4.5: Problems Affecting the Family and How Children React to Stress

Types of Families

We have discussed throughout these modules that families can mean different things to different people. Support the patient’s view of who constitutes their family. Some children come from homes with a single-parent, while others may have parents who are divorced, or a parent who has died. Some children live in blended families where a parent has remarried. There may or may not be children from the new parent’s previous relationship or even new children from the new marriage. These adjustments may be difficult for the child to deal with. Divorce may be particularly difficult for children and they may express emotions such as anxiety, depression, sadness, and anger. Some children may even act out and have temper tantrums, start fights, and get into trouble in school. Home Health Aides/Personal Care Aides should provide support to the child by allowing them room to express their thoughts and feelings. If they have concerns about the adjustment of the child, these should be discussed with their supervisor. A social worker may be able to work with the child to assist them to adjust during stressful time periods of family change.

Guidelines for Communicating with Children about Divorce:

• Explain that the separation is not the child’s fault and that they are loved by both parents and the entire family.
• Ensure the child understands that they will still be taken care of by their parents and others who love them.
• Give the child room to express their thoughts and feelings. Some children may prefer to talk about and others to draw about their feelings.
• Encourage the family to maintain routines in the home and to keep rules and traditions as consistent as possible for the child.
• Encourage the parents to explain to the child reasons for the separation in a way they will understand.

Styles of Parenting

There are different styles of parenting. Diana Baumrind is a developmental psychologist who described four types of parenting styles:

• Authoritarian parenting: In this style of parenting, firm limits are placed on children and parents expect children to do as told without question (Santrock, 2009). Parents may spank the child, be threatening, and enforce rules without explaining why they are in place. A typical statement by an authoritarian parent may be, “Do it because I said so or else.” Children from these types of parents may be fearful, unhappy, and have poor communication skills (Santrock).
• Authoritative parenting: In this style of parenting, limits are placed on children but there is a verbal give and take between parent and child (Santrock, 2009). Children are encouraged to be independent within limits. Parents are nurturing and demonstrate warmth toward their children. A typical statement by an authoritative parent may be, “Let’s talk about why I want you to follow this rule.” Children from these types of parents often learn self-control, tend to be cooperative with others and positive (Santrock).
• Neglectful parenting: In this style of parenting, parents are uninvolved with the child (Santrock, 2009). The child is allowed to do whatever they want. A typical statement by a neglectful parent may be, “I don’t care. Do what you want. I am busy.” Children from these types of parents tend to have low self-esteem and may end up in risky situations in which they get into trouble (Santrock).
• Indulgent parenting: In this style of parenting, parents are very involved with their child but do not place enough limits on their children (Santrock, 2009). Children are allowed to do whatever they want, although the parent cares and is involved. A typical statement by an indulgent parent may be, “It’s okay. You can do what you want. I want you to be able to control your own life.” Children from these types of parents tend not to learn self-control and expect to get whatever they want (Santrock).

Authoritative parenting tends to be associated with the most positive outcomes for children (Santrock, 2009). If Home Health Aides/Personal Care Aides have concerns about parenting styles they see in the home, they should be discussed with their supervisor. She can help them develop a plan for educating parents about other ways to communicate with and set limits with children. Remember that there may be cultural differences in parenting. For example, Asian American parents tend to be authoritarian but in a less dominating way. Latino families also tend to use a more authoritarian approach but in a way that emphasizes respect and is not threatening. African American parents also tend to be more authoritarian and may use spanking. However, the use of physical punishment within this culture has been shown to have more positive outcomes within African American families (Santrock). While it is important to promote the most positive parenting style, it is also important to be aware of cultural differences and what may work best within one culture versus another.

Self Check Activity \(\PageIndex{1}\)

1. Which of the following styles of parenting tends to be associated with the most positive outcomes for children?

a). authoritarian

b). authoritative

c). neglectful

d). indulgent

Answer

1. B

Feedback:

1. Authoritative parenting, in which limits are placed on children but there is a verbal give and take between parent and child and children are encouraged to be independent within limits tends to be associated with the most positive outcomes for children.

