Presentation is loading. Please wait.

Presentation is loading. Please wait.

MANDATORY CHILD ABUSE IDENTIFICATION & REPORTING

Similar presentations


Presentation on theme: "MANDATORY CHILD ABUSE IDENTIFICATION & REPORTING"— Presentation transcript:

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

2 OBJECTIVES 1. Define the terms child abuse, maltreatment, &neglect
2. List physical and behavioral indicators of abuse 3. Discuss the nurse’s role in reporting child abuse or suspected child abuse 4. Cite the steps of the reporting procedure At the end of this presentation participants will be able to:

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 INTRODUCTION & OVERVIEW
Rarely an isolated event 2005 899,00 children were victims of maltreatment 3.6 million cases referred to Child Protective Service (CPS) agencies Increased by approximately 5% since 2001 It is rarely an isolated event but indicative of overall family dynamic disturbances & dysfunction( inability of family to handle stressors)94.6 % is the recurrence rate reported by the child and welfare services review In the year 2005, 899,00 children were victims of maltreatment; 3.6 million cases were referred to Child Protective Service (CPS) agencies; the rate of children who received investigation or assessment increased from 43.2/ 1,000 in 2001 to 48.3/ 1000 children in increased approximately 5% Of these ¼ were determined to have been abuse or neglect; ¾ ( 75.3%) had no prior history

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 62.8 percent of victims experienced neglect, 16.6 % were physical abused; 9.3% were sexually abused;7.1% were psychologically maltreated; 2% were medically neglected;; 14.3 % experienced other forms of maltreatment such as abandonment, threats to harm the child; congenital drug addiction; 76.6 % of these fatalities were children young than 4 years old; Of this group, infant boys younger than 1 year old had the highest rate of fatalities( 17.3 % per 100,000 boys the same age)Infant girls had a rate of 14.5 % per 100,000; 13.4% of fatalities were children 4-7 yrs old; 4.0% ages 8-11 and 6.1% were yrs old

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) Statistics can be misleading as there is a 2 year lag time in collecting data from each State; Statistics are also misleading because many cases are not reported Fatalities due to abuse and neglect have a great potential for being underreported Some deaths “officially” labeled as accidents, child homicides, and/or Sudden Infant Death Syndrome (SIDS) might be attributed to child abuse or neglect Recent studies in Colorado and North Carolina have estimated that as many as 50 – 60 % of deaths resulting from abuse or neglect are not recorded (Crume, etal, 1999)

7 DOMESTIC VIOLENCE Who is at Risk
Children Domestic/ Intimate partner Elderly Who is at risk? : CHILDREN; DOMESTIC PARTNERS; The ELDERLY

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 The Federal Child Abuse Prevention and Treatment Act (CAPTA) provides a foundation for the States by defining child abuse and neglect AT MINIMUM as: - 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 or- An act or failure to act which presents an imminent risk of serious harm

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. New York defines an abused child as one whose parent or other person legally responsible for his or her care inflicts serious physical injury, creates a substantial risk of serious physical injury, or commits a sex offense against the child.

10 CHILD ABUSE DEFINITIONS
Maltreatment Neglect-Denial of basic necessities Parent or legal guardian’s failure to exercise a minimum degree of care In New York, the term maltreatment includes neglect( the failure to provide for a child’s basic needs) a child’s physical, mental or emotional condition has been impaired, or placed in imminent danger of impairment, by the parent or legal guardian’s failure to exercise a minimum degree of care; any excessive corporal punishment inflicted upon the child, abandoning child, or misusing alcohol or other drugs to the extent that the child was placed in imminent danger; 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
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

12 Forms of abuse Intimate partner abuse Physical abuse Maltreatment of
the elderly Physical abuse Emotional abuse Sexual abuse Most States recognize four major types of maltreatment; Abuse takes on many forms including physical and emotional abuse; sexual abuse, intimate partner abuse and maltreatment of the elderly

13 Physical abuse TYPES OF ABUSE Biting Shaking/Throwing Physical injury
Stabbing Choking Burning Use of weapons Sleep interference Physical injury Minor bruises Fractures Death Punching/beating Slapping/hitting Kicking is physical injury --ranging from minor bruises to severe fractures or death—as a result of punching, beating,slapping, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning or otherwise harming a child; Use of weapons; Sleep interference Such injury is considered abuse regardless of whether the caretaker intended to hurt the child .

