Sexual abuse and bullying, a School Nurse standpoint

"My Dirty Little Secret" from Scott Spideralamode

• From a nursing point of view, Scott's story is quite typical among drug abusers.  I researched perinatal substance abuse in my university education.  I found of those women who did not take the window of opportunity to quit drugs when discovering that they were pregnant, 98% of them were sexually abused as children.  You will find that the sluts and the bullies at school often are carrying a dirty secret.  Also, the morbidly obese girls at school.  They all have dirty secrets like Scott's that they are covering up with obesity, sexual promiscuity, drugs and bullying.  Some people wonder what school nurses do since they aren't doing bandaids and ice packs in the "nurse's office" anymore?  We research ways to reach out to these students and try to help them succeed at school.
• The other part of this equation are the parents of these children.  In Scott's case, his parents never betrayed his trust and the perpetrator was a semi-stranger.  More often, it is your mother's boyfriend, or your uncle.  And occasionally, it is your father.  And perpetrators of sexual abuse of children most often themselves have a history of childhood sexual abuse.  It is unfortunately a generational disease.

  
  
• Most often, the mother is totally dependent on the perpetrator and refuses to believe anything so horrible could be true.  In Scott's case, when his behavior changed after the incident, didn't his parents notice?  I would certainly know if my son's personality had changed and I would definitely intervene, and have several times already.  Where were Scott's parents?  Those children who have reached out for help and were heard, and the perpetrator was immediately removed from the situation, can recover and hope to live a productive and fulfilling life.  Those children who have reached out and been called a liar and punished, and weren't heard, are drug abusers, sluts, bullies or morbidly obese, all self-destructive acting-out behaviors.

  
  
• And how does the school nurse intervene? What does anybody's private family business have anything to do with the School Nurse who is paid by the state government? It is very challenging!  If there is current suspicion of abuse going on at home, like if the student shows up at school with a black eye and a bruised face and says he fell off his bike, then we at school are "mandated reporters" and we have to file a report with CPS.  Child Protective Services might investigate, but are understaffed, underpaid, and overworked.   Once the file of reports thickens, then they will intervene.  Eventually the parent will find out it was the School Nurse who wrote the report and will hate the nurse forever.

  
  
• If the child is old enough, the school nurse can try to reach out directly to the student. We never want to use shame or blame when interacting with problem families.   That makes it very tricky to come straight to the point without causing an upheaval that might cause the parent to pull their child out of school and disappear.  Sometimes, it needs to be approached very delicately over several meetings of getting acquainted and gaining trust.  It is advisable to collaborate with the school psychologist.

  
  
• But what injuries do we see at school from a child who is being sexually abused?  We can't assume every morbidly obese 1st grader, or 6th grader, are being abused.   They might have hypothyroid or their family eats a heavy lard and processed food diet.  We can meet with the family and teach them nutrition and exercise.   Educate them about the many health risks of obesity that can be avoided by reducing their weight.  And the advantages of good health.   We are keen to detect clues of self-destructive behaviors.  In kindergarten, that child might be sexually provocative to a classmate not realizing at 5yrs old that it is contrary to social mores because it is so normal at home. 

  
  
• We can't assume every slut or bully has been sexually abused. It could be that her mother and sisters all look like sluts, too, and that is the family norm.  There are plenty of other reasons to bully, often just modeling your parent's behavior.  It might be the family norm for men.  Or, it might be an acting-out behavior to cover up any number of other family or personal secrets besides childhood sexual abuse.  We need to meet with the family, and even do a home visit, always looking for clues of dysfunction or abuse.  The sooner we can intervene in an abusive situation, the sooner that student will mitigate their self-destructive behavior.

  
  
• The ideal student to school nurse ratio (excluding the severely handicapped) is 750:1.  

  The California average is 2500:1.  

  In my jobs at Windsor Unified School District and Santa Rosa City Schools, I had 5000:1.  

  
  These ratios reflect the low importance our government places on school nurses.  Not just the state governments which seem to cut the education budget first every time there's a deficit, and blame teachers when students can't achieve.  But also school districts, which put a low priority on their school nurse budget.  We compassionate idealists in school nursing think it is because the school board has no idea what school nurses do, an "information deficit" that can be solved with updates to the School Board.  

  
  But I think it is far more sinister.  I think it is a power trip.  Disrespect!  First, because school nurses, CPS workers, and public health nurses are mainly women.  Second, because they would rather blame and punish educators than proactively fund prevention, which is categorized by neo-liberals as "waste."  Ultimately, the whole system is designed for public schools to fail and the futureless products of that failed system to become the cannon fodder of the perpetual wars of the rich war-profiteers.