Socioeconomic Status

Socioeconomic status means the social and financial level of the family. Families who have low incomes may have less access to resources than families from higher incomes. They may need more support from a HHA/PCA and more assistance to find resources available to them. It is important to ensure the family has access to resources such as food, clothing, and healthcare. There are resources within communities to help families who may be struggling. Federal and state financial assistance may also be available for these families. Home Health Aides/Personal Care Aides should discuss their concerns with their supervisor and how they can best help these families.

Children from low income families may struggle in school. They may feel embarrassed if their family is unable to afford the latest trends in clothing or technology. They may struggle with schoolwork and may not be getting the help they need at home. Share any concerns with a supervisor so that these issues may be addressed within the Care Plan.

Domestic Violence

Domestic violence is abuse that occurs by spouses, intimate partners, or family members. It can include any type of abuse such as physical abuse, emotional abuse, financial abuse, or sexual abuse. Domestic violence and the different types of abuse were discussed in Module Two.

Child neglect or maltreatment is when a child is harmed by a caregiver, (whether it is a family member or a healthcare worker), when the caregiver fails to provide necessary care. This includes failing to provide for the basic needs of a child such as food, shelter, and clothing. Neglect can mean abandoning the child, being inattentive to the child’s emotional needs, and neglecting the child’s education. For example, allowing a child to miss school so they do not get an adequate education is neglect. Neglect can be just as harmful as abuse. In fact, child neglect occurs more often than child abuse.

Children who come from homes where domestic violence occurs may have adjustment problems. They may suffer from anxiety, depression, have trouble forming positive relationships with others, have low self-esteem, and may get into trouble or engage in risky behaviors. Children who come from abusive homes are at risk for later becoming abusive themselves, particularly for sons. Daughters are more likely to end up in an abusive relationship themselves. Problems with alcohol and drug abuse, depression, and anxiety can also occur in later life.

If Home Health Aides/Personal Care Aides ever notice any signs of domestic violence, child abuse, or neglect, they should immediately report these to their supervisor. All health care workers are required by the law and have an ethical obligation to report incidents of child abuse. Refer to the agency’s policy on guidelines for reporting observed or suspected abuse to agencies, such as the local Child Protective Services. Laws may differ from state to state and country to country about how to report child abuse and neglect. Always follow your agency’s rules and state/country law for reporting suspected child abuse/neglect.

In families where domestic violence is actively occurring, the abusive person may likely need to be removed from the home. In some instances, the abused family members may need to enter a domestic violence shelter or be placed in a secure and confidential location, away from the abuser. Families where domestic violence occurs may benefit from parenting classes and in or out of the home counseling.

Self Check Activity \(\PageIndex{2}\)

1. Which of the following would be signs of child abuse or neglect to report?

a). Unexplained bruises

b). Burn or teeth marks

c). Inadequate clothing for the weather (e.g. child has no coat in the winter)

d). Child is left home alone for two days

e). You observe a caretaker shaking an infant to stop him from crying

f). The child reports to you their uncle touched them “down there”.

g). You notice long marks, some scabbing and some seem to be new on the child’s back when you bathe them

h). You witness the father striking the mother across the face and pushing her

i). You notice there is not enough food in the home and the children are often hungry

j). You discover a parent or caregiver is intoxicated and has driven a car with their children inside

Answer

All answers are signs of abuse. If the HHA/PCA observes any of the above, they should immediately inform their supervisor and the appropriate authorities.

Special Issues of Families: Substance Abuse and Mental Health Issues

Some children may have parents that abuse alcohol or other substances or who have mental health illnesses. Substance abuse is a major factor in child abuse. According to the National Council on Child Abuse and Family Violence, more than 8 million children live with a parent who abuses substances, and between 40-80% of homes where there is substance abuse, there is also child abuse. The long-term effects of a parent abusing a substance on children include: depression, anxiety, an increased risk of the child eventually becoming a substance abuser, low self-esteem, and acting-out behaviors (National Council on Child Abuse and Family Violence).

