H1. The Protection Clarification: Strengthening the Role and Responsibility of the Non-Offending Caregiver in the Outcome for Child Victims

Rachael Garrett, M. Elizabeth Ralston, sponsored by the Dee Norton Lowcountry Children’s Center

Clinicians, case workers, guardians ad litem and other involved in the child protection system will learn about a tool to strengthen the non-offending caregivers willingness and ability to be a protective resource for their child. 

Abstract

Historically the child protection system has been ambivalent about the role and responsibility of the non-offending caregiver (NOC) when a child is abused. This response can extend from ignoring, to blaming and shaming and to recommending the NOC be charged with neglect. The research regarding child resiliency and child outcome offers guidance regarding the need to move beyond ambivalence to a position of engaging the NOC and clearly defining their role and responsibility. The Protection Clarification does just that. The PC is a treatment intervention and process that defines the NOCs responsibility as protective. The PC process involves identifying and overcoming any barriers to the NOCs willingness and ability to be child focused, to support and participate in the child’s treatment, to be a protective resource and to exhibit empathy for their child. The PC is focused on measurable outcomes important to the question of family preservation and family reunification. The Protection Clarification is the intervention for the NOC as the Abuse Clarification is for the offender in child maltreatment cases and is a part of the evidence based AF-CBT treatment model.

Learning Objectives

1. Understand the Protection Clarification process and its role in child safety and well-being;
   
2. Know how to monitor progress in the use of the PC;
   
3. Learn how to utilize this tool in a treatment/service plan.

Published Articles on Evidence-Based Topics

• The PC is a part of a treatment model designated in Child Physical and Sexual Abuse: Guidelines for Treatment as a “supported and acceptable treatment.. 
  
• An article, The Abuse Clarification Process in the Treatment of Intrafamilial Child Abuse was published in the peer reviewed journal, Child Abuse and Neglect, The International Journal. 
• Kolko, DJ and Swenson, CC, Assessing and Treating Physically-Abused Children and the Families: A Cognitive Behavioral Approach, Sage Publications, 2002.

Powerpoint presentation as PDF document: click here

H2. The Biology of Resilience

John Stirling

An exploration of the complex interactions of genetics, epigenetics, and traumatic experience.

Abstract

Many children suffer severe, lifelong consequences of early trauma, but what protects those who don't? We have long known that genes are responsible for many of our behavioral differences, but only recently have scientists begun to understand how gene expression may be modified by an individual’s experiences, and even those of previous generations.

This presentation will explore the new science of epigenetics as it relates to a child’s vulnerability and recovery. Other factors, including intrauterine drug exposure and attachment issues, will be addressed as well. A better understanding of resilience can guide us to more effective preventative and therapeutic interventions. Attendees will be able to: 1) explain how genes affect behavior 2) cite examples of genetic changes wrought by experience 3) relate these considerations to what we know about attachment and early drug exposures 4) incorporate this awareness into prevention efforts. References: McGowan et al. Epigenetic regulation of glucocorticoid receptor in human brain associates with childhood abuse. Nature Neuroscience 12, 342-348 (2009) Yehuda R & Bierer LM. The relevance of epigenetics to PTSD: Implications for the DSM-V. Journal of Traumatic Stress 22(5), 427-434 (2009) Stirling J & the Committee on Child Abuse and Neglect, AAP. Understanding the behavioral and emotional consequences of child abuse. Pediatrics 122, 667-673(2008).

Learning Objectives

1. Explain how genes affect behavior.
   
2. Cite examples of genetic changes wrought by experience.
   
3. Relate these considerations to what we know about attachment and early drug exposures.
4. Incorporate this awareness into prevention efforts.

Powerpoint presentation as PDF document: click here

H3. Cutaneous Abuse and Mimics: Invited Cases with Photos

Lori Frasier

An opportunity for participants to bring interesting and educational cases of cutaneous findings of abuse. Unusual cases and mimics are encouraged.

Abstract

The skin is the most common organ injured in abusive injuries. Skin findings may be straightforward or unusual and there are many skin conditions which mimic abuse. This session will be participant driven with the moderator guiding the discussion.

Learning Objectives

1. Identify unusual cases of cutaneous abuse.
   
2. Recognize cutaneous mimics of abuse.
   
3. Understand differential diagnosis in evaluating skin findings for abuse.

H4. Defining Reasonable Medical Certainty in Child Abuse Court Cases

Mark Dias

The term Reasonable Medical Certainty (RMC) is a standard used in court to define the probability to which an expert witness holds a point of view. We analyzed the definition of RMC among physicians who treat and/or care for children with child abuse.

Abstract

The term Reasonable Medical Certainty (RMC) was developed around the turn of the 20th century to establish the probability with which the opinions of an expert (medical, dental, engineering, or other technical professional) testifying in court were held. Originally used in a limited number of civil cases, the term RMC was both more widely adopted and expanded to other types of court cases so that, by the 1960s the term had gained wide acceptance nationwide.

However, what this term actually means—both to the experts themselves and to the court—in terms of any probabilistic statement is unknown; because of this, there is the potential for injustice if experts vary widely in their definitions of the term.

For this reason, we surveyed physicians who care for children and/or testify in court as expert witnesses in child abuse cases, to establish their definitions of RMC as well as the factor(s) that might contribute to the formation of those definitions. Among all respondents, the average probabilistic definition of RMC was approximately 90% although there was significant variability. Although only 50% of respondents reported any formal training in the definition of the term, their training was the only factor that consistently and significantly contributed to their own definitions of RMC. The implications of these results on the prosecution of child abuse cases are discussed.

Learning Objectives

1. Understand the origin and legal meaning of the term Reasonable Medical Certainty (RMC)
   
2. Understand the variability in the definition of RMC among legal scholars
   
3. Gain an appreciation of the definition and variability among clinicians who care for, and testify in, cases of child abuse

H5. Bridging Two Disciplines: Controlled Phone Calls and Clinical Interventions

Christine Borowski, Stacy Essex, Stefan Perkowski, sponsored by Child and Adolescent Services Treatment Center

Control phone calls are investigative and clinical tools leading to arrests and convictions in child sexual abuse cases. Risk management, including self-harm and suicide, is essential.

Abstract

Collaborative efforts of law enforcement and mental health best serve the needs of sexually abused children. Control phone calls have proven to be an invaluable investigative tool that has led to arrests, convictions, saved victims the stress of testifying and saved precious time and money. There are many considerations to take into account when dealing with the emotional trauma and stress the call itself can create.

The State Police Investigator will cover investigative issues, victim participation and the necessity of cooperation with clinicians to further care for the children. She will also address the expectations of district attorneys regarding the appropriateness of using the call in any one case. The clinicians will cover the clinical elements and benefits as well as contraindications. Risk management, from inappropriate guilt (manifested through self-harm and suicide), to recantation, will be highlighted through current case examples. Through this collaboration, the children benefit. Ample opportunity will be available for audience participation. Note: Actual calls will be played, some contain strong language.

Learning Objectives

1. Participants will recognize, accept and work within the structures and limitations of each other's filed.
   
2. For both professions, risk management features will be identified strategies offered.
   
3. Both law enforcement and clinical personnel will learn the contraindications of this approach.

Publications

• Jennifer Svoboda. Psychosocial Considerations in Pediatrics: Use of Amputee Dolls. Journal of Prosthetics and Orthotics 1992; Vol 4, Num 4. 
  
• Turgay A, Sonuvar B. Emotional Aspects of Arm or Leg Amputation in Children. Canadian Journal of Psychiatry 1983; 28. 
• Novotny MP. Body Image Changes in Amputee Children: How Nursing Theory Can Make the Difference. Journal of the Association of Pediatric Oncology Nurses 1986; 3.

Handout: click here

Computer Hi-Tech Investigator Training—sponsored by SEARCH

H6. Investigative USB APPS

Elizabeth Tow, Lauren Wagner

These classes are restricted to law enforcement, prosecutors, district attorneys, and investigator professionals.

Learn how to download, install and use portable apps as an investigative tool.  Firefox and related add-ons, LightScreen, and other programs will be covered.

Powerpoint presentation as PDF document: click here

H7. The Use of Other Act Evidence (OAE) in Child Abuse Prosecutions

Thomas Fallon

This workshop will explore the proper use of other act evidence (OAE) in child abuse prosecutions.

Abstract

The use of other act evidence (OAE) in child abuse cases is often perceived as a "red flag" in appellate review of successful prosecutions. This workshop will explore the proper techniques for identifying, investigating and introducing OAE in criminal prosecutions with a focus on theories of admissibility, analytical framework for argument and the reliance on social science evidence to properly admit OAE at trial and sustain it on appeal.

Learning Objectives

1. Identify & Investigate Other Act Evidence OAE
   
2. Articulate a proper purpose for the use of OAE
   
3. Techniques for Introduction of OAE

Powerpoint presentation as PDF document: click here

H8. Child Forensic Interviews: Differences, Debates and the Best Practice

Patti Toth

A review of research-based best practices in child forensic interviewing as well as a discussion of the differences and current debates among interviewers.

Abstract

State of the art practice with regard to investigative interviews of children in suspected abuse cases has changed greatly since the early 1980s and is now informed by ongoing research concerning children’s memory and suggestibility and the impact of different interviewing techniques. 

