268 -Child and Elder Abuse Indicators
Counselor Toolbox

 
 
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Abuse and Neglect Indicators Training
Protecting Children, Elders and Adults with Disabilities
Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Counselor Education
Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery
Objectives
• Define terms related to sexual, physical, mental and financial abuse and neglect of children and adults
• Identify signs of abuse or neglect in the victim as well as in the caregivers
• Learn about mandatory reporting
• Identify resources for the most up-to-date reporting guidelines

Definitions
• Definition of a child
• A Person less than 18 years old
• Definition of an elder
• Person 60 years AND SUFFERING from infirmities or aging as manifested by:
• advanced age (75 years or older) OR
• organic brain damage (delirium, dementia) OR
• other physical, mental, or emotional dysfunction in which person’s ability to care for self is impaired

Definitions of a Caretaker
• PARENT (Biological, foster or adoptive)
• ADULT HOUSEHOLD MEMBER(found in the home continually)
• ANOTHER ADULT( entrusted with; assumed responsibility)
• ANOTHER CHILD (employee or volunteer of daycare, private school, agency, camp, similar facility)
Disabled Adult
• A person 18 years or older AND suffers from a condition of physical or mental incapacitation due to:
• developmental disability
• organic brain damage
• mental illness
• one or more physical and/or mental limitations that substantially restrict the ability to function in activities of daily life (ADLs)
ABUSE
• Non-accidental infliction of physical or psychological injury or sexual abuse by parent, adult household member, or other person responsible for care of child
• Non-accidental action by a relative, caregiver or household member which causes or reasonably be expected to cause, physical or psychological injury or sexual abuse.
• Actively encouraging another person to commit an injurious act upon an elderly person or disabled adult

NEGLECT
• Failure/omission by a caretaker to provide the care, supervision, services or protection necessary to maintain physical and mental health
Note: This may include witnessing domestic violence or illicit drug use
• Repeated or single act of carelessness that causes or can be expected to cause serious physical, psychological injury, sexual abuse or substantial risk of death

THREATENED HARM
• SITUATION, CIRCUMSTANCES, or BEHAVIOR which lead person to have reasonable cause to suspect abuse or neglect has occurred or may occur in the immediate future if no intervention is provided.
SELF NEGLECT
• OMISSION or FAILURE of elderly or disabled person to maintain their own physical/mental health which is deemed essential for his/her well-being.

• This may include not taking medication as prescribed and substance abuse
EXPLOITATION
• May or may not stand in a position of trust and confidence to the victim, and
• Acts knowingly, by deception or intimidation, and
• knows or should know the victim lacks capacity to consent, and
• Intends to temporarily or permanently deprive the victim of funds, assets or property for the benefit of someone other than the victim

Physical Abuse
Physical Abuse – Type
• Burning
• Beating
• Kicking
• Punching/Slapping
• Shaking (especially infants)
• Misuse of medication
• Approximately 24 states have specific reporting procedures for cases of suspected substance-exposed infants.
• Standard reporting procedures apply in those states that statutorily define infant drug exposure as child abuse and neglect but have no specific reporting procedures for substance-exposed infants

Physical Indicators
• Unexplained Bruises/Welts on face, lips, mouth, torso, back, buttocks, thighs
• In various stages of healing, clustered, forming regular patterns, reflecting shape of object used
• On several different surface areas, regularly appear after absence, weekend or vacation
• Unexplained burns (soles, palms, back, buttocks)
• Immersion burns (sock like, glove-like, doughnut shaped on buttocks, genitalia)
• Patterned like electric burner, iron
• Rope burns (arms, legs, torso, neck)

Physical Indicators (con’t)
• Unexplained fractures (skull, nose, facial)
• various stages of healing
• multiple spiral fractures
• Unexplained lacerations or abrasions (mouth, lips, gums, eyes, external genitalia)
• Signs of confinement including bedsores

Physical Indicators
• Injury that has not been cared for properly
• Injury that is incompatible with explanation
• Pain on touching
• Dehydration and/or malnourishment; loss of weight (not illness related)
• Pallor
• Sunken eyes, cheeks
• Evidence of inadequate medical care
• Evidence of inadequate/inappropriate use of medication

Physical Indicators: Shaken Baby
• Extreme irritability and high-pitched crying
• Lethargy and poor feeding
• Vomiting without obvious reason
• Loss of social engagement (smiling, cooing, etc.)
• Poor suck/swallow coordination
• Unusual breathing patterns
• Bruising of the body due to the grip strength of the individual
• Seizures

