Roots and resiliency for native American young people

Aim: The presentation shares traditional Native American knowledge about wellbeing and caring for a person's body, heart, connection to the Creator, ancestors, and the land Methods: Drawing upon community narratives and traditional ancestral knowledge themes pertinent to the topic will be presented. Narrative Review Results: Ancestral knowledge is essential to access and practice in? community care and healing. This knowledge is sacred to the lives wellbeing, and continuation of traditional ways for Confederated Tribes of Warm Springs (CTWS) people. CTWS young people play an important role in these practices for their community and elders. The practice of taking CTWS children from families was a pivotal moment that pushed forward the concept of mental health for the CTWS. The threat of climate change, and the COVID-19 pandemic's activation of memories of imposed isolation between our people and from traditional ways continues to impact our young people. The process of healing from historical and present-day traumas includes grieving those losses and healing from addictions, as well as physical and sexual abuse Conclusion(s): Rebuilding and strengthening connections to the land Chuush (water in Sahaptin language), food gathering, and being with each other, is central to our young people's, and community's, healing The path of returning to our traditional understanding of the knowledge of what the Creator has provided for the CTWS people will be shared. This knowledge is useful for the care of young people Native and non-Native alike.

The impact of COVID-19 on women and children in the UK who were victims of domestic abuse: a practitioner perspective

PurposeThis study aims to explore the impact of COVID-19 on women and children in the UK who were victims of domestic abuse.Design/methodology/approachThe authors draw from their experiences of working in the domestic abuse sector to reflect on the impact of lockdown restrictions on women and children, focussing on the impact of government restrictions that created an environment in which abusers could control the movement of victims.FindingsThe impact of the pandemic was significant as victims were locked into the abuse, unable to escape for fear of breaching lockdown rules. The lockdown affected victims of different forms of violence against women and girls in the UK including forced marriage and female genital mutilation, which highlighted the ramifications of intersectional inequalities for abuse victims.Originality/valueThis paper articulates the devastating impact of the pandemic on vulnerable women, and their fair and just access to the family courts. This paper concludes that women were failed by the government and that there was not nearly enough support from support agencies, which has left many at risk and suffering significant harm.

Learning Strategies for Sensitive Content Detection

Currently, the volume of sensitive content on the Internet, such as pornography and child pornography, and the amount of time that people spend online (especially children) have led to an increase in the distribution of such content (e.g., images of children being sexually abused, real-time videos of such abuse, grooming activities, etc.). It is therefore essential to have effective IT tools that automate the detection and blocking of this type of material, as manual filtering of huge volumes of data is practically impossible. The goal of this study is to carry out a comprehensive review of different learning strategies for the detection of sensitive content available in the literature, from the most conventional techniques to the most cutting-edge deep learning algorithms, highlighting the strengths and weaknesses of each, as well as the datasets used. The performance and scalability of the different strategies proposed in this work depend on the heterogeneity of the dataset, the feature extraction techniques (hashes, visual, audio, etc.) and the learning algorithms. Finally, new lines of research in sensitive-content detection are presented.

The Trend of Online Child Sexual Abuse and Exploitations: A Profile of Online Sexual Offenders and Criminal Justice Response.

During the COVID-19 pandemic, the number of technology-facilitated crimes against children worldwide has increased substantially and become one of the most serious crime problems. Due to these considerations, there is a lack of large-scale systematic reviews investigating Cybercrime in and of itself could be challenging to investigate in comparison to traditional ones due to the elusiveness of the cyber realm. Specifically, investigating internet crimes against children comes with specific challenges. These offenses target vulnerable children who are less likely to realize their victimization, lowering the probability of reporting to the proper authorities. With these obstacles in mind, this research study utilizes data information regarding the characteristics of online CSAM users and their practices to inform law enforcement, parents, and the public for preventative and strategic purposes. Furthermore, this study diagnoses the significant challenges of investigating technology-facilitated crimes against children by examining how the current criminal justice system responds to these incidents. The policy recommendations discussed offer a holistic lens for highlighting this critical issue and implementing practical and proactive training solutions for law enforcement and the public.