A number of different interview approaches and protocols have emerged, but these approaches tend to fall into one of two categories:

1. Structured “Narrative” Interviews, emphasizing verbal narratives & discouraging use of media (e.g., NICHD protocol and adaptations or approaches incorporating its key principles & components); and
2. the “RATAC” protocol, the approach taught by the “Finding Words” and “ChildFirst” interview training programs (encouraging the use of media and early questions about “touch”)

Despite agreement regarding some basics of best practice interviewing, there are still significant controversies and differences.  Among these are whether to routinely include interview instructions, whether to elicit a promise from the child to tell the truth, whether to use anatomical drawings and/or anatomical dolls, the importance of an emphasis on “narrative practice” at the beginning of an interview, how to introduce the topic of suspected abuse during an interview, and whether child forensic interviewers should be ‘credentialed’ or ‘certified.’

This workshop will discuss areas of agreement and difference in interview practice.  It will include comparison of the key components of the NICHD and RATAC approaches, examples of some of the specific techniques being applied, and discussion of child interviewing skills and techniques that are most effective and forensically sound.  It will also contain information related to the use of dogs during child interviews and concerns related to the certification or credentialing of child interviewers.

Learning Objectives

1. Review current best practices and debates related to child forensic interviewing, especially with regard to interview instructions, use of media, truth/lie discussions, narrative practice, ‘transition’ questions, question types, and the use of dogs during interviews
   
2. Gain understanding about the differences between the RATAC and NICHD protocols
   
3. Understand the concerns related to certification/credentialing of child interviewers

Multiple documents were submitted for this session and have been placed in a folder and zipped. After downloading this file, unzip the folder to access the files: Handouts: click here

H9. Creating Trauma-Informed Child Welfare Systems (CTISP)

Lisa Conradi, Alison Hendricks, Charles Wilson

How to create a trauma-informed child welfare system and provide practical examples participants can take back to their jurisdictions.

Abstract

This presentation will describe a federally funded project that aspires to support the evolution of public child welfare agencies into trauma-informed organizations and to serve as agents of change in their communities. This highly collaborative project, led by a National Advisory Committee of child welfare and trauma experts from around the country, will help transform the wider community child welfare system. This system includes all the major systems that impact children and families involved with public child welfare, including children’s mental health, into a multi-dimensional, trauma informed, evidence-based system better able to meet the unique needs of abused and trauma-exposed children.

The presenters will begin by providing an overview of the Essential Elements of a trauma-informed Child Welfare system. These include:

• The impact of current and past trauma and post-traumatic stress on the children and families with whom child service workers interact
• The importance of maximizing the child’s sense of physical and psychological safety
• The need for comprehensive assessment of the child and family’s traumatic experiences
• The range of evidence-based and trauma-specific treatments and practices for children and families impacted by trauma and how to identify appropriate referrals.

The presentation will then focus on how these larger, overarching concepts have been operationalized and applied in Child Welfare jurisdictions across the country through this federal project and through this agency’s involvement in a Breakthrough Series Collaborative (BSC) on using trauma-informed child welfare practice to improve placement stability. This BSC includes nine diverse child welfare jurisdictions across the Country that are utilizing trauma-informed approaches in order to improve placement stability for children in their care.

Learning Objectives

1. Participants will be able to describe each of the essential elements of a trauma-informed child welfare system.
   
2. Participants will identify how multiple child welfare jurisdictions across the country are transforming their systems to become more trauma-informed.
   
3. Participants will be able to describe three concrete ways they can change their practice so it is more trauma-informed.

Powerpoint presentation as PDF document: click here

H10. Greatest Hits in Prevention Research for 2010 and 2011

Deborah Daro, Diane Paulsell, sponsored by Chapin Hall, University of Chicago

The purpose of this presentation is to highlight emerging research and conceptual work that the adaptive challenges facing those seeking to prevent child abuse. The presenters will provide (a) an overview of key research trends and findings and (b) review an approach to summarize and rate the empirical data program effectiveness.

Abstract

For the past several decades, public and private investments in resolving many social problems have been guided by emerging research and the ability of interventions to demonstrate measurable change in key outcomes areas. In the field of child abuse prevention, these trends have contributed to an intentional focus on early intervention with young children and their families and the promise such efforts hold in reducing a range of negative outcomes for children, including a reduction child maltreatment, and for enhancing positive child development. 

More recently, child abuse prevention practitioners and policy makers are interested in research that moves beyond documenting discrete program impacts and begins to address the more complex challenges of adapting promising programs  to diverse communities and populations, to structuring strategies and systems that facilitate cross agency and cross discipline collaboration, and to summarizing  performance data in ways that promoted sound investments and encourage continuous program improvement. 

The purpose of this presentation is to highlight emerging research and conceptual work that address these and similar adaptive challenges facing those seeking to prevent child abuse. 

Learning Objectives

1. To provide participants a summary of key research findings
   
2. To provide participants skill in determining the quality of evaluative research
   
3. To assist participants in utilize research findings in making policy and practice decisions

Multiple documents were submitted for this session and have been placed in a folder and zipped. After downloading this file, unzip the folder to access the files: Handouts: click here

H11. The Crucial Role of Supportive Structures at Three Levels of Contexts of Service and Care

This series of presentations focuses on the maximizing the impact of leadership to support evidence-based practice implementation, the support and structure needed to implement an a specific evidence-based intervention in a child welfare setting, and the sources, patterns, and impact of support systems in adolescent youth who entered out-of-home care early in development.

Learning Objectives

1. Understanding the importance of leadership in implementing evidence-base practice.
   
2. Understanding the process of implementing an evidence-based practice in Child Welfare.
   
3. Understanding the role of important support systems for youth with a history of out-of-home care, transitioning to adulthood.

H11a. Maximizing the Impact of Leadership to Support Evidence-Based Practice Implementation

Gregory Aarons

Abstract

Maximizing the Impact of Leadership to Support Evidence-Based Practice Implementation (Gregory A. Aarons, Ph.D.) Leading change is not an easy task and leading implementation of evidence-based practices presents a special set of challenges and opportunities for child welfare and mental health systems and organizations. Effective leadership is a critical driver of successful implementation and sustainment of innovation and change in healthcare and social service settings. This presentation will identify critical leadership skills that can be used to create an effective organizational climate for evidence-based practice implementation. Elements of organizational climate for implementation will be described. Proven leadership strategies will be presented along with specific ways to create an organizational climate supportive of evidence-based practice.

H11b. The Keep Foster Parent Intervention: Findings from a Community Agency Implementation Trial

Natalia Escobar Walsh, Joseph Price

Abstract

The KEEP Foster Parent Intervention: Findings from a Community Agency Implementation Trial. (Joseph M. Price, Ph.D. & Natalia Escobar, M.A.) Children in foster care are at risk for externalizing behaviors, which create challenges for caregivers and increase the risk of a failed placement, putting children at additional risk for psychopathology. To address the behavior problems of children in foster care, the KEEP foster parent training intervention was developed and tested in San Diego County. The intervention (a modification of Multidimensional Treatment Foster Care, MTFC), focuses on children between the ages of 5 to 12 in regular foster care. Because of the positive results of an NIHM funded effectiveness trial, the intervention was implemented in San Diego County by a mental health services contractor (Social Advocates for Youth, San Diego). The findings from this implementation trail will be presented.

Powerpoint presentation as PDF document: click here

H11c. Sources, Patterns, and Impact of Support Systems in Adolescent Youth Who Entered Out-Of-Home Care Prior to 4 Years of Age

Alan Litrownik

Abstract

Sources, patterns, and impact of support systems in adolescent youth who entered out-of-home care prior to 4 years of age (Alan J. Litrownik, Ph.D., Inger P. Davis, Ph.D., and Rae R. Newton, Ph.D) Adolescent youth preparing to transition into early adulthood face numerous challenges, especially those who entered foster care at an early age. The current presentation identifies and describes three systems of support (e.g., parental/caregiver, peer, and outside adults) assessed in over 200 16-year old adolescents as part of a 20-year longitudinal study that followed youth who entered substitute care at an early age due to maltreatment. Patterns of support will then be related to current living situations (e.g., adopted, reunified, kin care/guardianship, nonkin care/guardianship), as well as subsequent outcomes (e.g., educational, social, emotional) at age of 18-19.

Powerpoint presentation as PDF document: click here

H12. Beyond Self Care: Strategies for Addressing Secondary Traumatic Stress in a Direct Service Setting

Erika Tullberg

Using a module from the Resilience Alliance, an intervention for child welfare staff, this interactive workshop will demonstrate aspects of the intervention and with participants explore how it could be adapted for other settings.

Abstract

While social service systems increasingly understand the negative impact that secondary traumatic stress (STS) can have on their workforce and organizations, efforts to address it often begin and end with teaching self-care strategies to frontline staff. Although self care is a critical part of mitigating the effects of STS, a sole focus on the individual misses the impact that STS has on an organization’s overall functioning and can come across as “blaming the victim.”

In New York City, the Children’s Trauma Institute, a collaboration between the Administration for Children’s Services and NYU’s Langone Medical Center, has developed the Resilience Alliance, an intervention designed to address STS among child protective staff. This intervention engages all levels of the staff hierarchy, and frames STS as a natural result of working with traumatized children and families that can negatively impact both individuals and the organization as a whole.

