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Recognising indicators of risk of harm

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					        Types of child abuse and neglect resource book
    Overview ................................................................................................. 1
      Key Points ............................................................................................ 2
    Defining harm and abuse........................................................................... 2
      Harm ................................................................................................... 2
      Physical abuse....................................................................................... 2
      Emotional abuse .................................................................................... 3
      Neglect................................................................................................. 3
      Sexual abuse ........................................................................................ 3
      Living with Domestic Violence ................................................................. 4
    Indicators of risk of harm .......................................................................... 4
    Child Safety: Seeing the whole picture ........................................................ 6
    Case Scenarios......................................................................................... 8
      Case Scenario: Jacques .......................................................................... 8
      Case Scenario: Paris .............................................................................. 8
      Case Scenario: Domestic violence ............................................................ 9
      Case Scenario: Lily .............................................................................. 10




Overview
Harm to children is unfortunately prevalent in our society. Most people want to
love and care for their children, but, given the circumstances (stress, tiredness,
lack of skills, lack of information and support) anyone has the potential to harm a
child.

It is crucial to respond fairly, promptly and consistently when a concern about the
safety of a child is raised, and act appropriately through accurate observation,
recording and appropriate consultation.

An array of factors or indicators might alert you to the possibility that a child is
being harmed or is at risk of significant harm by someone in the home.

Some of these may be situational factors predisposing a family to a level of stress
which might lead to harm of a child. Unemployment, poverty, and poor living
conditions all increase stress on people. Children’s disability or behaviour may be
stressors and may also increase the vulnerability of the child to abuse.

The main observations that staff might make, which indicate a child may have
been harmed, include:

       changes in behaviour such as a quiet withdrawn child suddenly becoming
        aggressive and loud, or a child who is normally an extrovert becoming
        withdrawn
       physical signs e.g. bruises
       developmental delays e.g. speech

Recognising that any indicator may have more than one cause, the professional
approach has been to collect as much information as possible through
observation, recording and consultation. Formulating an assessment of risk to
the child and developing an action plan is therefore based on sound principles and
is mindful of the boundaries around the role and job responsibilities guided by the
policy of the organisation.

At times the level of risk indicates the involvement of the statutory child
protection organisation. At other times, the child care organisation will feel
confident that it can manage the situation by supporting the family and
monitoring the responses.

Key Points
     Nationally four different forms of abuse heave been recognised:
            physical and emotional abuse
            neglect
            sexual abuse.
            children living in situations where domestic violence is occurring.
     Workers in a children’s service need to be aware of signs which may indicate
      that a child in their care is at risk of harm.
     Workers have a duty of care towards the children within their service.
     If a worker suspects that a child has been harmed or is at risk of harm it is
      their responsibility to report it to the appropriate person.
     Regular observation of children and their development may in fact assist in
      identifying children who may be at risk of harm.

Defining harm and abuse

Harm
The Child Protection Act 1999 defines harm in the following way.


    9 What is harm
    (1) Harm, to a child, is any detrimental effect of a significant
        nature on the child’s physical, psychological or emotional
        wellbeing.
    (2) It is immaterial how the harm is caused.
    (3) Harm can be caused by—
        (a) physical, psychological or emotional abuse or neglect; or
        (b) sexual abuse or exploitation.



This same meaning is applied to the use of the term ‘harm’ within the Child Care
Act 2002.



Physical abuse

This includes physical injury to a child where the injury is not accidental, or
knowingly not prevented.
Signs of physical abuse may include:

    bruising
    bites
    scalds
    fractures
    inconsistent injuries.

Emotional abuse

This includes negative attitudes and behaviours (e.g. continually criticising,
teasing or belittling a child; not showing any affection or encouragement) which
severely impact on the child’s emotional and physical development.

Signs of emotional abuse may include:
    sleep disorders
    nervous habits
    withdrawal
    depression
    low self-esteem
    self-destructive behaviour
    relationship problems.

Neglect

This includes continual failure to provide a child with necessities such as food,
shelter and supervision appropriate to their age as well as essential physical and
medical care. Neglect is a very different form of abuse as it is the inaction on the
part of an adult which is abusive.

Signs of neglect may include:

    underweight
    poor growth pattern
    fatigue
    poor hygiene
    lack of supervision
    a child being forced to assume adult responsibilities.




Sexual abuse
This includes the use of a child for the sexual and/or physical gratification of
someone who takes advantage of their power and/or the child’s trust.

Signs of sexual abuse may include:
    withdrawn behaviour

    low self-esteem

    fearfulness of other people

    sexual themes in language

    knowledge of sexual matters too advanced for their age

    regression

    wearing layers of clothing (even when the weather is hot) in an attempt to
     hide their bodies.

