There are 4 categories of abuse in safeguarding children. These are:
- Physical
- Sexual
- Emotional
- Neglect
Physical and sexual only have to happen once to be categorised as abuse. Emotional and neglect are ongoing and persistent situations rather than one off incidents.
Whenever a child experiences physical abuse, sexual abuse or neglect, there will always be some degree of emotional abuse as well. Emotional abuse is the only category, therefore that can exist in total isolation from any of the others.
Physical abuse
Physical abuse is that which causes or exacerbates physical harm. It would include such actions as:
- Physical assaults that do not involve the use of a weapon or other implement; kicking, , punching, slapping, pushing, pinching, scratching, shaking, pulling hair, spitting etc.
- Use of an implement or weapon or throwing things; household items not normally considered to be weapons, DIY tools, knives or other kitchen implements etc.
- Burning or scalding
- Choking, strangling
- Poisoning including over medicating, inappropriate use of medicine, alcohol etc. (for example to “help the child to sleep”) and also including such things as salt poisoning
- Withholding or withdrawing medical treatments or attention
- Starvation, withholding drinks etc. so as to cause malnutrition or dehydration
- Force feeding, causing excessive obesity through overfeeding / inappropriate diet
- Inappropriate or rough handling, including when performing personal care or administering first aid (eg removing a plaster forcefully so as to cause tearing of the skin)
- The use of excessive force or inappropriate restraint
- Bullying that involves physical harm
- Etc
Physical abuse can happen antenatally through substance misuse etc.
Signs and indicators of potential physical abuse would include:
- Bruising
- Burns
- Cuts / lacerations
- Fractures or breaks
- Black eye
- Unexplained or inconsistently explained marks
- Untreated medical need (e.g. skin conditions nappy rash etc.)
- Stench of urine / faeces
- Drowsiness / excessive sleep
- Loss of weight
- Hunger / thirst
- Wearing extra layers of clothing
- Aggressive or violent behaviours
- Withdrawn, anxious, flinching in specific situations or with specific people
Examples of factors which could cause confusion would include:
- Mongolian Blue Spot
- Brittle bones
- Leukaemia
- Other medical conditions
- NB. It is not illegal (in England) for a parent to smack a child so long as the smack does not leave a lasting mark (e.g. not lasting more than 5 minutes or so). If the smack causes bruising it is excessive and is abuse and smacking in inappropriate places (e.g. head) is abuse.
- NB. The considered decision not to have a child vaccinated is not abuse but failing to attend appointments may indicate neglect.
Sexual abuse
Sexual abuse involves forcing, enticing or coercing a child into engaging in sexual activity or exposing a child to sexual materials or activity, whether or not the child is aware of the significance of what is happening. This would include:
- Forcing, coercing or enticing a child into sexual activity including grooming a child in preparation for abuse
- Physical sexual contact; rape (vaginally, orally or anally), penetration with an object, inappropriate touching / rubbing, fondling (whether inside or outside of the clothing) , kissing, masturbation etc.
- Non-contact activities; the viewing or production of sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, grooming a child in preparation for abuse
- Sexualised language or conversation and lack of appropriate boundaries and privacy
- Sexual harassment
- Indecent exposure
- Voyeurism
- Exploitation, causing someone to enter into prostitution
- Satanic or ritual abuse
- Bestiality
Signs and indicators of potential sexual abuse would include:
- Genital or urinary irritation or bruising in the genital area
- Frequent infections, pain or itching in the genital area
- Bleeding from the anus or vagina
- Sexually transmitted infections
- Stains on underwear or nightwear
- Wetting / soiling
- Bruising in inner thighs or upper arms
- Difficulty in walking and or sitting
- Wearing extra clothing
- Depression
- Role play
- Sexualised language or behaviour that is inappropriate for age or developmental stage
- Nightmares / flashbacks
- Agitation, upset or withdrawal from any physical contact
- Examples of factors which could cause confusion would include:
- Medical conditions or infections
- Excessive masturbation
- Age / developmentally appropriate inquisitiveness, exploration and play
Emotional abuse
- The persistent emotional maltreatment of a child resulting in ongoing severe adverse effects on emotional development, sense of security, identity and self-confidence. This would include:
- Making a child feel afraid, intimidated anxious or ridiculed including domineering behaviour
- Threatening the child, someone else, threatening to harm pets etc.
