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Family violence may2010


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Family violence may2010

  1. 1. Child Protection Family Violence Awareness Northtec May 2010
  2. 2. Introductions Vickie Rotzel Child Protection Educator Rachel McKinnon Family Violence Coordinator Julie Hall Child Protection Educator
  3. 3. Personal Considerations • Some people may have personal experiences of family violence or child abuse • Participants will not be asked to relate personal experiences • If concerns do arise, please take some time out.
  4. 4. Statistics In 2009 – 2,855 children were physically abused – 1126 children were sexually abused – 15,615 children suffered from emotional abuse and / or neglect
  5. 5. Statistics Cont’d - 248 children ended up in hospital as a result of abuse - 3,456 children under 2yrs were abused, physically, emotionally, sexually, or neglected - 75 babies were hospitalised as a result of abuse - That is on average one every five days
  6. 6. What is Child Abuse?
  7. 7. Definitions Child Abuse: Child abuse is the “harming (whether physically, emotionally, or sexually), ill treatment, abuse, neglect or deprivation of any child or young person” (C,YP & F Amendment Act 1994 section 2)
  9. 9. Emotional /Psychological - is any act or omission that results in impairment psychological, social, intellectual and/or emotional functioning and development of a child or young person.
  10. 10. Emotional/Psychological Examples • Isolation • Rejection • Corruption • Demeaning • Exploitation • Ignoring • Terrorising • Anti-social • Illegal activities activities. • Exposure to Family Violence 10
  11. 11. Research shows emotional abuse or maltreatment are more prevalent and more destructive than other forms of abuse 11
  12. 12. Emotional Physical Sexual Neglect Emotional Abuse always happens when another form of maltreatment occurs, but may also occur without
  13. 13. NEGLECT 13
  14. 14. Neglect includes Medical Neglect - is any act or omission that results in impaired psychological functioning, injury, and/or development of a child or young person
  15. 15. “Neglect is a condition imposed upon a child by his caretaker, whereby he/she experiences avoidable stress and/or fails to receive what is needed for his/her physical, emotional and intellectual development” (Polanski) 15
  16. 16. Neglect Examples • Physical • Emotional • Medical • Educational • Supervisory • Abandonment
  17. 17. SEXUAL ABUSE 18
  18. 18. Child Sexual Abuse Involves a child in sexual activity that… • He/she does not fully comprehend • Child is not developmentally able to give consent • Violates the laws or social taboos of society • Children can be sexually abused by adults and other children.
  19. 19. Types of Abuse… Touching: Which can include: • Putting objects or body parts inside the genitalia of a child • Touching children‟s private parts for sexual pleasure
  20. 20. Types of Abuse Non-touching abuse: Which may include: • Sexual talk with a child for adult pleasure • Exposing genital “flashing” • Encouraging a child to play “show me: games • Masturbating in front of a child
  21. 21. SEXUAL ABUSE W T To Safeguard Children 22
  22. 22. PHYSICAL ABUSE 23
  23. 23. Physical - is any act that results in inflicted injury to a child or young person.
  24. 24. Physical Injury Examples • Bruises and welts • Malnutrition • Cuts • Dehydration • Abrasions • Poor hygiene • Scalds • Poisoning • Fractures • Suffocation • Head injuries • Failure to thrive • Abdominal injuries • Stomach pains • Genital injuries
  25. 25. Photos
  26. 26. Maslow’s Hierarchy of Needs
  27. 27. A Māori Health Model Te Whare Tapa Wha Mason Durie 1984
  28. 28. Building A House Carpet, Curtains, Furniture: Cortex - logical thinking, impulse control Roof: Limbic system - emotional engagement Walls: Midbrain - movement Foundation: Brainstem - basic functions, safety
  30. 30. Shaken Baby Syndrome - SBS (shaken baby syndrome) is a combination of serious injuries that can occur when an infant or young toddler is violently shaken.
