Essay Instructions: Here is my first Draft. Please use it to shape up the paper, also, please add a conclussion and whatever you need to shape it up. I think I have cover the main points but I do not have anough time to complete it and polish.
Paper: the paper is a movie synopsis. the main idea is not to tell what the movie is about but to explained how abuse affect the present and the future of children.
At twenty years old, Will (Matt Damon) is a mathematical genius stuck between his abusive past and opportunity for greatness. Booked on assault charges, Will is allowed to leave prison on two conditions, taking math classes with a professor who recognizes his brilliance and psychotherapy. While algebra and exponents come easy for him, love and trust does not. With the help of his therapist (Robin Williams), Will begins to deal with his low self-esteem, fear of intimacy, and past physical abuse, until Will uses his intelligence and goes after Skylar (Minnie Driver), a woman who loved him unconditionally, to proclaim a life worth living.
1) Types of abuses that occurred to the major character
Abandonment: Will had never met his biological parents. He grew up as an orphan as he was abandoned by people who were supposed to love him the most.
Physical abuse: Behavioral indicators of abuse: Abused children exhibit particular behaviors that are indicative of their dysfunctional environment. Some of the first behavioral indicators of abuse can be observed by physicians in hospital settings. One of the most striking characteristics noted in the child is the little confidence in his abilities.
Will suffered from physical and psychological abused during his childhood. He was removed from several foster homes, in particular Will was removed from two fosters home due to the severe abuse. Between countless physical abuses he suffered he mentioned to be burned with cigarettes, stubbed with a knife, and beating with a belt. Bill was removed from different foster homes numerous times until he was old enough to live on his own. His foster parents used to put a belt and a ranch on the table to make him choose. Despite of the harsh attitudes, it is expressed that children can keep control of the abuse; it follows that they can control other aspects of their lives. They feel that punishment was deserved, it was their fault. Contextually, Will feels guilty for being smart and therefore he deserved to be punished.
Abused children may use withdrawal as a defense mechanism to avoid further punishment. The lead character shows oppositional behavior that is often termed as aggression or over hostility by others. Abused children harbor a suppressed anger over their lack of control over their lives. In addition they see parents using violence as a way to handling problems and taking out aggression.
Fearful of failure: Children perceive abuse as a deserved retribution.
2) Developmental stage(s) the abuse/neglect occurred in and possible short and long term consequences
We do not know when his abuse episode started; based on the information extracted from the film it can be established that the abuse occurred during middle childhood and early adolescence.
In Unites States children appear to be more susceptible to nonfatal physical abuse between the ages of 6 to 12. “Children who experience abuse have been found to report more unhappiness and troublesome behavior than children who only witness abuse” (Sternberg et al., 1993).
According to L. Charlesworth (2008),” the most widely recognized developmental task of this period is the acquisition of feelings of self-competence.” Children search for opportunities to demonstrate personal skills, abilities and achievement. Ideally, families play a critical role in supporting development of this sense. In this case, Will was not able to completely develop a sense of competence; in consequence he couldn’t increase his awareness of his fit in the network of relationships in his surroundings.
Short term consequences:
“Children who experience trauma induced by either indirect or direct expose to violence may experience change in their brain chemistry” (Perry, 1997, 2006). Clearly experiencing violence adversely affect children in a number of areas, including the ability to establish social, including peer, relationship. Childhood exposure to violence increases the possibility of mental health difficulties and violence perpetration or re-victimization. Will was forced to believe that the world is unpredictable and violent- a belief that threatens children's natural curiosity and desire to explore the social environments.
Long term consequences:
Will pushed people away before they can leave him; that was his defense mechanism to protect himself from being hurt again. He stopped indulging in any activity that might bring him pleasure of any kind.
3) Problems that, as an adult, the victim demonstrated in the movie
Poor mental and emotional health:
Long-term study shows, as many as 80 percent of young adults who had been abused met the diagnostic criteria for at least one psychiatric disorder at age 21. “These young adults exhibited many problems, including depression, anxiety, eating disorders, and suicide attempts” (Silverman, Reinherz, & Giaconia, 1996). “Other psychological and emotional conditions associated with abuse and neglect include panic disorder, dissociative disorders, attention-deficit/hyperactivity disorder, post-traumatic stress disorder, and reactive attachment disorder” (Teicher, 2000).
