Signs of harm and abuse

Physical abuse

Physical abuse may involve hitting, shaking, throwing, poisoning, burning, or scalding, drowning, suffocating, or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces illness in a child.

Emotional abuse

Emotional abuse is the persistent emotional ill treatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued insofar as they meet the needs of another person. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the ill treatment of another, causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of ill treatment of a child, though it may occur alone.

Neglect

Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to provide adequate food or clothing, shelter including exclusion from home or abandonment, failing to protect a child from physical and emotional harm or danger, failure to ensure adequate supervision including the use of caretakers, or the failure to ensure access to appropriate medical care or treatment. It may also involve neglect of, or unresponsiveness to, a child’s basic emotional needs.

Sexual abuse

Sexual abuse involves grooming, forcing or enticing a child; young person or vulnerable adult is to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative (e.g. rape or buggery) or non-penetrative acts. They may include non-contact activities, such as involving children in looking at, or in the production of, pornographic material or watching sexual activities or encouraging children to behave in sexually inappropriate ways.

The Care Act 2014 describes 10 categories of abuse:

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)

Psychological 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

Domestic abuse

Domestic violence or abuse can be characterised by any of the indicators of abuse outlined in this briefing relating to:

• Psychological
• Physical
• Sexual
• Financial
• Emotional

Sexual abuse and sexual exploitation

• 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

Financial 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 – e.g. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship

Modern slavery and trafficking

• 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

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
• 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

Organisational 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

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

Self-neglect

• Lack of self-care to an extent that it threatens personal health and safety
• 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

Child sexual exploitation

Child sexual exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity

• (a) in exchange for something the victim needs or wants, and/or
• (b) for the financial advantage or increased status of the perpetrator or facilitator.

The victim may have been sexually exploited even if the sexual activity appears consensual.

Criminal exploitation

Criminal exploitation is a form of modern slavery that sees victims being forced to work under the control of highly organised criminals in activities such as forced begging, shoplifting and pickpocketing, cannabis cultivation, drug dealing and financial exploitation. This occurs where an individual or group takes advantage of an imbalance of power to coerce, control, manipulate or deceive a child or young person under the age of 18 into any criminal activity in exchange for something the victim needs or wants and or for the financial or other advantage of the perpetrator or facilitator and/or through violence or the threat of violence.

County lines

Commonly involves the illegal distribution and dealing of seriously dangerous drugs from one city/town to another. The most common drugs involved are heroin and cocaine (crack and powder), but also MDMA, cannabis, amphetamines, and spice. Gangs sometimes use violence to threaten children and young people when recruiting them. Gangs also violently assault children and young people working for them if they find their drugs or money to be missing. Weapons such as firearms, knives, bats, acid are sometimes used to make violent threats.

Radicalisation

Radicalisation is the process by which a person comes to support terrorism and extremist ideologies. It is defined by the government as “the name given to the process that moves a person to legitimise their support or use of violence. It’s where terrorism begins.”

Bullying

Bullying is behaviour by an individual or group, repeated over time, that intentionally hurts another individual or group either physically or emotionally. Bullying can take many forms (for instance, cyber-bullying via text messages, social media, or gaming, which can include the use of images and video) and is often motivated by prejudice against particular groups, for example on grounds of race, religion, gender, sexual orientation, special educational needs, or disabilities, or because a child is adopted, in care or has caring responsibilities. It might be motivated by actual differences between children, or perceived differences.

Peer on peer or child on child abuse

Peer on peer or child on child abuse can be motivated by perceived differences e.g. on grounds of race, religion, gender, sexual orientation, disability, or other differences. It can result in significant, long lasting and traumatic isolation, intimidation or violence to the victim. Children or young people who harm others may have additional or complex needs e.g. significant disruption in their own lives, exposure to domestic abuse or witnessing or suffering abuse, educational under-achievement, being involved in crime. It should be recognised that child on child abuse is harmful to both the perpetrator and the victim.

Sexual violence and harassment

Sexual violence is rape, assault by penetration, sexual assault or causing someone to engage in sexual activity without consent. Sexual harassment is unwanted conduct of a sexual nature. Harmful sexual behaviour is problematic, abusive, and violent behaviour by a child/young person that is developmentally inappropriate and may cause developmental damage.

Honour based abuse and forced marriage

Honour based abuse is a broad umbrella term used to describe a combination of practices used principally to control and punish the behaviour of a member of a family or social group, in order to protect perceived cultural and religious beliefs in the name of ‘honour’. Although predominantly associated with women and girls, male members of a family can also be victims. Violence and abuse may occur when it is felt that an individual’s behaviour has broken the ‘honour code’, bringing disgrace to their family or social group. Perpetrators will feel that they need to restore their loss of face and standing within their community. There is often an element of approval and social acceptance from other family members and the community. A forced marriage is where one or both people do not (or cannot e.g. some people with learning difficulties or mental and physical disabilities) consent to the marriage, and then face coercion through honour-based abuse/violence such as emotional pressure and/or physical abuse which can involve being held captive, assaulted, harassed, raped, drugged, emotionally blackmailed etc.

Female Genital Mutilation (FGM)

Female Genital Mutilation (FGM) involves procedures that include the partial or total removal of the external female genitalia or other injury to the female genital organs.  It is often referred to as ‘female genital cutting’, circumcision, or simply ‘cutting’ or ‘initiation’. It is carried out for cultural, religious or other non-therapeutic reasons. FGM is illegal in the UK and there are no medical benefits from the practice. The FGM Act (2003) introduced a mandatory duty to report to the police 'known' cases of FGM in under 18s.

Hate crime

Hate incidents and hate crime are acts of violence or hostility directed at people because of who they are or who someone thinks they are. An example of this would be someone being verbally abused by someone because they were disabled, or someone thought they were gay.

Spiking

Spiking is when someone puts alcohol or drugs into another person's drink or body without their consent or knowledge. People can also be a victim of 'needle spiking', which is injecting someone with drugs without their consent.