CHILD PROTECTION FOR JMOs

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CHILD PROTECTION FOR JMOs

• Hunter New England Health 2009

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CONTENTS

• Definitions of Abuse
• Impact of Abuse, Neglect and Domestic Violence
• Prevalence of Abuse
• Child Death Review Team Reports
• Reporting to DOCS
• Requirements of HNE Health staff
• Coroners Act changes
• Crimes Amendment Act

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DEFINITIONS OF ABUSE

• PHYSICAL ABUSE
• Includes assault, non-accidental injury or
  physical harm to children or young person by a
  parent, caregiver, or other person responsible
  for the child or young person, or a sibling or
  other child in the household.
• Includes injuries or harm which are caused by
  excessive discipline, beating or shaking,
  bruising, lacerations or welts, burns, fractures
  or dislocation, female genital mutilation,
  attempted suffocation or strangulation. All of
  these may result in the death of the child or
  young person

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DEFINITIONS OF ABUSE (cont.)

• EMOTIONAL ABUSE
• Covers a range of behaviours that may cause
  psychological harm to a child or young person.
• It is behaviour by a parent, caregiver, older
  child, or another person that can damage the
  confidence and self-esteem of a child or young
  person resulting in serious emotional deprivation
  or trauma
• Emotional abuse is also experienced by a child or
  young person when living in a situation of
  domestic violence.
• Serious psychological harm involves the
  impairment of, disturbance or damage, to a child
  or young persons cognitive, emotional,
  behavioural, or social development

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DEFINITIONS OF ABUSE (cont.)

• NEGLECT
• Occurs when there is failure to provide the basic
  physical and emotional necessities of life. It
  may be ongoing and can be caused by the repeated
  failure to meet the basic psychological needs of
  a child or young person.
• Physical failure to provide the basic needs,
  including food, physical support,hygiene, and
  safety from harm (appropriate and adequate adult
  supervision)
• Psychological lack of sufficient or appropriate
  interaction, encouragement, nurturing or
  stimulation from parent/caregiver. Includes
  persistent ignoring of a childs signals of
  distress or pleas for help, comfort, reassurance,
  encouragement and acceptance, or disinterest in
  childs life.

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DEFINITIONS OF ABUSE (cont.)

• SEXUAL ABUSE
• Includes any sexual act or sexual threat imposed
  on a child or young person. Adults, adolescents
  or older children who sexually assault children
  or young people exploit their dependency and
  immaturity.
• Coercion, which may be physical or psychological,
  is intrinsic to child sexual assault and
  differentiates it from consensual sex with a peer.

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PERPETRATORS OF CHILD SEXUAL ABUSE

• Majority of perpetrators are men
• Victims are both male and female (1 in 3 girls
  and 1 in 7 boys have experienced some form of
  abuse)
• Children are most often sexually abused by
  someone they know and trust (relative friend
  significant other person in their life, person in
  a position of power)
• Perpetrators come from all socio-economic
  backgrounds and are often professional men
• Often abuse more than one child
• Child sexual abuse is planned and perpetrators
  use a range of strategies to identify, recruit
  and coerce their victims

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CHILDREN DISCLOSING SEXUAL ABUSE

• Can be very difficult for a child to disclose due
  to threats that have been made
• Disclosures often very tentative testing
  reaction
• Many children will retract disclosure does not
  mean they have lied reaction to process
• Children need to be supported
• Perpetrators who are not held accountable can
  continue to abuse other children who are not
  protected from them

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IMPACT OF SEXUAL ABUSE

• ON CHILDREN
• Fear or anxiety
• Depression/withdrawal
• Sleep problems
• Guilt
• Poor self-image/low self-esteem
• Difficulties in school
• Anger or hostility
• Inappropriate sexualised behaviour
• Running away
• Somatic complaints
• Eating disorders
• Suicide attempts/self mutilation
• Drug use

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IMPACT OF SEXUAL ABUSE ON CHILDREN (cont.)