- Verbal abuse; shouting, name calling, swearing, use of inappropriate nicknames or descriptions etc.
- Causing a sense of worthlessness or inadequacy, including constant comparison (e.g. why cant you be more like…)
- Making a child feel unloved or only conditionally loved (eg making a child feel that they are only valued or loved insofar as they meet the needs or expectations of someone else)
- Suppressing or denying the opportunity for the child to express their views, intentionally silencing them, ridiculing them for their views or beliefs or for the way they communicate
- Expectations that are age or developmentally inappropriate are imposed on the child (over expectation or overprotectiveness that denies or impedes the child’s development)
- Preventing appropriate social contact and interaction, isolation, ignoring or excluding, abandonment and imprisonment
- Bullying; including cyber bullying and harassment
- Emotional blackmail
- Making the child feel that they are in danger
- Exploiting or corrupting a child
- Denying access to services or support
- Denial of human rights
Signs and indicators of potential emotional abuse would include:
- Excessive fear or anxiety
- Flinching in the presence of a particular person or in particular circumstances
- Unusual patterns of crying / weeping / sobbing, etc.
- Low self-esteem
- Insomnia, sleep deprivation or the need for excessive sleep
- Change in appetite
- Unusual or unexplained weight loss or gain
- Paranoia
- Mood swings, changes in mood or behaviour
- Withdrawal and inability or discomfort with social situations and interaction
Examples of factors which could cause confusion would include:
- Death or illness in the family
- Family relationship breakdown
- Family stress or specific family issues
- Medical or psychological conditions
- Death of a pet
Neglect
Neglect is the persistent and ongoing failure to meet the basic physical and/or psychological needs of the child to the extent that it is likely to result in the serious impairment of the child’s health or development. This would include:
- Failure to provide the basic necessities of life such as adequate food, clothing, shelter
- Failure to protect a child from physical or emotional danger
- Abandonment, being left “home alone”, inadequate supervision (including inappropriate or inadequate care givers)
- Failure to provide adequate medical care (attending appointments, administering medications and / or treatments)
- Unresponsiveness to a child’s basic emotional, psychological or developmental needs
- Can occur antenatally through such things as maternal substance misuse
Signs and indicators would include:
- Significant needs persistently unmet
- Poor physical care
- Lack of food / drink inappropriate or inadequate diet
- Failure to access medical care or to follow medical advice / instruction
- Inappropriate clothing
- Poor hygiene
- Lack or supervision/Isolation, ignoring, exclusion
- Lack of heating / lighting
- Leaving a child to lie in faeces / urine
- Not aiding communication or providing adequate stimulation
- Failure to meet cultural, religious or social needs
- Neglecting pets
Examples of factors which could cause confusion would include:
- Medical conditions
- Poverty
- Family stresses
- Parental disabilities / young carers
Categories of Abuse (Adults)
People with care and support needs, such as older people or people with disabilities, are more likely to be abused or neglected. They may be seen as an easy target and may be less likely to identify abuse themselves or to report it. People with communication difficulties can be particularly at risk because they may not be able to alert others. Sometimes people may not even be aware that they are being abused, and this is especially likely if they have a cognitive impairment. Abusers may try to prevent access to the person they abuse.
Signs of abuse can often be difficult to detect. This section aims to help people who come into contact with people with care and support needs to identify abuse and recognise possible indicators. Many types of abuse are also criminal offences and should be treated as such.
The categories of abuse are:
- Physical abuse
- Domestic violence or abuse
- Sexual abuse
- Psychological or emotional abuse
- Financial or material abuse
- Modern slavery
- Discriminatory abuse
- Organisational or institutional abuse
- Neglect or acts of omission
- Self-neglect
Evidence of any one indicator from the following lists should not be taken on its own as proof that abuse is occurring. However, it should alert practitioners to make further assessments and to consider other associated factors. The lists of possible indicators and examples of behaviour are not exhaustive and people may be subject to a number of abuse types at the same time.
