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By V. Folleck. Boise State University.

Failure to provide food quality 480 mg septra, clothing appropriate for the weather order septra 480mg on line, supervision order septra 480mg fast delivery, a home that is hygienic and safe, and/or medical care, as needed. Failure to enroll a school-age child in school or to provide necessary special education. This includes allowing excessive absences from school. Failure to provide emotional support, love, and affection. Administration for Children and FamiliesNational Clearinghouse on Child Abuse and Neglect InformationNational Institutes of Health -National Library of MedicineU. Department of Health and Human Services, National Center on Child Abuse and NeglectReporting child abuse is critical in the prevention of the maltreatment of children. In the vast majority of cases, reports of child abuse are not made by the victims but rather by people around them who know of, or suspect, the abuse. How and where to report child abuse is something that every adult should know so that if needed, they can protect a child in danger. In fact, reporting of child abuse is taken so seriously that in every state child abuse laws require some professionals, and in many cases adults in general, to report suspected child abuse. In almost all states, the following professionals are required to report suspected child abuse: Law enforcement officialsChild abuse reporting laws also frequently apply to:Photograph / film processorsIn 18 states, any adult that "suspects or has reasons to believe" that a child has been abused or neglected must report the child abuse. Not reporting child abuse may not just hurt the child, but it also may hurt the non-reporter. Mandatory reporters who do not report child abuse face prosecution in the vast majority of states. Not reporting child abuse is typically considered a misdemeanor but may be upgraded to a felony in the case of not reporting serious situations or in the case of repeated non-reporting. Criminal penalties for not reporting child abuse range between 10 days to 5 years in jail and fines of between $100 and $5000. In some cases, not reporting child abuse also makes the non-reporter civilly liable. Knowing who to report child abuse to and how to report child abuse is important. Several systems are in place to make suspected child abuse reports easy to make. Reports of child abuse can be made: Through a law enforcement agency (call the non-emergency number of your local police)Child Protective Services (CPS)There is also a national child abuse hotline provided by Childhelp. Childhelp is a national organization that provides crisis assistance and other counseling and referral services. The Childhelp National Child Abuse Hotline is staffed 24 hours a day, 7 days a week, with professional crisis counselors who have access to a database of 55,000 emergency, social service, and support resources. Contact The Childhelp National Child Abuse Hotline at 1. In some states, mandatory reporters must include their name and contact information in child abuse reports. Once a report of child abuse is made, Child Protective Services must act. Initially, agency hotline or intake units will either screen in or screen out an individual report. Child abuse reports that are screened out may be referred to other agencies. Child abuse reports that are screened in require an official report and, normally, an investigation from CPS. About two million child abuse reports are screened in annually in the United States. Once an investigation is conducted, child abuse reports are listed as either: Substantiated ??? child abuse was proven under the law. Indicated ??? some states differentiate between indicated and substantiated child abuse reports. In indicated child abuse cases, the child abuse cannot be proven under the law but there is reason to suspect that the child was abused or at risk of abuse. Unsubstantiated ??? insufficient evidence was found to prove or suspect that child abuse had taken place. From there, CPS decides on appropriate action given the individual situation. Help for an abused child is needed when, unfortunately, steps taken to prevent abuse have failed. This is shockingly common as more than half-a-million children were confirmed victims of child abuse in 2010, according to Child Protective Services. In the United States , child abuse help is critical for these abused children so that their healing can begin and they can again return to a normal childhood. The first step in child abuse help is in properly dealing with the allegations of the abused child. If an abused child reports the abuse to you, you should: Reassure the child they did nothing wrong, it is not their fault and they will not be punishedReassure the child you believe them and that you are glad they toldOffer comfort ??? tell the child you will helpEnsure the safety of both you and the childUnderstand that the child may express him or herself with language appropriate for their age and may not know the proper terms for body parts or specific acts. Tell the child that you cannot keep this information secret (in many countries and states this is the law)Report the child abuse to the authorities immediatelyTo help an abused child you should not:Make suggestions as to what happenedAct shocked, disgusted or doubtful of the abuse. This may make the child uncomfortable and less likely to talk. These children continue to need love and support and if abuse is still suspected, the authorities should be informed. Child abuse help needs to take into account injuries that are physical, psychological and even spiritual in nature. This will likely mean that a team of people needs to be involved in helping the abused child. Persons on this team will likely include:A child psychologist or other mental health professionalA faith leader, if appropriateThe families of the abused child may also need their own treatment services to help get the family through a tough event that can affect everyone. Treatments that help abused children and their families include:Therapeutic day school programsHome and clinic setting treatmentGroup and family therapyWould you know how to spot child physical abuse? Despite the popular notion that physical child abuse is rare, almost 200,000 cases were reported in the United States and its territories in 2007.

