Child protection services
NT
- Territory Families, Housing and Communities — Central Intake Team
- 24 hour phone line — 1800 700 250
SA
- Department for Child Protection
- 24 hour phone line — 131 478
WA
- Department of Communities, Child Protection and Family Support — Central Intake Team
— Or after hours call Crisis Care 1800 199 008
Looking after yourself
- For most people the reality of child abuse and/or neglect is deeply distressing
- May help to talk to someone about your feelings — counsellor, Bush Support Services
1800 805 391
Cumulative harm
- Can be caused by multiple episodes of abuse or neglect — each event may not be severe
enough to raise child protection concerns
- Over time the repetition of these events may cause trauma and have negative effects
on child’s development
- Report cases where you suspect cumulative harm
Neglect
Parent/carer fails to provide level of physical and/or emotional care that child needs
to grow and develop well including
- Physical neglect
- Not providing child’s basic needs such as food, clothing or shelter
- Not adequately supervising child, not providing for their safety
- Emotional neglect
- Not meeting child’s needs for affection, nurturing, stimulation
- May ignore, humiliate, intimidate or isolate child
- Can be difficult to prove
- Educational neglect
- Not making sure child receives an appropriate education
- Medical neglect
- Not providing appropriate health or dental care
- Refusing care or ignoring medical advice
Neglect can be complex and hard to identify
- Parents/carers may neglect children if —
- They don't know what children need to grow well
- They don't have enough money or have problems managing money
- They have a mental illness and unable to care for child when unwell
- They have problems with substance abuse, gambling, domestic/family violence
- They didn't want the child
- Child has medical condition or disability making them hard to care for
Do
- Support parents/carers to solve problems
- Give information about what child/young person needs at different stages
- Ask about substance use and domestic/family violence
- Develop plan to make sure child’s needs are met
- Discuss with colleagues and record in file notes — concerns, support offered or attempted
and outcomes
- Talk with child health team, doctor, paediatrician about concerns
- If child remains at risk, even with support — notify child protection service
- If possible when reporting abuse (all types) advise protective parent/carer you are
making a report
- If not confident to do this — obtain medical advice, talk with child protection service
Emotional or physical abuse
- Changes in behaviour that may indicate abuse
- Nightmares, sleep walking
- Avoiding physical or other contact with certain people or groups
- Changes in general behaviour, activities
- Avoiding or running away from home
- Low self-esteem, increased anxiety
- Extremes of behaviour — very aggressive to very passive
- Self-harming behaviour, drug and alcohol use
Emotional abuse
Suspect emotional abuse if parent/carer
- Constantly criticises or teases child/young person
- Makes unreasonable demands relative to age/maturity of child/young person, criticises
or belittles them when they can't meet demands
- Blames child or young person for everything that goes wrong
- Calls child or young person names, sees them as 'evil'
- Exposes child or young person to domestic/family violence
- Isolates child or young person
Do
- Observe interactions between parents/carers and child/young person — warm and responsive
or hostile and threatening
- Ask child/young person how they feel, if they are safe. Take what child/young person
says seriously
- Support parents to solve problems
- Give information about what child/young person needs at different stages
- Ask about substance use and domestic/family violence
- Develop plan to make sure needs are met — see Child health check (0–5 years)
- Discuss with colleagues and record in file notes — concerns, support offered or attempted
and outcomes
- Talk with child health team, doctor, paediatrician about concerns
- If child remains at risk, even with support — medical consult, notify child protection service
See Child development concerns 0-5 years and School aged child and youth behaviour or development concerns
Physical abuse
Non-accidental injury caused by parent/carer. May be deliberate from physical discipline
or from inadequate supervision. May include hitting, punching, biting, burning, shaking,
kicking. Doesn't depend on intent of parent/carer
Consider abuse in infant, child or young person if
- History raises concern
- No history to account for the injury
- History of unwitnessed trauma
- History of family violence
- History incompatible with the child’s age or developmental capabilities
- History is not a likely explanation to account for the injury
- Inconsistent or changing histories
- Unreasonable delay in seeking medical attention
- Any injury in a child not yet walking
- History of another child causing significant injury
- Certain injuries with high specificity for abuse — ear bruising, rib fractures, any
injury in a child not yet walking
- An infant with unexplained neurological symptoms or obvious head injury (suspect abusive
head trauma)
- Inconsistencies which are
- Story of how injury happened suggests minor injury but injury is severe
- Story of how injury happened changes each time story is told
- People who saw what happened tell very different stories
- Story developmentally unlikely — child of this age unlikely to be able to do what was said
- Story biomechanically unlikely — this sort of injury is unlikely to result from that sort of story
- Story epidemiologically unlikely — this sort of injury very unlikely
Ask
- Ask what happened, where it happened, when it happened, who was there, what went wrong
- Always record detailed story of how injury occurred
Do
- Manage any injury
- Record injuries — use body diagram to record where injuries or bruises are
- Make sure child is safe, may need to send to hospital
- Medical consult, notify child protection service
Sexual abuse
Child sexual abuse is a crime — urgent medical consult
Must notify child protection service if you believe child/young person has been sexually abused (mandatory reporting)
You must know
- How your state/territory defines child sexual abuse — may need to report sexual activity
under certain ages even when there is consent
- Your organisation's policy for managing suspected child abuse
- Sexual abuse may be
- Obvious (eg physical indicators, trauma) — commonly called rape
- Suspected when seeing child/young person for another medical problem — STI, pregnancy, genital sores, injury to genital area, buttocks, thighs, breasts
- Suspected because someone told you, you heard rumour
- Disclosed (told) to you by child/young person
Child sexual abuse — definition
Child sexual abuse is a broad term to cover activities involving use of child/ young
person for sexual gratification by adult or older child/young person. Includes any
