IDENTIFYING AND DEALING WITH ABUSE

Statutory Definitions of Abuse – Children

Child protection legislation throughout the UK is based on the United Nations Convention on the Rights of the Child. Each nation within the UK has incorporated the convention within its legislation and guidance.

The four definitions of abuse below operate in England based on the government guidance ‘Working Together to Safeguard Children (2018)’.

What is abuse and neglect?
Abuse and neglect are forms of maltreatment of a child. Somebody may abuse or neglect a child by inflicting harm, or by failing to act to prevent harm. Children may be abused in a family or in an institutional or community setting, by those known to them or, more rarely, by a stranger for example, via the internet. They may be abused by an adult or adults, or another child or children.

Physical abuse
Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child.

Emotional abuse
Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the ill-treatment of another. It may involve serious bullying (including cyber bullying), causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.

Sexual abuse
Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse (including via the internet). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.

Neglect
Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:

  • provide adequate food, clothing and shelter (including exclusion from home or abandonment);
  • protect a child from physical and emotional harm or danger;
  • ensure adequate supervision (including the use of inadequate care-givers); or
  • ensure access to appropriate medical care or treatment.

Child sexual exploitation
Child sexual exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology.

Extremism
Extremism goes beyond terrorism and includes people who target the vulnerable – including the young – by seeking to sow division between communities on the basis of race, faith or denomination; justify discrimination towards women and girls; persuade others that minorities are inferior; or argue against the primacy of democracy and the rule of law in our society.

Statutory Definitions of Abuse – Vulnerable Adults
The following information relates to the Safeguarding of Adults as defined in the Care Act 2014, Chapter 14. Safeguarding, this replaces the previous guidelines produced in ‘No Secrets’ (Department of Health 2000)
The Safeguarding duties apply to an adult who :

  • has need for care and support (whether or not the local authority is meeting any of those needs); and
  • is experiencing, or at risk of, abuse or neglect; and
  • as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

Organisations should always promote the adult’s wellbeing in their safeguarding arrangements. People have complex lives and being safe is only one of the things they want for themselves. Professionals should work with the adult to establish what being safe means to them and how that can be best achieved. Professional and other staff should not be advocating ‘safety’ measures that do not take account of individual well-being, as defined in Section 1 of the Care Act.

This section considers the different types and patterns of abuse and neglect and the different circumstances in which they may take place. This is not intended to be an exhaustive list but an illustrative guide as to the sort of behaviour which could give rise to a safeguarding concern. These types of abuse include :
Physical abuse
Assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.
Domestic violence
Psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence.
Sexual abuse
Rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.
Psychological abuse
Emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.
Financial or material abuse
Theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.
Modern slavery
Slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.
Discriminatory abuse
Forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation, religion, marital status or pregnancy.~
Organisational abuse
Neglect and poor care practice within an Institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.
Neglect and acts of omission
Ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.
Self-neglect
Neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. Incidents of abuse may be one-off or multiple, and affect one person or more.

Recognising and Responding to Abuse
The following signs may or may not be indicators that abuse has taken place, but the possibility should be considered.

Signs of Possible Abuse – Children and Young People
Physical signs of abuse

  • Any injuries not consistent with the explanation given for them
  • Injuries which occur to the body in places which are not normally exposed to falls, rough games, etc
  • Injuries which have not received medical attention
  • Neglect – under nourishment, failure to grow, constant hunger, stealing or gorging food, untreated illnesses, inadequate care, etc
  • Reluctance to change for, or participate in, games or swimming
  • Repeated urinary infections or unexplained tummy pains
  • Bruises, bites, burns, fractures etc which do not have an accidental explanation
  • Cuts/scratches/substance abuse which may indicate child is self harming

Indicators of possible sexual abuse

  • Any allegations made by a child concerning sexual abuse
  • Child with excessive preoccupation with sexual matters and detailed knowledge of adult sexual behaviour, or who regularly engages in age-inappropriate sexual play
  • Sexual activity through words, play or drawing
  • Child who is sexually provocative or seductive with adults
  • Inappropriate bed-sharing arrangements at home
  • Severe sleep disturbances with fears, phobias, vivid dreams or nightmares, sometimes with overt or veiled sexual connotations.
  • Eating disorders – anorexia, bulimia

Emotional signs of abuse

  • Changes or regression in mood or behaviour, particularly where a child withdraws or becomes clinging. Also depression/aggression, extreme anxiety.
  • Nervousness, frozen watchfulness
  • Obsessions or phobias
  • Sudden under-achievement or lack of concentration
  • Inappropriate relationships with peers and/or adults
  • Attention-seeking behaviour
  • Persistent tiredness
  • Running away/stealing/lying

Neglect

  • Under nourishment, failure to grow, constant hunger, stealing or gorging food;
  • Untreated illnesses;
  • Inadequate care, etc

Signs of Possible Abuse (vulnerable adults)
Physical abuse

  • History of unexplained falls, fractures, bruises, burns, minor injuries.
  • Signs of under or over use of medication and/or medical problems left unattended.
  • Any injuries not consistent with the explanation given for them
  • Bruising and discolouration – particularly if there is a lot of bruising of different ages and in places not normally exposed to falls, rough games etc.
  • Recurring injuries without plausible explanation
  • Loss of hair, loss of weight and change of appetite
  • Person flinches at physical contact &/or keeps fully covered, even in hot weather;
  • Person appears frightened or subdued in the presence of a particular person or people

Domestic violence

  • Unexplained injuries or ‘excuses’ for marks or scars
  • Coercive, controlling and/or threatening relationship including psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence and Female Genital Mutilation.
  • Age range extended to 16 yrs.