Supporting survivors of institutional child sexual abuse during the COVID‐19 pandemic: A qualitative study of not‐for‐profit community and legal organisations in Greater Western Sydney

Before, during and since the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (2013–2017), not‐for‐profit community and legal services have been critical in supporting survivors of institutional child sexual abuse. This qualitative study aimed to explore the perspectives of community and legal service practitioners operating in Greater Western Sydney regarding the ongoing impact of the COVID‐19 pandemic on the service system for survivors of institutional child sexual abuse. Semistructured interviews were conducted with 21 practitioners at 15 community and legal services. Through thematic analysis, the study identified five areas of concern regarding service provision and COVID‐19, including difficulties in navigating shifts to remote service delivery;changes in service accessibility;complications in accessing the National Redress Scheme;safety challenges for clients;and safety challenges for practitioners. The research identified a need for services to finesse frameworks that ensure remote services can be delivered safely for clients and practitioners alike. Priorities include adequate funding for technology and infrastructure, supporting survivors of abuse perpetrated online and encouraging effective coping strategies for practitioners who undertake trauma support work from home. Future research should consider how shifts to remote service delivery have impacted survivors of different demographic groups and the survivor support workforce. [ FROM AUTHOR] Copyright of Australian Journal of Social Issues (John Wiley & Sons, Inc. ) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Moving school-based CSA prevention education online: Advantages and challenges of the "new normal".

One of the many outcomes of the COVID-19 pandemic was a shift in the delivery of elementary (primary) education. Schools transitioned swiftly to e-learning and prioritized education that was already or could be easily adapted to virtual formats. Given the paucity of online content available, it is not likely that child sexual abuse (CSA) prevention education was prioritized. Given that CSA prevention education has demonstrated success in increasing knowledge, protective behaviors, and disclosures, and the potential long-term need for e-learning options, there is a demand for an exploration of how CSA prevention can be implemented using e-learning strategies. In the current discussion, we explore how school-based CSA prevention education could be implemented in a "new normal" context of e-learning. We first present the existing e-learning content for CSA prevention education. We then describe how best practices for prevention education can be applied to e-learning. Finally, we present considerations for the use of e-learning specifically for CSA prevention education. In short, implementing CSA prevention programs through e-learning offers many affordances for program accessibility and reach, flexibility in implementation and opportunities for greater exposure to content, and a wide range of ways to demonstrate effective skills and engage children in cycles of practice and feedback. E-learning, may also, however, limit important conversations between children and trained instructors that lead to disclosures. The extant literature leaves us unsure as to whether implementing CSA prevention programs through e-learning will result in better or worse outcomes for children. However, given the increasing demand for e-learning options, and the promise of some new e-learning programs, further research on the effectiveness of e-learning CSA prevention programs is warranted.

International Legal Safeguards for Children and Adolescents in the Information Space

The world is on the cusp of a new technological revolution. The rapid development of advanced technology is already moving entire industries into the virtual realm. Global digitalization is penetrating all areas of social life. The contours of the emerging global information order are gradually taking shape. All of this not only opens gigantic opportunities for the development of all countries but also creates new challenges in terms of the legal regulation of cyberspace, which does not always adjust to current realities quickly enough. Therefore, new forms and ways of committing unlawful acts in cyberspace are emerging. The COVID-19 pandemic, which to a large extent has taken economic and social life online, has also led to the transformation of information crime. The potential victims most negatively affected by this situation are primarily vulnerable segments of society - children and adolescents. According to Interpol and Europol reports, there has been a significant increase over the past few years in material that contains child sexual abuse, especially in the streaming format, as well as an increase in the effectiveness of the Dark Web at adapting to such criminal activity.