  31. 31. Shaken Baby Syndrome • Subdural bleeding • Brain and/or spinal cord damage • Retinal bleeding • Rib fractures • Other fractures
  32. 32. The long-term effects… • Delay in normal development • Fits (seizures) • Blindness or eye damage • Damage to the spinal cord (paralysis) • Permanent brain damage
  33. 33. The long-term effects… • Cerebral palsy • Deafness • Severe learning difficulties • Sever behavioural problems • Persistent vegetative state • Death
  34. 34. It is estimated that around 23 babies each year are hospitalised because of being shaken 50% die
  35. 35. Who is responsible? Studies have shown that it is: 37% fathers 21% boyfriend/de facto 17.3% female care provider 12.6 % mother 12.1 % unknown •S.P. Starling
  37. 37. Family Violence 1. Support to staff 2. Screening Programme
  38. 38. Support to Staff Phone support Educational support Sharing of information Screening support
  39. 39. Family Violence Defined The New Zealand Domestic Violence Act 1995 defines Domestic Violence as violence against a person by any other person with whom that person is, or has been, in a domestic relationship with. The New Zealand Domestic Violence Act 1995 defines Violence as: (a) Physical abuse: (b) Sexual abuse: (c) Psychological abuse, including, but not limited to,--- (i) Intimidation: (ii) Harassment: (iii) Damage to property: (iv) Threats of physical abuse, sexual abuse, or psychological abuse
  40. 40. Family Violence Defined The New Zealand Domestic Violence Act 1995 defines “Domestic Relationship” as being a relationship with another person who: (a) Is a partner of the other person; or (b) Is a family member of the other person; or (c) Ordinarily shares a household with the other person; or (d) Has a close personal relationship with the other person.
  41. 41. What are we seeing?  Intimate Partner Violence both male and female victims and perpetrators  Staff victims and staff perpetrators  Financial and caregiver abuse of Older People  Concerns emerging with onset or progression of pregnancy  Teenage victims  Family trends  Repeat visits
  42. 42. NDHB STATS 3% Over 65 years old 8% Male 62% Maori 36% Under 25 years old 26% Pregnant Approximately 67% Child in the home
  43. 43. Family Violence & Children • Mum being assaulted while holding baby • Mum being assaulted & tried to get away – stumbled over child • Mum being assaulted and child intervened • Child treated abusively to coerce parent • Mum feels unable to access medical treatment for children • Dad feels unable to disclose his fears for children
  44. 44. DVD: SHE’LL BE SWEET 18 minutes
  45. 45. She’ll Be Sweet DVD 1 or 2 others who Making her like me a lot… I feel afraid - could go & find Banging on them – the roof of threatening to the car leave Knows her pin & You always can afford beer embarrass later yourself don’t you No need to work Defining roles in ever again/no house ie women longer sees cook and friends clean/telling her what to wear You were a pig to me all night – I cooked, help Dad says “what clean up! Why’d are you playing you let me make at” love to you then?
  46. 46. How else this may look… •Coercion by way of •Ability of victim self-harm of perpetrator to provide and the physical health accurate concerns that then arise information to for this person medical professional. •Inability to financially •Mental Health follow up with concerns arising prescriptions or from being further visits subjected to family violence •Perpetrator making the rules - •Practical effect Not allowing of being victim to access demographicall medical treatment y or physically – forbidding it – isolated i.e. this view inability to supported access health • Emotional disturbances •Not seeking medical care. •Teenagers - behavioural attention difficulties i.e. absconding, self harming
  47. 47. Screening Programme Whangarei Emergency Department Whangarei Maternity Services Kaitaia General Ward Kaitaia Accident and Medical Kaitaia Maternity Services
  48. 48. Who will be screened? • All females aged 16 years and older should be screened routinely • All females aged 12 to 15 years who present with signs and symptoms • Males aged 16 years and older who present with signs and symptoms
  49. 49. Screening • The subject of Family Violence is introduced • Permission is requested to ask questions • If permission is given then screening occurs • If permission not given then screening does not occur
  50. 50. What can you do in the meantime before the screening programme comes to you? Seek advice when needed (FVC/CPE) Be aware of the possibility Environment – Posters & Cards offer use of phone Imminent Threat – Notify Police Advise Family Violence Co-ordinator
  51. 51. “The Children are Watching” 3 minutes
  52. 52. ….FV encompasses a broad range of controlling behaviours, commonly of a physical, sexual and/or psychological nature and involves fear, intimidation and/or emotional deprivation… 61
  53. 53. More than 80,000 children are witnesses of Family Violence
  54. 54. Impact on children who see or hear their parent being abused • Terrorised • Scared • Anxious • Sensitive • Blame
  55. 55. Impact of Family Violence How do children feel? • Powerless & helpless • Guilty • Angry • Confused • Afraid, Isolated & Insecure • Dishonest, Embarrassed • Overwhelmed • Protective of siblings
  56. 56. Children who live with violence • Suffer mixed and confusing emotions • Harmed by constant stress and fear • Suffer from poor health • Depression • Low self esteem • Behaviour and speech • Eating and sleeping disorders • Attention seeking behaviours
  57. 57. A child growing up with abuse may… • Live in a constant state of arousal or dissociation • Have an over stimulated stress response • Be living in fear - expecting it • Respond to triggers in the environment e.g: Raised voice, door slamming • Demonstrate aggressive behaviour
  58. 58. Children imitate what they see and hear. Those who witness violence learn the pattern of using violence to control others
  59. 59. Why report child abuse? 16 Reasons Why
  60. 60. December 2008 16 month old Riley Justin Osbourne died from sever head injuries. Keri Keri Northland
  61. 61. 1 January 2009 11 week old Tahani Mohamed died of severe head injuries, her leg had been twisted until it had been broken. January 2009 A 4 month old little boy was severely shaken by his father causing permanent brain damage.