act that exposes child/young person to or involves them in sexual activity beyond
their understanding or that goes against community norms or the law
- Offender usually known to child/young person, may be member of family, may be with
the child in the clinic
- Sexual abuse can include
- Sexual touching
- Penetration
- Oral sex acts
- Sexually explicit talk
- Indecent exposure
- Taking sexualised photos of a child
- Involvement with pornography
- Involving a child in prostitution
- Female genital mutilation
- Threats or bribes to keep a child silent
Symptoms that may indicate child sexual abuse
- Physical evidence — not common
- Physical symptoms may include genital or anal pain, soreness, bleeding, discharge,
rash, frequency of or pain on passing urine, STIs, pregnancy. Interpreting
these symptoms depends on
- Age and developmental level of child/young person
- For older adolescents the presence/absence of consent
- Sexualised play
- If worried about child/young person's behaviour or psychological health — medical/mental health consult. Whether or not you suspect sexual abuse
Manage sexual abuse sensitively to protect child/young person and clinic staff. Following
disclosure or suspicion of abuse there may be threats toward child/young person, their
family, alleged offender and/or their family, clinic staff
Do
- If sexual abuse suspected — medical consult
- Plan for safety of child/young person, their family and clinic staff including ATSIHPs, who are part of the community
- May need to evacuate child/young person to ensure safety
- Must notify child protection service
- About presentation
- To plan management
Recent sexual abuse (up to 7 days post-assault)
Do not
- Do not try to question child/young person yourself — best done by trained interviewers
- Do not wash child/young person before talking with medical staff from sexual assault service
— may disturb forensic evidence
- Do not do internal examination unless needed for treatment of serious/life threatening
injuries — may disturb forensic evidence, should not be done by anyone without sexual
assault training
Do
- Medical consult with staff from sexual assault service — they will advise how to proceed and preserve
evidence
- Get support from experienced staff
- Assess and manage clinical situation
- Calculate age-appropriate REWS — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
- Weight, BGL
Collecting body fluid loss for forensic evidence
Collect forensic evidence with 'Early evidence kits' or ‘Preliminary forensic kits’
if available at your clinic
- Collect any urine and other body fluid loss — for young child use nappy
- Save all nappies, pads, clothing removed from child/young person
- Send all items with person — include clothing and blankets
- Put each item in separate paper bag (not plastic). Label, seal bags with tape, sign
across closure
- Record name of person receiving items (eg nurse on evacuating plane) get their signature
to maintain chain of forensic evidence
While waiting for evacuation
- Continue observations
- Record clinical findings and what you did — include how you were notified, who was
present, what was said, what child/young person was wearing, any clothing removed
or added by you
- Never force child/young person to talk
- Take accurate and detailed notes of what happened — as told to you
- Child/young person will sometimes tell you what happened. If they do — record it word
for word, but don’t ask questions. Not your job to collect a statement, leave this
to police
- Be supportive and believe them. Reassure them you will do all you can to keep them
safe
- Your documentation and attention to detail may be important if prosecution proceeds
Suspected sexual abuse
- If you think child/young person under 18 years is being or has been sexually abused
— after medical consult you must notify child protection service
- Suspicion is the key issue in proceeding with notification. Suspicion of sexual abuse
is managed and notified according to Flowchart 3.1
- Consider current safety of child/young person
- Young person’s intellectual and emotional development may lag behind physical age.
Age may suggest they can give consent, but intellectual and emotional development
may not. May be vulnerable to exploitation, not understand what is happening
- Sexual abuse often begins with non-invasive behaviours, but progresses to oral/anal/vaginal
sex
- Usually no physical or medical evidence of sexual abuse. May be signs in behaviour
that indicate child/young person stressed
- Talk with parents/carers about concerns, changes in child/young person's behaviour
- Avoid saying explicitly you are concerned about sexual abuse, as child/young person may
be inappropriately questioned
- Where possible advise protective parent/carer you are making report to child protection
service
- Support child/young person and protective parent/carer — will probably be stunned,
not know what to believe
- Expect to be pressured to not believe child/young person
- If not confident to do this — get help from someone who can
- Do not talk about child/young person’s allegations, or your suspicions. Principles of confidentiality
will protect you and child/young person
- Be aware: often other types of abuse happen with sexual abuse. May also be physical or emotional
abuse, exposure to domestic/family violence, neglect
Flowchart 3.1 Guidelines for suspected sexual assault, abuse or maltreatment of person under 18
years
State/territory legislation is subject to change. Recommendations correct March 2022
STI testing in children
- STI testing is not an appropriate way to confirm or form a suspicion of sexual abuse
- Negative STI test doesn't exclude sexual abuse in a child/young person
- If obvious sexual abuse — medical/paediatrician/sexual assault doctor consult before doing STI test
- If child/young person sexually active OR suspected sexual abuse —
Follow-up
People affected by sexual abuse (child/young person, parent/s, other people) may
suffer distress days to years later
- Talk to sexual assault service about counselling options for victims of sexual abuse
- Contact child protection service if
- Ongoing concerns about child/young person’s safety
- You have new information
Making a report
- You will need to provide
- Child's name, date of birth, address
- Parent/carer names
- Why you suspect or believe child/young person has been sexually abused (eg something
you saw or heard, behaviours that made you worried, something child/young person told
you)
- Any injuries or medical issues
- Where child/young person is now
- Whether you have concern for anybody's safety (eg child, you, other people)
- If alleged perpetrator named — who they are, if you know where they are
- Don't forget to talk with child protection service about what happens next
- Sexual abuse can’t always be substantiated — this doesn’t mean it didn’t happen,
only that there was not enough evidence to prove it. This doesn’t lessen your responsibility
to report suspected sexual abuse