Pengetahuan HIV/AIDS dan Faktor Keterlibatan dalam Hubungan Romantik serta Ketertarikan Seks Sesama Jantina : Kajian Kes dalam kalangan Mahasiswa Gay

Kajian ini bertujuan meneroka pengetahuan mahasiswa tentang risiko jangkitan HIV/AIDS, faktor keterlibatan dalam hubungan romantik dan ketertarikan seks sesama jantina. Masih kurang kajian yang memberi tumpuan kepada amalan hubungan romantik dan ketertarikan seks sesama jantina serta kesedaran mahasiswa tentang HIV/AIDS impak daripada tingkah laku seks berisiko ini. Banyak kajian terdahulu lebih menumpu kepada faktor keterlibatan dalam hubungan romantik dan ketertarikan seks sesama jantina tanpa mengaitkannya dengan kesedaran mahasiswa gay terhadap jangkitan HIV. Kajian ini menggunakan pendekatan kajian kes dan direkabentuk bersesuaian kaedah kajian kualitatif. Seramai empat informan dalam kalangan mahasiswa Institusi Pengajian Tinggi di Malaysia yang membuat pengakuan identiti gay telah terlibat dalam kajian ini. Pemilihan informan adalah menggunakan teknik Persampelan Snow Ball. Pengumpulan data telah dijalankan secara atas talian dengan menggunakan medium Google Meet. Semua informan ditemubual dalam talian secara konferen video. Data temu bual dianalisis menggunakan analisis tematik. Hasil analisis menunjukkan terdapat empat faktor risiko keterlibatan mahasiswa dalam hubungan romantik dan tingkah laku seksual sesama jantina iaitu (i) pengalaman menjadi mangsa gangguan seksual semasa kecil, (ii) faktor naluri semulajadi, (iii) pengaruh rakan/komuniti berisiko gay dan (iv) pengaruh negatif daripada media sosial dan internet. Informan juga mempunyai pengetahuan asas tentang risiko jangkitan HIV. Walau bagaimanapun, kesemua informan percaya tingkah laku mereka mempunyai risiko rendah dan tidak mudah untuk dijangkiti HIV. Salah faham tentang risiko jangkitan HIV bagi seks tidak selamat dan seks luar tabi' dipercayai mendorong amalan hubungan seks sesama jantina dilakukan tanpa rasa takut dan menurunnya keprihatinan kepada seks selamat dalam kalangan mahasiswa gay. Kajian mencadangkan salah faham tentang risiko jangkitan HIV sebagai faktor baharu penyebab amalan seks sesama jantina yang berterusan dalam kalangan informan yang dikaji. Intervensi perlu dibentuk bersesuaian faktor risiko hubungan romantik dan tingkah laku seksual sesama jantina agar ia dapat dibendung daripada menular dalam kalangan mahasiswa gay.Alternate :This study aims to explore the knowledge of HIV/AIDS infection risk and the factors that contribute to same-sex romantic relationship involvement and same-sex sexual attractions among university students. Less studies have been done focusing on same-sex romantic relationships and same-sex sexual attraction among self-identified gay university students and their awareness of the HIV/AIDS impact due to risky sexual behaviour. Many previous studies were found to focus only on gay students' romantic relationships and samesex sexual attraction involvement factors without relating these factors with their awareness of HIV infection. This study uses a case study approach and is designed following qualitative research methods. Four students who self-identified as gay were selected as informants. Snow Ball Sampling is used as the informants' selection technique. Data collection was conducted online using the Google Meet platform. All informants were interviewed online via video conference. The thematic analysis has been used to analyse the interview data. The study analysis demonstrated four risk factors conduce to a same-sex romantic relationship and samesex sexual behaviours among gay students: (i) sexual abuse experienced during childhood;(ii) same-sex sexual attraction as an instinct factor;(iii) gay friends/community influenced and (iv) internet and social media negative influence. All informants are identified to have basic HIV risk infection knowledge. However, those in a same-sex relationship believe same-sex romantic relationships and same-sex sexual practices have a low risk of HIV infection. The misunderstanding of HIV infection in same-sex sexual practices and unsafe sex is believed to contribute to a consistent no fear of same-sex sexual practices and less concern towards safe sex among ay students. This study suggests a misunderstanding of HIV infection as the new factor contributing to continuous same-sex sexual practices among studied informants. Intervention needs to be developed tailored to the same-sex romantic relationship and same-sex sexual attraction risk factors to curb the spread among gay students.