“Children who are abused and neglected by caretakers often do not form secure attachments to them. These early attachment difficulties can lead to later difficulties in relationships with other adults as well as with peers” (Morrison, Frank, Holland, & Kates, 1999).
Unable to trust others:
When Will needed to choose a therapist, he made fun of them as a barrier to talk about his issues; he made them look stupid. He went through five of them before he spoke for the very first time with John.
Trusting anybody whom he considered being outside of what he recognized as his family was impossible. Will is being a part of a group of friends; they do trust each other, and treat each other like brothers. Will had entrusted his friends with blind faith.
Juvenile delinquency and adult criminality:
“A National Institute of Justice study indicated being abused or neglected as a child increased the likelihood of arrest as a juvenile by 59 percent. Abuse and neglect increased the likelihood of adult criminal behavior by 28 percent and violent crime by 30 percent” (Widom & Maxfield, 2001).
Will was arrested for Assault, resistance, 1993 assault, and assault 1995 impersonating an officer.
There are faxes for this order.
Excerpt From Essay:
Essay Instructions: I am providing the instructions that were given to us for the capstone project:
EVIDENCE BASED PRACTICE PROTOCOL (EBPP)
Purpose: The purpose of this project is to provide the student with the opportunity to apply and integrate knowledge from previous coursework in the development and implementation of an evidence based practice protocol (guidelines) in the student's clinical specialty area.
Evidence Based Practice Protocol Criteria:
1. Identify and describe a clinical practice problem. (5 pts.)
2. Review and analyze the current research and clinical literature pertinent to the key issues of the clinical practice problem, including any published standards. Integration of this content should also be evident throughout the paper. (15 pts.)
3. Identify the need for development of an Evidence Based Practice Protocol or implementation of an existing EBPP to address the clinical practice problem identified in your setting. (5 pts.)
4. Provide a theoretical base for the proposed EBPP: physiological/psychological/pathophysiological, behavioral, developmental theories, etc. (5 pts.)
5. Describe/Develop the EBPP, and describe the process for its implementation in your practice setting (attach EBPP document as appendix). (30 pts.)
6. Identify ways in which the effectiveness of the EBPP will be evaluated and documented; identify outcomes. (10 pts.)
7. Describe the cost implications of the new EBPP. How will the implementation of this EBPP be financed? (5 pts.)
8. Summarize the significance of this case to the APN role, e.g., identify relevant specialty competencies. (10 pts.)
9. Use proper grammar (syntax and structure), current APA format, correct spelling, logical progression of ideas. (10 pts.)
10. Submit letter of inquiry to relevant journal to determine possibility for publication of project paper
I need to structure the evidence based practice protocol. I want to use a structure such as the WAST (womens assessment screening tool and/or HITS). I will translate it to Spanish since I need it in both languages. My plan is to use my EBPP in an emergency department. I will email you an article that compared the 2 screening tools (WATS & HITS) in Hispanic women.
This is what I have so far, so you can get an idea:
Running head: EVIDENCE BASED PRACTICE
Evidence Based Practice Protocol: Domestic Violence and Hispanic Women
Clinical Practice Problem
According to A Report of the Surgeon General (1999), domestic violence is considered one of the leading causes of serious injury to women ages fifteen to forty-four, accounting for about thirty percent of all acute injuries to women seen in emergency departments. Many victims of domestic violence do not report the crimes to authorities or healthcare professionals. The severe underreporting of violence against women leads to the belief that the problem is less widespread than it is; and this false sense can hinder healthcare providers from becoming more diligent at assessing women for domestic violence.
The rates of domestic violence detection in clinical settings are still low despite the fact that a high percentage of female victims of domestic violence visit emergency rooms for treatment. Garcia (2004) states that health professionals very seldom check for signs of violence or ask women about experiences of abuse. Although there is still certain argument about the value of domestic violence screening in general practice and primary care, there is an increasing recognition of the importance of domestic violence screening as an effective method of identifying and responding to domestic violence cases presenting to emergency departments. As research has shown, the use of emergency room protocols for identifying and treating victims of domestic violence has been found to increase the identification of victims by medical practitioners from 5.6 percent to 30 percent (Garcia, 2004, p. 536).
