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2.2.9 Physical abuse

Last Modified: 17-Aug-2018 Review Date: 02-Jan-2017

Purpose

To guide child protection workers on the assessment and response to allegations of physical abuse.

Practice Requirements

  • The child protection worker must prioritise a child’s immediate safety needs, medical, physical and emotional wellbeing throughout the assessment.
  • The child protection worker must refer a child for immediate medical attention where:
    • the child appears to be suffering, or is complaining of pain, injury or bleeding, and/or
    • a head injury (e.g. caused by shaking) is suspected (child must be sent to an emergency health service).
  • If a child’s injuries are suspected to be non-accidental the child protection worker must:
    • interview the injured child without the parent(s) present
    • interview the child’s parent(s) separately including screening for family and domestic violence, and
    • interview each of the injured child’s siblings and other related children without the parent(s) present to gather further evidence and assess whether they are also at risk of harm.
  • The child protection worker must refer a report of alleged child physical abuse to the Western Australian Police (WA Police) if the worker considers that the degree of physical abuse warrants WA Police investigation.
  • When a child has experienced significant harm, is likely to have experienced significant harm, or is likely to experience significant harm in the future from physical abuse, the child protection worker must assess and respond to child protection concerns, irrespective of whether or not the parents’ cultural values and beliefs have contributed to their behaviour.
  • When a family comes to the attention of the Department of Communities, Child Protection and Family Support division with a concern about Female Genital Mutilation (FGM), child protection workers must engage with the family to address any safety concerns for the child and any other female siblings and refer the matter to childFIRST - Child Assessment and Investigation Team (CAIT) where appropriate.
  • Professional interpreters must be engaged where necessary to enable the full participation of the child, parents or any other person being interviewed. The interpreter must be a neutral person, not a family member, and as far as possible, culturally appropriate, particularly in relation to such matters as age, gender and group membership (refer to Language and Interpreter Information in related resources).
  • Assessment and safety planning for cases of FGM must involve a number of different government and non-government agencies, as well as professionals in different fields, such as health, education, police and community health. Child protection workers must clarify the role each agency will play in the case.
    Child protection workers must use community resources to establish links with other agencies, health professionals and community groups who can assist and support families affected by the practice of FGM. 
     

Fabricated or Induced Illness (FII)

  • Child protection workers should intake cases (either to initial inquiries or a safety and wellbeing assessment) where WA Health staff (including specialist paediatricians) have reported concerns that a child’s illness is fabricated or induced by a parent or carer.
  • Child protection workers must be mindful that there is a high risk that the parent may stop all contact with services once they are aware that professionals are assessing their behaviour towards the child.
  • If FII is suspected the team leader must convene an interagency meeting, including the referrer and any other relevant agencies to discuss the concerns and agree on an action plan before contacting or meeting with the parent/carer, unless urgent action is required to promote the child’s safety. Child protection workers must continue to work closely with relevant agencies during the assessment to review and update any action plans.

Procedures

  • Introduction
  • Purpose of assessing physical abuse
  • Considerations
  • Undertaking an assessment of physical abuse
  • Safety planning
  • Potential legal claims of children in the CEO's care
  • Introduction

    The procedure for assessing and responding to allegations of physical abuse should be read in conjunction with Chapter 2.2: Assessment and investigation processes.

    Child protection workers must be cognisant of the following information relevant to assessing whether an injury or illness is non-accidental:

    • Accidental and non-accidental injuries and conditions that may be mistaken for physical abuse (in related resources); and
    • Dynamics and context of serious/fatal injuries in babies and young children (in related resources).
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    Purpose of assessing physical abuse

    The purpose of the assessment is to identify whether the injury/illness is non-accidental by assessing whether the explanation for the injury is consistent and fits with the developmental abilities of the child.