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Brewer says that there are times when the toxicity of our relationships with others is driven by a toxic relationship with yourself order 480 mg septra otc. As with many toxic substances septra 480 mg cheap, there are signs that may suggest you may need internal healing purchase septra 480 mg amex. Our topic tonight is "Toxic Relationships: How To Handle Them. She is based in Bethesda, Maryland, just outside of Washington, D. Brewer: A toxic relationship is one in which you are feeling harmed either emotionally or physically. David: What is it that causes us to get involved in toxic relationships? Brewer: There are many reasons why we choose toxic relationships. We may have grown up in a toxic household, we may have been taught that we are not deserving of happiness, or we may have learned to take responsibility for others. One of the most important things to remember about being in a toxic relationship, is that you do have choices and you can get out! David: Can you give us some examples of a toxic relationship? A toxic relationship is one in which you are chronically tired, angry, or frightened. A relationship in which you worry about a safe time to talk to your partner. A relationship in which you do not have the "right" to express yourself. In short, a relationship that is abusive in any way, may be a toxic relationship. David: Many get involved in these types of relationships and find it difficult to break away. What is it inside ourselves that keeps us from being able to do that? Brewer: Often, we stay in relationships because we do not understand that we have rights and options. Low self-esteem can be a factor in remaining, as well as depression, fear of being alone, or threats from the hurtful partner. Sometimes, people stay because the toxic relationship so much mirrors their lives as children, that they truly may not have a sense that it is a toxic relationship and that life can be better. Although low self-esteem can be a very complex experience, the bottom line is that the person does not have a good and clear sense of themselves, and so it is almost impossible, without clinical intervention, for that person to understand that there is a better, healthier way to be. Part of why the toxic person hurts, in addition to having to do with their own low sense of self, is that fear of being out of control and the fear of what exposing the true self would mean. Brewer, can you address the special issues when the toxic people are your parents who feel they deserve rights to your children. Brewer: Tell me more about how they behave in a way that lets you know that they believe your children are theirs. Brewer: How do they discipline them and have you told your parents that their behavior is objectionable to you? I have expressed this to them many times and have limited their interaction with them. My mother has hit the youngest for wanting a snack and forced him to eat her mashed potatoes. Brewer: Were your parents abusive towards you as a child? Brewer: What you are describing is abusive behavior. It must be very painful to know that your parents are harming your children. So, are your parents doing to your children what they did to you? Brewer: Have you considered working with a clinical professional? It sounds like you know that you have to protect your children from your parents, which means your children come first. You should feel very proud of yourself that you have been able to identify the abuse and are working to protect your children from the abuse. Michaelangelo37, please do what you can to help yourself as you and your family work to stop the abuse and good luck to you. SierraDawn: How about a relationship where one partner is giving what she feels is suggestions, and the other partner is seeing it as "criticism"? Brewer: It may depend on how the "suggestions" are being offered. If they are being offered as suggestions and the other has the option to agree or disagree, then the issue may be with the person who is perceiving criticism. SierraDawn: I am the one that gives the suggestions. Brewer: What might be useful, is communications skills counseling for both of you. You can start with some self-help books, but working with a counselor really might be the most useful thing for you both! David: And this pattern of behavior happens in many different types of relationships. Sometimes the "suggester" is really trying to control the other person by telling them "this is the right, the only way, (whatever it is) can be done. In part, such work really helps both to learn to speak for themselves; expressing their own thoughts and needs versus telling or interpreting for their partner. Even our pastor told us it was toxic before we ever got married. How can I get to the point of "not going against God" and filing for divorce before it is too late for me and my kids? I cannot bring myself to go against what the Bible says.