• FACTORS WHICH INFLUENCE OUTCOME
• Age/developmental stage of child
• Nature of abuse
• Circumstances surrounding abuse
• Relationship with abuser
• Duration/frequency
• Outcome of disclosure
• Believed and protected
• Whether abuse stops
• Any legal processes

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IMPACT OF CHILD SEXUAL ABUSE

• ON ADULTS
• Depression
• Substance abuse
• Eating disorders
• Dissociative Identity Disorder
• Borderline Personality Disorder
• Post-traumatic Stress Disorder
• Self-harm/suicidal behaviour

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DOMESTIC VIOLENCE

• Violent, abusive or intimidating behaviour
  carried out by an adult against a partner or
  former partner to control and dominate that
  person.
• It is most often violent, abusive or
  intimidating behaviour by a man against a woman.
• It includes physical assault, sexual assault,
  emotional abuse, social abuse, and economic
  abuse.
• DV has a profound effect on children and young
  people and constitutes a form of abuse. The
  psychological harm experienced are affected by
  age, personality, length of exposure to DV,
  nature of the incidents, and any assistance
  offered to the child.
• Children and young people may experience harm on
  a number of levels direct victims indirect
  victims when trying to protect another person
  victims of trauma living in a climate of fear and
  intimidation.

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IMPACT OF DOMESTIC VIOLENCE ON CHILDREN

• Exposure to chronic or extreme domestic violence
  may result in symptoms consistent with post
  traumatic stress disorder, including emotional
  numbing, increased arousal.
• Strong links between sexual offending behaviour
  in adolescents and exposure to DV as a child (63
  of sexually abusive youths had witnessed DV, 42
  had been physically abused, and 39 had been
  sexually abused)
• There may be negative effects in adulthood,
  including depression, low self-esteem, violent
  behaviour at home and criminal behaviour

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IMPACT OF DOMESTIC VIOLENCE ON CHILDREN (cont.)

• Studies show children who have witnessed
  domestic violence are more likely to
• Show aggressive behaviour
• Develop phobias and insomnia
• Experience anxiety
• Show symptoms of depression
• Have diminished self-esteem
• Demonstrate poor academic performance and
  problem-solving skills
• Reveal reduced social competence skills,
  including low levels of empathy
• Show emotional distress and have physical
  complaints

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IMPACT OF ABUSE

• Impact of physical abuse and neglect has long
  term adverse outcomes on intellectual and
  cognitive functioning mental health problems
  and general health
• Early neglect may be damaging in language
  development, psychosocial development and
  empathic responsiveness
• Physical and sexual abuse is a major factor in
  homelessness of young people, which can lead to
  risk taking behaviour substance use self-harm
  prostitution and other vulnerability

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PREVALENCE OF ABUSE

• Research relies on retrospective reporting by
  adults often not disclosed by children while it
  is happening
• Child Protection Reports are increasing. In
  00/01 159, 654 reports were received in 05/06
  241, 003 reports were received.
• Average 2.1 reports per child
• Domestic Violence is the highest primary risk
  factor identified in reports
• AD use is also a significant factor in reports
• Police, health and school make most reports.
• Children lt 1 year most frequently reported then
  children 1-4 years
• Strong links between DV and physical abuse (15
  times more likely)

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NSW OMBUDSMAN REVIEWABLE DEATHS REPORT 2006

• 123 reviewable
• 114 were reviewable as they or a sibling was
  known to DoCS
• 81 children had previous reports to DoCS
• 31 children siblings had previous DoCS reports
• 2 children had no previous DoCS reports
• 64 were under the age of 1

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NSW OMBUDSMAN REVIEWABLE DEATHS REPORT 2006 contd

• ½ review had parents with a history of DA issues
• 40 of review had parents where mental health
  problems were indicated
• Total of 40 deaths suspicious of child abuse or
  neglect
• 12 deaths from abuse
• 9 deaths from neglect
• 19 deaths suspicions

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OMBUDSMAN REPORT cont.

• Children whose deaths were reviewable are more
  likely to die as a result of meningococcal
  disease, epilepsy and pneumonia than children
  whose deaths were not reviewable.
• Issues included
• Non-compliance with medication
• Failure or delay in seeking medical attention
• Parental substance abuse
• History of general neglect

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CHILD DEATH REVIEW TEAM

• PARENTAL SUBSTANCE USE (98 - 99)
• 25 of child deaths directly or indirectly
  involve drugs and/or alcohol
• Intensive, compulsive and binge substance users
  pose special risks to their infants and children
• Parents who are substance dependent are at
  increased risk for problems correlated with child
  abuse/neglect.
• Children of substance using parents were
  significantly over-represented in children and
  infants who dies as a result of
• SUDI,
• undetermined/suspicious
• Non-accidental injury
• Acute toxicity
• Bed-sharing
• Natural causes