• Head trauma: bruising, swelling, deformity of the skull
• Inability of the infant eyes to track or focus on an object
• Unequal pupil size
• Abnormal increase in muscle tone
• Hemorrhages of the retina
• Bleeding and/or drainage of clear fluid from the nose or ear canal
• Developmental delays

Behavioral Indicators
• Wary of Adult Contacts
• Apprehensive when seeing other children cry
• Behavioral extremes – aggressiveness, withdrawal
• Frightened of Parents
• Afraid to go home
• Reports injury by parents
Sexual Abuse
Types
• The term ‘sexual abuse' includes:
• The employment, use, persuasion, inducement, enticement, or coercion of a child to engage in or to have a child assist any other person engage in sexually explicit conduct
• Any simulation of the conduct for the purpose of producing a visual depiction of the conduct
• The rape, molestation, prostitution, or other form of sexual exploitation of children
• Elder sexual abuse is defined as an action against an elder that is unwanted and sexual in origin. It usually involves those older than 60 years of age, and includes any sexual contact with an elder or disabled adult who, because of mental illness or dementia, cannot communicate their disapproval of the behavior against them or cannot communicate consent for the activity.

Types
• In 21 States, the definition of sexual abuse includes human trafficking, including sex trafficking or trafficking of children for sexual purposes.
• Human Trafficking
• Human trafficking of a child for sexual exploitation includes all forms of commercial sexual activity with a child, including prostitution and participation in the production of pornography.
• In 25 States, Guam, and the Northern Mariana Island, the term “commercial sexual activity” includes sexually explicit performance, such as performance in a strip club and exotic dancing or display

Types cont.
• The term ‘sexual exploitation' includes:
• Allowing, permitting, or encouraging a child to engage in prostitution
• Allowing, permitting, encouraging, or engaging in obscene or pornographic photographing, filming, or depicting a child for commercial purposes

Physical Indicators
• Difficulty walking, sitting
• Torn, stained, bloody underclothing
• Pain or itching in genital area
• Bruises or bleeding in external genitalia, vaginal or anal areas or to the inner thighs
• Venereal Disease
• Pregnancy
Behavioral Indicators
• Unwilling to change clothing or participate in gym classes
• Withdrawal, fantasy or infantile/ regressive behavior
• Bizarre, sophisticated, or unusual sexual behavior and/or knowledge
• Poor peer relationships
• Delinquent or run away
• Age-inappropriate sexual play with toys, self, others, younger kids
• Sophisticated sexual knowledge
• Comments such as “I’ve got a secret”, or “I don’t like Uncle”
• Fire lighting by boys
• Fear of certain places eg bedroom or bathroom
• Eating disorders
• Promiscuity or prostitution
• Making self as unattractive as possible
• Unexplained accumulation of money or gifts
• Overly compliant behavior (evidence of grooming)
• Nightmares
• Mood swings
• Self-injury and suicidal ideation
Adult Behavioral Indicators
• There may be indicators in adult behavior that could indicate sexual abuse. Some examples of this are:
• May be unusually over-protective of a child
• Is jealous of a child’s relationships with peers or other adults or is controlling of the child
• May favor the victim over other children
• Demonstrates physical contact or affection to a child which appears sexual in nature or has sexual overtones

Sibling Behavioral Indicators
• In addition to what has been listed above, sibling abuse may be indicated by:
• Siblings who behave like boyfriend and girlfriend.
• A child who fears being left alone with a sibling.
• Siblings who appear embarrassed when found alone together.
• One sibling antagonising the other but the other not retaliating (through fear, or fear of exposing the secret), or in some cases the threat of blackmail.

Mental Abuse
Physical Indicators
• Speech Disorders
• Failure – to – thrive
• Bed-wetting or bed soiling that has no medical cause
• Frequent psychosomatic complaints (eg. Headaches, nausea, abdominal pains)
• Has not attained significant developmental milestones
• Dressed differently from other children in the family
• Has deprived physical living conditions compared with other children in the family

Psychological Indicators of Mental Injury
• Ambivalence, deference, passivity, shame
• Confusion, disorientation
• Trembling, clinging, cowering, lack of eye contact
• Evasiveness
• Agitation, Anger
• Hypervigilance
• Resignation
• Implausible stories
• Contradictory Statements
• Denial
• Non responsiveness