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Your pharmacist can provide more information about Avandia cheap septra 480 mg. Rosiglitazone is available with a prescription under the brand name Avandia discount septra 480mg visa. Other brand or generic formulations may also be available generic septra 480 mg with amex. Ask your pharmacist any questions you have about Avandia, especially if it is new to you. Avandia 2 mg - pink, five-sided, film-coated tabletsAvandia 4 mg - orange, five-sided, film-coated tabletsAvandia 8 mg - red-brown, five-sided, film-coated tabletsRemember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Generic Name: exenatide (ex EN a tide)Byetta (exenatide) is an injectable diabetes medicine that helps control blood sugar levels. This medication helps your pancreas produce insulin more efficiently. Byetta is used to treat type 2 (non-insulin dependent) diabetes. Other diabetes medicines are sometimes used in combination with Byetta if needed. Byetta may also be used for other purposes not listed in this medication guide. Do not use Byetta to treat type 1 (insulin-dependent) diabetes, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). Before using Byetta, tell your doctor if you use any of these oral diabetes medications: acetohexamide (Dymelor), chlorpropamide (Diabinese), glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta), tolazamide (Tolinase), tolbutamide (Orinase). You must use this medication within 60 minutes (1 hour) before eating a meal. If you miss a dose, use the medication as soon as you remember, but only if you have not yet eaten a meal. If you have already eaten a meal, wait until your next scheduled dose (1 hour before a meal) to use the medicine. Your Byetta doses should be spaced at least 6 hours apart. Stop using Byetta and call your doctor at once if you have severe pain in your upper stomach spreading to your back, with nausea, vomiting, and a fast heart rate. It is important to use Byetta regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. To be sure this medication is helping your condition, you will need to check your blood sugar at home. Your blood will also need to be tested by your doctor on a regular basis. If you are using any type of antibiotic or birth control pill, take these medicines at least 1 hour before you use Byetta. If you have any of these other conditions, you may need a dose adjustment or special tests to safely use Byetta:kidney disease (or if you are on dialysis);problems with digestion; orsevere stomach disorders (gastroparesis). It is not known whether Byetta is harmful to an unborn baby. Before using Byetta, Tell your doctor if you are pregnant or if you become pregnant during treatment. It is not known whether exenatide passes into breast milk or if it could be harmful to a nursing baby. Do not take Byetta without telling your doctor if you are breast-feeding a baby. Donot use the medication in larger amounts or use it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Your dose needs may change if you are ill, if you have a fever or infection, or if you have surgery or a medical emergency. Do not change your dose of Byetta without first talking to your doctor. Use only the diabetes medications prescribed for you. Byetta is given as an injection under the skin, usually in the upper thigh, stomach area, or upper arm. Your doctor, nurse, or pharmacist will give you specific instructions on how and where to inject this medicine. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes. Byetta is usually injected twice a day, before the morning and evening meal. You must use this medication within 60 minutes (1 hour) before eating the meal. Your Byetta doses should be given at least 6 hours apart. Byetta comes in a prefilled pen with a "Pen User Manual" showing instructions for using the pen and injecting the medicine. You must do a "New Pen Set-Up" one time only, when starting a new prefilled Byetta Pen. If you do this "New Pen Set-Up" before each injection, you will run out of medicine before 30 days. Ask your doctor, diabetes counselor, or pharmacist which needle size is best for you. Store unused Byetta injection pens in the refrigerator, protected from light.

