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2.2.11 Physical abuse

Last Modified: 04-Sep-2019 Review Date: 02-Jan-2017

Purpose

To provide guidance to child protection workers (CPWs) on assessing and responding to allegations of physical abuse.

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

Practice Requirements
  • You must consider the following when assessing whether an injury is non-accidental:

    • the context of the injury and any previous injuries to the child,  and who was present when the injury occurred
    • the child's developmental abilities  in relation to the explanation given for the injury
    • how the parents respond to their child's needs and behaviour
    • whether the parents accessed medical treatment for the child
    • what methods of behaviour management the parents use, and
    • if family and domestic violence is occurring or has occurred.
  • You must assess physical abuse through a variety tasks including:

    • assessing medical treatments and assessments for the child
    • consulting with health professionals
    • interviewing the child, siblings and other related children
    • interviewing parents and other relevant individuals, and
    • reviewing the child's, sibling's and other related children's medical history and previous contacts with the Department.

You must send a child for immediate medical attention at an emergency health service 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. 

If you believe that the degree of physical abuse warrants a WA Police investigation, you must report to WA Police. 

 

Procedures

  • Overview
  • Considerations
  • Scapegoating
  • Different roles parents take in non-accidental injuries
  • Family and domestic violence
  • Alcohol and other drug misuse
  • Mental health issues
  • Abusive Head Trauma (Shaken Baby Syndrome)
  • Excessive physical punishment
  • Assessment
  • Medical treatment, assessments and consultations
  • Interviewing the child, siblings and other related children
  • Specific presentations of physical abuse
  • Female Genital Cutting/Mutilation
  • Fabricated or Induced Illness in children
  • Abuse linked to witchcraft and spirit possession
  • Safety planning
  • Potential legal claims of children in the CEO's care
  • Overview

    The procedure for assessing and responding to allegations of physical abuse should be read in conjunction with Chapter 2.2 entries: Conducting a Child Safety Investigation and High risk infants

    Physical abuse occurs when a child has experienced severe and/or persistent ill-treatment through behaviours such as beating, shaking, inappropriate administration of alcohol and drugs, attempted suffocation or excessive discipline or excessive physical punishment. 

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

    You must prioritise the child's immediate safety needs, medical, physical and emotional wellbeing throughout the assessment.

     

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    Considerations

    Child protection workers must consider possibilities below and ask parents,  their network of people. and professionals questions that will elicit information about which of these situations are most likely.  

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    Scapegoating

    Child physical abuse can be targeted to one child in the family, referred to as the 'scapegoat'. Scapegoating is a serious family dysfunctional problem where one child is often blamed, picked on, shamed and abused.

    Scapegoating of a child can occur in varying degrees of severity. The scapegoated child feels abandoned, rejected, bullied, ostracised and disfavoured over another sibling.

    Children that are not scapegoated often experience emotional abuse because they witness and participate in the abuse of their siblings. The non-scapegoated children often initially attempt to reach out to the child victim, but quickly learn that empathic behaviour is not a safe response.

    These children may experience emotional trauma through witnessing or participating in the abuse of their sibling and may develop empathy deficits as a way to protect themselves from the effects of witnessing the process or effects of the abuse.

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    Different roles parents take in non-accidental injuries

    Parents can take different roles in non-accidental injuries:

    • 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.

     You should also be aware of Fabricated or Induced Illness (FII).  This occurs when a parent or carer deliberately causes frequent physical or psychological harm to a child to garner medical attention.  For more information refer to the section 'Fabricated or Induced Illness in children' below. 

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    Family and domestic violence

    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. 

    It is important to be aware that adult victims of family domestic violence may be less likely to report abuse caused by their perpetrator              

    Map the perpetrator's pattern of behaviour so that the physical abuse is considered within that context.  For more information on family and domestic violence, refer to Chapter 2.3 Assessing Emotional Abuse – Family and Domestic Violence

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    Alcohol and other drug misuse

     

    Parental substance misuse frequently co-occurs with multiple complex problems such as FDV and mental health issues. Some children are able to experience supportive and nurturing environments despite the presence of these parental problems. 

    However, prolonged alcohol and other substance misuse can compromise parents' ability to consistently provide a stable, nurturing and safe environment for children. This can result in children being at heightened risk of abuse and neglect. It is also a key risk factor for physical abuse.