‘Sinawe' [we are with you]: Local churches as change agents in the lives of traumatised youth

The church has a key role to play in addressing the chronic levels of grief and trauma experienced by the youth in South Africa. It has a biblical mandate to bring hope and healing and has a unique station within South African society that positions it to bring about real transformation. ‘ Sinawe' (Zulu for [we are with you]) is a programme developed by Scripture Union South Africa to equip local churches as change agents through a relational youth ministry model that engages trauma, grief and holistic needs, both physically and spiritually. This is an important first step for churches wanting to reach and minister to young people. The South African church has an important and legitimate role to play in the lives of young people. Research indicates that although the church is considered by local residents as an important community resource, it remains ineffectual in intentional community-based youth ministry that leverages significant opportunity. This research identifies the church as an important community change agent and encourages church leaders to step into the open gap to reach local young people while providing the methodology with which to do so. This research paper examines the current South African social context, outlines a theological mandate for church involvement and presents a methodology for a supportive and effective approach to community engagement in the lives of young people led by local churches. Interdisciplinary: The article is relevant to the following disciplines within theology;missiology, family and youth ministry and pastoral care. It also has interfaces with education and sociology.

Intimate partner violence during the COVID-19 pandemic: An online survey

Objective:Intimate partner violence (IPV) against women is a human rights violation and a public health concern. The incidence of IPV increases in mass events such as epidemics. The aim of this study was to assess the nature and the extent of IPV among women in Turkey;to identify the associated factors, and mental health outcomes during the COVID-19 pandemic. Method:The study has a cross-sectional, descriptive design. An online self-report survey, based on World Health Organization guidance on epidemiological studies to assess IPV, was conducted among women between 09.01.2021 and 09.02.2021. The survey had 69 questions which covered sociodemographic characteristics, relationship history, types of violence and mental well-being. Inclusion criteria were being over the age of 18, and having a spouse/partner during the pandemic. Participation was on voluntary basis. 1372 women were included in the analysis. Results:Around a third (30.7%) of participants were exposed to any type of violence before the pandemic, with most common form being emotional violence, and this rate remained unchanged during the pandemic, despite the time spent with partners were expected to increase due to isolation measures. 61 women (4.4%), mostly university graduates living in cities, reported being subject to violence for the first time during the pandemic. 31.2% of them were cases of digital violence. Lower level of education, younger age and partner's alcohol and substance use was associated with IPV, and IPV was associated with poorer mental well-being. Discussion:Despite the public health measures taken during the pandemic (e.g. lockdowns), where women would have spent more time isolated with their partners, rates of IPV did not change from pre-pandemic to pandemic. This outcome needs to be compared with findings from other contexts. Strategies to prevent IPV is of utmost importance for the protection of mental well-being of women and the society during and after the pandemic. © 2023 ANP Publishing. All rights reserved.

The coronavirus crisis as "preparing ground" for abusive sexual behavior between siblings

This article presents the impacts and implications of the coronavirus (COVID-19) crisis on the complicated phenomenon of sexual abuse among siblings-the most frequently occurring type of sexual abuse of children. The COVID crisis led to a higher risk of this type of abuse occurring in normative families, or significantly escalating in families in which abuse had already occurred before the pandemic. Throughout the world, COVID-related social distancing and closure directives forced family members to stay together for extended periods of time in a shared space-essentially prisoners in their homes. The first part of this article gives an overview of the global situation that emerged in the wake of the pandemic, including social distancing and isolation, closure or limiting of support and treatment systems. In the second part, the consequences of this situation are described, noting the situational risk factors for the direct and indirect abuse and victimization of children The third part of the article presents how these risk factors have a mutually reinforcing relationship. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