14 PHYSICAL ABUSE: CHILD’S 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 Reports injury to teacher or others; Overly passive / extremely aggressive; Withdrawn behavior, fears going home; Frequently late or absent from school/ arrives too early and leaves too late; Wears long sleeves or other similar clothing to hide injuries Seeks attention from any adult; Apprehensive when other children cry

15 PHYSICAL ABUSE: CHILD’S PHYSICAL INDICATORS
Unexplained/ inadequately explained bruises, welts, burns, bites, lacerations, abrasions lesions or bruises at different stages of healing Lesions of distinctive patterns Unexplained or inadequately explained bruises, welts, burns, bites, lacerations, abrasions appearing most often on face, lips, mouth, back, buttocks and thighs Unexplained or accidental skin lesions or bruises on various parts of the body in different stages of healing Lesions of distinctive patterns—belt buckle, extension cord, hand print

16 PHYSICAL ABUSE: CHILD’S PHYSICAL INDICATORS
Unexplained burns Burns with distinctive patterns Choke marks Rope burns marks Unexplained or vaguely explained fractures Unexplained burns, such as cigarette burns on hands, feet, back, or buttocks, Burns that have distinctive patterns such as an iron or radiator; Burns reportedly due to accidental scalding from hot liquids or immersion in hot water Choke marks on neck, rope burns on wrists and ankles Unexplained or vaguely explained fractures

17 PHYSICAL ABUSE: PARENT’S BEHAVIORAL INDICATORS
Unrealistic expectations Inappropriate responses Discourages social contacts Discipline not age appropriate Delays medical care Misses clinic appointments Uses different medical facilities Unrealistic expectations of child; Inappropriate response to severity of injury; Discourages social contacts; Discipline inappropriate for child’s age; Takes an unusual amount of time to obtain medical care for the child; Misses clinic appointments Uses different medical facilities for each injury

18 PHYSICAL ABUSE: PARENT’S 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 May see the child as bad or evil; Gives different explanations to different staff for the same injury; Has a history of abuse as a child; May refuse consent for medical examination and diagnostic testing

19 SHAKEN BABY SYNDROME Violent shaking of a small infant
Brain stem edema and retinal hemorrhages Can produce brain hemorrhage and death SBS affects between children annually, approximately 25%-30% die from injuries according to the national center for injury prevention and control; Repeated violent shaking of a small infant by the arms or shoulders; Produces “whiplash” to the neck Can lead to brain stem edema and retinal hemorrhages; Severe retinal hemorrhages can produce brain hemorrhage and death

20 SHAKEN BABY SYNDROME Triggers: Frustrated caregiver Inconsolable child
Signs Decrease level of consciousness Irritability Lethargy/limpness Fixed pupils Bruises Fractures Triggers: Frustrated caregiver; Inconsolable child Signs: Decrease level of consciousness;; Irritability; Lethargy/limpness; Fixed pupils; Bruises on head/face; Fracture ribs, collarbone, long bones

21 SHAKEN BABY SYNDROME Confirm diagnosis CT and MRI X-rays Fundoscopy
Covert camcorders or “nanny cams” Damage is not readily apparent ; CT and MRI will confirm the diagnosis, x-rays, fundoscopy exam to diagnose retinal hemmorrhages Covert camcorders or “nanny cams” are used to videotape suspected babysitters

