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1 MANDATORY CHILD ABUSE IDENTIFICATION & REPORTING P rof. Chinazo Echezona- Johnson, RNC, MSN, LL.B St. Pauls School of Nursing.

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Presentation on theme: "1 MANDATORY CHILD ABUSE IDENTIFICATION & REPORTING P rof. Chinazo Echezona- Johnson, RNC, MSN, LL.B St. Pauls School of Nursing."— Presentation transcript:

1 1 MANDATORY CHILD ABUSE IDENTIFICATION & REPORTING P rof. Chinazo Echezona- Johnson, RNC, MSN, LL.B St. Pauls School of Nursing

2 2 OBJECTIVES 1. Define the terms child abuse, maltreatment, &neglect 2. List physical and behavioral indicators of abuse 3. Discuss the nurses role in reporting child abuse or suspected child abuse 4. Cite the steps of the reporting procedure

3 3 INTRODUCTION & OVERVIEW Child abuse is devastating and tragic problem in our society today The abuse and maltreatment of children is against the law (CRIME)

4 4 INTRODUCTION & OVERVIEW Rarely an isolated event ,00 children were victims of maltreatment 3.6 million cases referred to Child Protective Service (CPS) agencies Increased by approximately 5% since 2001

5 5 INTRODUCTION & OVERVIEW 62.8%: neglect 16.6%: physical abuse 9.3%: sexual abuse 7.1%:psychological maltreatment 2%: medical maltreatment 14.3%: other types of maltreatment 76.6 % of fatalities children young than 4 years old Infant boys highest rate of fatalities

6 6 INTRODUCTION & OVERVIEW Statistics misleading 2 year lag time Some deaths officially labeled as accidents, might be attributed to child abuse or neglect 50 – 60 % of deaths resulting from abuse or neglect are not recorded (Crume, et al, 1999)

7 7 DOMESTIC VIOLENCE Who is at Risk Children Domestic/ Intimate partner Elderly

8 8 DEFINITIONS The Federal Child Abuse Prevention and Treatment Act (CAPTA) Child abuse and neglect: Any recent act or failure to act on the part of a parent or caretaker which results in death serious physical or emotional harm, sexual abuse or exploitation An act or failure to act which presents an imminent risk of serious harm

9 9 CHILD ABUSE DEFINITIONS New York - Abused child parent or person legally responsible for care inflicts serious physical injury creates a substantial risk of serious physical injury commits a sex offense against the child.

10 10 CHILD ABUSE DEFINITIONS Maltreatment Neglect-Denial of basic necessities Parent or legal guardians failure to exercise a minimum degree of care

11 Include: Not providing:sufficient food, clothing, shelter, or education proper supervision, guardianship or medical care; Excessive corporal punishment; Abandoning child Misusing alcohol or other drugs that the child placed in imminent danger Poverty or other financial inability to provide the above is NOT maltreatment 11 CHILD ABUSE DEFINITIONS

12 12 Forms of abuse Physical abuse Emotional abuse Sexual abuse Intimate partner abuse Maltreatment of the elderly

13 13 TYPES OF ABUSE Physical injury Minor bruises Fractures Death Punching/beating Slapping/hitting Kicking Biting Shaking/Throwing Stabbing Choking Burning Use of weapons Sleep interference Physical abuse

14 14 PHYSICAL ABUSE: CHILDS BEHAVIORAL INDICATORS Reports injury Overly passive / extremely aggressive Fears going home Frequently lateness and absence from school Wears clothing to hide injuries Seeks attention from any adult Apprehensive

15 15 PHYSICAL ABUSE: CHILDS PHYSICAL INDICATORS Unexplained/ inadequately explained bruises, welts, burns, bites, lacerations, abrasions lesions or bruises at different stages of healing Lesions of distinctive patterns

16 16 PHYSICAL ABUSE: CHILDS PHYSICAL INDICATORS Unexplained burns Burns with distinctive patterns Choke marks Rope burns marks Unexplained or vaguely explained fractures

17 17 PHYSICAL ABUSE: PARENTS BEHAVIORAL INDICATORS Unrealistic expectations Inappropriate responses Discourages social contacts Discipline not age appropriate Delays medical care Misses clinic appointments Uses different medical facilities

