Child Abuse. It`s only getting worse! 7/29/2015. Define Abuse Types of Abuse Statistics How to fix the problem Documentation and reporting

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1 Child Abuse Allen D. Davis, NREMT-P, CCEMT-P Flight Paramedic Wings Air Rescue Define Abuse Types of Abuse Statistics How to fix the problem Documentation and reporting It`s only getting worse! 1

2 Types of Child Abuse What is Child Abuse? Child Abuse Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation of a child. An act or failure to act which presents an imminent risk of serious harm to a child. Childwelfare.gov Fatal child abuse may involve repeated abuse over a period of time (e.g., battered child syndrome), or it may involve a single, impulsive incident (e.g., drowning, suffocating, or shaking a baby). In cases of fatal neglect, the child s death results not from anything the caregiver does, but from a caregiver s failure to act. The neglect may be chronic (e.g., extended malnourishment) or acute (e.g., an infant who drowns after being left unsupervised in the bathtub). Federal Definition of fatal Child Abuse 2

3 Physical Abuse Definition Non-accidental trauma or physical injury caused by punching, beating, kicking, biting, burning or otherwise harming a child. Physical Abuse is the most visible form of child maltreatment. Physical Abuse Findings Unexplained injuries, especially those located on parts of the body not typically affected by normal childhood activities. Eyes, Mouth, Back, Thighs, Buttocks, Genital Areas Physical Abuse Findings 3

4 Repeated injuries, such as bruises, welts or burns, especially those in which the shape of the object is visible, i.e.; Ropes, cords, hair brush, belt buckle. Small Circular burns (Cigar or Cigarette burns) Doughnut Shaped burns to buttocks Burns that show the pattern of the object; fireplace tools, heaters, irons Friction burns: arms, neck, legs, torso Physical Abuse Unexplained Fractures; multiple long bone fractures, fractures in multiple stages of healing, facial fractures, rib fractures. Unlikely explanation for injuries, delays in obtaining medical care, increasing severity of injuries Physical Abuse May be the most difficult to detect Emotional Abuse 4

5 Definition Behaviors, speech, and actions of parents or other caregivers that have a negative mental impact on children. Some elements of emotional abuse will be found in all types of child abuse. Emotional Abuse Findings Verbal assaults Withholding of positive emotional support Wounds the spirit/destroys self confidence Difficulty sustaining healthy relationships as an adult May also develop antisocial behaviors Emotional abuse. Patterned behaviors that are extreme: Lying, Stealing, Fighting, Acting out, overly aggressive Defensive, extremely shy, or overly dependent Verbally Abusive to others (using the language and demeaning terms they experience) Emotional Abuse. 5

6 A problem enhanced by technology Sexual Abuse Definition ANY sexual act with a child performed by an adult or older child Includes but not limited to; Child pornography, Obscene phone calls, fondling, Incest, Indecent exposure, Peeping Toms, Violence (Sodomy, Rape, Molestation) Sexual Abuse. Findings Children that experience sexual abuse may present with the same characteristics as physical and emotional abuse. Children may also experience emotional abuse and neglect as well. Sexual Abuse 6

7 The most common type of abuse Neglect Definition Child Neglect is the continued failure to provide a child with the necessary care and protection including adequate shelter, food, clothing, medical care, etc.. Lack of appropriate supervision of young children for a prolonged period of time can also be defined as neglect. Neglect.. Findings Appears poorly nourished Consistently tired or listless Inconsistent attendance at school Lack of good hygiene Left alone for prolonged periods of time Medical needs not being met Unable to relate well with adults Problems forming relationships Neglect. 7

8 Over 100 reported of Child abuse cases in Tennessee every day! Statistics From 2001 to 2010 over 3 million cases of child abuse were reported each year. 1% to 3% of Children will experience Abuse 1 in 4 children live in poverty Child Abuse is the second leading cause of death in infants 1-6 months of age (SIDS #1) Second leading cause of death in Children 1-5 years of age. (Traumatic Accidents #1) Statistics 90% of abusers are related caregivers Homicide is the only cause of childhood death that has increased in the past 30 years. It is estimated that 60-85% of deaths related to child abuse is not recorded as such on death certificates. Why? 60% of patients in Drug Rehab centers admit to being abused or neglected as a child. Statistics.. 8