22 TYPES OF ABUSE: Sexual abuse
Indecent exposure Exploitation Non-consensual sex Denying reproductive freedom Include Fondling Penetration Incest Rape Sodomy Sexual abuse includes activities by a parent or caretaker such as fondling a child’s genitals, penetration, incest, rape, sodomy, indecent exposure and exploitation through prostitution or the production of pornographic materials;Non-consensual sex; Sexually degradation; Denying reproductive freedom

23 SEXUAL ABUSE Psychological, emotional after-effects Life time Effects
Substance abuse Sexual abuse, in particular, may not cause significant physical harm but the psychological and emotional after-effects can persist for a life time especially in the absence of prompt intervention ( have depression, guilt,, difficulty enjoying sexual relationships) Both men and women entering substance abuse treatment may have a history of being sexually or physically abused

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 Emotional- inattention to the child’s emotional needs, failure to provide psychological care, or permitting the child to use alcohol and other drugs Emotional abuse is a pattern of behavior that impairs a child’s emotional development or sense of self-worth. It can include constant criticism/disapproval, threats, or rejection as well as withholding love/ affection, support, or guidance;Jealousy; Discounting accomplishments

25 TYPES OF ABUSE: NEGLECT
Physical neglect Medical Neglect Unintentional Mistreatment Isolation Educational neglect Emotional Neglect Financial Exploitation Intimidation Physical neglect involves the failure to provide necessary food, shelter and appropriate supervision; Medical neglect:failure to provide necessary medical or mental health treatment, prescriptions not filled; no medical care;poor hygiene; malnourishment ; social isolation; UNINTENTIONAL MISTREATMENT:overwhelmed caregivers; ISOLATION:limiting outside involvement; public humiliation; monitoring all activity; Educational neglect:failure to educate a child or attend to special education needs; Emotional neglect:inattention to a child’s emotional needs, failure to provide psychological care, or permitting the child to use alcohol or other drugs; FINANCIAL EXPLOITATION ; withholding funds ; preventing someone from working ; careless spending ; restricting access & depleting savings; INTIMIDATION: Driving recklessly; Destroying property threats to children

26 TRIAD THEORY OF CHILD ABUSE
Most commonly theory why child abuse occurs (Helfer & Kempe, 1987) Triad of circumstances Potential of a parent Child seen as different Special event or circumstance Most commonly accepted theory why child abuse occurs (Helfer & Kempe, 1987); Proposes that a special triad of circumstances is present and includes: Potential of a parent to abuse a child (special parent); * A child is seen as different in some way by the parent ( special child); * A special event or circumstance brings about the abuse( special circumstances)

27 Special Parent Alcohol and drug abuse Mental illness
Lack of bonding or personal commitment to child by live-in “significant other” Mental illness Abused as child Lack knowledge of normal growth & development Socially isolated Negative or authoritarian parenting techniques “little joy” in parenthood 10 % HAVE HX OF MENTAL ILLNESS; abused as child; less self control than other parents; unfamiliar with normal growth/ development, unrealistic expectations of child; socially isolated, no support person available, overwhelmed by childrearing( little joy on parenthood); Excessive abuse of alcohol/drugs that removes inhibitions/ self control

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 Child more or less intelligent than other siblings or the parent him or herself; behavioral problems( attention deficit, autism); chronic illness from birth, born premature; Because seen as different good parent child relationship does not develop;

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 Viewed as “triggers” to abuse :Stress in family can include: lost of job,, illness, money, problems; Multiple or simultaneous stressful events including negative life events such as deaths, frequent moves, financial reversals, and poverty; To prevent abuse child may assume role reversal with parent, comfort parent to reduce stress because when parent upset they get hurt

30 ABUSE EFFECTS Long-term consequences Traumatic experience reenacted
PTSD 30% of abused children become abusive parents themselves Abuse of any type has long-term consequences; Abuse can lead to PTSD secondary to the traumatic experience be it physical or sexual (PTSD( post traumatic syndrome disorder) The traumatic experience is reenacted in a variety of interactions especially in play activities Adults who were abused tend to reenact the abuse with their children and other adults, one of the reasons abuse begets abuse; up to 30% of abused children many go on to become abusive parents themselves