  62. 62. February 2009 3 years old Cherish Tahuri-Wright dies after suffering multiple injuries March 7 2009 5 week old Jay Rhis Ian te Koha Lock-Tate died after suffering severe head injuries.
  63. 63. May 14 2009 7 year old Duwayne Pailegutu died after being savagely beaten and scalded. June 5 2009 1 year old Trent Matthews was found dead after being assaulted.
  64. 64. June 15 2009 8 year old wheelchair bound boy suffered severe injuries, he was beaten, burned with cigarettes and starved. July 15 2009 14 month old punched twice in the head by father, child hospitalised for three days.
  65. 65. July 22 2009 4 month old boy suffered severe brain damage from being shaken. July 27 2009 14 month old Melissa Sale died from traumatic brain injury.
  66. 66. August 2 2009 4 month old baby boy suffered extensive head injuries causing long term damage August 20 2009 3 year old Kash McKinnon died from extensive head injuries.
  67. 67. August 8 2009 2 year old Jacqui Peterson – Davis died from extensive injuries. Kaitaia Northland
  68. 68. August 11 2009 17 month Tinisha Lee Walker suffered severe head injuries and long term damage, she will require 24 hour care for the rest of her life. Whangarei Northland
  69. 69. 26 September 2009 22 month old Hail-Sage McClutchie died of serious injuries.
  70. 70. So why report child abuse?
  71. 71. Because the child who is most at risk is the child who is already being abused. (Patrick Kelly) If you don’t intervene, no-one else will
  72. 72. Barriers to reporting child abuse • Minimisation • Blurred boundaries • Retribution • Personal distress - Confidentiality • Isolation • Fear of being wrong • Culture
  73. 73. Form a Belief “Any person who believes that a child or young person has been, or is likely to be, harmed (whether emotionally, physically, or sexually) ill treated, abused, neglected or deprived may report the matter to a social worker or the police”
  74. 74. Child Protection Policy 2010
  75. 75. CP Policy states staff will… • Be conversant with the Northland District Health Board policy. • Understand the referral and management of suspected abuse and neglect • Take action when child abuse is suspected or identified
  76. 76. • Attend initial mandatory training and regular updates provided by the Child Protection Educator (CPE). • It is mandatory for all Northland District Health Board staff to complete the available training through the CPE, to ensure safety at all times for both patients and staff in the area of Child Protection.