18 18 PHYSICAL ABUSE: PARENTS BEHAVIORAL INDICATORS Sees child as bad or evil Gives different explanations for the same injury History of abuse as a child Refuse consent for treatment

19 19 SHAKEN BABY SYNDROME Violent shaking of a small infant Brain stem edema and retinal hemorrhages Can produce brain hemorrhage and death

20 20 SHAKEN BABY SYNDROME Triggers: Frustrated caregiver Inconsolable child Signs Decrease level of consciousness Irritability Lethargy/limpne ss Fixed pupils Bruises Fractures

21 21 SHAKEN BABY SYNDROME Confirm diagnosis CT and MRI X-rays Fundoscopy Covert camcorders or nanny cams

22 22 TYPES OF ABUSE: Sexual abuse Include Fondling Penetrati on Incest Rape Sodomy Indecent exposure Exploitation Non- consensual sex Denying reproductive freedom

23 23 SEXUAL ABUSE Psychological, emotional after- effects Life time Effects Substance abuse

24 24 TYPES OF ABUSE Emotional abuse Behavior that impairs child sense of self worth Includes: Belittling Constant criticism Threats Rejection Withholding love, support, or guidance Jealousy Discounting accomplishments

25 25 TYPES OF ABUSE: NEGLECT Types Physical neglect Medical Neglect Unintentional Mistreatment Isolation Educational neglect Emotional Neglect Financial Exploitation Intimidation

26 26 TRIAD THEORY OF CHILD ABUSE Most commonly theory why child abuse occurs (Helfer & Kempe, 1987) Triad of circumstances 1.Potential of a parent 2.Child seen as different 3.Special event or circumstance

27 27 Special Parent Mental illness Abused as child Lack knowledge of normal growth & development Socially isolated Negative or authoritarian parenting techniques little joy in parenthood Alcohol and drug abuse Lack of bonding or personal commitment to child by live-in significant other

28 28 Special Child Child more or less intelligent than other siblings or the parent him/herself Unplanned pregnancy Congenital birth defects Mental disorders/behavioral problems including learning disabilities Chronic illness

29 29 SPECIAL CIRCUMSTANCES Triggers to abuse General family dysfunction Stress in the family system Multiple or simultaneous stressful events Lack of support systems or faulty support systems

30 30 ABUSE EFFECTS Long-term consequences Traumatic experience reenacted PTSD 30% of abused children become abusive parents themselves

31 31 PHYSICAL EFFECTS Impaired growth and development Failure to thrive Physical Signs Poor growth Neurological deficits Developmental disabilities Undiagnosed medical conditions Death

32 32 SOCIAL EFFECTS Abuse child Less attached to the mother/primary caretaker Less interactive with peers less social involvement Lower sophistication in play Primitive play

33 33 SOCIAL EFFECTS Abused child Behavior Withdrawn/ overly aggressive Inappropriate responses to peer distress Flat affect Lack compassion

34 34 SOCIAL EFFECTS Abused children ( school- age) Conduct problems Overly aggressive Less compliant with rules and regulations Suspension and expulsion from school

35 35 SOCIAL EFFECTS Abused children Run away from home Poor impulse control Negative behavior

36 36 SOCIAL EFFECTS Abuse child Internalize problems Act out feelings sexually Pubescent girls: unwanted pregnancy

37 37 PSYCHOLOGICAL EFFECTS Low self- esteem /poor self-concept Helplessness/ hopelessness Cognitive impairment Signs and symptoms of PTSD Substance abuse Oppositional- defiant and conduct disorder Depressive disorders Suicide

38 38 REPORTING Mandatory Failure to report Penalties according to state statutes New York state Class A Misdemeanor Subject to fines Possible imprisonment Can lose license results in civil and criminal liability Legal immunity granted even if reports prove false provided the nurse acted in good faith

39 39 NURSE ROLE Assess handled knowledgeably and sensitively Overall goal restoring, improving and maintaining optimal family functioning Victims safety PARAMOUNT importance