31 PHYSICAL EFFECTS Neurological deficits Impaired growth and development
Developmental disabilities Undiagnosed medical conditions Death Impaired growth and development Failure to thrive Physical Signs Poor growth Failure to thrive- may be the earliest sign in infants infant falls below 5th percentile for weight and height on standard growth chart or falling percentile on growth chart ; Signs:Wasted buttock; Prominent rib cage; Protruding abdomen;Sparse hair growth;Pale; Decrease pulse, B/P, RR:Two types: organic cause (cardiac disease); non- organic-disturbance in parent-child relationship result in maternal insufficiency; form of neglect

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 EFFECTS OF ABUSE:More likely in the absence of therapeutic intervention; Manifest as disturbances in normal growth & development; Age-specific deficits are observable beginning in infancy: Type of effects include: social, physical, psychological SOCIAL:Children of abusers are less attached to the mother or primary caretaker than non-abused children; They tend to be less interactive with peers; They will display less social involvement and lower sophistication in play(Primitive play is often the FIRST SIGN OF DEVELOPMENTAL INCONSISTENCIES

33 SOCIAL EFFECTS Abused child Behavior Withdrawn/ overly aggressive
Inappropriate responses to peer distress Flat affect Lack compassion An abused child’s behavior can be withdrawn or aggressive. Angry; They can have inappropriate responses to peer distress including showing indifference, lack of compassion and caring, or teasing, taunting, belittling or bullying another child They may have a flat affect and be totally uncaring when a peer is injured during play

34 SOCIAL EFFECTS Abused children ( school- age) Conduct problems
Overly aggressive Less compliant with rules and regulations Suspension and expulsion from school Conduct problems at school are common; At school age they will be overly aggressive and less compliant with rules and regulations Their disturbed behavior can lead to suspension and expulsion from school

35 SOCIAL EFFECTS Abused children Run away from home Poor impulse control
Negative behavior Abused children often run away from home; Poor impulse control; Negative behavior can be a mechanism for gaining attention and/or punishing the abuser ; Such behavior can also be a cry for help

36 SOCIAL EFFECTS Abuse child Internalize problems
Act out feelings sexually Pubescent girls: unwanted pregnancy Some children will internalize their problems and start abusing alcohol and drugs Other children may act out their feelings sexually and are at risk for contracting STDs Pubescent girls can experience the added stress of an unwanted pregnancy

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 Abuse can lead to PTSD secondary to the traumatic experience be it physical or sexual (PTSD( post traumatic syndrome disorder) They are at high risk for developing oppositional-defiant disorder or conduct disorder related to poor impulse control

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 Reporting of any form of abuse is mandatory for health professionals(Who are Mandated reporters? handout) Nurses are mandatory reporters: Failure to report will result in penalties according to state statutes; Failure to report results in civil and criminal liability: in New York state is a “Class A” Misdemeanor subject to fines and possible imprisonment for up to one year; In some states, nurses and other health care professionals can lose their license; of victims physically abuse approximately 11.6 % were reported by medical staff; 24.3 by teachers, 23% by police or lawyers; Legal immunity granted even if reports prove false provided the nurse acted in good faith

39 NURSE ROLE Assess Victim’s safety PARAMOUNT importance
handled knowledgeably and sensitively Overall goal restoring, improving and maintaining optimal family functioning Victim’s safety PARAMOUNT importance Assessing possible cases must be handled knowledgeably and sensitively with the overall goal of restoring, improving and maintaining optimal family functioning The victim’s safety is of PARAMOUNT importance