Rather than condemning and further stigmatizing both individuals and the system for this, we partner with staff on recognizing their reactions and actively changing the way they manage the emotional challenges of child welfare work. After receiving an overview of the Resilience Alliance core concepts and structure, workshop participants will role-play with one of the intervention modules, thus learning how STS-related information presented didactically is paired with a skills-focused, applied “real world” exercise involving multiple levels of the organizational hierarchy. Participants will then brainstorm ideas for adapting the material for their own service settings. Conference attendees who manage frontline staff or who have leadership roles in their agencies are encouraged to attend.

Learning Objectives

1. Attendees will learn about the overall structure and focus of the Resilience Alliance intervention.
   
2. After participating in a role-play of one of the intervention modules, attendees will understand how the intervention’s concepts are applied with participating staff.
   
3. Attendees will develop ideas for adapting the intervention for other service settings.

Multiple documents were submitted for this session and have been placed in a folder and zipped. After downloading this file, unzip the folder to access the files: Powerpoint presentations as PDF documents: click here

William N. Friedrich Memorial Lecture & Luncheon

Sponsored by Mayo Clinic Child and Family Advocacy Program

Introduction—Daniel Broughton, MD, Director, Mayo Clinic Child Abuse Team, Rochester, MN

When Helping Hurts: Addressing Vicarious Trauma
Judith Cohen, MD, Medical Director, Allegheny General Hospital, Pittsburgh, PA

Child trauma therapists dedicate our professional lives to helping children heal from abuse, violence and other traumas. Our work provides remarkable rewards but sometimes helping hurts and the work we do can also lead to vicarious trauma. This presentation describes several situations in which vicarious trauma has occurred in child trauma therapists, for example when a therapist became overwhelmed by hearing repeated details of children's personal trauma experiences; when these stories resonated with a therapist's personal trauma history; when the therapist experienced too many demands at work with too little support; and when a therapist was not able to balance work with other aspects of life. The presentation will also discuss how child trauma therapists and their organizations can prevent and respond to vicarious trauma.

Multiple documents were submitted for this session and have been placed in a folder and zipped. After downloading this file, unzip the folder to access the files: Handouts: click here

Global Perspective Lectures

H13a. European Approaches: Prevent and Combat Child Abuse and Neglect —
What Works? Overview of National Strategies and Presentation of the Outcomes of an Evaluation With Parents and Professionals in Five Participating Countries

Presentation of the report on policy on CAN in 5 European Countries: Sweden, Germany, Netherlands, Hungary and Portugal, with focus on practice concerning the prevention, detection, reporting and stopping of CAN. Presentation of evaluation of the experiences of parents with the programmes and policies preventing child abuse in the 5 participating countries.

Abstract

The Netherlands Youth Institute initiated started in January 2011 a European 2-year-comparison of Approaches tackling Child Abuse and Neglect in 5 European Countries: Sweden, Germany, Netherlands, Hungary and Portugal. The first phase of the project is focused at describing the policy and practice concerning the prevention, detection, reporting and stopping of CAN in the participating countries. The overview and report on the situation in these countries will be ready in January 2012. The second phase is an evaluation of the experiences of parents and professionals with the programmes and policies preventing child abuse. The evaluations will also be presented in January 2012. The third and final phase of the project will be concentrating on identifying the effective elements of preventing child abuse based on the experiences in the participating countries and the outcomes of the evaluation with parents and professionals. In January 2013 the result of the project will be a manual on what works in tackling child abuse and neglect.

Learning Objectives

1. Overview of approaches in 5 EU-countries
   
2. Evaluation amongst parents of these approaches
   
3. First findings in the making of What Works Manual

Powerpoint presentation as PDF document: click here

Global Perspective Lectures

H13b. Child Helpline In Saudi Arabia

The workshop consists of the basic stages of CHI establishment, focusing how to apply it in real life.

Abstract

The main objective is to participate with other countries that had the same experience, comparing it to Saudi Arabia experience in the same field.

Learning Objectives

1. To identify the real reasons of "why Saudia Arabia established this line?"
   
2. To identify the challenges and difficulties that we faced when we started the line.
   

Powerpoint presentation as PDF document: click here

Global Perspective Lectures

H13c. Lighting a Spark in Difficult Times: Creating Amazing Programs With the Assistance of the Royal Bank of Canada

Serving children and families; retaining experienced staff; raising the visibility of your agency; building a sense of pride and accomplishment—all achievable in times of restraint when public and private sectors work together.

Abstract

In times of shrinking budgets and increasing demands, agencies providing mental health services are pressured to do more with less. Keeping the spark of creativity and productivity alive among clinicians and expanding services to meet the increasing needs of both urban and rural populations requires new ways of delivering service. Group programs have long been recognized as a cost efficient, evidence-based method of responding to increasing referrals for mental health services. Obstacles to providing group programs have included lack of resources to develop groups, limited numbers of or lone professionals available in small offices to facilitate groups, difficulty locating programs that are adaptable and the cost of purchasing prepared programs.

This presentation introduces the formation of a partnership between The Janeway Family Centre, a hospital-based children’s mental health service, and the Royal Bank of Canada that enabled the development of a wide spectrum of prevention and early intervention group programs adaptable for both urban and rural settings. This sponsorship also provided for the production of cost free manuals for each program and facilitator training workshops to help communities prepare for group facilitation. The prevention-focused groups in this collection include groups for parents of young children and teens as well as a group for parents coping with complex family situations. The early intervention focused groups include groups responding to family violence, sexual abuse, intergenerational physical abuse and separation and divorce. All programs can be delivered through multi-disciplinary, multi-agency collaboration in small communities with minimal cost.

This workshop will acquaint participants with the RBC Reaching Out project and provide contact information for areas interested in exploring the program for their own communities.

Learning Objectives

1. Building partnerships between public and private sectors
2. Motivating staff in difficult times
3. Providing low cost services for children and families

Powerpoint presentation as PDF document: click here

Global Perspective Lectures

H13d. Impact of Socio-Demographic Profile and Mother-Child Temperament Mismatch on Disciplinary Practices

Sociodemographic factors, mother-child temperament mismatch and disciplinary practices.

Abstract

Despite much research and increasing public awareness campaigns on child abuse, children continue to remain vulnerable to abuse. Abuse seems to be multi-factorial in origin. Various socio-demographic variable and parent-child temperament mismatch which may be correlates of disciplinary practices and child abuse needs to be explored in a greater depth.

This session will present data from a prospective research study of 300 cases in progress. It includes the type of disciplinary practices adopted by mothers of preschool children and associated socio-demographic factors. The socio demographic factors include basic information, literacy level, occupation, socio economic status, rural/urban residence, type of family (nuclear/joint), number of siblings, birth order of the index case and gender. This study explores some of the important mutual influences of disciplinary practices and temperament; hence reviewing the evidence for relations between temperament and disciplinary practices.

The presentation will also provide participants with the opportunity to develop the skill for assessing and rating themselves and their children, if any, on each of the seven dimensions of temperament i.e. Activity level, regularity, response to new situations, adaptability, distractibility, persistence and intensity. It will conclude with a discussion on how to find out any mismatch between the parent and child temperament and disciplinary practices adopted.

Learning Objectives

1. To learn the association between socio-demographic factors and disciplinary practices in developing countries
   
2. To develop the skill of assessing temperaments
   
3. To learn mutual influences of disciplinary practices and temperament

Powerpoint presentation as PDF document: click here

I1. News You Can Use: Applying Research from 2011 to Clinical Practice

Benjamin Saunders , Lucy Berliner, sponsored by CEBC

The most important child abuse research studies published in 2010 will be reviewed and implications and applications of results for clinical practice will be discussed.

Abstract

A significant challenge in the field of child abuse is translating findings of scientific research studies into practical directions for clinical practice. Practitioners often are daunted by reading research studies and may not have the ability to apply findings to their work.

This workshop will identify 6-8 of the most important published research studies of 2011 from the child abuse scientific literature. The speakers will review each of the studies from the perspective of clinician working in a community practice setting. Methods and results of the studies will be presented. The practical implications of the findings of the study for clinical practice will then be discussed. The primary goals of the each study review will be to: 1) highlight the main findings from a set of recently published research studies, 2) apply those findings to everyday clinical practice, and 3) discuss with participants the implications of the findings for how they conduct their practice in their setting with the clients they typically see. A second purpose will be to demonstrate how clinicians can critique scientific studies, translate findings to their particular work, and use them in their practice. Substantial discussion between the presenters and the workshop participants will be encouraged.

Learning Objectives

1. Participants will learn results of 6-8 of the most important research studies in 2010
   
2. Participants will learn how the results of these studies can be directly applied to clinical practice.
   
3. Participants will learn to critically review research and apply results to everyday clinical practice.

Powerpoint presentation as PDF document: click here

I2. The Dynamics of Spirituality: Where Do They Fit in Evidence-Based Treatment?, Part 1

LeAnn Gardner, Anna Shaw, sponsored by the Dee Norton Lowcountry Children’s Center

This learning opportunity will take a look at how spirituality plays into our helping and clients' healing through competence and self-awareness.

Abstract

Acknowledging spirituality, religion, and faith communities as an integral part of a family’s culture is crucial. Practitioners in all settings are continuing to see these supports as a component of resiliency and are including spirituality and religion in their assessment and treatment of clients, particularly when providing trauma focused treatment. Both the literature and antidotal evidence point to the fact that those who are dealing with traumatic events often find themselves asking existential questions (Why did God allow this to happen to me? What is God’s view of me now that this has happened to me?) These questions are also asked by the service providers who aim to help survivors of trauma. A crucial piece of competency in practice is self awareness in examining how working with trauma shapes the practitioner’s worldview. To dismiss this transactional dynamic is refusing to see the effects of trauma on both the client and the practitioner.