Domestic Violence and Hispanic Women
The prevalence of domestic violence among Hispanic women in the United States is increasing every year which poses a high threat for the development of mental illness among this population. According to Rodriguez, Heilemann, Fielder, Ang, Nevarez, & Mangione (2008), Hispanic women who experience physical violence are at increased risk for mental and physical problems including depression, anxiety and substance abuse. It is crucial to understand the cultural beliefs and practices of Hispanic women in order to increase reports of domestic violence. This knowledge and awareness will facilitate healthcare providers to specifically assess Hispanic women who present with signs and symptoms of physical abuse.
Many Hispanic women still believe that their role in the family and community is inferior in comparison to males. Some of these women are brought up in homes with male role models who are very controlling and manipulative. Some of these women also suffer sexual abuse as a child. It is common for Hispanic women to think that domestic violence acceptable since many are raised in abusive homes. Young females who get involved in abusive relationships during early adulthood often come from a family with history of intimate partner violence (Pailler, Kassam-Adams, Datner, & Fein, 2007).
The family is of utmost importance for Latin women; and therefore neglecting their own health needs is not unusual. According to Maternidad Latina (2008), pressure to “keep the family together” may come from family or church members, even if it means suffering more abuse. Religious and societal beliefs may make a woman feel guilty if she leaves her abusive partner or acts against his will. Hispanic women, particularly immigrants, may not be familiar with U.S. laws that protect women and children against violence; and these laws may differ considerably from those in other countries. They may also fear involving the law because of their immigration status. Another factor which restrains Hispanic women from seeking help is the language barrier and lack of financial means.
One of the most important elements for developing an evidenced based protocol for Hispanic women suffering from domestic violence and mental illness involves providing cultural sensitive interventions. According to National Alliance of Mental Illness, the first component is the education of Hispanic women about domestic violence and its negative effects on mental and physical health; available community resources for victims of domestic violence, treatment options and current research.
Domestic Violence and Mental Health Disorders
One of the major risk factors for the development of mental illness in women is physical violence. In 2006, the percentages of females with mental health disorders were higher than in males. Furthermore, Hispanics have the highest percentage for mental illness, which was 86.9 percent in 2006 according to the Substance Abuse and Mental Health Service. The percentage of women treated for psychiatric disorders has increased each year. A large amount of quantitative data on this population is found in the Substance Abuse and Mental Health Service Administration (SAMHSA) reports. SAMHSA reports include demographic data such as gender, age distribution, race/ethnic distribution, employment status, and living situation (Table 1, 3 & 4).
Many studies have proven that physical violence is often the number one risk factor for mental illness among women especially anxiety disorders such as post traumatic stress disorder. According to Baca-Garcia, Perez-Rodriguez, Mann & Oquendo (2008), women who experience higher rates of domestic violence or sexual abuse are linked to increased risk for mental health disorders, suicidal ideation and attempts. Pailler et al. (2007) state that individuals who suffer repeated physical violence report more symptoms of posttraumatic stress disorder and depression. Therefore, it is also important to identify the risk factors which increase the probability of women becoming victims of recurring violent acts.
Research studies indicate that mental health disorders are more prevalent in females than in males. A large volume of this evidence suggests that the reason relates to the higher rate of sexual and physical abuse in females. According to Dixon, Howie, & Starling (2005), abuse is an overwhelming risk factor for depression and posttraumatic stress disorder in females. Seventy percent of the females in this study who suffer from posttraumatic stress are victims of domestic violence and sexual assault. Many adolescent females also have dual diagnosis of depression, panic disorder, and/or substance abuse due to the physical abuse. There are several interventions that will impact and improve the health and quality of life of this population: prompt and accurate assessment of physical abuse through a domestic violence assessment tool; and proper use of mental health resources and referrals.