Sexual abuse

  • Pregnancy in a woman who lacks mental capacity or is unable to consent to sexual intercourse
  • Unexplained change in behaviour or sexually explicit behaviour
  • Torn, stained or bloody underwear and/or unusual difficulty in walking or sitting
  • Infections or sexually transmitted diseases
  • Full or partial disclosures or hints of sexual abuse
  • Self-harming
  • Emotional distress
  • Mood changes
  • Disturbed sleep patterns

Psychological abuse

  • Alteration in psychological state e.g. withdrawn, agitated, anxious, tearful
  • Intimidated or subdued in the presence of a carer
  • Fearful, flinching or frightened of making choices or expressing wishes
  • Unexplained paranoia
  • Changes in mood, attitude and behaviour, excessive fear or anxiety
  • Changes in sleep pattern or persistent tiredness
  • Loss of appetite
  • Helplessness or passivity
  • Confusion or disorientation
  • Implausible stories and attention seeking behaviour
  • Low self-esteem

Financial or material abuse

  • Disparity between assets and living conditions
  • Unexplained withdrawals from accounts or disappearance of financial documents or loss of money
  • Sudden inability to pay bills, getting into debt
  • Carers or professionals fail to account for expenses incurred on a person’s behalf
  • Recent changes of deeds or title to property
  • Missing personal belongings
  • Inappropriate granting and / or use of Power of Attorney

Modern slavery

  • Physical appearance; unkempt, inappropriate clothing, malnourished
  • Movement monitored, rarely alone, travel early or late at night to facilitate working hours.
  • Few personal possessions or ID documents.
  • Fear of seeking help or trusting people.

Discriminatory abuse

  • Inappropriate remarks, comments or lack of respect
  • Poor quality or avoidance care
  • Low self-esteem
  • Withdrawn
  • Anger
  • Person puts themselves down in terms of their gender or sexuality
  • Abuse may be observed in conversations or reports by the person of how they perceive themselves

Institutional Abuse

  • Low self-esteem
  • Withdrawn
  • Anger
  • Person puts themselves down in terms of their gender or sexuality
  • Abuse may be observed in conversations or reports by the person of how they perceive themselves
  • No confidence in complaints procedures for staff or service users.
  • Neglectful or poor professional practice.

Neglect and acts of omission

  • Deteriorating despite apparent care
  • Poor home conditions, clothing or care and support.
  • Lack of medication or medical intervention

Self-neglect

  • Hoarding inside or outside a property
  • Neglecting personal hygiene or medical needs
  • Person looking unkempt or dirty and has poor personal hygiene
  • Person is malnourished, has sudden or continuous weight loss and is dehydrated – constant hunger, stealing or gorging on food
  • Person is dressed inappropriately for the weather conditions
  • Dirt, urine or faecal smells in a person’s environment
  • Home environment does not meet basic needs (for example not heating or lighting)
  • Depression

How To Respond To A Child Or Vulnerable Adult Wanting To Talk About Abuse
Remember 3 principles:

  • Listen
  • Record
  • Refer

It is not easy to give precise guidance, but the following may help:

  • Show acceptance of what the child says (however unlikely the story may sound)
  • Keep calm
  • Look at the child directly
  • Be honest
  • Tell the child you will need to let someone else know – don’t promise confidentiality
  • Even when a child has broken a rule, they are not to blame for the abuse
  • Be aware that the child may have been threatened or bribed not to tell
  • Never push for information. If the child decides not to tell you after all, then accept that and let them know that you are always ready to listen. Ensure a report is written.

Helpful things you may say or show

  • I believe you (or showing acceptance of what the child says)
  • Thank you for telling me
  • It’s not your fault
  • I will help you

Don’t say

  • Why didn’t you tell anyone before?
  • I can’t believe it!
  • Are you sure this is true?
  • Why? How? When? Who? Where?
  • Never make false promises
  • Never make statements such as “I am shocked, don’t tell anyone else”

Concluding

  • Again reassure the child that they were right to tell you and show acceptance
  • Let the child know what you are going to do next and that you will let them know what happens (you might have to consider referring to Social Services or the Police to prevent a child or young person returning home if you consider them to be seriously at risk of further abuse)
  • Make notes as soon as possible (preferably within an hour of being told), writing down exactly what the child said, write what you said in reply to the child, when he/she said it and what was happening immediately beforehand (e.g. description of activity). Record dates and times of these events and date and time the record. Keep all hand written notes.
  • Report according to procedure in policy.