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. 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. 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
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. 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.
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. “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
19. 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.
20. 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
21. 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
31. Building A House
Carpet, Curtains, Furniture:
Cortex - logical thinking, impulse
control
Roof:
Limbic system - emotional
engagement
Walls:
Midbrain - movement
Foundation:
Brainstem - basic functions, safety
35. 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.
40. The long-term effects…
• Delay in normal development
• Fits (seizures)
• Blindness or eye damage
• Damage to the spinal cord
(paralysis)
• Permanent brain damage
41. The long-term effects…
• Cerebral palsy
• Deafness
• Severe learning difficulties
• Sever behavioural problems
• Persistent vegetative state
• Death
42. It is estimated that around
23 babies each year are
hospitalised because of
being shaken
50% die
43. 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
46. Support to Staff
Phone support
Educational support
Sharing of information
Screening support
47. 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
48. 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.
49. 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
50. NDHB STATS
3% Over 65 years old
8% Male
62% Maori
36% Under 25 years old
26% Pregnant
Approximately 67% Child in the home
51.
52. 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
54. 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?
55. 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
56. Screening Programme
Whangarei Emergency Department
Whangarei Maternity Services
Kaitaia General Ward
Kaitaia Accident and Medical
Kaitaia Maternity Services
57. 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
58. 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
59. 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
61. ….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
63. Impact on children who see or
hear their parent being abused
• Terrorised
• Scared
• Anxious
• Sensitive
• Blame
64. Impact of Family Violence
How do children feel?
• Powerless & helpless
• Guilty
• Angry
• Confused
• Afraid, Isolated & Insecure
• Dishonest, Embarrassed
• Overwhelmed
• Protective of siblings
65. 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
66. 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
67. Children imitate what they see and hear.
Those who witness violence learn the
pattern of using violence to control others
69. December 2008
16 month old Riley Justin
Osbourne died from sever
head injuries.
Keri Keri
Northland
70. 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.
71. 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.
72. 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.
73. 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.
74. 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.
75. 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.
76. August 8 2009
2 year old Jacqui Peterson – Davis died
from extensive injuries.
Kaitaia
Northland
77. 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
80. 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
81. Barriers to reporting
child abuse
• Minimisation
• Blurred boundaries
• Retribution
• Personal distress - Confidentiality
• Isolation
• Fear of being wrong
• Culture
82. 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”
84. 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
85. • 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.
86. 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
87. 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)
92. 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
93. Step 1
Recognition of possible abuse
• Signs & Symptoms
• History
• Identify any risk factors
• Form a belief or have suspicion
94. Sexual Abuse
• Recognition / Disclosure of SEXUAL
ABUSE in 0 – 17yrs
• Disclosure / Suspected Sexual Abuse
• Presenting Complaint / Concern
• Genital Injury
95. 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
96. 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
99. Step 3
Involve Family / Whanau
• As appropriate
• Consider child‟s safety first
• Also your own safety
100. 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
101. 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.
102. 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
103.
104. 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
105. 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
106. Step 5
Ensure safe plan for child / youth
• Admission plan
• Discharge plan
• Safety plan for the child and yourself.
107. 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.
