in six U.S.cities. It offers integrated services and enrichment activities to youth already in trouble with the law at intake (ages 11-13), and residing in the poorest and most crime-ridden neighborhoods of the cities in which the program functions â&#x20AC;&#x201D; the program deliberately targets "the worst kids in the worst neighborhoods."

First year findings reveal that the program is already making a significant difference (Harrell, 1995a).

Compared to a control group (youth were randomly assigned to treatment and control groups in each city), program participants had significantly fewer contacts with police and contacts with the courts, and were significantly more likely to be promoted to the next grade. In addition, trends in school attendance were in the right Equivalent to a high school diploma. Early intervention, at least by 8,9,10 Long time frame, stick with the kids from pre-adolescence through successful transition to adulthood Intensive personal involvement is possible, strong bonds with staff and staff with enough time to focus on each individual youth School involvementâ&#x20AC;&#x201D;either program located in schools, or strongly connected to schools Broad goals, offer many life options, offer something to give kids reason to expect decent future Offer multiple services, be able to treat youth and family holistically, be flexible Change institutionsâ&#x20AC;&#x201D;create linkages,make multi-agency arrangements, integrate services Maintain program integrity, do not water it down, do not compromise for financial political reasons.

The International Perspective A recent discussion paper prepared for the W HO / U N F PA / U N ICEF Study Group on Programming for Adolescent Health (1995) strongly supports the holistic approach to youth services , and gives a number of examples from around the world of youth - serving programs that take this approach . One of these ,Proyecto Alternativas in Honduras ,serves working children in the informal sector and

their families , as well as street children without families . It combines educational and social services , community - based health care , food supplementation , and basic and health education including a focus on the issues of sexuality, reproductive health and substance abuse , counseling, and significant levels of youth empowerment and control over the project's planning and decision - making.

Barker and Fuentes (1995) describe numerous youth -serving programs with integrative components ; most operate with in Latin America and the Caribbean . One ex ample is Servol in Trinid ad and Tobago. Primarily an employment and training project that now offers services throughout the country, Servol found that it had to incorporate a life skills component in order to help youth develop the personal skills they need to successfully function in the society and the workplace.

These include components from many service sectors , such as :self - awareness ; parenting ; nutrition , health and sex education ; drug abuse prevention ; sports and recreation ; basic literacy and social studies ; community service ; becoming a micro entrepreneur; and, obtaining immediate employment . Youth must complete the life skills component before receiving form job training. Gender equality in the program and in future work is an explicit goal of Servol . Unfortunately,basic evaluative assessments of these programs have not been done , although they are perceived to be successful at their goals .

The Need for Future Health and Productivity • Adolescents aged 10-19 are a very significant proportion of the population of Latin American and Caribbean countries, averaging 21.7 percent.

• The future economic development of Latin American and Caribbean countries depends on having increasing proportions of the population who are reasonably well educated, healthy, and economically productive.

• Many Latin American and Caribbean youth do not complete enough education to equip them for productive labor in the formal modern sector—this situation is worst among poor urban youth and among rural youth of all income levels.

• For many young adolescents, employment may be necessary to help family finances, but it interferes significantly with educational attainment. Conversely, many older adolescents cannot find adequate work and are neither in school nor employed.

• Teenage sexuality, pregnancy, and child bearing present maj or health issues ; the health risks to young women from illegal abortions are also great.

• The consequences of violence — from neighborhood violence and gangs , from household members (child abuse and domestic violence), and from war—are also severe in many countries of the region.

The Rationale for Investing in Youth • There are substantial costs to governments and to individuals for every failure of youth to reach adulthood alive and healthy, with an adequate education, and without children they cannot care for.

• These costs are almost always greater ,sometimes vastly greater than the costs of programs to help youth achieve these goals.

• Some of the costs have been calculated for the United States, and are of surprising magnitude:

– Each year's group of youth who do not finish high school will, over their lifetime, cost the nation $260 billion in lost earnings and foregone taxes.

– Each year,the U.S.spends roughly $20 billion in payments for income maintenance, health care, and nutrition to support families begun by teenagers.

Summary and Conclusions Youth behavior does not occur in a vacuum, and cannot be fixed in a vacuum. It occurs in the context of the youth's family and family dynamics, peer group, and neighborhood and social opportunities.

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(LAST COVER PAGE) Dr.Debasish Kundu a Ph.D in Spagyric Homeopathy from an American University is a renowned authority on Complementary and Alternative Medicine(CAM) , he is a Visiting Professor of Khulna Homeopathic Medical College & Hospital, affiliated to Ministry of Health, Peoples Republic of Bangladesh, Vice President of American Nutritional Medical Association, CA, U.S.A.,and International Homeopathic Medical Society, U.S.A., and Editor in Chief, International Journal of Homeopathy & Natural Medicines, Science Publishing Group, USA,Editor in Chief, The Internet Journal of Herbal and Plant Medicine , USA. He has also authored and edited numerous books and journals on CAM, Sexology and Homeotherapeutics. His website: http://debasishkundu.yolasite.com and email : drdkundu@msn.com

Dr Malik A Kaiyoom Awan is a leading personality of natural health movement in USA, he is a renowned scholar in Psychology, Homeopathy/Holistic Medicine and Religious Studies.

He is also a Doctor of Common Law and CEO and President of American Nutritional Medical Association , USA, International Holistic Medical Society, USA, International Homeopathic Medical Society, USA .

He has edited many journals and authored many books and articles on Natural Medicine. He is a laureate, Albert Schweitzer Award for Medicine.

His website: http://anmainc.webnode.com and email : drawan10@aol.com