    Consider the impacts of parental alcohol, drugs, substance misuse and risks to children such as:

    • parental dis-inhibition and poor impulse control (e.g. poor tolerance for frustration, violent outbursts)

    • difficulty regulating emotions (e.g. fluctuating mood swings from depression, manic to euphoria)

    • mental and cognitive impairment (e.g. poor recall of behaviour and events including violence, lack of awareness of impact on the child, lack of empathy for the child)

    • 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 with unsuitable others, or parents unconscious)

    • parental preoccupation and substance dependence may expose child to unsafe adults and activities (e.g. exposure of child to criminal behaviour such as drug use and/or dealing, drug overdose)

    • diminished parental responsibilities and difficulty maintaining basic household routines (e.g. preparing meals, doing laundry and ensuring the child attends school), 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).

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    Mental health issues

    ​Many children whose parents or carers have mental health issues go on to achieve their full potential in life. However, there is a risk that parental mental health problems can have a negative impact on children when mental illness is not adequately managed and causes problems across a range of domains, including parenting capacity and associated impacts on the child.

    The risks to children are greater when parental mental health problems co-occur / exist alongside domestic violence and parental alcohol and substance misuse.

    Consider whether parental mental health issues are resulting in:

    • lack of impulse control (frequent physical and verbal aggression)
    • a parent or carer deliberately causing physical or psychological symptoms on the child (e.g. Fabricated or Induced Illness by a carer), and/or
    • suicide attempts and self-harming.
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    Abusive Head Trauma (Shaken Baby Syndrome)

    ​Abusive Head Trauma (AHT) 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. Consider the additional vulnerability of babies and young children to AHT.

    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 AHT. The greatest risk period for babies is between six weeks and four months of age when the frequency of their crying increases. Shaking a baby vigorously causes the fragile brain to bounce back and forth against the sides of the skull and can result in serious brain trauma.

    Refer to Chapter 2.2 High Risk Infants for more information about how to investigate harm to infants.

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    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. 

    The Department only has a role when a parent uses excessive physical force, which results in, or is likely to result in significant harm to a child.

    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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    Assessment

    ​You must assess physical abuse through a variety tasks including:

    • assessing medical treatments and assessments for the child
    • consultation with health professionals
    • interviewing the child, siblings and other related children
    • interviewing parents and other relevant individuals, and
    • reviewing the child's, sibling's and other related children's medical history and previous contacts with the Department.

     

    You must refer a report of alleged child physical abuse to WA Police if you consider that the degree of physical abuse warrants a WA Police investigation.

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    Medical treatment, assessments and consultations

    ​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

    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 you will need to use other sources of evidence.

    Credible evidence can include:

    • verbal statements
    • medical evidence
    • photographic evidence
    • observations, including behavioural indicators
    • relevant information from other agencies
    • hearsay evidence that has been corroborated, and/or
    • witness to the harm.

    1.  Consult with social workers and/or consultant paediatricians  in the Perth Children's Hospital Child Protection Unit (PCHCPU) in metropolitan areas or the local medical service (GP or hospital) in regional areas 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 e.g. where a general practitioner has seen the child and is concerned that the child's injuries may be non-accidental.

    2.  Make an appointment for the child at the PCHCPU or local medical service 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.

    3.  Take the child to an emergency department if their injuries are serious. Where necessary the child will be referred to the PCH CPU by emergency department/hospital staff.

    For detailed information on medical assessments in both metropolitan and regional areas, refer to the section 'The medical assessment' in Chapter 2.2 High Risk Infants. 

    Information in this section for both metropolitan and regional and remote areas applies to children of all ages. 

     

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    Interviewing the child, siblings and other related children

    The purpose of the interview is 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 (you 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.

    For further information, refer to the sections 'Child assessment interview – planning and considerations' and 'Undertaking a child assessment interview' in Chapter 2.2 Conducting a Child Safety Investigation.

    Interviewing parents and other relevant individuals

    It is best practice to conduct separate interviews with each parent or carer, and with the child.

    In your interviews 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 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.

    Child protection workers should also be aware of delays in parents seeking medical assessment of injuries.

    It is important to note that assessments and responses are irrespective of whether or not the child's parents' cultural values and beliefs have contributed to their behaviour.

    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 the Department

    Review previous contacts with the Department and consider obtaining medical records to establish a chronology for the child to assess whether this is a pattern of abuse, and/or whether it is escalating.