This workshop will provide assessment techniques and strategies to help practitioners and professionals in various settings use a family’s religious beliefs and/or spirituality to leverage for positive change in the client system, while being in tune with the practitioner’s own set of values and beliefs. Strategies will also be given to help deal with religion and spirituality when it appears to be a barrier in the healing process and how therapists can be ethical and respectful in understanding and supporting the clients’ beliefs.

Learning Objectives

1. Understand the definitions of spirituality and religion and how these concepts are integral to a family’s culture and learn effective techniques and strategies to determine the role of spirituality and/or religious beliefs in the family system.
   
2. Learn how religion/spirituality were leveraged for strength and when they can appear to be barriers to the healing process through a case study.
   
3. Examine practitioner’s own worldview regarding spirituality and religion and how this affects service delivery.

Powerpoint presentation as PDF document: click here

I3. Sexual Abuse: Medical Aspects 101

Lori Frasier

This workshop is designed for new examiners, and those who want to know the basics of the medical assessment of child sexual abuse.

Abstract

Are you a new medical examiner in child sexual abuse? Are you professional who receives medical reports? This workshop is designed to introduce attendees to the basic aspects of the child sexual abuse medical examinations: Indications, timing of the exam, the process of examination, interpretation of findings, common mimics, and an introduction the sexually transmitted diseases that are occasionally seen. The workshop focuses on the medical evaluation of children that is forensically sound.

Learning Objectives

1. Understand the indications for a medical examination for child sexual abuse.
   
2. Recognize the limitations of the medical examination for child sexual abuse.
   
3. Know the common sexually transmitted infections that are tested for and their prevalence in sexually abused children

I4. Sorting Out the Role of Hypoxia in Traumatic Brain Injury

Christopher Greeley

Hypoxia is an integral component of traumatic brain injury and has been cited as a mimic for the findings seen in Abusive Head Trauma. This talk will outline the important literature on the role of hypoxia in traumatic brain injury.

Abstract

Hypoxia is integral to some short and long term clinical complications of traumatic brain injury (TBI). It has been cited as a mimic of the findings of Abusive Head Trauma (AHT) since the publication of the Unified Theory in 2003. This talk will explore the published literature addressing the role of hypoxia in TBI and allow the participant to appreciate the arguments for and against the hypoxia as a mimic of AHT. As cervical spine injury has also recently received a lot of attention, it will be discussed in its relation to hypoxia and AHT.

Learning Objectives

1. Appreciate the role that hypoxia plays in some of the clinical features of traumatic brain injury
   
2. Understand some of the supporting medical literature on the role of hypoxia
   
3. Appreciate the role that cervical spine (neck) injury plays in hypoxia

Powerpoint presentation as PDF document: click here

I5, I7. Child Trafficking Investigation and Prosecution

Kyle Reardon, sponsored by USDOJ, Derek Stigerts, sponsored by FBI

This seminar focuses on the investigative techniques and prosecutorial challenges associated with prosecution of domestic child sex trafficking in the state and federal systems.

Learning Objectives

1. Provide relevant information to attendees about the nature and scope of the problem of domestic child sex trafficking
2. Highlight challenges and areas of concern in the investigation and prosecution of these cases

Computer Hi-Tech Investigator Training—sponsored by SEARCH

I6. Social Networking Sites Investigative Tools, Tips and Techniques, Part 1

Elizabeth Tow, Lauren Wagner

These classes are restricted to law enforcement, prosecutors, district attorneys, and investigator professionals.

How to effectively search social networking websites (predominately MySpace, Facebook and Twitter) using Google Advanced Operators. This workshop will also cover techniques on capturing profiles for evidentiary purposes as well as mapping tools for friend networks in both MySpace and Facebook.

Powerpoint presentation as PDF document: click here

I8. The Prostituted/Trafficked Teen: Understanding Dynamics and How to Utilize Within the Forensic Interview, Part 1

Catherine Connell, Terri Patterson

This presentation will address the unique offender/victim dynamics in child prostitution investigations. These dynamics will be discussed in the context of the forensic interview.

Abstract

Many child and adolescent victims of exploitation require interviews significantly different from those in which investigators are typically trained. Accordingly, the forensic interviewing of children and adolescents has become a specialized field. Interviewers must understand the special dynamics present in these crimes to facilitate the interview process. This presentation will address those dynamics within the context of the forensic interview.

Learning Objectives

1. Identify the primary components of the victim/offender dynamics in child prostitution matters.
   
2. Learn how to utilize victim/offender dynamics in the forensic interview.
   

I9. Knowing the Best of What’s Out There to Help Families in the Child Welfare System

Cambria Rose Walsh, Blake Zimmet, sponsored by CEBC

The California Evidence-Based Clearinghouse for Child Welfare (CEBC) continues to strengthen its reputation for being a useful and practical resource for those looking to find in-depth, yet user-friendly, information on Evidence-Based Practices in the field of Child Welfare. Come and see just how the CEBC works to help child welfare professionals in their tireless pursuit to serve the children and families!

Abstract

In California, the California Evidence-Based Clearinghouse for Child Welfare (CEBC) has been designed to assist in the critical examination of the evidence that exists for programs being considered for implementation. The website based resource provides easy to understand information on almost 200 discrete models in areas such as Trauma Treatment and Interventions for Neglect.

This project, while based in California, is applicable to other states and the website has been visited and utilized by over 200,000 people throughout the United States as well as around the world. This workshop will assist participants in defining EBP, understanding the process of how the CEBC rates the programs on the website and increasing their ability to identify EBPs relevant to Child Welfare. Since identifying the practices is just the first step towards implementing EBPs, the workshop will also help participants navigate through the process of selecting and implementing EBPs. While the science behind implementation is emerging, this workshop will look at lessons learned from the implementation of EBPs in Child Welfare as well as in Mental Health, Medicine and Business. In addition, participants will be given the opportunity to share their own experiences with the implementation of EBPs.

Learning Objectives

1. Define Evidence-Based Practice and its importance to the field of Child Welfare, while also determining the level of empirical support that exists to help select the best practice available.
   
2. Understand practical applications of the web-based tool for those working with child welfare populations.
   
3. Identify some of the emerging challenges with implementing EBPs and learn successful strategies to overcome them.

Multiple documents were submitted for this session and have been placed in a folder and zipped. After downloading this file, unzip the folder to access the files: Handouts: click here

I10. A Strategic Approach to Child Maltreatment Prevention

Melissa Merrick, Sharyn Parks, sponsored by CDC

The child maltreatment field to date has largely focused on risk factors and associated risk models; CDC’s strategic focus on examining positive relationship factors along each of the safe, stable, and nurturing domains in child maltreatment prevention is, thus, innovative in the field.

Abstract

This presentation will highlight the surveillance and epidemiologic child maltreatment prevention work that is currently a priority for the Centers for Disease Control and Prevention’s (CDC) Division of Violence Prevention (DVP). Healthy child development is an important concern for public health in that the role of early experiences in determining lifelong learning, emotional and physical well-being, and presence or absence of chronic disease is very well documented. However, the vast majority of child maltreatment prevention efforts to date have focused almost exclusively on reducing risk factors in children’s lives. In addition to continued research on risk factors for maltreatment and its adverse outcomes, CDC has prioritized identifying and measuring factors which may buffer or ameliorate risk. Using the public health model as a framework, recent and ongoing work in DVP has focused on defining child maltreatment, including abusive head trauma, and examining the role of safe, stable, and nurturing relationships and environments (SSNRs) on child maltreatment and healthy child development.

Learning Objectives

Provides participants an overview of:

1. CDC's use of the public health framework for child maltreatment prevention,
   
2. DVP’s recent surveillance and epidemiologic work in child maltreatment prevention,
3. How risk and protective factors can be integrated into child maltreatment related research and practice.

Presented by LONGSCAN and supported by the Children's Bureau, Human Health & Services since its inception with additional support from the National Institute of Health, Centers for Disease Control, and the Doris Duke Charitable Foundation.

I11. A Longitudinal Look at the Impacts of Physical Abuse, Sexual Abuse, Psychological Abuse and Witnessed Violence on Child Mental Health

Desmond Runyan

Highlighting major findings from a 20 year longitudinal cohort study of maltreated and at risk children in 5 locations around the US. LONGSCAN enrolled 1354 children from five distinct samples and has followed the children into adulthood.  this presentation will highlight the longitudinal patterns of exposure to child maltreatment, child self-report, the adverse effects of child maltreatment types at different ages, and the characteristics and protective factors than appear to have protected many of the children from long-term consequences.

Powerpoint presentation as PDF document: click here

I12. Understanding the Role of the Brain in Pedophilia: From the Basics to the State of the Art, Part 1

James Cantor

A training for the general audience with little or no background in brain anatomy or neuroscience. Not only will current literature be made more accessible, and professionals will be helped to critically evaluate the claims made about the implications of MRI findings for policy, practice, and science.

Abstract

The brain has been hypothesized to contribute to the behavior of sexual offenders for well over a century. It has only been in the past few years, however, that advanced brain imaging techniques have been used with pedophilic men.

This session is aimed at general audiences with little or no background in brain anatomy or neuroscience and will help attendees to understand:

The portions of the brain that process sexual stimuli;

1. The MRI techniques that are used to study relevant brain functions and brain structure;
   
2. The neuropsychological and other known correlates of sexual offending behavior; and
   
3. The current body of MRI findings from offenders.

This training will not only make the current literature more accessible for the audience, but will also help professionals to critically evaluate the claims made about the implications of MRI findings for policy, practice, and science.