Physical Abuse
Types of physical abuse
- Assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing
- Rough handling
- Scalding and burning
- Physical punishments
- Inappropriate or unlawful use of restraint
- Making someone purposefully uncomfortable (e.g. opening a window and removing blankets)
- Involuntary isolation or confinement
- Misuse of medication (e.g. over-sedation)
- Forcible feeding or withholding food
- Unauthorised restraint, restricting movement (e.g. tying someone to a chair)
Possible indicators of physical abuse
- No explanation for injuries or inconsistency with the account of what happened
- Injuries are inconsistent with the person’s lifestyle
- Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps
- Frequent injuries
- Unexplained falls
- Subdued or changed behaviour in the presence of a particular person
- Signs of malnutrition
- Failure to seek medical treatment or frequent changes of GP
Domestic Abuse
Types of domestic violence or abuse
Domestic violence or abuse can be characterised by any of the indicators of abuse outlined in the sections relating to:
- psychological abuse
- physical abuse
- sexual abuse
- financial or material abuse
Domestic violence and abuse includes any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been, intimate partners or family members regardless of gender or sexuality. It also includes so called ‘honour’ -based violence, female genital mutilation and forced marriage.
Coercive or controlling behaviour is a core part of Domestic Abuse
Coercive behaviour can include:
- acts of assault, threats, humiliation and intimidation
- harming, punishing, or frightening the person
- isolating the person from sources of support
- exploitation of resources or money
- preventing the person from escaping abuse
- regulating everyday behaviour.
Possible indicators of domestic violence or abuse
- Low self-esteem
- Feeling that the abuse is their fault when it is not
- Physical evidence of violence such as bruising, cuts, broken bones
- Verbal abuse and humiliation in front of others
- Fear of outside intervention
- Damage to home or property
- Isolation – not seeing friends and family
- Limited access to money
Sexual Abuse
Types of sexual abuse:
- Rape, attempted rape or sexual assault
- Inappropriate touch anywhere
- Non- consensual masturbation of either or both persons
- Non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth
- Any sexual activity that the person lacks the capacity to consent to
- Inappropriate looking, sexual teasing or innuendo or sexual harassment
- Sexual photography or forced use of pornography or witnessing of sexual acts
- Indecent exposure
Possible indicators of sexual abuse:
- Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck
- Torn, stained or bloody underclothing
- Bleeding, pain or itching in the genital area
- Unusual difficulty in walking or sitting
- Foreign bodies in genital or rectal openings
- Infections, unexplained genital discharge, or sexually transmitted diseases
- Pregnancy in a woman who is unable to consent to sexual intercourse
- The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude
- Incontinence not related to any medical diagnosis
- Self-harming
- Poor concentration, withdrawal, sleep disturbance
- Excessive fear/apprehension of, or withdrawal from, relationships
- Fear of receiving help with personal care
- Reluctance to be alone with a particular person
Psychological Abuse
Types of psychological or emotional abuse
- Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends
- Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance
- Preventing someone from meeting their religious and cultural needs
- Preventing the expression of choice and opinion
- Failure to respect privacy
- Preventing stimulation, meaningful occupation or activities
- Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse
- Addressing a person in a patronising or infantilising way
- Threats of harm or abandonment
- Cyber bullying
Possible indicators of psychological or emotional abuse
- An air of silence when a particular person is present
- Withdrawal or change in the psychological state of the person
- Insomnia
- Low self-esteem
- Uncooperative and aggressive behaviour
- A change of appetite, weight loss/gain
- Signs of distress: tearfulness, anger
- Apparent false claims, by someone involved with the person, to attract unnecessary treatment
Financial or Material Abuse
Types of financial or material abuse
- Theft of money or possessions
- Fraud, scamming
- Preventing a person from accessing their own money, benefits or assets
- Employees taking a loan from a person using the service
- Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills,
- property, inheritance or financial transactions
- Arranging less care than is needed to save money to maximise inheritance
- Denying assistance to manage/monitor financial affairs
- Denying assistance to access benefits
- Misuse of personal allowance in a care home
- Misuse of benefits or direct payments in a family home
- Someone moving into a person’s home and living rent free without agreement or under duress
- False representation, using another person’s bank account, cards or documents
- Exploitation of a person’s money or assets, e.g. unauthorised use of a car
- Misuse of a power of attorney, deputy, appointeeship or other legal authority
- Rogue trading – eg. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship
Possible indicators of financial or material abuse
- Missing personal possessions
- Unexplained lack of money or inability to maintain lifestyle
- Unexplained withdrawal of funds from accounts
- Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity
- Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so
