Wednesday May, 30 2012

Nature: Abuse (Child, Elder, Sexual & Bully) Training – Recognizing & Reporting

Address: Station #1 – Oak Orchard

On Wednesday evening, May 30th, the Indian River Volunteer Fire Company hosted is monthly drill event and conducted a professional development training exercise on Abuse Training - Recognition & Reporting Information.

This training module was specially prepared for volunteer fire company representatives and EMS responders to assist with identification and potential reporting suspected various abuse and neglect alloegations.

The presentation covered three overall topics:

• Topic 1: Recognizing Abuse and Neglect—Definitions and Indicators; and

• Topic 2: Responding to Suspected Abuse or Neglect

• Topic 3: Reporting Obligations

What are Operational Definitions?

Legal definitions do not provide enough detail to allow mandated reporters to determine whether or not a report of maltreatment is required. Therefore, researchers and social workers have developed a set of operational definitions to help with this task. Operational definitions are definitions that specify what to look for when you are deciding whether or not to report.

Remember:

• Operational definitions can never be exact. • Even though your basis for suspicion should be as clear as possible, you are only reporting suspected maltreatment.

Recognizing Abuse and Neglect

 What are Indicators?

Often we use the term “indicators” to refer to those specific behaviors, conditions, or consequences that support suspicion of maltreatment. For example, certain types of bruises on a child might be an indicator of abuse. If a child is afraid to go home, or expresses fear of a parent, this might also be an indicator of abuse. However, remember that an indicator of abuse only indicates that abuse may have occurred.

The following information will describe the legal and operational definitions as well as indicators of various forms of maltreatment.

(A) Physical Abuse

All children get bumps and bruises. Recognizing when those bumps and bruises may be indicative of physical abuse is part of your task as a potential mandated reporter.

Legal Definition

Physical abuse “causes or threatens to cause non-accidental physical injury.” For instance, physical abuse can include bruises, lacerations, fractures, or internal injuries.

Operational Definition

An act of physical abuse involves two things:

1. An action on the part of a caregiver (e.g., parent, person acting in the stead of a parent, other person responsible for a child), and

2. An effect upon a child, such as a physical injury or a particular behavior. Physical abuse is any act that, regardless of intent, results in a non-accidental physical injury to a child.

Inflicted physical injury most often represents unreasonably severe corporal punishment. This usually happens when the parent is frustrated or angry and strikes, shakes, or throws the child. Physical abuse may also be an intentional, deliberate assault, such as burning, biting, cutting, and the twisting of limbs.

Physical Indicators (physical injuries)

You may witness parental behaviors that seem abusive; you are much more likely to see the after-effects: injuries that suggest abusive parental/caregiver behavior.

Injuries that have the following characteristics may indicate abuse has occurred:

? Questionable bruises and welts, or other injuries

• On the face, lips, mouth • On the torso, back, buttocks, thighs • In various stages of healing • Clustered • Forming regular patterns • Reflecting the shape of the object used to inflict the injury (electric cord, belt buckle) • On several different body surface areas • Regularly appearing after an absence, weekend, or vacation • Consistent with human bite marks

? Questionable burns

• Cigar or cigarette burns, especially on soles, palms, back, or buttocks • Immersion burns (sock-like or glove-like burns on feet or hands, or doughnut-shaped burns on buttocks or genitalia) • Burns patterned like electric stove burner, iron, etc. • Rope burns on arms, legs, neck, or torso

? Questionable fractures

• To the skull, nose, facial structure • In various stages of healing • Multiple or spiral (twisting) fractures

? Questionable cuts and scrapes

• To the mouth, lips, gums, eyes • To external genitalia

Remember, in all cases, consider the context. Look for a combination or pattern of indicators. Consider indicators along with the child’s explanation of the injury, the child’s developmental and physical capabilities, and any behavioral changes you notice in the child.