    Child protection workers must consider the following when assessing whether an injury is non-accidental:

    • context of the injury and any previous injuries to the child, including who was present when the injury occurred
    • developmental abilities of the child relevant to the explanation provided for the injury
    • how parents respond to the child’s needs and behaviour, including medical treatment
    • what methods of behaviour management the parents use, and
    • if family and domestic violence is occurring or has occurred.
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    Considerations

    Scapegoating

    Child protection workers must be cognisant that child physical abuse can be targeted to one child in the family, referred to as the ‘scapegoat’. Scapegoating of a child can occur in varying degrees of severity. Children that are not scapegoated often experience emotional abuse because they witness and participate in the abuse of their sibling(s). Children that are not scapegoated often initially attempt to reach out to the child victim, but quickly learn that empathic behaviour is not a safe response. These children may develop empathy deficits as a way of protecting themselves from the effects of witnessing the process or effects of the abuse.

    Different roles parents can take in non-accidental injuries

    Child protection workers must be cognisant of the different roles parents can take in non-accidental injuries including:

    • one parent may have caused the injury without the knowledge of the other parent and does not wish this to be known
    • one parent may have caused the injury and, due to a mechanism of impaired memory or consciousness, genuinely may not remember doing so
    • both parents may have caused the injury and have agreed to conceal the cause or the event, or
    • one parent may have caused the injury and the other parent was complicit in the abuse.

    Family and domestic violence

    Child protection workers should consider whether the perpetrator’s behaviour may be affecting the adult victim’s ability to respond protectively towards the child, particularly where the adult victim may have been a bystander (witnessed the abuse without intervening) and/or acted to conceal the event.

    Alcohol and other drug misuse

    Child protection workers should consider whether parental alcohol/drugs/substance use is resulting in:

    • parental disinhibition and poor impulse control (e.g. poor tolerance for frustration, violent outbursts)
    • distorted parental perceptions and cognitions (e.g. lack of awareness of impact on the child, lack of empathy)
    • parental mood dysfunction/swings (ranging across depression, agitation, panic, manic to euphoria)
    • impact on parental memory (e.g. poor recall of behaviour and events – including violence – when intoxicated)
    • parental preoccupation with immediate adult needs (e.g. lack of attention to child’s needs and routine)
    • inadequate supervision of the child (e.g. child being left unsupervised by unsuitable others, or parent(s) unconscious)
    • parental preoccupation and dependence on drug/alcohol sub-culture (e.g. exposure of child to disinhibited, disturbed and criminal behaviour of a range of adults)
    • degeneration of parental self-care which affects care of the child and household, and
    • deliberate or accidental ingestion of parents’ drugs by child (e.g. through lack of supervision or intentionally administered to subdue the demands of the child).

    Mental health issues

    Child protection workers should consider whether parental mental health issues are resulting in:

    • lack of impulse control (frequent physical and verbal aggression)
    • psychiatric disorder
    • suicide attempts and self-harming
    • postnatal depression, or
    • personality disorders.

    Abusive head trauma (previously Shaken Baby Syndrome)

    Child protection workers should consider the additional vulnerability of babies and young children to abusive head trauma. Abusive head trauma refers to an injury to the skull or the intracranial contents (e.g. brain) due to inflicted blunt impact (child being hit in the head or having their head hit against something) and/or shaking. This type of injury has some of the most severe consequences for a child’s future wellbeing and is the leading cause of death amongst children who have been abused.

    Children aged less than six months are most vulnerable to abusive head trauma. The greatest risk period for babies is between six weeks and four months of age when their crying can be particularly problematic for parents.

    Excessive physical punishment

    It is lawful in Australia for parents, or those with parental responsibility, to use reasonable force to manage a child’s behaviour.  We only have a role when a parent uses excessive physical force, which results in or is likely to result in significant harm to a child.

    Child protection workers should consider the following factors to assess whether the use of physical punishment is reasonable:

    • age and development of the child
    • method of punishment
    • parent’s motive for punishing the child and the context
    • child’s developmental capacity to understand the use of physical punishment, and
    • harm caused to the child.
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    Undertaking an assessment of physical abuse

    Child protection workers must assess physical abuse through a variety tasks including:

    • medical treatment and assessments for the child, including consultation with health professionals
    • interviewing the child, siblings and other related children
    • interviewing parent(s) and other relevant individuals, and
    • reviewing the child’s, sibling’s and other related children’s medical history and previous contacts with us.