Powerpoint presentation as PDF document: click here

J1. Project Best: Bringing Evidence Supported Treatment to Children Through Community-Based Learning Collaboratives

M. Elizabeth Ralston, Phil Redmond, sponsored by the Dee Norton Lowcountry Children’s Center and the Duke Endowment

Learn how to implement and sustain evidence-supported MH treatment across an entire community using a Community Based Learning Collaborative model. This workshop is appropriate for members of a community Multidisciplinary Team or of any child serving agency.

Abstract

Fortunately there has been a growing “movement” to implement evidence-supported programs and models to treat traumatized children and their families. Unfortunately, most of the time efforts to implement such programs fail because those who work with abused and traumatized children are not trained, knowledgeable or skilled in the use of strongly recommended, empirically supported treatments (ests). Most private and public agencies who serve abused and traumatized children simply do not have the ability to deliver ebts. Even in situations where some basic training in an evidence-supported treatment has been conducted, there is little evidence that practitioners actually adopt and use the evidence-supported treatment consistently or with a reasonable degree of fidelity to the model. Most workers in brokering agencies (those who identify and then refer abused and traumatized children to mental health services) are unaware of and inadequately prepared to obtain empirically supported treatments for their client families. And, equally important is how do you take an evidence-supported treatment to scale so that more than just a few children and their families benefit? The workshop will engage participants in a discussion about how to provide adequate training, support and coaching to providers and referring partners in communities so that an ests can be implemented with fidelity and in such a way to benefit many children and families.

Learning Objectives

1. Participants will be able to identify the core elements of a community based learning collaborative.
   
2. Participants will able to articulate the barriers to a community-wide deployment of an evidence-supported treatment and strategies for overcoming those barriers.
   
3. Participants will be able to discuss initial steps for engaging in a similar strategy in their community including identifying possible key agencies from which to begin.

Publications

• Multiple articles on the NCTSN Web site related to the Learning Collaborative Model, and to the evidence-based treatment, TF-CBT that is the focus of Project BEST.

Powerpoint presentation as PDF document: click here

J2. The Dynamics of Spirituality: Where Do They Fit in Evidence Based Treatment?, Part 2

LeAnn Gardner, Anna Shaw, sponsored by the Dee Norton Lowcountry Children’s Center

This learning opportunity will take a look at how spirituality plays into our helping and clients' healing through competence and self-awareness.

Abstract

Acknowledging spirituality, religion, and faith communities as an integral part of a family’s culture is crucial. Practitioners in all settings are continuing to see these supports as a component of resiliency and are including spirituality and religion in their assessment and treatment of clients, particularly when providing trauma focused treatment. Both the literature and antidotal evidence point to the fact that those who are dealing with traumatic events often find themselves asking existential questions (Why did God allow this to happen to me? What is God’s view of me now that this has happened to me?) These questions are also asked by the service providers who aim to help survivors of trauma. A crucial piece of competency in practice is self awareness in examining how working with trauma shapes the practitioner’s worldview. To dismiss this transactional dynamic is refusing to see the effects of trauma on both the client and the practitioner.

This workshop will provide assessment techniques and strategies to help practitioners and professionals in various settings use a family’s religious beliefs and/or spirituality to leverage for positive change in the client system, while being in tune with the practitioner’s own set of values and beliefs. Strategies will also be given to help deal with religion and spirituality when it appears to be a barrier in the healing process and how therapists can be ethical and respectful in understanding and supporting the clients’ beliefs.

Learning Objectives

1. Understand the definitions of spirituality and religion and how these concepts are integral to a family’s culture and learn effective techniques and strategies to determine the role of spirituality and/or religious beliefs in the family system.
   
2. Learn how religion/spirituality were leveraged for strength and when they can appear to be barriers to the healing process through a case study.
   
3. Examine practitioner’s own worldview regarding spirituality and religion and how this affects service delivery.

Powerpoint presentation as PDF document: click here

J3. Domestic Violence for the Child Abuse Pediatrician

Cynthia Kuelbs

The presence of domestic violence in a child's home is a great risk factor for other forms of abuse and has neurobiological and developmental consequences for the child. Prevalence, screening, and effects of DV will be explored.

Powerpoint presentation as PDF document: click here

J4. Cranial Meninges: Development, Anatomy and Physiology as Related to Intradura/Subdural Bleeding

Mark Dias

Discussing the embryology, anatomy, and physiology of the dura and cranial meninges with the purpose of better understanding the pathophysiology and differential diagnosis of subdural hemorrhage in infants.

Abstract

One of the most highly significant features of abusive head trauma, occurring in 80-85% of cases, is subdural (or more correctly intradural) hemorrhage (SDH). How and from what source subdural bleeding arises is debated. Moreover, a number of other conditions, such as benign extra-axial collections of infancy, Menkes Kinky Hair syndrome, arachnoid cysts, spontaneous intracranial hypotension, and glutaric aciduria are associated in some instances with subdural bleeding and can mimic AHT. The purpose of this talk is to review the embryology, anatomy and physiology of the dura, providing an overview of the literature regarding the origin and pathophysiology of subdural bleeding.

Learning Objectives

1. Understand the development, anatomy and physiology of the meninges.
   
2. Know the various causes of subdural bleeding in infants and how to identify them.
   
3. Understand the limits of interpreting radiographic findings of subdural bleeding to determine the time of injury.

Powerpoint presentation as PDF document: click here

J5. Accident vs. Intentional Injury: The Use of Re-Enactment / Scene Reconstruction in Child Abuse / Neglect and Child Death Cases, Part 1

Constance Shingledecker

Scene re-enactment/scene reconstruction in serious child injury and death investigations is beneficial in determining accidental from intentional injury. These investigations assist Child Protection Team physicians, Medical Examiners and other medical specialists in determining cause of injury and death in child abuse cases.

Abstract

Scene Re-enactment/ Scene Reconstruction in serious child injury and death investigations is beneficial in determining accidental from intentional injury. These investigations assist Child Protection Team physicians, Medical Examiners and other medical specialists in determining cause of injury and death in child abuse cases. Scene Re-enactment and Reconstruction can lead to successful identification of the responsible party and prosecution when the injury or death is attributed to abuse or neglect. The student will learn what scene re-enactment and re-construction is; who, when, where and how to conduct this type of investigation, and a review of numerous cases studies.

Learning Objectives

1. What scene re-enactment and re-construction is.
   
2. Who, when, where, and how to conduct this type of investigation
   
3. How the review of child abuse/neglect death cases can benefit both Law Enforcement and Child Protection investigations.

Computer Hi-Tech Investigator Training—sponsored by SEARCH

J6. Social Networking Sites Investigative Tools, Tips and Techniques, Part 2

Elizabeth Tow, Lauren Wagner

These classes are restricted to law enforcement, prosecutors, district attorneys, and investigator professionals.

How to effectively search social networking websites (predominately MySpace, Facebook and Twitter) using Google Advanced Operators. This workshop will also cover techniques on capturing profiles for evidentiary purposes as well as mapping tools for friend networks in both MySpace and Facebook.

Powerpoint presentation as PDF document: click here

J7. Prosecuting Physical Child Abuse Cases

Nicole Rooney

This course will cover the complex world of prosecuting physical child abuse cases focusing on pervasive forms such as abusive head trauma, fractures, burns and “failure to thrive”, and will discuss ways to build and prove such cases.

Abstract

A successful child abuse prosecution involves cooperation between law enforcement, Health and Human Services, medical professionals and the attorneys trying the case. Starting with the investigative phase, this course will explore the important witnesses to interview, crucial records to obtain and the critical importance of establishing a timeline. Keys to charging the case follow including: who to charge, what to charge them with and accomplice liability. Additionally, the law of child abuse is addressed including the continuous course of conduct and unanimity law. Turning to presenting the case to a jury, the course demonstrates persuasive physical child abuse arguments, trial strategies, legal arguments and the effective use of exhibits using specific case examples. Finally, the most recent scientific findings regarding abusive head trauma, fractures, burns and “failure to thrive” will be reviewed and discussed along with common defense strategies being used to counter these findings. It is expected that a participant in this course will come away with a good understanding of the multiple pieces required to successfully prosecute a physical child abuse case, and the tools needed to fit them all together.

Learning Objectives

1. Learn how to build your case from the ground up
   
2. Discuss methods of presenting the case at trial
   
3. Review current scientific findings behind symptoms and causes of abuse and common defense strategies used to counter them

j8. The Prostituted/Trafficked Teen: Understanding Dynamics and How To Utilize Within the Forensic Interview, Part 2

Catherine Connell, Terri Patterson, sponsored by FBI

This presentation will address the unique offender/victim dynamics in child prostitution investigations. These dynamics will be discussed in the context of the forensic interview.

Abstract

Many child and adolescent victims of exploitation require interviews significantly different from those in which investigators are typically trained. Accordingly, the forensic interviewing of children and adolescents has become a specialized field. Interviewers must understand the special dynamics present in these crimes to facilitate the interview process. This presentation will address those dynamics within the context of the forensic interview.