- The person allocated to manage financial affairs is evasive or uncooperative
- The family or others show unusual interest in the assets of the person
- Signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA
- Recent changes in deeds or title to property
- Rent arrears and eviction notices
- A lack of clear financial accounts held by a care home or service
- Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person
- Disparity between the person’s living conditions and their financial resources, e.g. insufficient food in the house
- Unnecessary property repairs
Modern Slavery
Types of modern slavery
Human trafficking
Forced labour
Domestic servitude
Sexual exploitation, such as escort work, prostitution and pornography
Debt bondage – being forced to work to pay off debts that realistically they never will be able to
Possible indicators of modern slavery
- Signs of physical or emotional abuse
- Appearing to be malnourished, unkempt or withdrawn
- Isolation from the community, seeming under the control or influence of others
- Living in dirty, cramped or overcrowded accommodation and or living and working at the same address
- Lack of personal effects or identification documents
- Always wearing the same clothes
- Avoidance of eye contact, appearing frightened or hesitant to talk to strangers
- Fear of law enforcers
- Further Home Office information on identifying and reporting modern slavery
Discriminatory Abuse
Types of discriminatory abuse
- Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as ‘protected characteristics’ under the Equality Act 2010)
- Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic
- Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader
- Harassment or deliberate exclusion on the grounds of a protected characteristic
- Denying basic rights to healthcare, education, employment and criminal justice relating to a protected characteristic
- Substandard service provision relating to a protected characteristic
Possible indicators of discriminatory abuse
- The person appears withdrawn and isolated
- Expressions of anger, frustration, fear or anxiety
- The support on offer does not take account of the person’s individual needs in terms of a protected characteristic
Organisational Abuse
Types of organisational or institutional abuse
- Discouraging visits or the involvement of relatives or friends
- Run-down or overcrowded establishment
- Authoritarian management or rigid regimes
- Lack of leadership and supervision
- Insufficient staff or high turnover resulting in poor quality care
- Abusive and disrespectful attitudes towards people using the service
- Inappropriate use of restraints
- Lack of respect for dignity and privacy
- Failure to manage residents with abusive behaviour
- Not providing adequate food and drink, or assistance with eating
- Not offering choice or promoting independence
- Misuse of medication
- Failure to provide care with dentures, spectacles or hearing aids
- Not taking account of individuals’ cultural, religious or ethnic needs
- Failure to respond to abuse appropriately
- Interference with personal correspondence or communication
- Failure to respond to complaints
Possible indicators of organisational or institutional abuse
- Lack of flexibility and choice for people using the service
- Inadequate staffing levels
- People being hungry or dehydrated
- Poor standards of care
- Lack of personal clothing and possessions and communal use of personal items
- Lack of adequate procedures
- Poor record-keeping and missing documents
- Absence of visitors
- Few social, recreational and educational activities
- Public discussion of personal matters
- Unnecessary exposure during bathing or using the toilet
- Absence of individual care plans
- Lack of management overview and support
Neglect or Acts of Omission
Types of neglect and acts of omission
- Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care
- Providing care in a way that the person dislikes
- Failure to administer medication as prescribed
- Refusal of access to visitors
- Not taking account of individuals’ cultural, religious or ethnic needs
- Not taking account of educational, social and recreational needs
- Ignoring or isolating the person
- Preventing the person from making their own decisions
- Preventing access to glasses, hearing aids, dentures, etc.
- Failure to ensure privacy and dignity
Possible indicators of neglect and acts of omission
- Poor environment – dirty or unhygienic
- Poor physical condition and/or personal hygiene
- Pressure sores or ulcers
- Malnutrition or unexplained weight loss
- Untreated injuries and medical problems
- Inconsistent or reluctant contact with medical and social care organisations
- Accumulation of untaken medication
- Uncharacteristic failure to engage in social interaction
- Inappropriate or inadequate clothing
Self-Neglect
Types of self-neglect
- Neglecting to care for one’s personal hygiene, health or surroundings
- Inability to avoid self-harm
- Failure to seek help or access services to meet health and social care needs
- Inability or unwillingness to manage one’s personal affairs
- Indicators of self-neglect
- Very poor personal hygiene
- Unkempt appearance
- Lack of essential food, clothing or shelter
- Malnutrition and/or dehydration
- Living in squalid or unsanitary conditions
- Neglecting household maintenance
- Hoarding
- Collecting a large number of animals in inappropriate conditions
- Non-compliance with health or care services
- Inability or unwillingness to take medication or treat illness or injury
- Lack of self-care to an extent that it threatens personal health and safety
Information taken from SCIE website: www.scie.org.uk