"We're Not Allowed to Have Experienced Trauma. We're Not Allowed to Go through the Grieving Process” - Exploring the Indirect Harms Associated with Child Sexual Abuse Material (CSAM) Offending and Its Impacts on non-offending Family Members

Online child sexual abuse encompasses a range of offenses including the accessing, downloading, sharing and creating of images of child sexual abuse, often referred to as Child Sexual Abuse Material (CSAM). CSAM consumption has increased exponentially, and the lockdowns implemented as a response to COVID-19 have exacerbated this problem. CSAM offenders are more likely than other sex offenders to be married, to have children and to live with a partner and child(ren). Policy, practice and research has largely considered these families within the context of their protective properties, with little consideration for the individual and collective harms that they experience, and their unique support needs. Using data from 20 interviews with family members of those convicted of CSAM offenses in the UK, we propose seven key elements that characterize the impacts of CSAM offending on non-offending family members. We categorize these as: 1) Disenfranchised Grief;2) Ambiguous Loss;3) Ontological Assault;4) Contamination by Causal Responsibility;5) Wall of Silence;6) No-Win Situation, and 7) Burden of Responsibility. We propose policy and practice responses to minimize these harms. © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

Skills Training in Affective and Interpersonal Regulation Narrative Therapy Delivered via Synchronous Telehealth: A Case Study of a Rural Woman Veteran With Complex Posttraumatic Stress Disorder

The International Classification of Diseases-11 th Revision (ICD-11) includes the diagnosis of complex posttraumatic stress disorder (CPTSD). Clinical practice guidelines support the use of phased care for individuals with CPTSD. This case study illustrates the use of synchronous telehealth to deliver phased treatment to a rural woman veteran with CPTSD. Mrs. A experienced sexual, physical, and emotional abuse throughout her life, perpetrated by family members, intimate partners, and military authority figures. She sought treatment for posttraumatic nightmares and body image issues;she also had pain related to fibromyalgia and chronic migraine headaches. Mrs. A participated in 19 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative therapy via synchronous telehealth. Trauma and eating disorder symptoms were assessed before and after treatment and the patient demonstrated clinically significant improvement on measures of these disorders. Patient-provider working alliance and quality of life were assessed post-treatment. Synchronous telehealth use drastically increased with the onset of COVID-19;however, little information on treating CPTSD via synchronous video teleconferencing is available. This case study illustrates an evidence-based, phased therapy for CPTSD while highlighting the feasibility and value of in-home delivery of psychotherapy for CPTSD via synchronous telehealth.Copyright © The Author(s) 2023.

Consultations due to suspected child and adolescent sexual abuse at the Department of Gynecology of a children's hospital: pre- and intra-COVID-19 pandemic / Consultas por sospecha de abuso sexual infantojuvenil en la sección de Ginecología de un hospital pediátrico: variaciones prepandemia e intrapandemia de COVID-19

Introducción. Se ha postulado que el aislamiento social debido a la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) aumentaría la incidencia de abuso sexual infantojuvenil (ASIJ). Objetivo. Comparar la incidencia y las características de las consultas realizadas en Ginecología en relación con ASIJ antes y durante la pandemia de COVID-19. Materiales y métodos. Se realizó un estudio descriptivo, observacional y comparativo entre las situaciones de sospecha de ASIJ ocurridas durante la pandemia de COVID-19 en relación con las del mismo período del año previo en un hospital pediátrico de alta complejidad. Resultados. Se consignaron 122 consultas por sospecha de ASIJ, 78 en el período previo a la pandemia y 44 en la pandemia. El motivo de consulta al hospital más frecuente, en ambos grupos, fue el relato de ASIJ y, al Servicio de Ginecología en particular, la evaluación de genitales externos. La mayor parte presentó un examen físico normal. Se observó una mayor prevalencia de infecciones de transmisión sexual (ITS) en el grupo de pandemia. Se realizaron más internaciones y denuncias para protección de víctimas en dicho grupo. Se registró que el agresor era conocido de la víctima en casi el 90 % de las víctimas de ambos grupos. Conclusiones. Durante la pandemia se evidenció una disminución en el número total de consultas a Ginecología, de modo que aquellas por sospecha de ASIJ representaron un mayor porcentaje. Sin embargo, las características en relación con la presencia de lesiones graves, infecciones de transmisión sexual o embarazo no se vieron modificadas

