Child Abuse: Signs, Symptoms, and How to Report

1. Child Abuse: Signs, Symptoms, and How to Report Presented By: Amy Callaway Williamson County Children's Advocacy Center April 21, 2016 www.wilcocac.org 512-943-3713 outreach@wilcocac.org

2. What is a Children’s Advocacy Center? • A Children’s Advocacy Center, also known as CAC, is a child-focused, community-oriented, facility-based program in which representatives from many disciplines such as lawenforcement, CPS, the District Attorney’s Office, and medical professionals, meet to discuss and make decisions about investigations, treatment, and prosecution in child abuse cases. They also work to prevent further victimization of children.

3. Services Offered • Forensic Interviews • Therapy for the client • Case Review • Case Tracking • Outreach (Community Awareness) • Parent Support Group • Medical Exams, also known as a SANE examination

4. What is Child Abuse?(For the purpose of this presentation, definitions are coming from the Texas Family Code)

5. 4 Major Types of Child Abuse • Physical Abuse • Sexual Abuse • Neglect • Emotional Abuse

6. Physical Abuse • physical injury that results in substantial harm to the child, or the genuine threat of substantial harm from physical injury to the child, including an injury that is at variance with the history or explanation given and excluding an accident or reasonable discipline by a parent, guardian, or managing or possessory conservator that does not expose the child to a substantial risk of harm • Physical injury (ranging from minor bruises to severe fractures or death) can result from punching, beating, shaking, kicking, biting, throwing, stabbing, hitting, burning, choking, or otherwise harming a child. Injuries like these are considered abuse regardless of whether the caretaker intended to hurt the child.

7. Indicators of Physical Abuse • Injuries that are not consistent with the explanation given • Injuries inconsistent with the child’s age and developmental phase • Facial injuries in infants and preschool age children • Presence of various injuries over a period of time and/or in various stages of healing (bruising of different colors, healed scars with new scars) • Red and purple bruises are indicative of new injuries, whereas green, yellow, and brown colored bruises indicate healing bruises.

8. Indicators of Physical Abuse Behavioral Indicators include: • Not being able to recall or offering inconsistent explanation for injuries • May cringe or flinch if touched unexpectedly • Infants may display a vacant/blank stare • Extremely aggressive, withdrawn, compliant, and/or eager to please • Indiscriminately seeks affection

9. Neglect • (4)  "Neglect" includes: • (A)  the leaving of a child in a situation where the child would be exposed to a substantial risk of physical or mental harm, without arranging for necessary care for the child, and the demonstration of an intent not to return by a parent, guardian, or managing or possessory conservator of the child; • (B)  the following acts or omissions by a person: • (i)  placing a child in or failing to remove a child from a situation that a reasonable person would realize requires judgment or actions beyond the child's level of maturity, physical condition, or mental abilities and that results in bodily injury or a substantial risk of immediate harm to the child;

10. Types of Neglect medical neglect physical neglect educational neglect RAPR (refusal to accept parental responsibility) Abandonment

11. Indicators of Neglect Physical Indicators: • Poor hygiene • Medical needs such as dental work or glasses that have not been taken care of Behavioral Indicators: • Pale, listless, unkempt • Inappropriate clothing for weather or dirty clothes • Frequent absence from school • Engaging in delinquent acts such as drug/alcohol use

12. Emotional Abuse Emotional abuse is mental or emotional injury that results in an observable and material impairment in a child’s growth, development, or psychological functioning. It includes extreme forms of punishment such as confining a child in a dark closet, habitual scapegoating, belittling, and rejecting treatment for a child.

13. Indicators of Emotional Abuse Physical Indicators: • Child fails to thrive (very frail, can look much younger than their actual age) • Bed wetting that is non medical in origin • Frequent psychosomatic complaints, headaches, nausea, and abdominal pains Behavioral Indicators: • Severe depression • Extreme withdrawal, aggressive, compliant, too well mannered, neat, or clean • Extreme attention seeking • Displays extreme inhibition to play

14. Sexual Abuse Sexual abuse includes fondling a child’s genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or producing pornographic materials.