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CHILD DEATH REVIEW TEAM FINDINGS

• Characteristics common to children who die as a
  result of abuse or neglect
• a. Age of victims
• b. Over-representation of indigenous families
• c. Family violence and criminal behaviour
• d. Family stress factors
• e. Inadequate supervision of young children
• Systemic problems
• a. Not recognising and reporting serious and
  unstable situations
• b. Inadequate risk assessment
• c. Poor interagency collaboration and
  co-ordination

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REPORTING ABUSE and RISK OF HARM TO DOCS

• MANDATORY REPORTING
• Under Section 27 of the Children and Young
  Persons (Care and Protection) Act a person who
• In the course of his or her professional work or
  other paid employment delivers health care wholly
  or partly to children, and
• Has reasonable grounds to suspect that a child is
  at risk of harm
• Must as soon as practicable, report to the
  Department of Community Services, the name of the
  child and the grounds for suspecting risk of
  harm.

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REPORTING (cont.)

• OTHER REPORTS TO DOCS
• Workers SHOULD report risk of harm for
• Young people aged 16 or 17
• A child who is homeless
• Prenatal reports
• A class of children or young people

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REPORTING (cont.)

• Health workers who provide services to adults
  have an obligation to consider the parenting
  capacity of adult clients in meeting their
  obligations to assess and report risk of harm

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RISK OF HARM

• Under S 23 of the Act a child is at risk of harm
  if current concerns exist for the safety welfare
  or well-being of the child because of the
  presence of any of the following
• the child or young persons basic physical or
  psychological needs are not being met
• the parents or caregivers have not arranged and
  are unable or unwilling to arrange for necessary
  medical care
• the child or young person has been, or is at risk
  of being, physically or sexually abused
• the child or young person is living in a
  household where there have been incidents of
  domestic violence, and as a consequence, the
  child or young person is at risk of serious
  physical or psychological harm
• a parent or other caregiver has behaved in such a
  way toward the child that the child has suffered
  or is at risk of suffering serious psychological
  harm

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RISK OF HARM cont

• F. the child was subject of a prenatal report
  under section 25 and the birth mother of the
  child did not engage successfully with support
  services to eliminate, or minimise to the lowest
  level reasonably practical, the risk factor that
  gave rise to the report. 
• Section 25 Pre-natal reports
• a)     to allow assistance and support to be
  provided to the expectant mother to reduce the
  likelihood that her child, when born, will need
  to be placed in out-of-home care, and
• b)     to provide early information that a child
  who is not yet born may be at risk of harm
  subsequent to his or her birth, and
• c)      in conjunction with section 23 (f) and
  section 27, to provide for mandatory reporting if
  there are reasonable grounds to believe that the
  child is at risk of harm subsequent to his or her
  birth.

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KEY POINTS IN ASSESSING RISK OF HARM

• The age, development, functioning and
  vulnerability of the child or young person
• Behaviour that suggests they may have been or are
  being harmed by another person
• The behaviour of another person that has had, or
  is having, a demonstrated negative impact of the
  child
• Contextual risk factors such a recent abuse or
  neglect of a sibling or other adult behaviour
• Factors that may help reduce risk of harm and
  provide protection eg secure positive
  relationship with one other parent/adult

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HOW TO REPORT TO DOCS

• DOCS HELPLINE is a 24 hour service to receive all
  Reports across NSW
• Phone number for mandated Reporters is 133 627
• If a DOCS caseworker is not available to take the
  call a voice message can be left and DOCS should
  return the call.
• Another option is to fax the details of the
  Report to the Helpline on 96337666
• DOCS should give the Reporter a reference number
  for your records and send a feedback form about
  the outcome of the Report
• A copy of the Report form should be placed in the
  clinical record as evidence of the Report being
  made.