Introduction. It has been suggested that the social isolation due to the coronavirus disease 2019 (COVID-19) may increase the incidence of child and adolescent sexual abuse (CASA). Objective. To compare the incidence and characteristics of medical consultations made to the Department of Gynecology due to CASA before and during the COVID-19 pandemic. Materials and methods. Descriptive, observational, and comparative study about suspected CASA events occurred during the COVID-19 pandemic compared to those occurred in the previous year at a tertiary care children's hospital. Results. One hundred and twenty-two medical consultations due to suspected CASA were recorded; 78 before and 44 during the pandemic. In both groups, the most common reason for consultation at the hospital was an account of CASA and, at the Department of Gynecology in particular, the external genitalia examination. Most subjects had a normal physical examination. There was a higher prevalence of STI in the pandemic group. In addition, there were also more hospitalizations and police reports for victims protection in this group. The abuser was known to the victim in almost 90% of cases in both groups. Conclusions. During the pandemic, the total number of medical consultations to the Department of Gynecology decreased so the percentage of those due to suspected CASA was higher. However, the presence of severe lesions, STIs or pregnancy did not change

Technology-Facilitated Sexual Violence Victimization during the COVID-19 Pandemic: Behaviors and Attitudes

Despite the growing attention to Technology-Facilitated Sexual Violence (TFSV) experienced by adults, this is still an underexplored topic. This study involved a sample of 289 adults (aged 18 to 56), focusing on reported indicators of TFSV in a year dominated by the coronavirus disease (COVID-19) pandemic. Reports of TFSV victimization were analyzed using an existing 21-item scale that encompassed four TFSV dimensions: i) digital sexual harassment;ii) image-based sexual abuse (IBSA);iii) sexual aggression and/or coercion;and iv) gender and/or sexuality-based harassment. While examining the experience of one or more TFSV behaviors by independent socio-demographic variables (e.g., gender, age, or sexuality), the results showed that women were significantly more likely than men to report several forms of sexual harassment victimization. LGB+-identifying adults were significantly more likely than heterosexual-identifying respondents to report 11 behaviors from the used TFSV victimization scale. During the current COVID-19 pandemic, many types of violence against women and the LGBT+ community have been intensified, and this study indicates TFSV as no exception to that. The results show gendered patterns in online sexual victimization, as well as in the nature of TFSV. These findings indicate the importance of considering additional institutional measures to prevent this phenomenon.Copyright © 2022 Taylor & Francis.

Enhancing children's awareness of sexual abuse in Pakistan with video literacy interventional cartoons.

In presence of violent extremism, children in Pakistan are at high risk for child sexual abuse (CSA), especially after the COVID-19 pandemic. Effective approaches for preventing CSA include enhancing resilience resources in violence-affected societies. Previous research suggests that video-based curricula effectively enhances learning in primary schoolchildren. We pilot tested a video literacy program to build awareness in children, creating a 'personal safety and space bubble' as an educational approach for prevention of sexual abuse with an experimental 6 weeks long pre- and post-test design. We conducted qualitative interviews with students, teachers, and parents and identified themes using frequency analyses. Results showed a 96.7% increase in awareness about 'personal safety and space bubble'. The pilot study is valuable for public health researchers and policy makers seeking to curtail sexual abuse in extreme violence affected Pakistan. Primary schools can use such interventional cartoons to enhance awareness about child sexual abuse.

Knowledge and Experience of Sexual Violence among Female Adolescents in Public Schools in Enugu State during the Covid-19 Pandemic.

