Abuse Protection Support

Definition identification of high risk dependent relationship and actions to prevent further
Infliction of physical or emotional harm
Activities:
Identify adult(s) with a history of unhappy childhoods associated with abuse, rejection, excessive criticism,
or feelings of being worthless and unloved as children
Identify adult(s) who have difficulty trusting others or feel disliked by others
Identify whether individual feels asking for help is an indication of personal incompetence
Identify level of social isolation present in family situation
Determine whether family needs periodic relief from care responsibilities
Identify whether adult at risk has close friends or family available to help with children when needed
Determine relationship between husband and wife
Determine whether adults are able to take over for each other when one is too tense, tried, or angry to deal
With a dependent family member
Determine whether child/dependent adult is viewed differently by an adult based on sex, appearance, or
behavior
Identify crisis situations that may trigger abuse such as poverty, unemployment, divorce, or death of a
loved one
Monitor for signs of neglect in high-risk families
Observe a sick or injured child/dependent adult for signs of abuse
Listen to the explanation of how the illness or injury happened
Identify when the explanation of the cause of the injury is inconsistent between those involved
Encourage admission of child/dependent adult for further observation and investigation, as appropriate
record times and durations of visits during hospitalization
Monitor parent-child interactions and resend observations, as appropriate
Monitor for under reactions or overreactions on the part of an adult
Monitor child/dependent adult for extreme compliance, such as passive submission to hospital procedures
monitor child for role reversal, such as comforting the parent or overactive or aggressive behavior
Listen attentively to adult who begins to talk about own problems
Listen to pregnant womans feelings about pregnancy and expectations about the unborn child
Monitor new parents reactions to infant, observing for feelings of disgust, fear, or unrealistic expectations
Monitor for a parent who holds newborn at arms length, handles him/her awkwardly, or ask for
Excessive assistance
Monitor for repeated visits to a clinic, emergency room, or physicians office for minor problems
Monitor for a progressive deterioration in the physical and emotional care provided to child/dependent
Adult in the family
Monitor child for signs of failures to thrive, depression, apathy, developmental delay, or malnutrition
Determine expectations adult has for child to determine if expected behaviors are realistic
Instruct parents on realistic expectations of child based on developmental level
Establish rapport with families with a history of abuse for long-term evaluation and support
Help families identify coping stressful situations

Activities:-contd
Instruct adult family members on signs of abuse
Refer adults(s) at risk to appropriate specialists
Inform the physician of observations indicative of abuse
Report any situations where abuse is suspected to the proper authorities
Refer adult(s) to shelters for abused spouses, as appropriate
Refer parents to parents anonymous for group support, as appropriate
Encourage patient to contact police when physical safety is threatened
Inform patient of laws and services relevant to abuse