Behavioral Indicators

Physical abuse is frequently accompanied by certain child behaviors. These may include:

• Being uncomfortable with physical contact • Being wary of adult contact • Being apprehensive when other children cry • Showing behavioral extremes—aggression or withdrawal • Being frightened of parents • Being afraid to go home • Arriving at school early or staying late, as if afraid to be at home • Reporting being hurt by a parent • Complaining of soreness or moving uncomfortably • Wearing clothing inappropriate to the weather to cover the body • Chronically running away from home (adolescents) • Being reluctant to change clothes for gym activities (attempt to hide injuries, bruises, etc.)

(B) Neglect

When deciding if you suspect a child is being neglected, it is critical to first determine if the caregiver is unwilling to provide for the child's care, or if the caregiver is unable to provide care due to circumstances such as poverty or a lack of resources. A referral to community-based resources may be appropriate. “Neglect” means that, despite available resources, a child’s needs are not met.

Legal Definition

Neglect is defined as failing to provide food, clothing, shelter, or health care that is necessary for a child’s health.

Operational Definition

Neglect can be defined as a caregiver’s failure to provide for the child’s developmental and related needs.

As with physical abuse, neglect involves two things:

1. An omission on the part of the caregiver, and

2. An effect upon the child. The effect may be physical, behavioral, emotional, or cognitive/developmental.

Examples of Caregiver Neglect:

? Failure to provide a child with adequate:

• Food • Clothing • Shelter • Supervision

? Not attending to a child's medical needs:

• Leaving dental cavities untreated • Failing to seek medical attention for a serious illness or injury

? Abandoning a child

Some Causes of Neglect:

◊ Family crisis: • Job loss • Serious illness • Divorce

◊ Chronic and/or intergenerational patterns, such as: • Chaotic households • No structure or routines, such as regular o meal time o bedtime o homework time • No spaces in the household set aside specifically for the child

Remember, the consequences to the child must be taken into consideration. For instance, a five-year-old is more likely to experience greater harm from parental failure to provide meals than a twelve-year-old.

Physical Indicators

A child in your class:

• Looks undernourished and is usually hungry • Is often lethargic, as if the child hasn’t slept well • Has untreated injuries or maladies, like a badly infected cut or a toothache • Chronically has injuries that you can attribute to a lack of supervision, including being harmed by others.

Behavioral Indicators

Behaviors often associated with neglect include:

• Begging for or stealing food because of persistent hunger • Noticeably poor hygiene • Inappropriate dress for the weather • Accidents and injuries • Risky adolescent behavior • Promiscuity, drugs, and delinquency • Being shunned by peers • Clinging behavior • Poor ability to relate to others

Emotional Indicators

Emotional consequences of neglect often include:

• Poor self-esteem • Attachment difficulties • Emotional neediness • Social problems; reduced pro-social behaviors • Difficulty setting personal boundaries • Inability to say “no” to inappropriate requests (related to neediness for attention) • Impaired initiative

Cognitive/Developmental/Academic Indicators

Children who have been neglected may suffer cognitive/developmental consequences that show up as difficulties in school and with academic pursuits, including:

• Excessive absences from school • Lack of learned self-discipline • Inability to apply self to a task • Poor grades in school • Learning difficulties

(C) Sexual Abuse

Sexual abuse is a complex type of abuse with significant implications for the child victim. Often there are no physical signs, and behavioral indicators can be subtle or attributed to other things.

Legal Definition

Sexual abuse is defined as any illegal sexual act upon a child. This includes:

• Incest • Rape • Indecent exposure • Fondling • Child prostitution • Child pornography

Operational Definition

Sexual abuse, covered by both civil and criminal code, comprises a range of inappropriate sexual behaviors a caregiver may perpetrate on a child, including:

• Non-touching offenses, such as indecent exposure and exposing a child to pornography • Touching offenses, such as fondling and inanimate-object penetration • Sexual exploitation, such as prostituting a child or using a child in pornography • Sexual intercourse, which includes rape, incest, and sodomy Sexual abuse may interfere with a child’s normal physical, psychological, and cognitive development. Physical Indicators Most physical indicators of child sexual abuse would be found on physical exam by a medical practitioner. Other professionals rely more upon behavioral, emotional, and cognitive/academic indicators in determining whether to suspect sexual abuse.