Home Health Aides/Personal Care Aides may be the first to recognize that a parent is abusing a substance or has mental health issues. They should always report their observations to their supervisor and seek direction from them about what to do. They should also remember that if they ever feel unsafe in the home, leave immediately and call their supervisor.

Signs of Substance Abuse:

• An odor of alcohol on the breath
• The parent appears unkempt in appearance or the home is unkempt
• Children needs are not met and they may be neglected (e.g. no food, clothing, not going to school)
• The parent appears to be intoxicated (e.g. stumbling, slurring of words, abusive language)
• Blood shot eyes
• Shaky hands and irritability
• You find bottles or drugs hidden around the home
• The parent or caregiver seems forgetful, moody, or you observe sudden changes in behavior
• You notice the caregiver has insomnia or they report not sleeping for a couple of days
• You observe bizarre behaviors
• The children report they see their parent drink or use drugs
• The children seem afraid of the caregiver

Signs of Mental Illness:

• Children needs are not met and they may be neglected (e.g. no food, clothing, not going to school)
• You notice the caregiver has insomnia or they report not sleeping for a couple of days
• You observe bizarre behaviors
• The caregiver reports seeing or hearing things that are not there
• You notice the caregiver talking to themselves or what appears to be another person even though no one else is there
• The parent appears unkempt in appearance or the home is unkempt
• The children report strange behaviors of the parent
• You notice a change in behavior or mood
• You notice the parent seems withdrawn or apathetic (does not seem to care) about what is going on around them
• The children seem afraid of the caregiver

Self Check Activity \(\PageIndex{3}\)

True or False?

1. Homes where substance abuse occurs also have higher rates of child abuse and neglect. True or False. ________

2. You should immediately report signs of substance abuse or mental health issues to your supervisor. True or False. ________

Answer

1. True

2. True

Feedback:

1. Homes in which substance abuse occur also tend to have higher rates of child abuse and neglect. If the HHA/PCA suspects substance abuse or child abuse, they should immediately inform their supervisor.

2. If the HHA/PCA suspects substance abuse or child abuse, they should immediately inform their supervisor. It is important to protect the safety and well-being for children and to get the family the help that they need.

Stress

An important aspect of child development is to learn how to cope effectively with stress. Younger children are less able to understand stressful or traumatic events. They may think that they have caused the stressful event to happen. They may become unhappy, listless, not want to play as usual, forget to do homework, get poor test scores in school, or even become aggressive and act out, getting into trouble at home or in school. Older children and adolescents are better able to understand the causes of stress and to use cognitive coping skills to deal with the stressors in their lives. They too, however, may become anxious, depressed, and hopeless, make statements of wanting to hurt themselves or die, become aggressive, and get into trouble in the home or at school. Sometimes adolescents who have stress may engage in risky behaviors such as driving recklessly, engaging in unsafe sexual activity, or beginning to use drugs or alcohol.

How to Help Children Cope with Stress

• Provide reassurance that the child is safe and protected.
• Allow the child room to talk or draw about their thoughts and feelings.
• Reassure children that it is okay to feel stress, anxiety, or depression.
• Reassure children that traumatic events are not their fault.
• Protect children from stressful situations as much as possible and avoid discussing stressful or traumatic events in front of them.
• Correct any misconceptions about the stressful or traumatic event. Explain the situation in words the child understands.
• Teach children coping techniques to use when feeling stressed such as engaging in relaxing activities. These may include listening to music, dancing, coloring, and engaging in physical activities such as running and bike riding.
• For families that practice religious or spiritual beliefs, encourage children to turn to these practices in times of stress. Provide support and be respectful of these practices. Encourage children to talk to religious leaders.
• For older children and adolescents, talk to them about the cause of their stressors and help them plan ways to overcome the stressors. Children in these age groups are able to have a better understanding of stress and can think about how the future may be different without the stress. They are also able to think about what they could do to make changes to better deal with their stress. This helps to give them hope that things can change.