Sexual violence among female adolescents is a pervasive problem. This is even worse in periods of unrest such as the COVID-19 pandemic, which heighten the vulnerability of these female adolescents' victims to the potential perpetrators of sexual violence. This study assessed the knowledge and experience of sexual violence amongst female adolescents in public schools in Enugu State, Nigeria, during the COVID-19 pandemic. Three hundred twenty-five adolescents (aged 10-19 years with a mean age of 12.8 ±2.8) female school students were purposively recruited in this cross-sectional study to complete a scale designed to measure the knowledge and experience of sexual violence among female adolescents. Findings showed a high (90.8%) knowledge level of sexual violence among adolescents. The majority of the perpetrators were their uncles (40.4%) and cousins (28.6%). Among 9.8% of the participants who had forced to have sex, about two-thirds (65.6%) have been raped 2 to 5 times. A significant difference was noted only between the respondent's class levels and their knowledge of sexual violence (p < .05) with higher classes having better knowledge. Female adolescents showed a good knowledge level about sexual violence, which might explain the low prevalence of sexual violence in the sample population. The study also provides evidence that females are most at risk of sexual violence from closer relations during times of crisis. Thus, these study findings add evidence to the literature that would guide policymakers, health, and social workers toward making campaigns and interventions that would prevent female adolescent sexual violence.

Management of Extremely Complex Constipation Patients in a Nurse-Led Clinic with Health Play Specialist Involvement

Introduction Children with idiopathic chronic constipation are extremely challenging to manage. Before review by tertiary specialist teams, Children have suffered for years with constipation, which leads to significant behaviour related issues around toileting, despite adequate medical treatment. The involvement of the health play specialist (HPS) in the nurseled constipation clinic is to address behaviours around toileting. Aims To demonstrate involvement of HPS in the clinic led to improved outcomes for children and families. This will be identified through the use of parental satisfaction questionnaires and four case studies. Case Studies We demonstrate four extremely complex constipation cases referred to clinic and successfully managed by HPS with unique individualised approach with support and plans for parents and school. 9-year-old boy with history of sexual abuse, with soiling and wetting accidents. 5 sessions with the HPS, focusing on toileting behaviours. Sessions involved desensitizing play around the body, use of toilet related games/activities, videos and mobile apps. All issues resolved. 5-year-old boy: Stool with-holding, will only pass stools in a nappy and soiling. 8 sessions with HPS - Intense toilet training for 2-4 days with hourly sits. Reward charts to compliment interests, targets adjusted when goal reached, prizes given. Desensitization play around toileting behaviours. Using analogies to improve behaviour, he loved dustbin lorries - body empties the waste (poo) just like the bin men collecting the rubbish to get rid of it from home. No more accidents, independent toileting achieved 5-year-old girl Issues with constipation, soiling and toilet refusal. All bowel movements in knickers. Complete HPS treatment virtually, secondary to COVID restrictions. 6 Video call sessions- individualised plan of regular sits to relax, with no pressure to perform. To do an activity whilst on the toilet. Visual pictures/videos explaining how the body works and the plan was adjusted on the video. Rewards when child reached the target, and prize sent in post. Outcome -no fear of the toilet, bowels open on the toilet, no accidents. 8 year old boy premature 33 + 5 weeks. Constipation with overflow since birth. Referred to surgeons for rectal biopsies and botox injections at the age of 3 but no improvement. Age 4 admitted to the ward for 1 week for observation, transit marker study and toilet training was unsuccessful. Referred to another unit for second opinion at parental request. Started to refuse medications. ACE surgery discussed. Diagnosed with Autism at 7 years. Invited for a week of intense toileting with HPS, hourly sits and desensitization activities on medication taking, toileting, with-holding, signs and signals of body. Reward system in place, when reached expectations, reward given by hospital. Outcome bowels open daily in the toilet, wears pants all the time. Satisfaction questionnaires were given to parents and feedback was extremely positive. Conclusion The health play specialist involvement in the nurse led constipation clinic allows for individualised intervention guided by the child's needs. Pharmacological interventions alone may be unsuccessful without addressing behavioural needs.