40 40 NURSES ROLE Routinely screen for abuse Ask simple, direct questions Assess patient safety Document your findings Ensure privacy and confidentiality Review options and referrals MUST REPORT DIRECTLY TO CPS Must submit written report within 48 hours

41 41 INDICATORS OF CHILD ABUSE Considered case on individual basis General indicators regarding type of abuse Assessment Physical & behavioral indicators observed in the child Behavioral indicators observed in the parent /caretaker

42 42 MUNCHAUSEN SYNDROME BY PROXY Suspected when parent repeatedly brings well child to a health care facility reports signs and symptoms of illness in the child child subjected to diagnostic procedures, often invasive, and medical treatment

43 43 MUNCHAUSEN SYNDROME BY PROXY Give child laxatives Place own blood childs urine sample to produce hematuria Child subjected to slow poisoning Holds child close to chest to suffocate, then calls 911

44 44 MUNCHAUSEN SYNDROME BY PROXY Symptoms Not easily detected Present only when abuser present Symptoms disappear when cared for by another person Classic sign Has medical knowledge Appears loving, caring and conscientious parent

45 45 MUNCHAUSEN SYNDROME BY PROXY Using child to obtain attention for self May be neglected Single parent No family or outside support systems Diagnosis: video surveillance

46 46 METHAMPHETAMINE HOME LABS Accessible Expose child to Physical abuse Sexual abuse Neglect Severe burn trauma Toxic smoke inhalation Decontaminate Call poison control Medical history/ physical O2 Sat Blood work Refer to child protective agency

47 47 RITUAL ABUSE Culturally-based Part of a fanatical religious cult/ a Satanic worship ceremony Involves multiple perpetrators Victims abused over an extended period of time

48 48 Folk remedies Suspicion of child abuse Used to treat physical conditions Coining Southeast Asian Practice Petechiae/ purpura on back or chest Cupping Russian, Mexican, Asian, Mexican-American Erythema, petechiae, burns

49 49 OTHER FORMS OF NEGLECT Medical - the failure to provide necessary medical or mental health treatment for the child Educational- the failure to educate the child or attend to special education needs

50 50 Elder abuse Estimate up to two million abused Four types Physical Psychological Financial Neglect by self or caregiver


52 52 REPORTING CHILD ABUSE WHAT………… to report? WHEN………… to report? WHO…………... will report? WHERE………... to report? HOW…………… to make a report?

53 53 SUMMARY & CONCLUSIONS Children are our future Nurses obliged to identify and report all cases of suspected child abuse Identify indicators of potential abuse

54 54 SUMMARY & CONCLUSIONS Nurses should do: Education parents/caretakers Be familiar with support services and community resources Abusive parents and caretakers very likely abused as children Need psychological treatment and healing

55 55 SUMMARY & CONCLUSIONS Nurses should: Maintain therapeutic relationship Refrain from judging Compassion and understanding needed Increase Public awareness

56 56 SUMMARY & CONCLUSIONS Primary goal of treatment Restore family stability Parents or caretakers require support Parents can be reunited with their child


58 58 If you see a child without a smile…give him or her one of yours!!!!

59 59 REFERENCES Besharov, D.J. (1990). Recognizing child abuse: A guide for the concerned. New York: The Free Press (division of Simon & Shuster). Bonner, B. L., Logue, M. B. & Kees, M. (2003). Child maltreatment. In M.C. Roberts (ED.) Handbook of pediatric psychology ( 3rd ed., pp ). New York: The Guilford Press. Crume, T. etal. (2002). Underascertainment of child maltreatment fatalities by death certificates, Pediatrics. 110 (2). Goldman, J., Salus, M.K., Wolcott, D. & Kennedy, K.Y. (2003). A coordinated response to child abuse and neglect: The foundation for practice. Fairfax, VA: Caliber Associates.* * published under contract number HHS

60 60 REFERENCES Helfer, R.E. & Kempe, R.S. (1987). The battered child. Chicago: University of Chicago Press. Spader, C., RN. (2008) Cooking Up Trouble. Nursing Spectrum, February 11, policies/state/index.cfm?event=stateStatutes. policies/state/index.cfm?event=stateStatutes htm 05.htm. Chapter three and four. 2005

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