Learning Objectives

1. Identify the primary components of the victim/offender dynamics in child prostitution matters.
   
2. Learn how to utilize victim/offender dynamics in the forensic interview.
   

J9. The Resilience Alliance: A Review of a Secondary Trauma Intervention for Child Welfare Staff

Erika Tullberg

An overview of secondary traumatic stress and an intervention developed to address STS among New York City child welfare staff. Project findings and some examples of intervention materials will be shared.

Abstract

Increasingly, social service systems understand the negative impact that secondary traumatic stress (STS) can have on their workforce and organizations, and how it can contribute to low morale, compromised decision-making and high levels of attrition. In New York City, the Children’s Trauma Institute, collaboration between the Administration for Children’s Services and NYU’s Langone Medical Center, has developed the Resilience Alliance, an intervention designed to address STS among child protective staff.

The Resilience Alliance is a skill-based staff development intervention for child protective staff that focuses on improving job satisfaction, resilience, optimism, self-care and social support, while decreasing attrition, stress reactivity and burnout. Our overall goal is to positively impact the culture of the city’s child protective offices, which can be impacted by secondary traumatic stress in many of the same ways as individuals within the system are, by becoming insular, crisis-driven, negative and resistant to collaborating internally and with outside professionals and systems. Our intervention emphasizes that this is a natural consequence of secondary trauma; rather than condemning and further stigmatizing the system for this, we partner with staff on recognizing their reactions and actively changing the way they manage the emotional challenges of child welfare work.

This workshop will provide an overview of secondary traumatic stress, highlighting its impact on child welfare staff, present the core concepts stressed in the Resilience Alliance, and describe how it was implemented in a child protective office setting. Examples of project materials, and findings to-date, will be shared.

Learning Objectives

1. Attendees will understand the concept of secondary traumatic stress and how it impacts child welfare staff.
   
2. Attendees will understand the core concepts stressed in the Resilience Alliance intervention.
   
3. Attendees will learn how this intervention has been implemented in New York City, and findings to date.

Powerpoint presentation as PDF document: click here

J10. The Economic Burden of Child Maltreatment in the United States and Implications for Prevention

Xiangming Fang, sponsored by CDC

The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is estimated to exceed $121 billion. Compared with other health problems, the substantial burden of CM indicates the importance of prevention to address the high prevalence of CM.

Abstract

Child maltreatment (CM) is a serious and prevalent public health problem in the United States and has been shown to have lifelong adverse health, social, and economic consequences for survivors. Previous estimates of the economic burden of CM have been criticized for methodological errors, miscalculations, and inadequate transparency around cost inputs.

We address these and present new estimates of the average lifetime cost per CM victim and aggregate lifetime costs for all new CM cases incurred in 2008 using an incidence-based approach. The estimated average lifetime cost per victim of nonfatal CM is $205,541 in 2008 dollars, including $31,953 in childhood health care costs; $10,306 in adult medical costs; $141,285 in productivity losses; $7,564 in child welfare costs; $6,604 in criminal justice costs; and $7,829 in special education costs. The estimated average lifetime cost per death is $1,245,800, including $13,800 in medical costs and $1,232,000 in productivity losses. The total lifetime economic burden resulting from new cases of fatal and nonfatal CM in the United States in 2008 exceeds $121 billion. In sensitivity analysis, the total burden is estimated to be as large as $572 billion. Compared with other health problems, the burden of CM is substantial, indicating the importance of prevention efforts to address the high prevalence of CM.

Learning Objectives

1. To learn the average lifetime cost per child maltreatment victim
   
2. To learn the aggregate lifetime costs for all new child maltreatment cases incurred in 2008
   
3. To learn how to use the cost data in advocating for child maltreatment prevention and for economic evaluation of child maltreatment prevention activities.

Presented by the Administration for Children and Families (ACF), Children's Bureau, Office of Child Abuse and Neglect, Chapin Hall, University of Chicago, and Mathematica Policy Research, Inc., University of CA-San Diego

J11. Replicating and Supporting Evidence-Based Home Visiting Models (Ebhv): Emerging Lessons From Cross-Site Research, Part 1

Catherine Nolan, Moderator

The presentation discusses key practice and policy implications of findings from the cross-site evaluation of the Federal Evidence-Based Home Visitation (EBHV) Initiative.

Abstract

A common vehicle for reaching children as early as possible, before pre-school or other formal early education efforts become available, is offering pregnant women or new parents home visitation services. In response to the strong interest in this approach, the Children’s Bureau (CB) within the Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services funded 17 cooperative agreements in 2008 to support building infrastructure for the widespread adoption, implementation, and sustaining of evidence-based home visitation programs. In addition to supporting individual grantees, CB/ACF also funded Mathematica Policy Research and Chapin Hall at the University of Chicago to conduct a cross-site evaluation of the grantees’ programs.

More recently, Federal investments in home visiting programs has been significantly expanded with the passage of the Maternal, Infant, and Early Childhood Home Visitation (MIECH) Program included within the Patient Protection and Affordable Care Act of 2010. This legislation provides $1.5 billion dollars to states over the next five years to support the expansion of specific evidence-based national home visiting models.

The methodology and initial findings from the EBHV cross-site evaluation effort offers states and local planners useful information to enhance their effective and efficient use of these new federal dollars.

The purpose of this two-part session is to report on the evaluation’s methodology and initial findings in four key areas:

1. how evidence-based models can best be replicated with fidelity;
2. how states can track the impacts of these investments on a common set of child and family outcomes;
3. how states can leverage these investments to develop more robust state infrastructure;
4. and how states can accurately monitor initial costs and potential savings.

Learning Objectives

1. Provide participants with a clearer understanding of the core knowledge elements essential for successful program replications (fidelity, outcomes, infrastructure, and costs).
   
2. Identify key practice implications emerge from a large scale cross-model evaluation of EB home visiting programs.
   
3. Discuss the policy implications of creating networks of evidence-based models to achieve population change.

Powerpoint presentation as PDF document: click here

J11a. Replicating Evidence-Based Programs With Fidelity: Common Indicators/Common Considerations

Deborah Daro

Multiple documents were submitted for this session and have been placed in a folder and zipped. After downloading this file, unzip the folder to access the files: Handouts: click here

Powerpoint presentation as PDF document: click here

J11b. Defining Common Outcomes Across Evidence-Based Home Visiting Models: Shared Expectations and Measurement

Debra Strong

Powerpoint presentation as PDF document: click here

J11c. Voices from the Field

Greg Aarons, Melissa Brodowski

Powerpoint presentation as PDF document: click here

J12. Understanding the Role of the Brain in Pedophilia: From the Basics to the State of the Art, Part 2

James Cantor

A training for the general audience with little or no background in brain anatomy or neuroscience. Not only will current literature be made more accessible, and professionals will be helped to critically evaluate the claims made about the implications of MRI findings for policy, practice, and science.

Abstract

The brain has been hypothesized to contribute to the behavior of sexual offenders for well over a century. It has only been in the past few years, however, that advanced brain imaging techniques have been used with pedophilic men.

This session is aimed at general audiences with little or no background in brain anatomy or neuroscience and will help attendees to understand:

The portions of the brain that process sexual stimuli;

1. The MRI techniques that are used to study relevant brain functions and brain structure;
   
2. The neuropsychological and other known correlates of sexual offending behavior; and
   
3. The current body of MRI findings from offenders.

Powerpoint presentation as PDF document: click here

K1. Social Support and School-Based Mental Health Care Post-Hurricane Katrina: A Five Year Synopsis

Laura Danna, Douglas Walker, sponsored by Mercy Family Center, Project Fleur-de-lis

Project Fleur-de-lis was designed as an intermediate and long-term school-based mental health model following Hurricane Katrina using a trauma informed model in order to provide mental health services.

Abstract

Project Fleur-de-lis (PFDL), an intermediate and long-term school-based mental health response to Hurricane Katrina was designed to conduct school-based trauma informed treatment, to triage students in need of community-based mental health care, and to provide social and professional support to school-based mental health professionals.

Qualitative data describing PFDL’s supportive consultation is gleaned from school-based mental health professionals associated with the program over the past 5 years. Quantitative data for this workshop is derived from weekly case consultation and school-based interventions provided by PFDL since the program's inception in September 2006. Creating collaborative working relationships with schools to provide mental health services post-disaster is a complex process that is significantly influenced by the nature of the disaster, the hierarchy of needs of schools as they recover, the manner in which schools are continually engaged, and the type and duration of mental health supportive services available. Collaborative relationships with school-based mental health professionals post-disaster provide social and professional support that increases the long-term sustainability of mental health within school settings and the larger community health system.

Learning Objectives

1. Participants will describe how school-based mental health professionals can be engaged post-disaster to form collaborative partnerships.
   
2. Participants will demonstrate an understanding of the myriad of barriers facing collaborative partnerships and school-based intervention implementation post-disaster.
   
3. Participants will be able to list specific strategies and programming to strengthen social and professional support of school-based mental health professionals post-disaster.

Powerpoint presentation as PDF document: click here

K2. Attachment, Sensory Integration, Post-Traumatic Stress Disorder (PTSD), and Attention Deficit/Hyperactivity Disorder (ADHD): What’s Really Going On?

Kim Vander Dussen

Clinicians struggle with interpreting DSM criteria to fit symptom presentation. In this workshop clinicians will learn the etiology behind these disorders, how to translate diagnostic criteria, and how neurobiology research can be used to help children.