As stated earlier purchase 480 mg septra otc, some children and adolescents will have prolonged problems after a traumatic event purchase septra 480 mg on line. These potentially chronic conditions include depression and prolonged grief generic septra 480mg overnight delivery. Another serious and potentially long-lasting problem is post-traumatic stress disorder (PTSD). This condition is diagnosed when the following symptoms have been present for longer than one month:Re-experiencing the event through play or in trauma-specific nightmares or flashbacks, or distress over events that resemble or symbolize the trauma. Routine avoidance of reminders of the event or a general lack of responsiveness (e. Increased sleep disturbances, irritability, poor concentration, startle reaction and regression. Rates of PTSD identified in child and adult survivors of violence and disasters vary widely. For example, estimates range from 2% after a natural disaster (tornado), 28% after an episode of terrorism (mass shooting), and 29% after a plane crash. The disorder may arise weeks or months after the traumatic event. PTSD may resolve without treatment, but some form of therapy by a mental health professional is often required in order for healing to occur. Fortunately, it is more common for a traumatized child or adolescent to have some of the symptoms of PTSD than to develop the full-blown disorder. People differ in their vulnerability to PTSD, and the source of this difference is not known in its entirety. Research has shown that PTSD clearly alters a number of fundamental brain mechanisms. Because of this, abnormalities have been detected in brain chemicals that affect coping behavior, learning, and memory among people with the disorder. Recent brain imaging studies have detected altered metabolism and blood flow as well as anatomical changes in people with PTSD. Further information on PTSD and research concerning it may be found in the NIMH fact sheet, "Facts About Post-Traumatic Stress Disorder," which is posted on the NIMH Web site ( http://www. People with PTSD are treated with specialized forms of psychotherapy and sometimes with medications or a combination of the two. One of the forms of psychotherapy shown to be effective is cognitive-behavioral therapy, or CBT. In CBT, the patient is taught methods of overcoming anxiety or depression and modifying undesirable behaviors such as avoidance. The therapist helps the patient examine and re-evaluate beliefs that are interfering with healing, such as the belief that the traumatic event will happen again. Children who undergo CBT are taught to avoid "catastrophizing. Play therapy and art therapy also can help younger children to remember the traumatic event safely and express their feelings about it. Other forms of psychotherapy that have been found to help persons with PTSD include group and exposure therapy. Research has shown that support from family and friends can be an important part of recovery and that involving people in group discussion very soon after a catastrophic event may reduce some of the symptoms of PTSD. There has been a good deal of research on the use of medications for adults with PTSD, including research on the formation of emotionally charged memories and medications that may help to block the development of symptoms. Medications appear to be useful in reducing overwhelming symptoms of arousal (such as sleep disturbances and an exaggerated startle reflex), intrusive thoughts, and avoidance; reducing accompanying conditions such as depression and panic; and improving impulse control and related behavioral problems. Research is just beginning on the use of medications to treat PTSD in children and adolescents. There is preliminary evidence that psychotherapy focused on trauma and grief, in combination with selected medications, can be effective in alleviating PTSD symptoms and accompanying depression. More medication treatment research is needed to increase our knowledge of how best to treat children who have PTSD. A mental health professional with special expertise in the area of child and adolescent trauma is the best person to help a youngster with PTSD. Organizations on the accompanying resource list may help you to find such a specialist in your geographical are. Many patients with dissociative disorders need to express the " memories and feelings connected to their traumas, but are afraid to, because of the fear, pain, anger, and shame connected to them, of which they may not even be conscious" (Franklin, 1988, p. Franklin suggests that this leads to a conflict between expression and hiding which often leads to a compromise where the memories and feelings escape through subtle signs of dissociation. In relation to models of suppression and repression, Franklin states that the subtle signs are returns of the dissociated rather than a return of the repressed and that internal or external stressors may serve as triggers which activate these memories. He also states that child abuse, trauma, and family violence is the single largest preventable cause of mental illnes and that it is in this light that dissociative symptoms should be routinely and persistently looked for and inquired after to insure proper mental health care delivery. As society has become increasingly aware of the prevalence of child abuse and its serious consequences, there has been an explosion of information on posttraumatic and dissociative disorders resulting from abuse in childhood. Since most clinicians learned little about childhood trauma and its aftereffects in their training, many are struggling to build their knowledge base and clinical skills to effectively treat survivors and their families. Understanding dissociation and its relationship to trauma is basic to understanding the posttraumatic and dissociative disorders. Dissociation is the disconnection from full awareness of self, time, and/or external circumstances. Dissociation exists along a continuum from normal everyday experiences to disorders that interfere with everyday functioning. Common examples of normal dissociation are highway hypnosis (a trance-like feeling that develops as the miles go by), "getting lost" in a book or a movie so that one loses a sense of passing time and surroundings, and daydreaming. Researchers and clinicians believe that dissociation is a common, naturally occurring defense against childhood trauma. Children tend to dissociate more readily than adults.

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