    Consider the medical histories of the child, siblings and other related children and note:

    • 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 practitioners 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 with 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 the section 'Medicare' in Chapter 4.2 Working with other agencies – Memoranda of Understanding and information sharing

    When developing a chronology of events, 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.

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    Specific presentations of physical abuse

    ​On occasion, you may have concerns about the following forms of physical abuse. 

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    Female Genital Cutting/Mutilation

    Where you have concerns that a child may be at risk of FGC/M you must discuss with your team leader, seek further information in the Australian Institute of Family Studies for resources and research on Female Genital Mutilation and the Department's SharePoint CaLD Resource Library, and request a consult with the Professional Practice Unit.

    Female Genital Cutting/Mutilation (FGC/M) is a form of physical abuse which can have significant emotional and psychological impacts, and serious lifelong medical consequences. It includes all procedures involving the partial or total removal of the external female genitalia or any other injury to the female genital organs for non-medical reasons.  

    The World Health Organisation classifies Female Genital Cutting/Mutilation into four types:

                            Type 1

    Clitoridectomy or circumcision - partial or total removal of the clitoris and /or prepuce

                            Type 11

    Excision – partial or total removal of the clitoris and the inner labia minora with or without the labia majora (larger outer lips)

                            Type 111

    Infibulation – "sewn closed" – removal of external genitalia and stitching the vaginal opening. A small hole 2-3mm is left open for urine and menstrual flow. Type III is also performed on women to re-close the vagina after childbirth

                            Type IV

    Type IV – other harmful procedures to the female genitalia such as symbolic pricking, piercing, or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterisation by burning of the clitoris and surrounding tissue; or scraping of the tissue surrounding the vagina.

     

    There is a correlation between FGC/M and family and domestic violence and forced or arranged marriages.  If FGC/M is prevalent, you should screen for FDV.

    Female Genital Cutting/Mutilation is practiced in across the world.  The resource Traditional terms for Female Genital Mutilation lists over forty countries where FGC/M is practiced.  

    Girls most at risk of FGC/M in Australia are from Kenyan, Somali, Sudanese, Sierra Leonean, Egyptian and Eritrean communities. Non-African communities that practice FGM include Yemeni, Afghani, Kurdish, Indonesian and Pakistani.

    The procedure may be carried out on girls of any age but is most commonly performed before puberty in girls between the ages of five and eight years.

    You must use interpreters whenever required, in order to clearly communicate with children and their family. For more information Language and Interpreter Information (also in related resources).

    Female Genital Cutting/Mutilation is not a religious practice. It is practiced by people from many religions, including Christianity, Islam and other traditional religions. Neither the Bible or the Koran support FGC/M. It is an ancient cultural practice which predates Christianity and Islam.

    For more information refer to Female Genital Cutting/Mutilation: A Guide for Health Professionals.    

    The 2019 Australian Institute of Family Studies (AIFS) report Towards estimating the prevalence of FGC/M in Australia estimates that 53,000 girls and women may have undergone FGM in Australia. 

    The AIFS also has additional research and resources on Female Genital Mutilation.

    Female Genital Cutting/Mutilation in WA

    Female Genital Cutting/Mutilation is a criminal offence in WA when it is practiced for cultural or non-medical reasons. A person who takes a child from the state or arranges for a child to be taken from the state with the intention of subjecting the child to FGC/M can also be charged with a criminal offence under s.306 Criminal Code Act Compilation Act 1913.

    Trauma resulting from FGC/M

    Female Genital Cutting/Mutilation can have ongoing psychological issues related to trauma, serious long term health consequences, including death.

    Short-term consequences include severe pain and bleeding, shock, genital swelling and infection, difficulty urinating and acute urinary retention.

    In the long-term women can suffer chronic pain and infection, painful sexual intercourse, infection, genital cysts and abscesses, difficulties with periods, fertility problems and pregnancy and childbirth complications.