Abuse Protection Support: Child

Definition identification of high risk dependent child relationship and action to prevent
Possible or further infliction of physical, sexual, or emotional harm or neglect of basic
Necessities of life
Activities:
Identify mother who have a history of late (4 month or later) or no prenatal care
Identify parents who have had another child removed from the home or have placed previous children
With relatives for extended periods
Identify mother who have a history of substance abuse, depression, or major psychiatric illness
Identify parents who demonstrate an increased need for parent education (e.g. parents with learning
problems, parents who verbalize feelings of inadequacy, parents of a first child, teen parents)
Identify parents with a history of domestic violence or mother who has a history of numerous
Accidental injuries
Identify parents with a history of unhappy childhoods associated with abuse, rejection, excessive criticism,
or feelings of being worthless and unloved
Identify crisis situations that may trigger abuse (e.g. poverty, unemployment, divorce, homelessness, and
Domestic violence)
Determine whether the family has an intact social support network to assist with family problems, respite
child care, and crisis child care
Identify infants/children with high care needs (e.g. prematurity, low birth weight, colic, feeding
Intolerances, major health problems in the first year of life, developmental disabilities, hyperactivity,
And attention deficit disorders)
Identify caretaker explanations of childs injuries that improbable or inconsistent, allege self-injury,
Blame other children, or demonstrate a delay in seeking treatment
Determine whether a child demonstrates signs of physical abuse, including numerous injuries in various
Stages of healing; unexplained bruises and welts; unexplained pattern, immersion, and friction, burns:
Facial, spiral, shaft, or multiple fractures, unexplained facial lacerations and abrasions human
Marks: intracranial, subdural, intraventricular, and intraocular hemorrhaging: whir lash shaken infant
Syndrome and diseases that are resistant to treatment and/or have changing signs and symptoms
Determine whether the child demonstrates signs of neglect including poor or inconsistent growth patterns.
Failure to thrive, wasting of subcutaneous tissue. Consistent hunger, poor hygiene, constant fatigue and
Listlessness, bald patches on scalp or other skin afflictions, apathy, unyielding body posture, and
Inappropriate dress for weather conditions
Determine whether a child demonstrates signs of sexual abuse, including difficulty walking or sitting:
Torn, stained, or bloody underclothing: reddened or traumatized genitals; vaginal or anal lacerations;
Recurrent urinary tract infections; poor sphincter tone; acquired sexually transmitted diseases;
Pregnancy; promiscuous behavior or prostitution; a history of running away, sudden massive weight
Loss or weight gain, aggression against self, or dramatic behavioral or health changes of undetermined
Etiology
Determine whether a child demonstrates signs of emotional abuse, including lags in physical
Development, habit disorders, conduct learning disorders, neurotic traits/psychoneurotic reaction,
Behavioral extremes, cognitive developmental lags, and attempted suicide
Encourage admission of child for further observation and investigation, as appropriate
Record times and durations of visits during hospitalizations
Monitor parent-child interactions and record observations
Determine whether acute symptoms in child abate when child is separated from family
Activities:-contd

Determine whether parents have unrealistic expectations for childs behavior or whether they have
Negative attributions for their childs behavior
Monitor child for extreme compliance, such as passive submissions to invasive procedures
Monitor child for role reversal, such as comforting the parent, or overactive or aggressive behavior
Listen to pregnant womans feelings about pregnancy and expectations about the unborn child
Monitor new parents reactions to their infant, observing for feelings of disgust, fear, or disappointment in
gender
Monitor for a parent who holds newborn at arms length, handles newborn awkwardly, asks or excessive
Assistance, and verbalizes or demonstrates discomfort in caring for the child
Monitor for repeated visits to clinics, emergency rooms, or physicians offices for minor problems
Establish a system to flag the records of children who are suspected victims of child abuse or neglect
Monitor for a progressive deterioration in the physical and emotional state of the infant/child
Determine parents knowledge of infant/child basic care needs and provide appropriate child care
information as indicated
Instruct parents on problem solving, decision making, and childrearing and parenting skills, or refer parents
to programs where these skills can be learned
Help families identify coping strategies for stressful situations
Provide parents with information on how to cope with protracted infant crying, emphasizing that they
should not shake the baby
Provide the parents with no corporal punishment methods for disciplining children
Provide pregnant woman and their families with information on the effects of smoking poor nutrition, and
substance abuse on the babys and their health
Engage parents and child in attachment-building exercises
Provide parents and their adolescents with information on decision making and communication skills and
refer to youth service counseling as a appropriate
Provide older children with positive affirmations of their worth, nurturing care, therapeutic communication
and developmental stimulation
Provide children who have been sexually abused with reassurance that the abuse was not their fault and
allow them to express their concerns through play therapy appropriate for age
Refer at-risk pregnant woman and parents of newborns to nurse home visitation service
Provide at-risk families with a public health nurse referral to ensure that the home environment is
monitored, that siblings are assessed, and that families receive continued assistance
Refer families to human service and counseling professional, as needed
Provide parents with community resource information that includes addresses and phone numbers of
agencies that provide respite care, emergency child care, housing assistance, substance abuse treatment,
sliding-fee counseling service, food pantries, clothing distribution centers, health care, human services, hot
lines, and domestic abuse shelters
Inform physician of observations indicative of abuse or neglect
Report suspected abuse or neglect to proper authorities
Refer a parent who is being bettered and at-risk children to domestic violence shelter
Refer parents to parents anonymous for group support, as appropriate