Of 2,043 women aged 18 to 59 who participated in the 1998 Centers for Disease Control and Prevention: Behavioral Risk Factor Surveillance System, women experiencing intimate partner violence were more than 3 times more likely than other women to have been depressed for over half of the past month and approximately twice as likely to have been anxious or suffered insomnia for over half of the past month compared to women without a history of violence. A study of 84 women diagnosed with depression who disclosed intimate partner violence revealed that 18.6 percent of abused women reported post traumatic stress disorder, compared to 6.7 percent of non-abused women (Dienemann, Boyle, Baker, Resnick, Wiederhorn & Campbell, 2000). According to the same study, 53.5 percent of abused women reported sleeping problems and nightmares, compared to 23.3 percent of non-abused women.
A cross-sectional survey by Coker, Smith, Thompson, LcKeown, Bethea & Davis (2002) of 1,152 women aged 18 to 65 conducted between 1997 and 1999 found that 36.8 percent of women who ever experienced domestic violence reported having considered suicide, compared to 25.9 percent for all the women in the sample. Similarly, 18.6 percent of those who ever experienced violence reported having attempted suicide, compared to 11.8 percent for all the women in the sample.
Psychosocial stressors, negative environmental influences and traumatic experiences are unfortunately inevitable in the lives of some women. The way that women deal with these experiences sets up coping mechanisms for future stressful events. All these risk factors in women pose an enormous threat not only to the development of mental illness but also to the progression and deterioration of mental health. Healthcare providers should be meticulous in the initial physical, mental, and psychosocial assessment of women to exclude any suspicion of domestic violence and mental illness.
Evidence Based Support
Survivors of abuse have reported that they support primary care professionals inquiring about history of physical abuse and mental health issues. According to Nakell (2007), asking patients about their trauma history can be useful to patients in several ways. First, when patients acknowledge their history of trauma, the healthcare provider can provide psycho-education to help patients understand their trauma and its effects, and then can recommend useful treatment. Second, clinicians who understand patient’s histories of trauma and mental illness can appreciate the patient’s symptoms and therefore treat patients with appropriate care.
The American College of Obstetricians and Gynecologists (ACOG) guidelines on domestic violence recommend that clinicians routinely ask women direct and specific questions about abuse. The American Medical Association also recommends routine screening of intimate partner violence and referrals to community-based services. The American Academy of Family Physicians (AAFP) states that family healthcare providers can offer early intervention by routine screening and identification of abuse and mental health issues. The AAFP recommends that family clinicians be aware for the presence of family violence in every patient encounter.
Recommendations are also made for working with families to prevent abuse by teaching conflict resolution skills that promote respectful and peaceful relationships. The mental health consequences of domestic violence are detrimental. Increased rates of depression, posttraumatic stress disorder, other anxiety disorders, somatization, drug and alcohol abuse, chronic mental illness, and suicide attempts have all been documented in survivors of domestic violence (Falsetti, 2007).
American Academy of Family Physicians (AAFP) (2009). Retrieved August 10, 2008
Carrasco, M. (2004). Latino Outreach Resource Manual: National Alliance on Mental
Illness. Retrieved July 31, 2008 from
Centers for Disease Control and Prevention: Behavioral Risk Factor Surveillance System
(1998). Retrieved August 10, 2008 from http://www.cdc.gov/brfss/
Centers for Disease Control and Prevention: National Center for Health Statistics (2008). Deaths: Preliminary Data for 2006. National Vital Statistics report. Retrieved July 11, 2008 from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf
Centers for Disease Control and Prevention: National Center for Health Statistics (2008). Cause of Death: Preliminary Data for 2006. National Vital Statistics report. Retrieved July 11, 2008 from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf
Coker A. L., Smith P. H., Thompson M. P., LcKeown R. E., Bethea L., & Davis K. E.
(2002). Social Support Protects against the Negative Effects of Partner Violence on Mental Health. Journal of Women’s Health and Gender-based Medicine, 11 (5), 465-476.
Dienemann J., Boyle E., Baker D, Resnick W., Wiederhorn N., & Campbell J. (2000).
Intimate Partner Abuse Among Women Diagnosed with Depression. Issues in Mental Health Nursing, 21(5), 499-513.