Behavioral Indicators (Children)
• Habit Disorders: sucking, biting, rocking
• Sleep disorders
• Behavioral extremes
• Suffers from severe developmental gaps
• Symptoms of depression, anxiety, withdrawal or aggression
• Severe symptoms of self destructive behavior – self harming, suicide attempts, engaging in drug or alcohol abuse
• Overly compliant, too well-mannered, too neat and clean
• Displays attention seeking behaviors or displays extreme inhibition in play
• When at play, behavior may model or copy negative behavior and language used at home
• Overly adaptive behavior; inappropriately adult or infantile

Indicators In Adult Behavior
• Calls the person names, labels the person or publicly humiliates him or her
• Continually threatens the person with physical harm or forces the person to witness physical harm inflicted on a loved one or pet
• Has unrealistic expectations of the person
• Specifically regarding children
• Involves the child in “adult issues”, such as separation
• Keeps the child at home in a role of subservient or surrogate parent

Neglect
Types of Neglect
• Substance Misuse
• Inadequate Supervision
• Environmental Neglect
• Lack of Health Care
• Threatened Harm
• Special Conditions
• Failure to Protect
• Death
Physical Indicators
• Consistent hunger
• Poor hygiene
• Inappropriate dress
• Consistent lack of supervision – especially in dangerous activities or for prolonged periods of time
• Unattended physical problems or medical needs
• Alcohol and/or drug abuse
• Abandonment

Behavioral Indicators
• Begging, stealing food
• Extended stays at school; early arrival, late departure OR
• Poor school attendance or school performance
• Constant fatigue, listlessness, falling asleep in class
• Delinquency (thefts)
• States there is no caretaker
• Demonstrates severe lack of attachment to other adults
• Poor social skills
• Is very demanding of affection or attention
• Has no understanding of basic hygiene

Financial Exploitation
Elder and Disabled Adults
Indicators of Exploitation
• Financial
• Banking activity
• Documents drawn for elder to sign
• Living situation not commensurate with elder’s estate
• Caregiver expresses concern over elder’s financial status, personal belongings, (jewelry, art, furs are missing)
Exploitation (con’t)
• Refusal to spend money on adult/elder
• Expresses gushy undying affection
• Lack of amenities
• Caretaker tries to isolate older adult from friends/family, maintains total control
• Promises lifelong care for deed/accounts
• Documents signed when elder cannot write
Indicator’s of Exploitation (con’t)
• Elder not given opportunity to speak without caregiver being present
• Caregiver exhibits high levels of indifference or anger towards adult
• Overmedication/sedation
Factors which contribute to Child Abuse/Neglect
• Socioeconomic status stressors
• Parental inability to cope (regardless of SES)
• Substance abuse/dependence
• Marital problems
• Job related stress
• Family violence
Factors which may contribute to Elder/ Disabled Adult Abuse/Neglect
• Chronic Self Neglect
• Dementia
• Illness
• Malnutrition
• Overmedication
• Depression
• Substance Abuse
• Poverty
• Isolation
REPORTING
ABUSE AND NEGLECT
The Law
• Florida (example)
• Chapter 415, Florida Statues provides a central abuse registry (1-800-96-ABUSE)
• Defines who must report abuse
• Assigns the Department of Children and Families all responsibility for receiving, investigating and acting on all reports
• Find your state (Adults)
• Find your state (Youth)
• Financial Abuse Reporting:
• Delaware, Missouri, Washington, Alabama, Indiana, Vermont
• Now includes financial advisors
Immunity from Liability and Confidentiality
• Florida Law Protection
• Reports made “IN GOOD FAITH” immune from civil or criminal charges
• Reporter’s name will not be released to anyone (other than DCF, State Attorney’s Office, or written consent of reporter)
• Encourages professionals to inform families that he/she is obligated by law to report
How to Report
• Call 1-800-96-ABUSE – 1-800-962-2873 24 hours a day 7 days a week
• Provide – Names, addresses of child, parent(s), guardian(s) or other persons responsible for child/adult’s welfare
• Provide child/adult age, race sex, sibling(s)
• Nature and extent of alleged abuse
• Identity of Abuser, if known
• Other information as applicable
• Child/Adult’s location at time of report
Summary
• There are mandatory reporting laws for children, elders and adults with certain disabilities.
• Laws regularly change, so it is important to regularly check your state’s statutes.
• Ensure that front desk staff, in addition to clinicians are aware of the signs of abuse.
• Remember that many things can cause individual symptoms, so it is important to thoroughly assess behaviors