9 Maybe not abuse.. What is the problem and how are we going to fix it? Drug abuse Alcohol abuse Holes in the system Poverty Insignificant punishment Lack of outreach Problems.. One third to two thirds of child maltreatment cases involve substance use to some degree In one study, children whose parents abuse alcohol and other drugs were three times more likely to be abused. As many as a two thirds of the people in treatment for drug abuse report being abused or neglected as children. More than a third of adolescents with a report of abuse or neglect will have a substance use disorder before their 18 th birthday, three times as likely as those without a report of abuse or neglect. Drug and alcohol Abuse.. 9

10 Demand increase Inconsistent training and decision making for case workers Pressure to make appropriate decisions Liability Concerns Holes in the system Studies show that children from families with annual incomes below $15,000 in 1993 were 22 times more likely to be harmed by child abuse and neglect as compared to children from families with incomes above $30,000. In 1999, 85% of states identified poverty and substance abuse as the top two problems challenging families reported to child protective services agencies. Poverty Some primary emergency medical providers receive as little as 5 minutes of child abuse training in their careers. Failure to report suspected child abuse cases due to lack of understanding. Lack of outreach 10

11 Tennessee requires all persons; health care providers, mental health professionals, child care providers, dentist, family members and friends to report suspected cases of child abuse and neglect. Failure to report such cases is a direct violation of the law. R-E-A-C-T R- Remove/Rescue E- Evaluate A- Assessment C- Care T- Transport/Tell R-E-A-C-T 11

12 REMOVE/RESCUE SAFETY OF RESPONDERS IS ALWAYS THE FIRST PRIORITY. REMOVE CHILD FROM SITUATION CONFIRM SAFETY OF CHILD AND ANY OTHER VICTIMS CONTAIN EMOTIONS. THE WELLBEING OF THE CHILD IS THE ULTIMATE GOAL R-E-A-C-T Evaluate Inspect surroundings and environment Red Flags - Evidence of drug alcohol abuse, hygiene, lack of food and medical care. Interaction of child with other children, parents and responders. Inappropriately dressed; Unkempt R-E-A-C-T Assessment General Impression (Across the room assessment) Life Threats (A-B-C-D-E) Pediatric Assessment Triangle -Appearance -Work of breathing -Circulation of skin R-E-A-C-T 12

13 Color Red Blue/Purple Green/Yellow Yellow/Brown Cleared Age (Approximate) 0-1 days 1-4 days 5-7 days 8-10 days 1-3 weeks Approximate dating of bruses Care Treat all life threatening injuries Treatment should not differ from the accidental injured child, with the exception of forensic data collection Gather detailed history from everyone Treat Child with dignity Preserve evidence R-E-A-C-T Transport/Tell In suspected cases of child abuse, pre-hospital providers should transport child to hospital. If the situation arises that the parent or caregiver will not allow the child to be transported, Law enforcement/cps should be involved. It is EMS providers responsibility to notify appropriate authorities. Follow Protocol R-E-A-C-T 13

14 Some wounds never heal.. Long term effects Permanent Disabilities Abuse is responsible for 25% Neglect is responsible for 52% Effects. Physical Disabilities; shaken baby syndrome, blindness, mental retardation, learning disabilities, cerebral palsy, paralysis, impaired brain development, lifelong poor physical health Psychological Disabilities; depression and anxiety, low self esteem, eating disorders, suicide attempts Behavioral issues; eating disorders, teen pregnancy, drug use, delinquency, poor academic performance, increased criminal behavior, increase involvement in violent crimes, abusive behavior Effects.. 14

15 Direct Child Welfare Law Enforcement Judicial Cost Health and Mental Health Issues Estimated cost in Billion Indirect Substance Abuse Mental Illness Domestic Violence Unemployment Special Education Estimated cost in Billion Societal Effects Child Abuse ` ` ` ` ` ` Total: 15, 510 ` ` ` ` Military `01-12 `02-49 ` ` ` ` Total: 5,877 ` ` ` ` Child abuse deaths V/S combined military deaths in Afghanistan and Iraq TN- 309 VA- 297 NC-67* KY- 296 GA- 651 * Only reported in 2001 and 2002 Child abuse Deaths per state

16 Document objectively, not subjectively Describe injuries in detail Include what Child, Caregiver, Parent or siblings tell you Describe the conditions of the environment, the scene and your surroundings Documentation Use Color Camera High Resolution Use different angles; at least two photos Ruler or coin for size reference Include patients face in at least one Name, location of injury, date, time, name of photographer, and names of all present on back Follow Protocol Photographs * *Report to local law enforcement or CPS Reporting 16

17 There is no more fundamental test of a society, than how it treats its Children -Abraham Lincoln Questions??? 17