Falsetti, S. A. (2007). Screening and Responding to Family and Intimate Partner Violence
in the Primary Care Setting. Primary Care: Clinics in Office Practice 34 (3). Retrieved August 18, 2008 from http://www.mdconsult.com/das/article/body/-8/jorg=journal&source=MI&sp=19972184&sid=/N/608462/1.html
Family Violence and Prevention Fund (1999). Preventing Domestic Violence: Clinical
Guideline on Routine Screening. Retrived August 10, 2008 from http://endabuse.org/programs/healthcare/files/screpol.pdf
Manderscheid, R. W., Atay, J. E., Hernandez-Cartagana, M. R., Edmond, P. Y., Male, E., & Parker, A. C. E. (2001). Highlights of organized mental health services in 1998 and major national and state trends. Mental Health, United States, 2000 (135– 171). Washington, DC: U.S. Government Printing Office.
Maternidad Latina (2007). Promoting Child and Maternal Health. Retrieved August 1,
2008 from http://www.nchealthystart.org/aboutus/maternidad/vol1no3.htm
McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, Implementing, &
Evaluating Health Promotion Programs. San Francisco: Pearson Benjamin Cummings.
Mental Health: A Report of the Surgeon General (1999). Retrieved July 11, 2008 from http://www.surgeongeneral.gov/library/mentalhealth/home.html
Nakell, L. (2007). Adult Post traumatic Stress Disorder: Screening and Treating in
Primary Care. Primary Care: Clinics in Office Practice, 34 (3). Retrieved August 18, 2008 from http://www.mdconsult.com/das/article/body/-8/jorg=journal&source=MI&sp=19972190&sid=/N/608468/1.html
Pailler, M. E., Kassam-Adams, N., Datner, E. M., & Fein J. A. (2007). Depression, Acute Stress and Behavioral Risk Factors in Violently Injured Adolescents. General Hospital Psychiatry, 29 (4). April 20, 2008, from http://www.mdconsult.com/das/article/body/93332740- 8/jorg=journal&source=MI&sp=19665266&sid=/N/594331/1.html
Rodriguez, M. A., Heilemann, M. V., Fielder, E., Ang, A., Nevarez, F., & Mangione, C.
M. (2008). Intimate Partner Violence, Depression, and PTSD Among Pregnant Latina Women. Annals of Family Medicine, 6 (1). Retrieved August 1, 2008 from http://www.mdconsult.com/das/article/body/-5/jorg=journal&source=MI&sp=20349779&sid=/N/626290/1.html
Substance Abuse and Mental Health Service Administration (2006). Florida Mental
Health National Outcome Measures (NOMS): CMHS Uniform reporting System. Retrieved July 10, 2008 from
Substance Abuse and Mental Health Service Administration (2005). United States Mental Health National Outcome Measures (NOMS): CMHS Uniform reporting System. Retrieved July 10, 2008 from
Substance Abuse and Mental Health Service Administration (2004). United States Mental Health National Outcome Measures (NOMS): CMHS Uniform reporting System. Retrieved July 10, 2008 from
The American College of Obstetricians and Gynecologists (ACOG) guidelines (2009).