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PROTECTION FOR REPORTERS

• If a Report is made in good faith the Report
• does not constitute a breach of professional
  ethics or a departure from acceptable standards
  of professional conduct
• does not constitute grounds for liability for
  defamation
• does not constitute grounds for civil proceedings
  for malicious prosecution or conspiracy
• cannot be admitted in evidence against a person
  in any court proceedings
• The identity of a reporter cannot be disclosed
  except where the person gives consent or with the
  leave of the court.
• The penalty for failing to Report is currently
  22,000

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INFORMATION REQUIRED BY DOCS IN A REPORT

• Includes
• Name or description of the child and whereabouts
• Reason for concerns about risk of harm be
  specific about impact on child dont just
  describe adult behaviour
• All available information relating to safety
  well-being and welfare of child
• Information about the person suspected of abusing
• Information about childs history, current
  circumstances
• Information about the parent/caregiver/family
• ?ATSI ?Disability ? Interpreter required

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INFORMING FAMILIES

• It is best practice to inform families when
  making a Report to DOCS, unless your professional
  judgement determines otherwise
• Eg concerns for personal safety
• Or knowledge of the report may increase the risk
  to the child
• Do not inform the alleged offender of sexual
  abuse or domestic violence of the Report

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ACTION BY DOCS

• DOCS Helpline assesses whether child is at risk
  of harm and identifies risk level
• If low risk may close file
• Medium and high risk will refer to local DOCS
  office for ongoing action.
• Local DOCS office will review action plan may
  close case may refer to other service may take
  further action as required may decide on
  Childrens Court action

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ADDITIONAL RESPONSIBILITIES FOR HNE HEALTH STAFF

• EXCHANGE OF INFORMATION WITH DOCS
• Under S248 of the Act we are required to provide
  information to DOCS relating to the safety,
  welfare and well-being of a child or an unborn
  child the subject of a pre-natal report.
• Includes information about the child the
  parent/family capacity to adequately care for
  child eg drug and alcohol/D.V./mental health
  concerns.
• Requests under S248 must be in writing and come
  via Central Contact Point Clinical Information
  at JHH

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ADDITIONAL RESPONSIBILITIES FOR HNE HEALTH STAFF
(cont.)

• Under S 17 of the Act DOCS may request a
  government department to provide services to a
  child or family in order to promote and safeguard
  the safety, welfare and well-being of the child.
• Under S18 of the Act the government department
  must use its best endeavours to comply with the
  request

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ADDITIONAL RESPONSIBILITIES FOR HNE HEALTH STAFF
(cont.)

• Under S173 of the Act DOCS or the Police may
  require a child to be presented to a specified
  medical practitioner for a medical examination.
  A written report must be supplied to DOCS about
  the examination.
• If parents remove a child from a hospital against
  medical advice that may be grounds to report to
  DOCS, who have the power to assume the care and
  protection of the child under S44 of the Act.

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ADDITIONAL RESPONSIBILITIES FOR HNE HEALTH STAFF
(cont.)

• Allegations of abuse or reportable conduct by
  staff
• HNE Health is required to notify the Ombudsman of
  any allegations of reportable conduct or
  convictions made against an employee it
  includes in the course of employment, or in any
  other situation, including the home or other
  community or recreational activities.
• Such information is to be reported to the
  relevant Manager and to Human Resources who will
  undertake an investigation process which protects
  the child whilst also ensuring employees rights
  are protected

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AMENDMENTS TO CORONERS ACT

• Deaths reportable to the Coroner have been
  extended to include
• Children in care
• Children who have been reported to DOCS within
  three years prior to their death
• Children who are siblings of a child who has been
  reported to DOCS within three years prior to
  their death

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CRIMES AMENDMENT ACT (CHILD PROTECTION PHYSICAL
MISTREATMENT) ACT 2001

• Under this law it is considered unreasonable
  for a parent
• To use force above a childs shoulders
  (includes neck, face and head)
• To use force below the childs shoulders in
  such a way that it could harm the child for
  more than a brief period
• Parents will no longer be able to use reasonable
  punishment as a defence if charged with assault.

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SERVICES AVAILABLE IN HUNTER HEALTH

• JHH CHILD PROTECTION SERVICES
• MAITLAND HOSPITAL CHILD PROTECTION SERVICE
• SEXUAL ASSAULT SERVICE
• CHILD PROTECTION AND FAMILY COUNSELLING SERVICE
• SEXUALISED BEHAVIOURS CLINIC
• GENERALIST COUNSELLING
• SPECIALIST SERVICES FOR CHILDREN

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WHAT YOU CAN DO

• Think about the context of child/family situation
• Ask about children
• Consider the impact and consequences of adult
  behaviour on children
• Listen to children
• Consult if concerned