Abstract

Research indicates that the above referenced disorders are often incorrectly diagnosed or overlooked. This has long-reaching implications for our clients and the play therapists that treat them. From an evidenced based and developmental perspective this workshop will focus on neuroscience and psychology research, etiology, symptom presentation, differential diagnosis, and comorbidity as it pertains to Attachment Disorders, Sensory Integration Dysfunction and disorders of Self-Regulation, Post Traumatic Stress Disorder, and Attention Deficit Hyperactivity Disorder. Diagnostic systems reviewed will include the DSM-IV TR and DC 0-3 R: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood.

In this workshop clinician’s will be exposed to expanded diagnostic considerations for their clients. The reported symptoms and play behaviors present by children will be explored to help participants correctly diagnose and therefore treat their clients.

The relationship between trauma, disorders of self-regulation and attachment will also be explored.

Clinician’s will also learn how PTSD presents in children ages 0-18. Research findings regarding phenomena unique to children such as omen formation and time skew will also be presented in order to facilitate the correct diagnosis of these disorders.

New and exciting research regarding the neurobiological differences in the ADHD brain will be reviewed. Clinicians will be exposed to limitations of the diagnostic criteria for this disorder based on current research findings. Additionally they will learn an assessment process to help them more correctly identify the actual existence of this disorder in their clients.

 Additionally clinician’s will learn how to identify Sensory Integration Dysfunction and be exposed to the DC 0-3’s diagnostic criteria for Disorders of Self-Regulation. How these three disorders are often related and produce similar symptomology will be reviewed.

Learning Objectives

1. After the session participants will be able to correctly identify the symptoms associated with PTSD, Attachment Disorders, Sensory Integration Dysfunction, Disorders of Self Regulation, and ADHD.
2. After the session participants will be able to interpret caregiver report of symptoms and clinical observations within the context of existing diagnostic systems and newly emerging diagnostic systems.
3. After the session participants will be able to identify how these disorders impact the child’s relationship with their caregivers and larger social environment.

Publications

• Brozina, K. and Abela, J.R.Z. (2006). Symptoms of Depression and Anxiety in Children: Specificity of the Hopelessness Theory. Journal of Clinical Child and Adolescent Psychology, 35(4), 515-527. 
  
• Perry, B.D. (2006). Applying Principles of Neurodevelopment to Clinical Work with Maltreated and Traumatized Children in Traumatized Youth in Child Welfare. New York, New York: Guilford. 
• Frailberg, S., Adelson, E., Shapiro, V. (1975). Ghosts in the Nursery: A Psychoanalytic Approach to the Problems of Impaired Infant-Mother Relationships. Journal of the American Academy of Child Psychiatry 14, 387-421.
• Schore, A.N. (2001). The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health. Infant Mental Health Journal, 22(1—2), 201-269.
• DeGangi, G. (2000) Self-Regulation in Infants and Children in DeGangi, G. Pediatric Disorders of Regulation in Affect and Behavior: A Therapist’s Guide to Assessment and Treatment.pp 2-35. San Diego: Academic Press. 5. Mash, E.J. and Barkley, R. A Eds. (2002) Child Psychopathology. New York: The Guilford Press.
• Zeenah, C.H. Ed. (2009) Handbook of Infant Mental Health 3rd Edition. New York: Guilford PressZero to Three (2005). Diagnostic Classification of Mental Health And Development Disorders Of Infancy and Early Childhood: DC:0-3R. Washington, D.C: Zero to Three.

Powerpoint presentation as PDF document: click here

K3. Teaching Alternatives to Corporal Punishment

John Stirling

Almost nobody likes spanking, but most kids still get spanked. Here's how to get parents to listen while you help restock their disciplinary "toolkit."

Abstract

Research and experience have consistently shown corporal punishment to be an ineffective and occasionally dangerous way to influence a child’s behavior, yet a surprising number of professionals tolerate (or even advocate) its use. In one and one-half hours, we explore what’s known about corporal punishment and, using a “cross-cultural” model, suggest convenient and effective screening and intervention. Logical consequences and the difference between punishment and discipline are stressed. Group participation is encouraged, in a nonjudgmental atmosphere.

Learning Objectives

1. Identify ways in which misuse of corporal punishment can be harmful
   
2. Distinguish between “punishment” and “discipline”, practically
   
3. Convincingly suggest several alternatives to punishing an oppositional child

Publications

• Straus, Sugarman, Giles-Sims. Spanking by parents and subsequent antisocial behavior, Arch Ped Adol Med, 151:756-767 (1997). 
  
• Gunnoe & Mariner, Toward a Developmental-Contextual Model of the Effects of Parental Spanking on Children's Aggression, Arch Ped Adol Med, 151: 768 – 775 (1997).
• Bauman LJ & Freidman SB, Corporal Punishment, Pediatric Clinics of North America. 45(2):403-414 (1998).

Powerpoint presentation as PDF document: click here

K4. The O.S.C.A.R.S. (OutStanding Child Abuse Research Selections)

Christopher Greeley

This presentation will discuss some of the important new published contributions to the field of Child Abuse Pediatrics.

Abstract

Each year there are thousands of papers published in the literature. This talk will cull through all of them and present those top papers which have made a meaningful contribution to the field in either scope or clarity. This talk will present some literature appraisal techniques to all the participants to hone their own literature appraisal skills. Additionally, this talk will include a discussion of some of the "Rotten Tomatoes" and highlight some flaws to be cautious of.

Learning Objectives

1. Appreciate some of the important published contributions to the field of child abuse pediatrics
   
2. Appreciate some techniques of literature appraisal to assess the quality of a published paper
   

Powerpoint presentation as PDF document: click here

K5. Accident vs. Intentional Injury: The Use of Re-Enactment / Scene Reconstruction in Child Abuse / Neglect and Child Death Cases Part 2

Constance Shingledecker

Scene re-enactment/scene reconstruction in serious child injury and death investigations is beneficial in determining accidental from intentional injury. These investigations assist Child Protection Team physicians, Medical Examiners and other medical specialists in determining cause of injury and death in child abuse cases.

Abstract

Scene Re-enactment/ Scene Reconstruction in serious child injury and death investigations is beneficial in determining accidental from intentional injury. These investigations assist Child Protection Team physicians, Medical Examiners and other medical specialists in determining cause of injury and death in child abuse cases. Scene Re-enactment and Reconstruction can lead to successful identification of the responsible party and prosecution when the injury or death is attributed to abuse or neglect. The student will learn what scene re-enactment and re-construction is; who, when, where and how to conduct this type of investigation, and a review of numerous cases studies.

Learning Objectives

1. What scene re-enactment and re-construction is.
   
2. Who, when, where, and how to conduct this type of investigation
   
3. How the review of child abuse/neglect death cases can benefit both Law Enforcement and Child Protection investigations.

Computer Hi-Tech Investigator Training—sponsored by SEARCH

K6. Using Virtual Machines in an Investigative Capacity

Chris Armstrong, Timothy Lott

These classes are restricted to law enforcement, prosecutors, district attorneys, and investigator professionals.

Introducing the concept of the virtual computer environment for testing, research and undercover investigations.  Students will walk through setting up a virtual Linux computer before opening an existing instance of Windows XP for testing.

Powerpoint presentation as PDF document: click here

K7. Aggressive Motion Practice in Child Abuse Prosecutions

Thomas Fallon

Pretrial Motion Practice: It's not just for the Defense!

Abstract

Pretrial motion practice is often viewed as solely the stock in trade of the criminal defense. This workshop will explore the effective use of pretrial motions by the prosecution and will focus on motions to prepare the child for court and to prepare the court for the child.

Learning Objectives

1. Identification of appropriate pretrial motions
2. Use of Social Science as a basis for pretrial motions
   
3. Use of Analytical Framework for Admissibility Arguments

Powerpoint presentation as PDF document: click here

K8. Consensual But Unlawful

Andra Chamberlin, sponsored by National Child Advocacy Center (NCAC)

Age is just a number and they’re in love. They’re also angry, confrontational, insulting… Learn why teens do what they do, how to talk with them, and how to get them to talk back.

Abstract

The workshop will aid participants in identifying the developmental characteristics of adolescents which increases their risk-taking behavior and results in victimization. Practical solutions to address negative emotional responses displayed by the teen will be addressed, and participants will learn how to adapt their interview process to the adolescent interview.

The purpose of the session is to examine adolescent development in relation to risk-taking behaviors, learn how to keep reactions to angry teens from derailing the interview, and examine how adolescent interviews may be different from interviews with younger children. The outcome of the session is to prepare interviewers for the specific challenges of talking with adolescents. Listed below are three published articles dealing with adolescents: Finkelhor, D. (2008). Childhood victimization: Violence, crime and abuse in the lives of young people. Oxford: Oxford University Press. Hines, A. D., & Finkelhor, D. (2007). Statutory sex crime relationships between juveniles and adults: A review of social scientific research. Aggression and violent behavior, 12, 300-314. Noll, J. G., Trickett, P. K., & Putnam, F. W. (2003). A prospective investigation of the impact of childhood sexual abuse on the development of sexuality. Journal of Consulting and Clinical Psychology, 71(3), 575-586.

Learning Objectives

1. Participants will identify the developmental characteristics of adolescents which increases their risk-taking behavior and results in victimization.
   
2. Participants will learn practical solutions to addressing negative emotional responses displayed in the forensic interview.
   
3. Participants will learn how to adapt guidelines, protocols, and techniques to the adolescent interview.

Publications

• Finkelhor, D. (2008). Childhood victimization: Violence, crime and abuse in the lives of young people. Oxford: Oxford University Press. 
  
