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Mental Health of Child and Family District 7980 Conference in Saratoga Springs. 2012-13 Rotary Ambassadorial Scholar Sponsor Club: Tokyo-Konan RC (District 2750) Host Club: Bronxville RC (District 7230). Tamaki Hosoda Columbia University, MA in Clinical Psychology. JAPAN.

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Mental Health of Child and Family District 7980 Conference in Saratoga Springs


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    1. Mental Health of Child and FamilyDistrict 7980 Conference in Saratoga Springs 2012-13 Rotary Ambassadorial Scholar Sponsor Club: Tokyo-Konan RC (District 2750) Host Club: Bronxville RC (District 7230) Tamaki Hosoda Columbia University, MA in Clinical Psychology

    2. JAPAN

    3. Kiyomizu Temple in Kyoto

    4. Kiyomizu Temple in Kyoto

    5. TOKYO

    6. Tokyo is a dense city. Commuting rush in Tokyo… fierce!

    7. My House

    8. Family Mother Relatives at New Years Party Paternal grandmother Father Me Brother

    9. Naughty friend Paternal grandfather

    10. Friend and her dog

    11. Cooking Driving

    12. Became a Clinical Psychologist Lecture at a University

    13. My Previous Workplace Juntendo University Hospital in Tokyo

    14. Former Colleagues

    15. Types of Pediatric Psychological Services

    16. Classification of Main Concerns • Parents’ concerns: • Child maltreatment • Parent’s own mental/physical diseases • Concerns about relationships with teachers, other mothers, pediatricians, etc. Hosoda (2012)

    17. Through psychological interventions, many mothers confided their maltreatment-like behaviors or fear to become abusive mothers. Another survey also shows that 18% of mothers feel they are abusive. (The Japanese Society of Child Health, 2012) Mothers want to confide or change in a positive way if someone respectfully appreciates their efforts or understands them.

    18. JPN: Trends of Child Maltreatment Number of Child Abuse Consultations toChild Guidance Offices 60 times from 1990 to 2011 59,862 (2011) 1,101 (1990) The Association of the Prevention of Child Abuse & Neglect (NPO) Child Abuse Prevention Law (2000) (Ministry of Health, Labourand Welfare of Japan, 2012)

    19. The Number of Maltreatment Consultations US Japan 10 0.023 deaths per 1000 children under age 18 3.5 0.006 deaths per 1000 children under age 15 (Calculation based on Japan Preventive Association of Life-style related Disease, 2012; U.S. Department of Health and Human Services, Administration on Children, Youth and Families, 2008; Virginia.com, 2012)

    20. ☆What causes the dramatic increase of child maltreatment in Japan? →Enhanced awareness to child maltreatment? ☆What causes such a difference between the US and Japan? →Societal change in terms of family structure?

    21. Family Structures US Japan Nuclear family model Prevailing a nuclear family model, but the mentality of extended family still remains Interdependence Independence Paternal in-laws Extended family D Dad (Oldest son) Mom Nuclear family Child

    22. JPN: What happens due to this? • Interdependence increases attentions to the child from In-laws (especially paternal grandmother) (e.g., which school to go, how to scold, how to wash hands, mother’s cooking skills, etc.) • Mother’s pressure (expected to be amenable) • Father as a mediator between in-laws and mother --- Fights often occur while father is at his workplace… • Implicit pressure to child Everyone wants to rear children appropriately though…

    23. Extended family model Cons: • Expectations can pressure the family. Pros: • Social support from in-laws • Surveillance function against child maltreatment Often cause problems! Even if an extended family model can be deterrent for maltreatment, such expectations may cause different types of problems. Expectations Bind us + Give us bonds Support!

    24. On the other hand… Nuclear family model Pros:Obtain independence and freedom Cons:Lose support and surveillance function Everything has pros and cons… My viewpoint: Japanese are going to lose social support due to the change of family structure, which may have become a factor of the dramatic increase of child maltreatment. Although we ourselves have chosen freedom, we still need support from and bonds with others. →So how can we help such families?

    25. When We Hear Child Maltreatment…

    26. Natural reactions: Fear, impetus to save children, anger to parents, guilt when we can do nothing for the child, etc… Even childcare professionals often feel overwhelmed by such feelings… Accusation, criminalization, enforcement of strict laws, seeing every parent as a potential abuser

    27. Do such critical eyes on parents really save children? Children Parents - “Your parents are bad,” can be a message, “You’re a bad child.” = Harm identity - Deprivation of parents = Traumatic experience Afraid to be stigmatized as abusive parents Feel constrained See others as detectives to find their faults →Such pressure and stresscan create a vicious cycle of maltreatment. -------- How can we provide support for families in need?

