3018 wk 9 lec

Children and Young Persons (Care and Protection) Act 1998

Health professionals are mandatory reporters

• Children that are admitted to hospitals are more likely to be victims of child abuse/neglect

Commission for Children and Young People Act 1998

Maintaining systems to prevent reportable conduct by health workers

• Responsibility to also report colleagues who are not reporting children at risk, or themselves are harming / abusing children

• Can happen in work or outside of work

This can be managed with a Working with Children check + Police Check

Professional responsibilities of Nurses in child abuse/neglect

Goes beyond simple ‘legal’ obligations (i.e. mandatory reporting and providing info to Children’s court if called upon)

• Recognising and responding to vulnerabilities and needs of the child

• Collaborating with other health professionals and agencies to support and strengthen families

• Promote children’s health, safety, and wellbeing

What is Child abuse?

All types of physical and/or emotional ill-treatment

• Sexual abuse

• Neglect

• Negligence

• Exploitation that results in harm of the child’s health, trust, development etc.

Statistics on Child Abuse in Australia

• Nearly 1/3 have experienced physical abuse

• Nearly 40% have exposure to domestic violence

• 30% have experienced sexual abuse and emotional abuse

How much % of reports are made by medical and health personel?

11.6%

What is Risk of Significant Harm?

ROSH

The likelihood that a child or young person may suffer physical, psychological, or emotional harm as a result of abuse or neglect

When risk is high for SIGNIFICANT harm, this warrants a mandatory report irrespective of the family’s consent

What is Physical Abuse?

A child or young person sustains a non-accidental physical injury or is being treated in a way that has or is likely to cause injury

• May be inflicted by carer, parent, or other adult

• May also be happening between children

How to assess Physical Abuse? (bruising assessment)

TEN - 4 - FACESp

• Torso, Ears, Neck

• 4mo or less requires noting the presence of a bruise NO MATTER WHERE

• Frenulum (under / behind top lip), Angle of Jaw, Cheeks, Eyelids, Subconjuctivae (major red eye)

• Patterned Bruising

These locations of bruising are HIGHLY UNLIKELY to happen by accident

What is Sexual Abuse?

Sexual activity or behaviour that is imposed, or is likely to be imposed, on a child or young person.

Sexual Activity includes:

• Sexual acts

• Exposure to sexually explicit material, including inducing or coercing a child to engage or assist in these act

• Exposing a child to a situation where sexual abuse may occur

How to recognise signs of sexual abuse?

• Self destructive behaviours

• Genital trauma

• Trauma to breasts, buttocks, thighs

• Bite / burn marks

• Direct or indirect disclosure

• Disturbed sleep

• Noted changes in behaviour that may signal sexual abuse

• Sexualised behaviours

• Extensive knowledge surrounding sexual acts and topics

What is Psychological Harm?

Child’s psychological state has been, or is at risk of being harmed, because of a parent or carer’s attitudes and behaviours.

This could include:

• Domestic Violence

• Mental Health aspects

• Drug and alcohol use

• Criminal or corrupting behaviour

• Other exposure to traumatic events

Psychological Harm also includes the impairment, disturbance, or damage to the child or young person due to experiencing or witnessing such violence

What is Domestic Violence?

Any abuse behaviour used by a person in a relationship to gain or maintain control over their partner / ex-partner

• Can include a broad range of behaviours or actions to cause fear, physical, and/or psychological harm

  • (in acting out of their personal interest)

What is Neglect?

When a child’s basic needs are intentionally/unintentionally not met, or at risk of not being met

• Inevitably causing impact and adverse outcomes to the child’s health and wellbeing

Aspects of Child basic needs include:

• A safe shelter

• Nutrition

• Education

• Medical care

• Supervision

• Clothing

• Lack of acknowledgment from carer / parent

What is Medical Neglect?

When parents:

1) Failure to note and detect obvious signs of serious illness

2) Failure to follow a medical practitioner’s instructions once medical advice has been provided and a plan is set

What is Prenatal Harm?

Circumstances or behaviours of a parent that put a baby during pregnancy at risk of significant adverse health outcomes

• Acts are known or highly likely to compromise child’s safety, welfare, health, and wellbeing once born

Challenges of Nurses in responding to Child Abuse/Neglect

1) Rigid Systems, presence of hierarchies

e.g. Junior nurse consults with senior nurse seeking advice - who turns down the concern and influences the junior otherwise

2) Poor communication / collaboration

e.g. Poor communication from handover with info becoming lost, poor documentation surrounding child protection

3) Fear of making mistakes

e.g. Being wrong and possibly accused, scared of responsibility

4) Workload / burnout

Strengths of Nurses working within a System

1) Child centred practice

e.g. listen and understand to the child

2) Relational practice

e.g. promote trust, respect and compassion with the child and others

3) Cultural Safety

4) Reflective practice and learning

How to effectively evaluate risk

1) Work as a team

2) Use risk assessment tools

3) Always remain curious

4) Do not confront the perpetrator

5) Document all aspects of risk evaluation

How to respond to disclosures surrounding child abuse / neglect

• Stay calm

• Thank the person and acknowledge the courage of the person for informing you

• Ask open-ended questions to gather more info and accurately evaluate risk

• Avoid ‘leading’ questions

• DO NOT make promises that can’t be kept (e.g. confidentiality, since you have to be a mandatory reporter)

• Reassure them and inform them you are there to support them

Communicating Concerns with parents

• Comfort and validate emotions and feelings

• Allow parents to vent

• Remain non-judgemental and professional

• Be clear and honest about the next steps

• Grasp understanding of the experience from the side of the child and the parents/carer, and even potentially siblings

Interagency Collaboration for managing child abuse / neglect

A professional and legal requirement.

→ Best practice for the child’s health, safety, welfare, and wellbeing

Aboriginal Children and their risk of child abuse / neglect

8x more likely to be engaged with Child Protection services and be in out-of-home care compared to non-aboriginal children

What does this mean?

• Importance of Cultural Safety

• Reflective practice and learning

Things to consider when caring for a patient

These scenarios all involve considering the potential for child abuse / neglect