Retrieved August 10, 2008 from http://www.acog.org/
United States Department of Health and Human Services. Healthy People 2010. Retrieved July 10, 2008 from http://www.healthypeople.gov/Search/objectives.htm
Demographic Characteristics of adults with a serious mental illness served by a Statewide Mental Health Agency (SMHA) in the US 2006
Total number of adults with a serious mental illness served by SMHA system 3,833,500
Gender Male: 47.3%
Age Distribution 18 – 20: 3.8%
21- 64: 64%
Race/Ethnic Distribution American Indian/Alaskan Native: 1.0%
Asian/Island Pacific: 1.6%
Black or African American: 21.7%
Hispanic or Latino: 86.9%
Native Hawaiian/Pacific Islander: 0.2%
White Caucasian: 61.9%
Employment Percent Employed: 18%
Percent not in Labor Force: 56%
Percent Unemployed: 26%
Living Situation Private residence: 66.1%
Foster home: 1.8%
Residential care: 3.7%
Crisis residence: 1.0%
Institutional setting: 2.7%
Jail/Correctional facility: 2.0%
Homeless or shelter: 2.4%
Other living situation: 3.1%
Medicaid Funding Status of the Consumers Medicaid only: 46%
SMHA funds only (Non-Medicaid): 38%
Both Medicaid and other funds: 16%
Disparities for Focus Area 18: Mental Health and Mental Disorders, 2002
Health People 2010
Hispanic/Latino Black Non-Hispanic White Non Hispanic
serious mental illness:
18+ years 50 to 99% 50 to 99% The group with the
18+ years 50 to 99% 50 to 99% The group with the
anxiety disorder: 18+ years Data not
available 10 to 49% The group with the
Employment: 18+ years
With a serious mental
illness 10 to 49% 10 to 49% The group with the
Demographic Characteristics of adults with a serious mental illness served by a Statewide Mental Health Agency (SMHA) in the US 2005
Total number of adults with a serious mental illness served by SMHA system 3,556,280
Gender Male: 48.4%
Age Distribution 18 – 20: 4.4%
21- 64: 62.3%
Demographic Characteristics of adults with a serious mental illness served by a Statewide Mental Health Agency (SMHA) in the US 2004
Total number of adults with a serious mental illness served by SMHA system 3,174,121
Gender Male: 48.4%
Age Distribution 18 – 20: 3.6%
21- 64: 61.4%
Female deaths by age and race in the US, preliminary 2006
Centers for Disease Control and Prevention
[Age specific rates are 100,000 population in specified group]
All Races Number Rate
15 – 24:
White females Number Rate
15 – 24:
Non-Hispanic White females Number Rate
15 – 24:
Black females Number Rate
15 – 24:
Hispanic females Number Rate
15 – 24:
Deaths and death rates for selected mental health causes in the US 2006
[Rates are per 100,000 population]
Alzheimer’s Disease 72,914 24.4
Total suicide 32,185 10.7
Suicide by firearm 16,650 5.6
Suicide by other unspecified means 15,535 5.2
Drug induced deaths 34,678 11.6
Alcohol induced deaths 21,513 7.2
There are faxes for this order.
Excerpt From Essay:
Essay Instructions: Write an essay to answer all four (4) questions. Each of the four (4) questions should be answered in no less than 300-500 words each. Please utilize verifiable and renowned academic journals and/or books as sources (Do not cite other college papers or theses).
1. Neglect is the result of a parents failure to meet a childs needs: food, shelter, safety and affection. The neglectful parent is most commonly viewed as the mother. How does Norman A. Polansky categorize neglectful mothers (catagories include : Reactive-Depressive, Apathetic Futile, Impulse Ridden, Mental Retardation)? Explain each category and now they differ. Finally, assess why you think his categories refer to just mothers. Could these categories apply to other caregivers, and if so, defend your position.
2. Physical abuse must be defined within a social and cultural context. What is thought to be physical abuse today may not have been in the past, nor do various cultures agree as to what constitutes abuse. What causes abuse? Cite and explain the three models (models include: Interactional, Environmental/Life Stress, and Social/Cultural/Economic)
3. Most current models to explain perpetrators of sexual abuse refer to males. Although women also perpetrate, they are less likely to be reported unless their pathology is extreme. Why are men more likely to abuse than women? First, describe the reasons why men are more likely to abuse than women. Second, offer your analysis as to how this may be rooted in the attitudes of our culture. Finally, offer your insights to the question: might this differ in other cultures? Provide justification for your perspective.
4. Two groups have been instrumental in bringing to the publics attention the issue of child sexual abuse and need for treatment for victims: the feminist movement and the child protection movement. There remains a lot we still dont understand about why adults sexually exploit children. Discuss two models used to explain why perpetrators sexually abuse children (models include: repulse prevention model & the precondition model).
Critique your two choices: which do you think is more accurate? Explain your answer.
Excerpt From Essay:
Essay Instructions: No more than 20% of paper is quaoted. APA style with a works cited page. Paper needs to be about the typology abuse of power 1)physical abuse and excesssive force 2) verbal and pysocological abuse and 3) legal abuse/violations of civil rights. Pper is about police managing the use of force.
Excerpt From Essay:
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