    Medical treatment, assessments and consultations

    The child protection worker must refer the child for a medical assessment for the purposes of:

    • providing treatment for the child’s injury or illness and recommendations for further medical treatment
    • documenting the current injury (written and photographic)
    • investigating other possible injuries or signs of previous injury
    • conducting an in depth health assessment including blood tests, bone scans and x-rays (where necessary), and
    • obtaining a medical opinion on the child’s injuries, including the degree to which the explanation/mechanism matches the injury. The term mechanism is used by health professionals to describe the circumstances of the injury.

    Medical evidence

    Child protection workers should consider all available medical evidence alongside evidence gathered through interviews, observation and other relevant information sources. In some cases, medical evidence may not be available or conclusive and child protection workers will need to use other sources of evidence.

    Consultation with Perth Children's Hospital, Child Protection Unit or other medical practitioner

    Child protection workers should consult with social workers and/or consultant paediatricians in the Perth Children's Hospital (PCH) Child Protection Unit in the following circumstances:

    • if the context of the child’s injury is uncertain and it is necessary to clarify whether a particular pattern or location of an injury is indicative of a non-accidental injury
    • to seek advice on whether further medical treatment or assessment is necessary for the child, and/or
    • where a second medical opinion is required. For example where a general practitioner has seen the child and is concerned that the child’s injuries may be non-accidental.

    Child protection workers should make an appointment for the child at the PCH Child Protection Unit before taking the child there. This will allow relevant health professionals to prepare for the child’s assessment appropriately so the child is not further traumatised by being kept waiting. The child should be taken to an emergency department if their injuries are serious. Where necessary the child will be referred to the PCH Child Protection Unit by emergency department/hospital staff.

    Interviewing the child, siblings and other related children

    Child protection workers must interview the child, siblings and other related children to gather information on:

    • child’s, siblings and other related children’s explanation of the injury, including who was present when the injury occurred
    • child’s, siblings and other related children’s feelings towards each parent and their experience of the child’s injury
    • whether the child, sibling or other related children have experienced similar injuries or illness and the circumstances of these injuries or illnesses
    • child, siblings and other related children’s experiences of being parented as an individual and as a group (child protection workers must be mindful of scapegoating)
    • how the child, siblings and other related children’s behaviour is managed, including any triggers for their parent’s being frustrated, angry or aggressive, and
    • any other information that may be relevant about the family.

    Interviewing parent(s) and other relevant individuals

    Child protection workers must interview the parent/carers separately and consider the following:

    • the explanation of the child’s injury
    • who was present when the child’s injury occurred
    • each parent/carer’s response to the child’s injury
    • each parent/carer’s and other’s feelings towards child, siblings and other related children
    • whether the child, siblings or other children have experienced similar injuries or illness, and the circumstances of these injuries or illnesses
    • each parent’s experience of parenting the child, siblings and other related children including any developmental issues
    • each parent’s method of managing the child, siblings and other related children’s behaviour, including any triggers for parental frustration and aggression, and
    • general parental stressors and resources.

    Interviewing other relevant individuals

    Child protection workers should consider interviewing any other individuals who may have relevant information, particularly those who have, or may have, witnessed the events that led to the child’s injuries.

    Reviewing the child, siblings and other related children’s medical history and previous contacts with us

    Child protection workers should review previous contacts with us and consider obtaining medical records to establish a chronology for the child, and assess whether this is a pattern of abuse, and/or whether it is escalating.

    The child protection worker should consider:

    • the medical history of the child, siblings and other related children including general health, developmental progress, previous injuries and hospitalisations, congenital conditions (conditions existing at or before birth) and chronic illnesses, and
    • whether there is a family medical history especially of bleeding, bone and metabolic or genetic disorders, which could explain the signs of physical harm.