    Risk factors

    Usually a girl's parents or her extended family are responsible for arranging FGC/M.  A combination of the following factors or behaviours may indicate that a female child is at immediate risk of FGC/M:

    • the family comes from a country or community (e.g. Somalia) that practices FGC/M
    • the child's mother has undergone FGC/M
    • the child's sister/s has already undergone FGC/M
    • a close female relative of the child (e.g. cousin) has undergone FGC/M
    • parents tell another person (e.g. a teacher) that they or a relative have plans to take the child out of the country for a prolonged period to a country where FGC/M is prevalent
    • the child talks about taking a long holiday in her country of origin or another country where FGC/M is prevalent, including African countries, some Asian countries (e.g. Indonesia) and Middle Eastern countries
    • the child discloses to a teacher or another family member that she is to have a 'special procedure' or to attend a special occasion, particularly where it is overseas
    • the child seems scared or nervous about an upcoming family holiday overseas
    • another adult overhears reference to FGC/M in conversation, for example a teacher may overhear a child telling another child about it
    • the child may request help from a teacher or another adult, and/or
    • there is evidence of family disputes or conflict, family and domestic violence or running away from home, particularly with older children.

     

    Communities that practice FGC/M tend to use local names and may not identify with the term 'mutilation' or 'cutting'.  When engaging with a community or individual in sensitive discussions, be the naïve enquirer and ask what the local word for FGC/M is, and if they would prefer to use that word. 

    This list provides traditional terms for FGC/M in different countries.

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    Fabricated or Induced Illness in children

    Fabricated or Induced Illness in Children (FII) is a form of physical and/or emotional abuse.  It refers to a parent or carer who deliberately causes frequent physical or psychological harm on the child's health and reports concerns to garner medical attention.  This was formerly known as Munchausen by Proxy and is also referred to now as Factitious Disorder Imposed Upon Another. 

    Erroneous verbal reports (with or without the intention to deceive) are more common than direct methods to deceive, such as falsifying records or inducing signs of illness.  The reports may occur over many years and not progress to inducing illness in a child.  These cases are more difficult to identify and assess than cases involving deliberately induced illness in a child (Induction). Induction produces direct and often serious physical harm to a child or children.

    Fabricated or Induced Illness in children affects the entire family system.  Signs to look out for:
    • Child has a repeated or unusual illness and no reason can be found.
    • Child does not get better even with treatment.
    • Symptoms occur or get worse when main carer is with the child.
    • The other parent/carer is not involved in caring of the child.
    • Child gets better when not with the carer.      

     

    Fabricated or Induced Illness in children affects the entire family system and you should consider the safety issues for each child in the family. You should be mindful that more than one child may be affected and that another child in the family could become the focus of the parent's behaviour if the original child is no longer available in the sick role.

    Keeping their actions towards the child 'secret/undetected' is a high priority for the parent, particularly in cases of induced illness.

    A multi-agency approach is essential in FII in children.

    The following impacts are associated with FII in children:

    Physical health - The child may experience:

    • physical harm related to repeated investigations, procedures, treatments and periods of hospital admission which in retrospect are found to be unnecessary, and/or
    • physical harm and child death particularly related to illness induction.

    Daily life and functioning - The child may experience:

    • low or interrupted school attendance and education
    • limited 'normal' activities such as sport or after-school activities
    • assumption of a sick role with aids (e.g. wheelchairs); and/or
    • social isolation.

    Emotional - The child may:

    • develop a distorted view of their health leading them to become anxious and preoccupied with their state of health and vulnerability
    • become very confused if they are subjected to repeated examinations, investigations and treatments despite not feeling ill
    • become entrapped into colluding with the parent to erroneously report the illness
    • be traumatised by repeated investigations, procedures, treatments and periods of hospital admission
    • have distorted relationships with other siblings and family members, and/or
    • develop a fictitious or somatic symptom disorder, particularly where FII continues in adolescence. This disorder is a form of mental illness in which the person experiences symptoms (e.g. extreme pains) that are inconsistent with or cannot be fully explained by an underlying general medical or neurologic condition.

    Examples of harmful behaviours by the parent include:

    • deliberately inducing symptoms by administering medication or other substances (this includes non-accidental poisoning), or by intentional suffocation
    • obtaining specialist treatments or equipment for children that are not required
    • falsifying test results and observation charts
    • interfering with treatments by over-dosing, not administering medication or interfering with medical equipment such as infusion lines
    • alleging unfounded psychological illness in a child; and/or
    • claiming the child has symptoms that are unverifiable unless directly observed, such as pain, frequent passing of urine, vomiting or fits, resulting in unnecessary investigations and treatments.