40 NURSES ROLE Ensure privacy and confidentiality
Review options and referrals MUST REPORT DIRECTLY TO CPS Must submit written report within 48 hours Routinely screen for abuse Ask simple, direct questions Assess patient safety Document your findings Nurses are often the first to identify signs of abuse; Routinely screen for abuse:Listen to parent/care giver noting any discrepancies between their explanation and physical findings(Nurses must ask about scars, bruises and marks on a child’s body while keeping in mind that most injuries are the result of legitimate accidents; Once organic causes are ruled out and injuries remain suspicious the nurse can gradually introduce questions regarding disciplinary and parenting practice; “What do you do when your child misbehaves?”“Who else cares for the child?” ; Child :Bruises and marks must be questioned;Ask simple, direct questions “I notice you have a number of bruises. Did someone do this to you?” Assess patient safety” Is the patient afraid of someone and will that person be a hospital visitor? “Are there weapons at home? “”Are children involved? ‘Document your findings in chart:document facts, observations not interpretation( ”parent spoke loudly and slurred his words” not “ parent was intoxicated”), photo of physical abuse if appropriate can enhance testimony; Explanations of injuries;; Preserve evidence; Use direct quotes whenever possible; Avoid using the word“alleged” – it implies you disbelieve the patient (would you ever use the term “alleged heart attack”?); Ensure privacy and confidentiality ; Nurses need to be aware of specific protocols within the their health care settings; Review options and referrals;Contact the proper authorities ;Utilize social services; Hotline and shelter information ;Since 10/2007 NYS social services : MANDATORY REPORTER MUST REPORT SUSPECTED CHILD ABUSE ; MUST REPORT DIRECTLY TO CPS THEMSELVES THEN NOTIFY PERSON INCHAREGE OR DESINGATED AGENT IN INSTITUTION; Once oral report made; written report must be submitted within 48 hours; Once a case is reported to the Child Protective Service (CPS) Agency, a caseworker will be assigned to investigate the situation in depth in order to determine how best to protect the child, child can be held in protective custody for up to 72 hrs so social worker can determine if abuse has occurred, after 72 hrs, court determines if child can be returned to parent, or placed in safer location; In-depth interviewing and questioning will be done; reporter are not required to discuss with parent that child abuse suspected ( want to maintain open line of communication important to protect child and arrange counseling for parent)In most cases, nurses will be conveying their assessment findings to other members of the healthcare team, in particular, physicians and social workers

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 Each case must be considered on an individual basis: General indicators are helpful in form an opinion regarding type of abuse Assessment incorporates physical and behavioral indicators observed in the child AND behavioral indicators observed in the parent or caretaker

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 Suspected when a parent repeatedly brings a well child to a health care facility and reports signs and symptoms of illness in the child Reports can include such conditions as seizures, increased sleepiness, abdominal pain or blood in the urine The child will then be subjected to diagnostic procedures, often invasive, and medical treatment

43 MUNCHAUSEN SYNDROME BY PROXY
Give child laxatives Place own blood child’s urine sample to produce hematuria Child subjected to slow poisoning Holds child close to chest to suffocate, then calls 911 The parent may give the child laxatives to produce cramping abdominal pain and diarrhea The parent can place her own blood into the child’s urine sample to produce hematuria The child can also be subjected to slow poisoning with prescription drugs

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 Symptoms are not easily detected on physical exam Signs and symptoms are present only when abuser is providing care and disappear when care is provided by another person ----a classic sign of Munchausen by Proxy The parent usually has medical knowledge Appears to be a loving, caring and conscientious parent

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 The mother is using the child in a vicarious manner to obtain attention for herself She is may be neglected by her husband or may be a single mother with no family or outside support systems Diagnosis is made by video surveillance