Behavioral Indicators

The range of behavioral indicators of child sexual abuse includes:

• Expressions of age-inappropriate knowledge of sex and sexually “pseudo-mature” behaviors • Sexually explicit drawings • Highly sexualized play • Expressions of unexplained fear of a person or place • Avoiding or attempting to avoid a familiar adult • Signs of posttraumatic stress disorder • Nightmares • Sleep interruptions • Withdrawal • A child’s statement

One of the strongest indicators of sexual abuse is a child’s report. When a child says that he or she has been sexually abused, take the statement seriously. Resolve doubt in favor of the child, and err on the side of protection.

Emotional Indicators

Sexual abuse is often a devastating breach of trust for a child. Furthermore, the adult usually tries to manipulate the child into collusion or silence (“this is our little secret”) with real or implied threats. This manipulation is far beyond the child’s ability to understand. Not surprisingly, the child may experience a range of emotional responses, including:

• Self-image problems • Low self-confidence • Guilt (“my fault”) • Shame • Depression • Anxiety • Mood swings

Cognitive/Developmental/Academic Indicators

Because of the emotional maelstrom that is often inside sexually abused children, they may show:

• Difficulty learning • Interrupted concentration • Academic deterioration

In determining whether sexual activity between children can be considered sexual abuse, Child Protective Services considers:

• Whether the activity was an expression of normal sexual curiosity that is developmentally appropriate • The age difference between the children • Whether force or violence was used • The nature and frequency of the sexual activity • The existence of a power differential or knowledge differential • The gratification differential between child perpetrator and victim

Children who perpetrate sexual assault against other children or who engage in repetitive sexually exploitive behaviors, use violence, or demonstrate other anti-social behaviors may themselves be victims. They should be evaluated for intervention services that are appropriate for the situation. Child Protective Services may be able to help identify resources within the community for the child and his or her family.

(D) Emotional Maltreatment

Suspecting emotional maltreatment is challenging. The child will show no bruises or welts and may be appropriately fed and clothed. Yet some consider the damage caused by emotional maltreatment to exceed that of other forms of abuse and neglect. Adding to the challenge is that the child may not be able to disclose the maltreatment, as he or she may think that emotional maltreatment is part of normal parenting.

Legal Definition

Emotional maltreatment is called “Mental Abuse” in Virginia Code. Emotional maltreatment includes patterns of the following behaviors:

• Ridicule • Rejection • Intimidation • Ignoring a child • Indifference • Bizarre discipline

Operational Definition

Emotional maltreatment is perhaps the most difficult form of abuse to define, yet its consequences can be devastating. In addition, it is likely that some element of emotional maltreatment is involved in other forms of abuse and neglect.

Caregiver actions that may be considered emotionally abusive include patterns of:

• Belittling • Ridiculing • Intimidating • Ignoring or rejecting • Withholding love • Seeming unconcerned about a child’s problems • Holding impossible expectations without regard to developmental capability • Bizarre discipline

It can be very hard to tell the difference between less-than-optimal parenting and emotional maltreatment. Remember, like neglect, emotional maltreatment hinges on the consequences to the child. If the child has persistent, adverse reactions to caregiver behaviors like the ones mentioned above, emotional maltreatment may be suspected.

