Let’s take a moment to talk about a very serious topic called child abuse and neglect, a subject none of us really want to talk about, but is vitally important, especially if you work in an industry where you might be mandated to report such abuse or neglect. First though, let's cover a little bit of background about this subject. According to the statistics covered by the United States Department of Health and Human Services, the Administration for Children & Families, an estimated 679,000 children were victims of abuse and neglect and of those, over 1,500 children died from abuse and neglect just in 2013. Of these children, 80% suffered from neglect; 18% suffered a physical form of abuse; and 9% were victims of sexual abuse. As you can clearly see, this is a problem that is serious and far too common. My hope is that this training will give you the knowledge to recognize true abuse and neglect, and help you protect the innocent. Now, depending on your state laws, you may have a legal requirement to report suspected abuse as a person called a 'mandated reporter.' A mandated reporter is a person who is legally required to ensure a report is made to the proper authorities when abuse is observed or suspected. Specific details vary across states and jurisdictions so make sure you know your particular details. Abuse that must be reported typically includes that which can be categorized as neglect, physical, or sexual in nature. Mandated reporters may be paid staff or volunteers, but who have assumed full or even limited responsibility for the care of a child. This often includes, but not limited to: teachers, daycare providers, EMS personnel, coaches, camp staff, and other professionals. Unfortunately, abuse can occur anywhere, and some examples may include: childcare centers, schools, religious institutions, recreational and athletic programs, camps, residential facilities and sadly even at home. The most predominant type of abuse is neglect. Neglect is something that means, 'despite available resources, the parent or legal caregiver fails to provide adequate food, clothing, shelter, supervision and may not seek appropriate medical attention for illness or injury.' This can happen for a number of reasons, but may specifically include a family crisis, or a job loss, a serious illness to a caregiver or a divorce or separation of parents that all leads to causing chaos in household that also alters the structure or routines, or the home may seem that is has little space left over for the child. Now, indicators of neglect may include: a child who looks undernourished and hungry. Now, these children might be beggars for food because of this persistent hunger. The child might be more lethargic, like they're not getting enough sleep due to disrupted schedules. They’ve got noticeably poor hygiene. Maybe they're inappropriately dressed for the weather. The child may have injuries that can be attributed to a lack of supervision, including those kind of associated from being harmed by other people. The trigger that makes them suspect of abuse is that they say they have frequent 'accidents and injuries'. Along with these injuries, they have a poor ability to relate to others and have poor self-esteem. Maybe they have attachment difficulties or other social problems like their inability to say no to inappropriate requests. These are all different ways we can suspect neglect and recognize that there may be a problem. Now, unlike neglect, physical abuse is any act that, regardless of the intent, results in a non-accidental, physical injury to a child. It can happen as a result of a parent becoming frustrated or angry and striking, shaking or even throwing a child. Physical abuse may be an intentional, deliberate assault, such as burning, biting or cutting the child. It's vital to remember that all children get bumps and bruises and cuts, but it's important to recognize when those bumps and bruises may be the indication that there's physical abuse rather than just normal, childhood accidents. In all cases, consider the context. Take into account the child's explanation of the injury, the child's age and the overall behavior that you notice in the child. Now let’s take a closer look at specific signs of physical abuse. Like questionable bruises and welts or other injuries on the face,or around their lips and mouth. Cuts and bruises on the torso, back, buttocks and thighs, in various stages of healing. In other words, the bruises might be different colors like some red and purple and others are yellowish-green. The bruises reflect the shape of the object used to inflict the injury, like an electrical cord or belt buckle. For questionable burns, like cigarette burns, especially on the soles of the feet, palms of the hands, the back or even the buttocks of the children. You may see signs of something we call immersion burns. This can be 'socklike' burns where we've seen they've put the baby or child into hot water. Now donut shaped burns on the buttocks or genitalia or burn patterns that are like electric stove burners, where they're round and circular or look like the surface of an iron. Maybe some rope burns on arms and legs, neck or torso. Look for fractures to the skull, the nose, the face, and black eyes all in various stages of healing. These could all indicate signs of physical abuse. So let's look at behavioral indicators now. Some behavioral indications might be that the child is uncomfortable with physical contact, being weary of adults and being apprehensive when other children cry. They may show emotional extremes like being overly aggressive or extremely withdrawn. In some cases the child may be frightened of the parents and afraid to go home. They may arrive to school very early or stay very late, again, all possible indicators that the child is avoiding the need to go home. Look for a track record where the child has made repetitive attempts to run away from home. So be alert to these reports that the child is being hurt by a parent or someone at home or in their community and maybe they are even complaining of body or limb soreness or moving uncomfortably. Maybe the child is wearing clothing inappropriate to the weather, I liken this to say a big bulky shirt and loose pants in order to cover the body or wounds. Additionally, they may even be reluctant to change clothes in public or for gym activities. This again being an attempt to hide injuries or bruises as a result of the abuse. So, how do you tell the difference between normal discipline and abuse? Well, it's important that there be some objective guidelines between corporal punishment and abuse. Corporal punishment, which is allowed in some areas of the United