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 An internet search of “ how to make methamphetamine brings up almost 2million results; schedule II stimulant related to amphetamine Short-term effects include enhanced mood and body movement,heighten sexual arousal; dangerous household ingredients: drain cleaner, battery acid, iodine, pool acid, antifreeze, red phosphorous( used in road flares), sodium hydroxide, lithium/sodium metal, hydrochloric acid, anhydrous ammonia( fertilizer) Children exposed through: intrauterine , breast milk, second hand smoke inhalation, ingestion, drug hidden in baby bottles, crib ; children prone to neglect, sexual abuse and physical abuse because drug impairs parent’s judgment, causes extreme mood swings, heighten sexual arousal ( child exposed to family and friends that come to home and are sex predictors) Meth labs expose child to possible fire, severe burn trauma, toxic smoke inhalation If child is suspected of exposure:DECONTAMINAT as per hospital policy; call poison control; medial history and physical exam( neurological exam, respiratory status, tenmperature) o2 saturation, Blood work( liver function- AST, ALT total bilirubin, alkaline phosphatase); kidney function( creatinine, BUN); CBC; electrolytes, urine toxicology and dipstick for blood;) refer to child protective services, developmental and mental screening,;permission for child’s medical records to be released to appropriate agencies

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 Can be culturally-based; Can also be part of a fanatical religious cult; Can be part of a Satanic worship ceremony Involves multiple perpetrators whose victims are abused over an extended period of time

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 Coining –southeast Asian practice to rid body of disease, coins used and rubbed length-wise on oiled skin with vigorous downward motion to back, chest, causing petechiae or purpura Cupping- used in Mexican, Russia, and Mexican-American cultures, used to” draw out poison” or other evil elements; place a container( bottle, jar) containing steam against skin, when heated air cools a vacuum is produced, drawing skin up and causing an ecchymotic area to form; where container was placed

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 Elder abuse Estimate up to two million abused Four types Physical
Psychological Financial Neglect by self or caregiver Researchers estimate that up to 2 million elderly abuse in US each year, expected to get worse as population become older, sicker and financial pressure strain personal relationships; four types; physical( slapping, pushing, punching, pinching, burning, sticking with an object) psychological(Care giver indifferent, angry toward elder, patient appears withdrawn, isolated, depressed, fearful) financial abuse( family, caregivers take control of elder’s resources either by misrepresentation, coercion, theft), neglect by self or caregiver( failure to meet nutritional and hygienic needs to manslaughter,suicide

51 SUMMARY & CONCLUSIONS

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

53 SUMMARY & CONCLUSIONS Children are our future Nurses
obliged to identify and report all cases of suspected child abuse Identify indicators of potential abuse Children are our future They need our protection, attention, guidance, nurturing and LOVE Nurses are obliged to identify and report all cases of suspected child abuse in all its forms to prevent further abuse Nurses must also conduct a thorough family assessment to identify indicators of potential abuse

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 Education of parents or caretakers is the first step toward breaking the cycle of abuse Nurses need to be familiar with support services and community resources such as “Parents Anonymous” Abusive parents and caretakers were very likely abused as children and will be in need of psychological treatment and healing

55 SUMMARY & CONCLUSIONS Nurses should: Maintain therapeutic relationship
Refrain from judging Compassion and understanding needed Increase Public awareness Nurses need to maintain a therapeutic relationship with parents or caretakers and must refrain from judging them These individuals need compassion and understanding throughout the helping process Public awareness has grown out of the suffering of our children---do not let their deaths be in vain

56 SUMMARY & CONCLUSIONS Primary goal of treatment
Restore family stability Parents or caretakers require support Parents can be reunited with their child Remember that the primary goal of treatment is to restore family stability and not to take the child away Parents or caretakers are going to require much support as they begin to face their own emotional pain The good news is that they can be reunited with their child if they comply with the treatment plan

57 APRIL IS CHILD ABUSE PREVENTION MONTH

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

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 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, 30-31 2005 05.htm. Chapter three and four. 2005


Download ppt "MANDATORY CHILD ABUSE IDENTIFICATION & REPORTING"

Similar presentations


Ads by Google