Physical Indicators

Emotionally maltreated children often show:

• Non-organic failure to thrive (infants) • Speech disorders • Developmental delays

Behavioral Indicators

The range of possible behavioral indicators of emotional maltreatment include: • Habit disorders (sucking, biting, rocking) • Conduct disorders (antisocial, destructive) • Neurotic traits (sleep disorders, inhibition of play) • Behavioral extremes (compliant, passive, undemanding, aggressive, demanding, raging) • Overly adaptive behavior (inappropriately adult, inappropriately infantile and needy) • Self-destructive behavior and suicide attempts • Cruelty; seemingly taking pleasure in hurting other people or animals • Delinquent behavior

Emotional Indicators

The developmental delays that are apt to accompany emotional maltreatment include delays in emotional development and can have a significant effect on a child’s ability to age-appropriately handle his or her emotions and social interactions. For example, emotional abuse can be seen as a self-fulfilling prophecy. If a child is degraded enough, the child will begin to live up to the image communicated by the emotionally abusive parent or caretaker. This will affect the child’s relationships with others and his or her sense of self-worth.

Cognitive/Academic Indicators

The developmental delays that are apt to accompany emotional maltreatment include delays in cognitive development and can have a significant effect on a child’s academic performance.

Special Issue: Maltreatment of Children with Disabilities Maltreatment of children with disabilities can and does occur. Pay close attention to the attempts of a child with a disability to communicate that maltreatment has occurred.

Maltreatment of children with disabilities may involve any of the forms of abuse we’ve discussed. Many of the dynamics and indicators are the same. However, this topic deserves special consideration because of some unique features. Though we do not have a clear picture of the extent of maltreatment of children with disabilities, it is generally thought that they are at greater risk than children without disabilities. Some of factors believed to increase their risk are:

• Society’s devaluing children with disabilities • Failure to acknowledge the sexuality of children with disabilities, coupled with failure to provide developmentally appropriate sexual information • Denial that abuse can affect children with disabilities to the same extent that it can affect other children • Inability to accept that caregivers of children with disabilities would abuse them • Caregiver lack of knowledge of how to care for a child with disabilities and lack of knowledge regarding realistic expectations • Caregiver lack of social, emotional, and financial resources • The child’s own internalization of his or her devaluing by society, resulting in shame and reluctance to demand respectful treatment • The child’s compliance and reluctance to stand up for his or her rights • The child’s lack of understanding that the abuser’s behavior is wrong • The child’s inability to defend against the abuser • The child’s difficulty in communicating the maltreatment, and the abuser’s assumption that the child can’t tell or won’t be believed

Reporting Abuse and Neglect Obligations

Professionals Obligated to Report

Many states designate professions who are mandated by law to report maltreatment.

Individuals designated as mandatory reporters typically have frequent contact with children and/or elderly.  Such individuals may include: •  Social workers; •  Teachers and other school personnel; •  Physicians and other health-care workers; •  Mental health professionals; •  Child care providers; •  Medical examiners or coroners; •  Law enforcement officers; •  clergy; •  emergency medical service providers, •  firefighter first responders, etc.

Some other professions mandated across the States to report include:  •  commercial film or photograph processors, •  substance abuse counselors,  •  probation or parole officers, •  domestic violence workers,  •  animal control or humane officers, and •  court-appointed special advocates. 

Reporting by Other Persons

Any person who suspects abuse or neglect is required to report.

Standards for Making a Report

Typically, a report must be made when the reporter, in his or her official capacity, suspects or has reasons to believe that a person has been abused or neglected. Another standard frequently used is when the reporter has knowledge of, or observes a child being subjected to, conditions that would reasonably result in harm to the child.   

Additional information and reporting links may be viewed at the following websites:

(1) State of Delaware – Child Abuse Reporting

Mandatory Reporting of Child Abuse and Neglect in Delaware

http://kids.delaware.gov/fs/fs_iseethesigns.shtml

How to report suspected child abuse:

http://kids.delaware.gov/fs/fs_iseethesigns.shtml#iseeHowToReport

(2) Elderly Abuse and Exploitation in Delaware

http://www.attorneygeneral.delaware.gov/seniors/elderlyabuseandexpl.shtml

(3) Bully Prevention Law in Delaware

http://www.doe.k12.de.us/infosuites/students_family/climate/files/Bully%20Prevention%20Law%20Outline.pdf