States, such as spanking, may be used as a discipline technique by parents or guardians to teach appropriate behavior. Discipline is a learning process though; the goal is to teach appropriate behavior. Abuse on the other hand is not a learning process, where the goal is not to stop inappropriate behavior but to inflict pain and is usually the result of anger, loss of control and frustration. See, there's a difference between accidents and purposeful injury. But how does one tell the difference between abuse and accidental injury? Well, abuse and accidental injury can look similar, but there are important differences and they are that cuts and bruises caused by accidents normally occur in outside areas of the body, like the elbows and the knees. But accidental injuries to soft tissue areas like the stomach and the buttocks are way less likely. Now, if the same type of injury happens frequently it's less likely to be an accident unless it's in a location that is socially acceptable for the appropriate age and activity level of the child. If multiple injuries are present, especially in different stages of healing, it's less likely to be an accident unless the child is involved in a full-contact sport. If a series of injuries appear in a pattern or resemble an object like an electric cord or a wooden spoon, well, that’s very suspicious and it may have been inflicted by abuse. If a child's caregiver gives an explanation for injuries that’s not consistent with the facts, then the injury may be suspect. Sometimes examples can be helpful so here’s a couple. Steve, a ten-year-old boy, arrived at school with a bruise on his elbow and a scrape on his knee. And sSo, you ask him what happened and Steve says, "I got hurt riding my bike when I hit a curb. I fell on the road." He says his father gave him a spanking because he told him not to ride on the road. Steve's father states the same exact thing when he picked Steve up from school, and Steve was glad to see his dad. In this situation, abuse would not be suspected. See, Steve's injuries are consistent with his explanation. His father's explanation was the same, and his injuries are on the outer, bony areas of the body, not the soft inner tissues. Steve behaved normally with his father and had no bruises or injuries from the corporal punishment, again, indicating that this was probably not abuse. Now, here's the second. You notice that Susie, a nine-year-old, is trying to hide from the other girls in the locker room when she changes into her gym t-shirt. You notice that she has bruises on her upper arms and back as well as strap welts and bruises on her lower back in various stages of healing. When you question her about it, she says, "Well, I fell down the stairs." She's very afraid that you might ask her mother about it. See, in this situation, you should suspect abuse. Susie's secrecy, her fear of her mother being called, the bruises on her upper arms and back, the specific injury pattern, and the evidence of the various stages of healing are all multiple indicators of possible abuse. Remember, reporting suspected abuse is helping to protect those who are being abused. Now let's talk about sexual abuse. It's a complex type of abuse with significant implications for the child victim. Often there are no physical signs or behavioral indicators that can be seen or they’re subtle and attributed to other things, but the adult abuser usually tries to manipulate them into silence by using things like, "This is our little secret." With real or implied threats. See this type of manipulation is far beyond the child's ability to understand. This is emotionally confusing to the child and will often create a wide range of emotional responses. Sexual abuse can be defined as any illegal sexual act upon a child. And it includes incest, rape, indecent exposure, fondling, child prostitution, and child pornography. Indicators of child sexual abuse include inappropriate knowledge of sex or sex behaviors, sexually explicit drawings or highly sexualized play, maybe expressions of unexplained fear of a person or place, avoiding or attempting to avoid a familiar adult, they also include nightmares, sleep interruptions, withdrawal, guilt-like feelings like "It's my fault." They may also indicate shame. They may have serious depression or maybe depression in general, anxiety, or mood swings. Make no mistake, one of the strongest indicators of sexual abuse is when a child simply says that he or she has been sexually abused. Take the statement seriously. Resolve doubt in favor of the child and error on the side of protection. If it’s not truly abuse a good justice system will find that out. So how should you respond to the abuse? Abusers often tell children that bad things will happen if they tell others about it or that it's a secret that is not to be shared. Because of this fear, children are more likely to share information in an indirect way, hoping you'll figure it out and figure out what they're trying to tell you. There are different forms of disclosure, let's cover a few, like indirect. Indirect disclosure might sound like this, "My babysitter keeps bothering me." There’s also disguised disclosure. Disguised disclosure sounds like, "What would happen if a girl was being touched in a bad way and she told someone about it?" A disclosure with strings might be something like, "I have a problem but if I tell you about it, you have to promise not to tell anybody." So, if a child wants to tell you something, listen to them but remain calm. Encourage the child to tell you what happened but please do not press the child beyond that which they’re willing to provide. It's important not to promise that you won't tell anyone else either. Let the child know that you may need to tell someone else in order to help them. Remember, you are not responsible to prove that the abuse or neglect occurred. Just that you have a suspicion that a child is being abused or neglected. If you have reason to suspect abuse has occurred then report the situation to a local child protective service office. And if you're a mandated reporter, you have a legal responsibility to report. There may be a policy that governs who actually makes a report to child protective services when abuse is suspected. It is important that you know your reporting policies and procedures. Please, don't shirk your responsibilities and please don't overestimate the strength and power of a healthy relationship that is simply good discipline and training. It's going to take discernment and wisdom on your part, but when you do suspect true abuse because of multiple indicators, you're acting on the part of a true rescuer for a child who may be in serious danger.