Living with Domestic Violence

‘Domestic Violence’ refers to violence, abuse and intimidating behaviour
perpetrated by one person against another in a personal, intimate relationship.
Domestic violence occurs between two people in a relationship, where one person
has the power over the other, causing fear, physical and/or psychological harm.
Domestic violence has a profound effect on children and constitutes a form of
child abuse. Children can be affected by witnessing violence or becoming the
victims of violence, or a combination of both.



Indicators of risk of harm
As a worker in a children’s service you need to be aware of signs which may
indicate that a child in your care is at risk of harm. Remember, you have a duty
of care towards the children within your service. If you suspect that a child has
been harmed or is at risk of harm you have a responsibility to report it to the
appropriate person.

Cooper & Sutton (1999) studied the effects of harm on the play of preschool
children and compiled a list of indicators. The main ones are:

    delayed play skills and overall developmental delay

    decreased imaginative play

    aggressive social play

    social withdrawal

    increased emotional or behavioural disturbance manifested in play

    behaviour attracting negative attention

    sexualised play

    low skills development – gross/fine motor, limited use of materials,
     repetitive actions

    inability to initiate, organise and complete activities
The regular observations which you make of children and their development may
in fact assist you in identifying children who may be at risk of harm. From your
observations, you may identify patterns of behaviour which are of concern. The
reporting of suspected risk of harm may result from observations of the child over
time, or from one significant incident of concern.
Child Safety: Seeing the whole picture
   Keep an open mind.
    You may see what you think are indicators that a child is at risk or may
    have been harmed … but there may be other explanations.

    Some children are very active and adventurous in their play and as a result
    have lots of falls which cause bruising to various parts of their body. Without
    careful consideration someone who does not know the child may
    misinterpret this repeated bruising seen on the child. As you can see in this
    example the context of the child’s experiences are very important.

    However, if you noticed bruising on a child coupled with some of the other
    indicators of harm which have been outlined, you would have cause for
    concern and need to report your suspicions.

   Don’t assume that it is not abuse.
    It is also important not to immediately assume that …

        a child with injuries is not abused

                           or

        a family living in a high stress situation has everything under control.

    Remember the active child referred to earlier. While you may assume that
    all of the bruising is because of normal activities, it may also be that the
    parents find the child’s behaviour a great challenge and respond to this in
    ways that are harmful.

    This creates great challenges for workers – hence the importance of
    observation, recording and discussing.

   The age and development of a child will mean that they may or may
    not give information.
    While you work with children and have some understanding of their capacity
    for openness and honesty, you know that they can be confused about what
    is happening, and may not know what to tell, or who to tell. Also, children
    who are being abused may not tell because they love the person who is the
    abuser (e.g. a parent) or because they have been told to keep it a secret.

   As adults we have a responsibility to act responsibly.
    However, it is not necessary (or in the best interests of the child) to wait
    until you have conclusive proof before reporting your suspicions of harm. It
    is not your role to investigate but it is your role to report any suspicion of
    harm to a child. It is the responsibility of the child protection agency to
    determine if your expression of concern should become a notification.

   Be aware of what you are assuming.
    Don’t read between the lines. Look and listen.

   Be aware of your own values.
    Remember that your own upbringing influences the way you interpret
    behaviour, and the way you act.

    If you have the belief ‘that families are generally caring and need support…’,
    this could lead you to avoid acting at an early point when you notice some
    concerns about a child’s well-being.

    On the other hand the belief ‘that parents have an obligation to care for
    children and should be reminded of their obligations’, might lead you to
    accuse rather than offer support.

    Someone who was brought up in a family where clean clothes and tidiness
    are important may find that they react to a family situation where the
    children are often dirty or they look a bit dishevelled. Is this a case of
    neglect or rather a family where these values are of less importance to the
    parents?

    Take a few minutes to think about your own values and upbringing. Ask
    yourself: Are there aspects from my own upbringing that may trigger a
    reaction from me? It is important to be aware of these when working in
    children’s services.

   Being ‘sensitive to the parent’s needs’ might mean that we are no
    longer acting as an advocate for the child.
    Often positive relationships are established with parents. This is the goal of
    quality practice in children’s services. However, sometimes these efforts to
    build relationships, to be supportive and understanding of the parent’s
    position, can get in the way of the best interests of the child. If you work
    in a home-based care situation (Family Day Care) you may find this very
    difficult due to the close relationships developed with families over time. You
    do however need to remain focused on the needs of the child as your first
    priority.
Case Scenarios
Case Scenario: Jacques
Jacques is a 5 year old boy who lives with his Mother, Father and 3 older sisters.
His father is a businessman who works long hours and is away from home at
least 3 weeks in the month. His mother is a nurse and Jacques’s grandmother-
Antoinette lives with the family and brings him to day care. Antoinette calls into
the Directors office and stated she is very concerned about Jacques as his mother
is very strict with him and has made him sleep in the garage when he is naughty,
on one occasion she locked him out of the house for an hour. Jacques is very
frightened about being outside alone when it is dark. Antoinette says the
Jacques‘s mother tells him he is a very bad boy and that she wishes he was never
born.