    The types of conditions that the parent is most likely to present the child with include those that:

    • rely on history e.g. apnoea, headaches
    • are episodic with periods of normality in between, e.g. seizures
    • are easy to falsify, e.g. fever, blood on a nappy, blood in urine
    • unexplained vomiting and nausea
    • failure to thrive
    • neuro-muscular disorders, and
    • multiple sexual assault allegations without substance.

    Motivations and mechanisms that explain FII in children include:

    • extreme parental anxiety leading to exaggeration of symptoms and signs, encouraging the health practitioner to rule out or identify any treatable disorder
    • seeking medical attention to confirm a false belief about the child's health
    • seeking attention, including social contact
    • deflection of blame for child's difficulties (often behavioural)
    • maintain closeness to the child (particularly where the child's 'illness' results in the child staying home a lot), and/or
    • material gain (e.g. a welfare benefit).

    Research has identified the following characteristics in parents and carers who fabricate or induce illness in their children:

    • in 76% of cases female parents or carers were most likely to fabricate or induce illness in their children
    • high rates of past trauma including child abuse, fabricated or induced illness in childhood and/or significant loss and grief in female parents
    • 7% of cases where fathers who fabricated or induced illness in their children were often found to either have a factious illness or somatoform disorder
    • grandmothers can sometimes support the female parent in their behaviour or may fabricate or induce the child's illness when performing a parental role, and
    • 14-30% of parents or carers had professional ties to the health-care profession.

    The following indicators are associated with FII of children:

    • the child has repeated and unexplained illnesses or symptoms
    • the child's reported symptoms only occur in the presence of the parent
    • the parent reports symptoms or observed signs that are not explained by any other medical condition
    • physical examinations and results of investigations do not explain symptoms reported by the parent
    • the child has an inexplicably poor response to prescribed medication or other treatment
    • acute symptoms are only observed in the presence of a parent
    • the child's daily life is limited beyond what is expected due to a disorder from which the child is expected to suffer e.g. school non-attendance or unnecessary special aids
    • objective evidence of fabrication – reported events by the parent are biologically implausible
    • while the parent stays with the child all the time in hospital and attends to the child well, she may not appear as concerned about the child's wellbeing as the health professionals caring for the child, or in contrast she may seem overly concerned
    • the parent talks to the medical team a lot and tries to establish a 'working' relationship with them; becomes aggressive, evasive or confrontational if her views on what is  wrong with the child are challenged; encourages the medical staff to undertake tests on the child which most parents would agree to only if absolutely necessary, including tests and procedures that are painful for the child
    • the parent does not agree to the child being admitted for observation or investigation of the reported symptoms, and
    • documents or other sources indicate that the mother has changed doctors frequently, and/or has visited different hospitals for her child's treatment. 
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    Abuse linked to witchcraft and spirit possession

    ​Child abuse linked to a belief in spirit possession or witchcraft is uncommon but can lead to significant physical, sexual and emotional harm and in some cases child death.

    A multi-agency response to the immediate safety concerns for the child is critical.

    Cultural beliefs in spirit possession refers to an evil force that has entered a child and has taken possession of him or her.  The term witch may be used if the child's family believe that the child is able to use an evil force to harm others. 

    Other terms that may be used by the family include: kindoki, ndoki, sorcerers, the spirit world, the evil eye, djinns, black magic, voodoo, obeah and demons.

    Abuse and neglect occur when a child's parents attempt to rid the child of 'evil' through methods such as beating, burning, starvation, cutting, stabbing and/or isolation within the household.

    Rituals used to neutralise a 'witch' or rid the child of a 'demon' are commonly known as deliverance, exorcism, and less commonly as healing or 'praying for children'. Other terms used include:

    • 'beating the devil out' (beating);

    • 'burning the devil out' (burning, scalding, rubbing chilli in the child's eyes and genitals);

    • 'creating a way out for evil' (refers to cutting/stabbing);

    • 'squeeze the life out of the evil' (refers to strangulation);

    • 'weakening the evil spirit' (starving or fasting, making the child go without water, tying the child up);

    • 'stopping the spread of evil' (isolation including siblings not allowed to speak with the child, not touching or allowing the child physical contact, not allowing the child to eat with the family or share a room with family member, making the child sleep in the bath); and

    • 'purging the child of evil' (forcing the child to ingest poisons by the mouth, eyes or ears to induce vomiting or defecation).

    There are also circumstances where parents believe a child has passed evil spirits onto an unborn child, which may lead to abandonment or killing the child.