    28. Pediatrics 1. Familiar place 2. Being able to seek help through somatic problems 3. Moderate distance in relationship between the family and pediatricians However, in Japan, …

    29. My Journey with Rotary Began Service Above Self Tokyo Konan Rotary Club Meeting My sponsor counselor Masami Azuma and his wife, TakakoAzuma 2750 District Governor Takamoto Sakuma

    30. Have Come to NYC!Graduate Studies at Columbia University But English…

    31. NY Life with Rotary District 7230 Scholar Orientation Seminar Host Counselor Doris Benson and Bob Benson

    32. Learning from Rotary • World-wide Perspectives • Meeting with Rotarians in the US • Meeting with other Scholars My academic interests: Child & Pediatric Psychology, including child psychiatric problems, childhood cancer, collaboration among multidisciplinary professionals, child abuse, etc.

    33. Thank you very much!

    34. Factors Domestic violence Developmental disorders Physical disease Insufficient communication skills to seek help Physical disease Early separation from child Psychiatric disorders/drug abuse Match with parents in terms of characteristic Divorce Family(Parents) Child Child Maltreatment Birth order Unintended pregnancy/perinatal problems Insufficient parenting skills Culture (e.g., Is spanking child abuse?) Social Aspect Insufficient education / intelligence Religion Social isolation (physical/psychological) Insufficient social support from grandparents, in-laws, friends, etc. Financial problem

    35. Social Resources Work Place Child Maltreatment Child-Parent Pediatrics School Teachers/Friends Friends Psychiatry Educational Center Relatives (Grandparents, in-laws, etc.) Child Welfare System Child Protective Services (CPS) Neighbors Court Public Health Center Police Church Safety net

    36. Need to consider socio-cultural contexts Let’s compare the US and Japan!

    37. US and Japan (including personal Images…)

    38. US: Child Maltreatment Typical classification: • Neglect • Physical abuse • Psychological/emotional abuse • Sexual abuse (Childhelp, 2012; Wekerle, 2003)

    39. US: Trends (Virginia.com, 2012)

    40. US: Risk Factors in Families • Unemployed parents: 2 times the rate of child abuse and 2–3 times the rate of neglect • low socioeconomic families: 3 times the rate of child abuse and 7 times the rate of neglect • living with a single parent and a live-in partner: 8 times the risk of abuse and neglect (Iannelli, 2010)

    41. US: Parental Issues Many parents show: • Depression • Anxiety • domestic violence • substance abuse • personality disorders • social isolation • Poverty and their combination… Most parents do not show: - Psychotic or severe mental illnesses (Wekerle, 2003)

    42. Comparative Overall Trends US Japan The incidence is slightly decreasing. The incidence is as approximately three times as in Japan. The incidence has dramatically increased in these two decades, butthe rate of increase is becoming lower these days. (Iannelli, 2010) • Possible interpretations for this increase: • Enhanced awareness to child maltreatment? • Societal change (i.e., family structure)?

    43. US: Mechanism(information-processing model) Negative misinterpretation (e.g., intentional, trying to annoy me) • anxiety, depression • low self-efficacy • Threat-oriented communication pattern • low IQ and problem solving skills) Fear Defensive Misbehaviors or ambiguous behaviors (e.g., smiling, crying ) Abusive/punitive Neglectful Guilt (Wekerle, 2003)

    44. JPN: How Maltreatment Is Like 1970s: Child maltreatment was rare in Japan. US: Japan: Crimes (e.g., rape 5 times) Suicide↑ violence ↑ “impulses turns inside” →Especially, “joint suicide” (Wagatsuma, 1983) 2011: Child death due to maltreatment per year in Japan • Joint suicide: 47 • Except for joint suicide: 51 • (Ministry of Health, Labour and Welfare of Japan, 2012) Related to our apparent personalities?

    45. Family Structures US Japan Nuclear family model Prevailing a nuclear family model, but the mentality of extended family still remains Paternal in-laws Extended family D Dad (Oldest son) Mom Nuclear family Child

    46. JPN: What happens due to this? • Interdependence increases attentions to the child from In-laws (especially paternal grandmother) (e.g., which school to go, how to scold, how to wash hands, mother’s cooking skills, etc.) • Mother’s pressure (expected to be amenable) • Father as a mediator between in-laws and mother --- Fights often occur while father is at his workplace… • Implicit pressure to child Everyone wants to rear children appropriately though…

    47. Extended family model Cons: • Expectations can pressure the family. Pros: • Social support from in-laws • Surveillance function against child maltreatment Often cause problems! Even if an extended family model can be deterrent for maltreatment, such expectations may cause different types of problems. Expectations Bind us + Give us bonds Support!

    48. On the other hand… Nuclear family model Pros:Obtain independence and freedom Cons:Lose support and surveillance function Everything has pros and cons… My viewpoint: We are going to lose social support due to the change of family structure, which may have become a factor of the increase of child maltreatment. Although we ourselves have chosen freedom, we still need support from and bonds with others. So, how can we complement the deficit?

    49. Let’s look at what is occurring in the real world!