Reflect on the following:
    What are the indicators of harm?
    How would you respond?
    What outcomes would you like to achieve?
    What are you required to do according to the policies of the Centre.

Feedback

The Child Care Centre would need to make notification to the Department of
Communities using Form 25- Reporting of Harm or Suspected Harm. The Centre
should make sure that Jacques is supported by caring adults and plan to spend
time with him each day.

Professional counselling may be provided by the department and it would be the
Centre’s duty to make sure Jacques is able to play freely with his peers at the
Centre.




Case Scenario: Paris

Paris is an eight year old girl attending after school care and was overheard by
the assistant telling her friend that, “Daddy said if I tell my secret to anyone then
he will go to jail and I wouldn’t see him anymore”. The assistant is very
concerned as she has observed Paris changing from being a happy outgoing child
to one who is moody, aggressive and tearful.

Paris often complains of having a sore tummy and a headache. She often visits
the toilets. At times she has tried to get the boys to kiss her and chase her
behind the trees, where she has been seen to lift up her dress, then run away.




Reflect on the following:

    What are the indicators of harm?
    How would you respond?
    What might the toilet visits indicate?

Feedback

Although one single indicator can be as significant as the presence of a number of
indicators, the assistant here has observed many behaviours and signs that
indicate possible harm from sexual abuse. Therefore she must report her
concerns to the Coordinator, who will need to make a notification on Form 25-
Reporting of Harm or Suspected Harm.

The After School Care Service would need to continue to observe and monitor
Paris - particularly in her interactions with other children. Paris will need to be
shown more appropriate behaviours when interacting with others. As part of the
Child Protection investigation, a medical examination may be required.



Case Scenario: Domestic violence

An inner city family with 6 children all under the age of 6 are constantly arriving
at the Family Day Care Home unfed, looking as if they have been taken straight
from bed and brought to Family Day Care. A few months earlier the mother had
mentioned to Jane, the Family Day Care provider, that her husband is very
violent when he has been drinking and she often has no money to buy food. Jane
speaks to her coordinator about the situation and the coordinator contacts the
Department of Communities for assistance. The Department approaches the
mother to offer food vouchers, but when the husband finds out he becomes
violent, as he doesn’t want interference in his family. The mother arrives at
Jane’s house one day with bruises on her face and the children are very
distressed.




Reflect on the following:

    What are the indicators of harm?
    What support can the Family Day Care provider offer?
    What other services other than the Department of Communities may be able
     to assist with the situation?

Feedback

Jane could notify the Department on the basis of the emotional harm to the
children and the mother being unable to protect the children (or herself). Then
Jane would have an important role in monitoring the situation. Counselling may
be able to be organised for the mother through the Family Day Care Scheme,
during the day at the Schemes head office. The children need to be supported by
Jane and Jane would need support through her Coordinator.

There are domestic violence workers who can provide advice and assistance, but
these resources are fairly limited. A domestic violence refuge may be one option
for the mother and children; however, the mother would need significant support
in this.
Case Scenario: Lily

An eight month old infant called Lily attends a Long Day Care Centre. She arrived
one morning looking very listless. Her mother Dr Smith said the baby had a slight
head cold and had not slept very well the previous evening. She also mentioned
that Lily is a terrible sleeper and keeps her awake most nights. She rushed off to
work. The Group Leader noticed during the morning that Lily was not responsive
to the other carers and was continually whimpering. The Group Leader was quite
concerned as Lily was usually a very happy baby, so she asked the Director to
contact the mother and asked her to pick her up as soon as possible. Next day Dr
Smith said there had been nothing wrong and that the group leader was over
reacting.

The following week when Lily was again brought into the Centre, the Group
Leader noticed some tiny brown marks on her bottom when she was changing her
nappy. Lily was also very ‘clingy’ and did not respond to the care givers
interactions and refused her morning bottle. This type of behaviour went on for a
number of weeks. When the Group Leader kept questioning Dr Smith about Lily
she refused to answer and would storm out of the room. Lily was removed from
the Centre by her mother after the Group Leader asked about the marks on her
bottom.




Reflect on the following:

    What are the indicators of harm?
    What support can the Centre offer?
    What other services other than the Department of Communities may be able
     to assist with the situation?

Feedback

The Group Leader needs to document the observations she has made of Lily’s
behaviour and also of the conversations she had with Dr Smith, Lily’s mother.
She should also report this information to the Director of the Centre. The
department would need to be notified with the concerns, so that they can follow
up with the mother if they think there is concern of harm.

The Centre could also provide the mother with some information about strategies
for ‘irritable’ babies and provide names of associations such as the Riverton
Parent Centre.

				
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