    Parents and family members of a child believed to be possessed or a witch may seek help from their place of worship, faith leaders or traditional healers for help and guidance. Children may then be subject to 'deliverance' or 'exorcism' carried out by the faith leaders and other members of the community.

    Language the parents may use about the child could include:

    • 'The child has something evil in them.'

    • 'The child needs to be fixed.'

    • 'We need to send the child home (overseas) to be fixed/treated.'

    Belief in spirit possession and witchcraft is not confined to particular countries, cultures or religions or to recent migrants, and it does not always lead to harmful practices.

    Perpetrators may be parents, family members, family friends, carers, faith leaders and other figures in the community.

    There is a clear distinction in the way the child and their risk to others is perceived between a belief that a child is possessed by spirits or demons and a belief that a child is a witch.

    Spirit/demon possession: the child is believed to be harmed by the spirit or demon

    Parents and family members believe that the child has been taken over completely by 'the evil'. The perpetrators may genuinely believe that abuse is not going to affect the child because they are not really there anymore and the behaviour is directed at 'the devil/the evil'.

    Witchcraft: the child is believed to inflict harm on others

    Parents and family members believe that the child has the ability to inflict harm on others, by causing illness or misfortune on a family member. In these cases family members may be fearful or even terrified of the child, believing that everything, including their own lives, is under threat.

    Children most vulnerable to accusations of spirit possession and witchcraft include:

    • infants born with a congenital defect, albino children, twins, 'badly born' (breech, posterior, face up positions)

    • children with physical disability or difficulties with speech (stammering is commonly linked with these accusations)

    • orphans/divided family structure

    • children with a psychological disorder, learning difficulty, mental health problem or those who are particularly gifted

    • children who display 'naughtiness', stubbornness, aggression, thoughtfulness, laziness or who are withdrawn

    • stepchildren within a family

    • children who experience nightmares and/or bedwetting, and/or

    • children that have been trafficked.

    Indicators of abuse linked to belief in spirit possession

    • the child discloses to someone that they are or have been accused of being 'evil' and/or that they have had the 'evil' beaten out of them

    • there is a complex family structure where the parents live with other relatives and/or unrelated individuals and some of these relationships may be transient

    • the child is vulnerable due to disability, a weak attachment with a parent or carer and/or the child may not be the biological child of the parent/carer – these factors may lead to the child being singled out

    • the child has marks such as bruises (especially multiple bruises in soft tissue areas) or burns in unusual patterns or locations, e.g. superficial circular burns on their back

    • the child has become noticeably confused, withdrawn, disorientated or isolated and appears alone amongst other children

    • the child's physical care has deteriorated, for example, the child is always hungry, attends school without lunch and presents as more and more unkempt

    • the child's parent/carer does not appear to show concern for the child or have a close bond with the child

    • parent's appear afraid of the child and avoid physical contact with the child

    • the child's attendance at school has become irregular or the child has been taken out of school altogether without another school place having been organised, or there is a deterioration in the child's performance at school

    • the child appears to be the only child in the family showing signs of abuse and neglect – it is common for one child in family to be targeted due to a difference such as disability, bed wetting, a medical condition, or the child's particular temperament

    • parents recognise their faith leader as all powerful, and/or

    • parents place a very high value on preserving family honour.

    Child abuse linked to belief in spirit possession usually stems from a child being used as a scapegoat in response to underlying factors such as family stress, deprivation, family and domestic violence, alcohol and substance misuse and/or mental health issues.

    Particular considerations

    • Could the parents' behaviour be related to mental health concerns?

    • Is there a place of worship or community that the child and family are connected, and could any of its members be implicated in the abuse? If so, could other children be at risk?

    • Is the child a victim of child trafficking?

    • Once a child is stigmatised, the possibility that they will be accused again is very high.

    • The child may also believe that they are a witch or possessed.

    • The child's siblings may have been encouraged to participate in the abuse.

    • It may be very difficult or impossible for professionals to change the family's beliefs. This may require the assistance of a community member. 

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    Safety planning

    Refer to 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 you are unable to determine who is responsible for harm. In these circumstances you must initiate safety planning and ongoing assessment to actively manage this uncertainty.

    Considerations for safety planning

    Consider the following when developing a safety plan for allegations of physical abuse cases:

    • strategies to manage or 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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