    The following tasks may be involved in seeking a medical history:

    • contacting the child, sibling and other related children’s medical practitioner(s) for information on current and previous injuries
    • contacting WA Health services that the child, siblings and other related children may have attended for treatment of injuries (e.g. hospital Emergency Departments), and
    • obtaining a record of Medicare claims including the treating or referring doctor’s name and address, service item number and description and date of service. This may assist in establishing a pattern of abuse and/or identifying where child protection workers should seek medical information. For information on obtaining Medicare records, refer to Chapter 4.2: Information sharing between commonwealth agencies and the Department of Communities.

    When developing a chronology of events, child protection workers should focus on identifying and analysing:

    • the type of harm
    • source of harm
    • frequency, duration and severity of adult behaviours
    • impact on the child, and
    • effectiveness or impact of past interventions (what worked well and what didn’t work and why).

    If there is a sibling group, consider the above list for each child including the developmental trajectory. This should also include any unrelated children living in the family.

    Specific presentations of physical abuse

    Child protection workers should refer to more detailed guidance for assessing the following concerns in related resources:

    • Fabricated and Induced Illness in Children;
    • Female Genital Mutilation; and
    • Abuse linked to witchcraft and spirit possession.
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    Safety planning

    Child protection workers should refer to Casework Practice Manual Chapter 2.2: Signs of Safety - child protection practice framework for guidance on safety planning, including developing harm and/or danger statements and safety goals.

    The following considerations also apply to safety planning in relation to physical abuse:

    Unable to determine who is responsible for harm

    There may be circumstances where the child protection worker is unable to determine who is responsible for harm. In these circumstances safety planning and ongoing assessment must occur to actively manage this uncertainty.

    Considerations for safety planning

    Child protection workers may consider the following when developing a safety plan for allegations of physical abuse cases:

    • strategies to manage/reduce stress at trigger times, such as feeding, night waking, financial difficulties, unexpected illness, and
    • management and monitoring of medical care and treatment for injuries or illness.

    Parental behaviours that indicate strengths and when tested demonstrate safety

    Specific parental behaviours that indicate strengths and when tested demonstrate safety can include:

    • parents overcome their initial feelings of fear, suspicion or hostility to take part in discussions that focus on the concerns for the child
    • parents complete necessary tasks because they want to benefit the child and family, not because they have to
    • parents start to reflect on their thoughts, feelings and behaviours from the perspectives of others
    • parents are able to describe and reflect on how their behaviour has affected the child, siblings and other related children
    • parents are able to reflect on their contributions to complex situations, rather than blaming others for difficult situations
    • information and themes are retained and linked between meetings. Parents show evidence of continuing to reflect on the key concerns between sessions, rather than going over the same material from the same starting point each time
    • parents demonstrate greater awareness and insight into their own behaviour and an increased recognition of the need for change in relation to our concerns. For example, using agreed strategies to respond to behavioural triggers or altered/planned use of substances
    • parents become willing to participate constructively in joint sessions with each other, and with significant others (e.g. key extended family members) allowing for effective solutions to difficult issues
    • parents are increasingly able to receive and consider feedback on their behaviour and underlying attitudes and/or assumptions, and show that they have given the feedback serious consideration by demonstrating changed behaviours
    • parents take practical steps to reduce the impact of psychosocial stressors and increase the stability of their lifestyle
    • parents are open to a coordinated assessment that includes sharing relevant information with other service providers. They play an active role in identifying and discussing how to meet the child and family’s needs, and/or
    • parents focus on what they need to do to maintain behavioural changes and plan for how they will respond to any relapses, with the child’s safety as their primary consideration.
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    Potential legal claims of children in the CEO's care

    Where physical injury to a child in the CEO’s care constitutes or results from an offence (whether before or after the child comes into the CEO’s care), the child may be able to claim Criminal Injuries Compensation. For further information, refer to Chapter 3.3: Legal rights of children and caseworker responsibilities.

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