  77. 77. In any situation where there are concerns for a child‟s safety there must be consultation, as per flowchart which may result in mandatory reporting to CYFS and Police
  78. 78. Paramount The welfare and interests of the child or young person are the first and are of paramount consideration. This ranks higher than any other consideration. Therefore the child and young person must always be the primary concern. (section 6 CYPF Act 1989)
  79. 79. Paramouncy Principle Also applies to the viable fetus from 24 weeks gestation
  80. 80. The policy provides ALL NDHB staff With a framework to identify & manage actual and/or suspected child abuse & neglect
  81. 81. Child Protection Flow Chart 2010
  82. 82. STEP 1 Recognition of possible abuse - Signs & Symptoms - History CHILD - Identify any risk factors Important Phone - Form a belief or have suspicion PROTECTION Numbers FLOWCHART Recognition / Disclosure of SEXUAL ABUSE 0 – 17yrs Refer to the „Child Paediatrician on call - Disclosure / Suspected Sexual Abuse Protection Policy & 24hrs – via operator - Presenting Complaint / Concern Guidelines‟ for full details (09) 4304100 - Genital Injury on each step. Social Workers STEP 2 Consultation 8am – 4.30pm - Collegial Consultation e.g. Social Via operator (09) 4304100 Worker, Paediatrician, NDHB Child Protection Team - Cultural Support e.g. Takawaenga Child Protection - Plan of action to be made AFTER Educators HOURS – Contact On call 8am – 4.30pm Paediatrician 021 354 171 021 817 291 Consultation with Sexual Abuse Team Clinical Nurse Specialist Takawaenga 8am – 5pm REMEMBER IN 7.30am – 4pm 021 345 758 ALL CASES Via operator – ask for (09) 438 1018 Duty Takawaenga where child abuse After hours contact is suspected CYFS 24hrs Paediatrician on call 0508 FAMILY 24hrs – via operator a CYFS (0508 326 459) (09) 4304100 notification Family Violence STEP 3 Involve Family / Whanau MUST BE MADE Coordinators - As appropriate 8am – 4.30pm - Consider child‟s safety first 021 817 636 021 354 302 STEP 4 Referral to statutory authorities - Child, Youth & Family Service (CYFS) NZ Police 24hrs - Police Whangarei (09) 430 4500 - Complete NDHB referral form Kaikohe (09) 405 2960 Fax to – NDHB Child Protection Dargaville (09) 439 3400 Team (09) 4381019 Kaitaia (09) 408 6500 CYFS (09) 9141211 STEP 5 Ensure safe plan for child / youth - Admission plan - Discharge plan - Safety plan STEP 6 Documentation - Document thoroughly in client‟s notes - Copy of CYFS referral in client‟s notes Fax to – NDHB Child Protection Team (09) 4381019 Ensure staff safety - case debrief as required Sep 2009
  83. 83. Step 1 Recognition of possible abuse • Signs & Symptoms • History • Identify any risk factors • Form a belief or have suspicion
  84. 84. Sexual Abuse • Recognition / Disclosure of SEXUAL ABUSE in 0 – 17yrs • Disclosure / Suspected Sexual Abuse • Presenting Complaint / Concern • Genital Injury
  85. 85. Step 2 Consultation with who? • Collegial Consultation, • With your manager • Social Worker, Pediatrician, • NDHB Child Protection Team • Cultural Support e.g. Takawaenga • AFTER HOURS – Contact On call Paediatrician • Child, Youth and Family / Police
  86. 86. Case Study Case Study 17 year old presents to ED after November 2007 attempting to hang herself while 5 months pregnant Maternity antenatal contact. Staff and Social Worker have concerns May 2008 re Family Violence: CYF referral made and Family Violence system implemented ED child presented with October 2008 Bronchiolitis - discharged against medical advice ED child presented with head injury May 2009 suggestive of base of skull fracture Child presented to ICU with August 2009 fractured skull and transfer to Starship
  87. 87. If in doubt – Consult
  88. 88. If NOT in doubt – Consult
  89. 89. Step 3 Involve Family / Whanau • As appropriate • Consider child‟s safety first • Also your own safety
  90. 90. Involve the whanau In most cases whanau should be informed of CYF and Police referral This shows transparency and honesty to all working and involved with the whanau
  91. 91. When not to Involve the whanau If circumstances are dangerous to the child and / or the staff to inform the family of a referral, therefore, in these cases informing the whanau should be deferred until the appropriate time has been decided.
  92. 92. Step 4 Referral to Statutory Authorities CYF Notification Process When a notification is made to CYF, provide as much information as you can, and the reasons why it is believe a child is at risk of suffering abuse
  93. 93. Needs Risk of danger or harm • Food, clothing, • Clear signs of physical housing, medical and abuse health. • Disclosure of sexual • Supervision, parental abuse support • Serious or repeated • Education needs Family violence • Behavioural • Failure to thrive and Management serious neglect • Social support • Chaotic family dynamics causing emotional abuse to the child or young person
  94. 94. If a referral is made to CYF A copy needs to be placed in the child‟s notes And a copy to be faxed to – NDHB Child Protection Team (09) 4381019
  95. 95. Step 5 Ensure safe plan for child / youth • Admission plan • Discharge plan • Safety plan for the child and yourself.
  96. 96. Step 6 Documentation Documentation should be factual and accurate. If a disclosure is made by a child, document it verbatim. Include the date, time, signature and name (clearly) and your designation.
  97. 97. © CPS 2009 109