15. Indicators of Sexual Abuse Behavioral Indicators: • Inappropriate sexual knowledge given their age, i.e. play with toys, self, or others displaying explicit sexual acts, sexually explicit drawing and/or descriptions • Delinquent behaviors • Regressive behaviors (bed wetting, deficating, sucking the thumb, child like voice) • Sleep and eating disorders • A sudden onset or fear of adults and/or places not previously feared

16. How Children Tell,Outcries and Disclosures

17. Types of Disclosures Accidental- information revealed by chance (such as a child shouting out what happened to them) Purposeful- information revealed via conscious decision to tell by the child (often they have had enough and do not want to endure it anymore) Tentative- giving a small piece of information about what happened when there may be more abuse (they are watching to see how the first part of information is handled before they make a decision whether or not to tell about the rest of what has been happening)

18. Stages of the Disclosure Process • Denial (saying that it did not happen) • Tentative (giving bits and pieces of information) • Active (giving all details about what happened) • Recant (taking back what they said) • Reaffirmation (saying again what happened)

19. Factors that Influence the Disclosure Process Age Culture Social Skills Gender Verbal Skills Disabilities School Socio-Economic Family

20. Who are the most common perpetrators? • A good majority of the time, the accused is a family member or someone with whom the child has lived. • This person is often the provider in the family, and the child is scared to tell because they know that their abuser will get in trouble. • Children also fear the reactions of their family members, or they take on the guilt and think it is their fault. • They often fear that they will be physically punished as well for talking about what happened. • Therefore, please be sensitive and supportive of them! It’s not easy to tell!

21. Factors that Can Trigger Disclosure • Child acting out • Watching program about abuse on t.v. • Disclosure by another child • Fear of seeing the alleged perpetrator again • School “safety” program • Sensory triggers • Disclosure to child friend • Siblings being close to the age when their abuse started (need to protect that sibling from possible abuse)

22. Factors that Can Trigger Disclosure in Compliant Child Victims A compliant victim is a victim that was an active participant in their own abuse (often seen in teenagers who view their abuser as their boyfriend or girlfriend) Factors that can trigger disclosures: - Sexual activity is discovered or suspected (abduction by offender, overheard conversations, discovered text messages, statements made by other victims, association with the known sex offender)

23. Factors that Can Trigger Disclosure in Compliant Child Victims (Continued) • Offender becomes aggressive • Offender seducing younger sibling/close friend • Victim may come forward because he/she was “dumped” • The abuse ended • Significant changes in their lives

24. Possible Barriers to Disclosure • Gender • Type of Abuse: Intrafamilial (within the family) vs Extrafamilial (outside of the family) • Length of Abuse (Delay of Disclosure) • Fear of Negative Consequences • Perceptions of Responsibility • Communication/Comprehension Skills • Language • Shame • Embarassment

25. Barriers continued.. • Guilt or Culpability- Self Blame • Compliant Victims • Grooming/Seduction Process (starting off with games such as tickling, giving gifts, minor touching that advances over time to the private areas of the body, complimenting) • Relationship Dynamics

26. Barriers Continued.. Threats: Emotional Physical Fear Loyalty Family Privacy Protection Competency (developmental issues, emotional status)

27. When a child discloses,Don’t Panic!

28. When a Child Discloses.. Professional Duty to Report Outcry Witness (the first adult the child told) This person is the only person that can go to court and testify without it being considered hearsay (information from third parties) Please do not… - Form an opinion if the abuse occurred or not - Ask questions, probe, or encourage further discussion - Make critical marks about the alleged abuser - Counsel the child, make promises, or give advice

29. Thing to Remember.. • Every time a child has to their account of what happened..the child is re-victimized

30. Other things to remember • Stay calm! • Get on the same level as the child (don’t stand above them staring down at them) • Please watch your tone of voice, your posture, and your gestures! • If you stay calm, the child will feel more at ease!

31. How to Report! Contact Child Protective Services: 1-800-252-5400 (for emergency reports where the child is in immediate danger) Reports can be made to CPS for non-emergencies at: www.txabusehotline.org If the child is in immediate danger, contact your local law enforcement agency!!!

32. Who has to report child abuse? • EVERYONE! If you know or suspect abuse in the state of Texas, you are required by law to report it!

33. Family Code Reporting Laws • Sec. 261.106.  IMMUNITIES. (a) A person acting in good faith who reports or assists in the investigation of a report of alleged child abuse or neglect or who testifies or otherwise participates in a judicial proceeding arising from a report, petition, or investigation of alleged child abuse or neglect is immune from civil or criminal liability that might otherwise be incurred or imposed. • (b)  Immunity from civil and criminal liability extends to an authorized volunteer of the department or a law enforcement officer who participates at the request of the department in an investigation of alleged or suspected abuse or neglect or in an action arising from an investigation if the person was acting in good faith and in the scope of the person's responsibilities. • (c)  A person who reports the person's own abuse or neglect of a child or who acts in bad faith or with malicious purpose in reporting alleged child abuse or neglect is not immune from civil or criminal liability.