• Hines, A. D., & Finkelhor, D. (2007). Statutory sex crime relationships between juveniles and adults: A review of social scientific research. Aggression and violent behavior, 12, 300-314. 
• Johnson, R. (2011, Spring). Talking with teens…Really? Is that in my job description? ChildFirst. Retrieved from http://ncptc.nonprofitoffice.com/index.asp?Type=B_BASIC&SEC={F036F982-64E1-4093-A693-6F89008B71D3}&DE={3AC5C343-6859-4D13-A96F-3A94ECD42652}.
• Noll, J. G., Trickett, P. K., & Putnam, F. W. (2003). A prospective investigation of the impact of childhood sexual abuse on the development of sexuality. Journal of Consulting and Clinical Psychology, 71(3), 575-586.

Powerpoint presentation as PDF document: click here

K9. Creating a Practice Model for Trauma-Informed Child Welfare

Alison Hendricks, Thomas Morton, sponsored by CTISP

The presentation explores the core elements of creating trauma informed practice model in child welfare and introduces the Practice Guidelines developed by the Chadwick Trauma-Informed Systems Project.

Abstract

Numerous studies have identified the sequelae of child abuse and neglect on adult growth and development. Foremost among these are the Adverse Childhood Experiences (ACE) studies. Though the trauma impact and after math of abuse and neglect is well-documented, for the most part child welfare agencies remain limited in their incorporation of trauma-informed practices into day-to-day policies and practices. Many child welfare agencies have developed practice models that focus on the immediate aspects of child welfare interventions and are now seeking to further advance their models by incorporating trauma-informed guidelines. This presentation explores the critical elements of a practice model, guidelines developed by the Chadwick Trauma-Informed Systems Project and the challenges of blending and implementing the two.

Learning Objectives

1. Participants will be able to identify the critical elements of a practice model
2. Participants will be able to identify critical elements of trauma-informed practice
3. Participants will be able to identify critical challenges to implementing trauma-informed practice in child welfare

Powerpoint presentation as PDF document: click here

K10. Applying a Systems Dynamic Approach to Child Maltreatment Prevention

Sandra Alexander, Richard Puddy, sponsored by Centers for Disease Control & Prevention (CDC)

Description of systems dynamics thinking and the application of this approach to child maltreatment prevention as a way identify high leverage prevention actions and build broader support for prevention at the community and societal level.

Abstract

Child maltreatment prevention is a complex issue requiring the identification of new leverage points to assure Essentials for Childhood: Safe, Stable and Nurturing Relationships and environments for children and families. Improving the collective understanding of individuals, organizations, and communities of the far reaching benefits of preventing child maltreatment often requires changing current unhelpful mindsets that drive system and individual behavior and actions.

Applying systems dynamic thinking can help identify and implement high leverage actions that fundamentally change systems, take advantage of existing synergies, and avoid negative unintended consequences. CDC’s Knowledge to Action (K2A) Child Maltreatment Prevention Consortium has applied a system dynamics approach to identify key leverage points for moving current prevention knowledge to action at the community/societal level by developing an interactive learning lab (tool) to help facilitate a “mind shift” regarding prevention.

This workshop will review the systems thinking approach and demonstrate its application to child maltreatment prevention. Feedback from previous experience with the learning lab will be shared as well as work to use it as a tool to help build the business case for prevention.

Learning Objectives

1. Describe systems dynamics thinking
   
2. Illustrate how it can be applied to and useful for prevention
   
3. Identify ways that the learning lab tool can be disseminated

Presented by the Administration for Children and Families (ACF), Children's Bureau, Office of Child Abuse and Neglect, Chapin Hall, University of Chicago, Mathematica Policy Research, Inc., Oklahoma State Department of Health

K11. Replicating and Supporting Evidence-Based Home Visiting: Emerging Lessons from Cross-Site Research: Part 2

Catherine Nolan, Moderator

The presentation discusses key practice and policy implications of findings from the cross-site evaluation of the Federal Evidence-Based Home Visitation (EBHV) Initiative.

Abstract

A common vehicle for reaching children as early as possible, before pre-school or other formal early education efforts become available, is offering pregnant women or new parents home visitation services. In response to the strong interest in this approach, the Children’s Bureau (CB) within the Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services funded 17 cooperative agreements in 2008 to support building infrastructure for the widespread adoption, implementation, and sustaining of evidence-based home visitation programs. In addition to supporting individual grantees, CB/ACF also funded Mathematica Policy Research and Chapin Hall at the University of Chicago to conduct a cross-site evaluation of the grantees’ programs.

More recently, Federal investments in home visiting programs has been significantly expanded with the passage of the Maternal, Infant, and Early Childhood Home Visitation (MIECH) Program included within the Patient Protection and Affordable Care Act of 2010. This legislation provides $1.5 billion dollars to states over the next five years to support the expansion of specific evidence-based national home visiting models.

The methodology and initial findings from the EBHV cross-site evaluation effort offers states and local planners useful information to enhance their effective and efficient use of these new federal dollars.

The purpose of this two-part session is to report on the evaluation’s methodology and initial findings in four key areas:

1. how evidence-based models can best be replicated with fidelity;
2. how states can track the impacts of these investments on a common set of child and family outcomes;
3. how states can leverage these investments to develop more robust state infrastructure;
4. and how states can accurately monitor initial costs and potential savings.

Learning Objectives

1. Provide participants with a clearer understanding of the core knowledge elements essential for successful program replications (fidelity, outcomes, infrastructure, and costs).
   
2. Identify key practice implications emerge from a large scale cross-model evaluation of EB home visiting programs.
   
3. Discuss the policy implications of creating networks of evidence-based models to achieve population change.

K11a. Building Infrastructure: Partnering to Strengthen Program Implementation and Sustainability

Diane Paulsell

Powerpoint presentation as PDF document: click here

K11b. Documenting Current Costs: Maximizing Your Return on Investment

Debra Strong

Powerpoint presentation as PDF document: click here

K11c. Voices from the Field

Melissa Brodowski, Annette Jacobi

Movie / Documentary

K12. Trust: Second Acts in Young Lives

Nancy Kelly, Char Rivette, sponsored by Kelly+Yamamoto Productions, Chicago Child Advocacy Center

TRUST is a documentary film about 18-year-old Marlin, a survivor of child sexual abuse who, propelled by theater, experiences a very healthy movement away from identifying herself with that trauma.

Abstract

TRUST deals with three subjects that are part of today’s national dialogue:

• Rape/incest/child sexual abuse — Child sexual abuse is one of the world’s most pervasive, persistent forms of violence, without regard to nation, race, class, religion, gender. Most people know someone who has been sexually abused and whether we are aware of it or not, many of us know a perpetrator. Thirty to forty-five percent of women and thirteen to sixteen percent of men report being sexually abused before age eighteen.
• Education — The Healing Aspect of Art – TRUST highlights how using art can be a compelling and life-changing catalyst to healing and moving forward after the horror of sexual abuse. This particular experience was such a powerful modality for change for the following reasons:

   

  1. Marlin found a trusting and safe relationship with the APTP Director, allowing her to let her guard down and talk about her abuse.
  

  2. The APTP experience allowed her a venue to slowly, naturally disclose and cope with her pain. This was done through intense concentration on the events, but within a displaced setting, allowing her to experience it without it being too painful to continue. • The community of actors within the company gave Marlin a peer group that accepted her for who she was; supported her, and cared for her but also saw her as a typical teenager. She was completely accepted.
  

• Immigration — Chicago’s Albany Park neighborhood mirrors America: approximately 26.3 million immigrants now live in the United States, where one in five children is either an immigrant or has an immigrant parent. As immigrants transform many American communities, it becomes important to look at how our society supports and empowers this new generation of citizens.

Learning Objectives

1. Viewers of TRUST will come away understanding that making art is making community, is making society, and—in a small but important way—is changing the world.
   

2. Attendees will learn that art can be a strong healing catalyst for survivors of sexual abuse.
   
3. Attendees will see firsthand how poverty and legal status can impact a child victim of sexual abuse, and realize the need to provide resources for victims within their community (ethnic, neighborhood, etc).

Publications

• Lusebrink, Vija B. (2010). “Assessment and Therapeutic Application of the Expressive Therapies Continuum: Implications for Brain Structures and Functions.” Art Therapy: Journal of the American Art Therapy Association, 27(4) pp. 168 – 177. 
  
• Howard, Rosemarie (1990). “Art therapy as an isomorphic intervention of the treatment.” American Journal of Art Therapy, Feb., Vol. 28, p. 78. 
• Pretorius, Gertie Centre for Psychological Services and Career Development, University of Johannesburg, Johannesburg, South Africa and Pfeifer, Natascha University of Johannesburg, (2010). “Group art therapy with sexually abused girls.” South African Journal of Psychology, pp 63 - 73. Research is in the early stages in regards to evidence-based treatment specifically for the sexual abuse of Latino children. Some of the following articles appear to include Latino children.
• Briere, J (1996) Trauma Symptom Checklist for Children (TSCC). Odessa, Florida. Psychological Assessment Resources. • Cohen, J. A. & Mannarino, A. P. (1996). A treatment study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 42-50.
• Deblinger, E., Lippmann, J. & Steer, R. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1, 310-321.
• Deblinger, E., Stauffer, L. B. & Steer, R. A. (2001). Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their non-offending mothers. Child Maltreatment, 6, 332-343.