SPECIAL LAW IN THE PHILIPPINES Child Abuse.pptx

SPECIAL LAW IN THE PHILIPPINES Child Abuse.pptx

1. CHILD ABUSE Republic Act No. 7610. Special Protection of Children Against Abuse, Exploitation and Discrimination Act.

2. Child Refers o person below eighteen (18) years of age or Those over but are unable to fully take care of themselves or protect themselves from abuse, neglect, cruelty, exploitation or discrimination because of a physical or mental disability or condition

3. Child Abuse refers to the maltreatment, whether habitual or not, of the child which includes any of the following: Psychological and physical abuse, neglect, cruelty, sexual abuse and emotional maltreatment; Any act by deeds or words which debases, degrades or demeans the intrinsic worth and dignity of a child as a human being; Unreasonable deprivation of his basic needs for survival, such as food and shelter; or Failure to immediately give medical treatment to an injured child resulting in serious impairment of his growth and development or in his permanent incapacity or death Republic Act No. 7610. Special Protection of Children Against Abuse, Exploitation and Discrimination Act.

4. History taking comprises 90% of the diagnosis follows the sequence of events as they happened obtained in a developmentally appropriate, non-leading and non-suggestive manner confidential and part of the medical records not a forensic interview formulate a diagnosis as to the physical and mental health of the child look for possible evidence of abuse observe confidentiality at all times Protocol for Case Management of Child Victims of Abuse, Neglect, and Exploitation Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016

5. Components of History Patient’s profile Observations on behavioral and physical appearance of the patient History Chief complaint Disclosure Incident Alleged Perpetrator Acts Described Past and Comorbid Abuse Past Medical History Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016

6. Physical Examination Purpose: to assess the patient for acute or chronic injuries to treat and prevent sexually transmitted infections Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016

7. Components of Physical examination General survey and nutritional status Mental status Orientation to time, place and person Consciousness, demeanor Developmental assessment Mental health assessment Child’s behavior Extragenital examination Anogenital examination Tanner Staging External genitalia Urethral and perihymenal area Hymen Perineum Vaginal discharge Internal and speculum examination Anal examination Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016

8. Case 1 Nanay Flora had a grandson named Mac-mac. He was a son of a respected general, Ricardo Dalisay. Nanay Flora was very strict. She wanted Mac-mac to become a soldier and follow the steps of his dad. However Mac-mac wanted to pursue hairdressing. With Nanay Flora’s frustrations, she called Mac-mac “ salot ”. Even when talking with her grandson’s teachers or friends, she referred Mac-mac as “ salot ”. Mac-mac then committed suicide. What was the type of abuse present? A. Educational neglect B. Emotional abuse C. Physical abuse D. Sexual abuse

9. EMOTIONAL ABUSE

10. Definition aka psychological maltreatment, mental violence, verbal abuse most common form of child maltreatment most unreported and unrecognized Psychological maltreatment: “repeated pattern of caregiver behavior or extreme incident/s that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s needs (APSAC, 1995) Navarro, X., et al. 2014. Fundamentals of Pediatrics: Competency-based.

11. Mental violence: described as psychological maltreatment, mental abuse, verbal abuse and emotional abuse or neglect and this can include: All forms of persistent harmful interactions with the child, for example, conveying to children that they are worthless, unloved, unwanted, endangered or only of value in meeting another’s needs Scaring, terrorizing and threatening; exploiting and corrupting; spurning and rejecting; isolating, ignoring and favoritism; Denying emotional responsiveness; neglecting mental health, medical education and needs; Insults, name-calling, humiliation, belittling, ridiculing and hurting a child’s feeling; Exposure to domestic violence; Placement in solitary confinement, isolation or humiliating or degrading conditions or detention; and Psychological bullying and hazing by adults or other children, including via information and communication technologies such as mobile phones and the internet (known as “cyberbullying”) UN General Comment No. 13 on UN Convention on the Rights of the Child (CRC) Article No. 19

12. Management Improved parenting skills Parental self-care Social support Interventions appropriate for recognized risk factors such as: Mental health problems Substance abuse Developmental disorders Monitoring Navarro, X., et al. 2014. Fundamentals of Pediatrics: Competency-based.

13. CASE 2 Daniela, a very rich and ambitious woman, was occupied in planning revenge to Romina. Daniela was constantly out meeting gunmen. When at home, she was at her room devising plots. Marga , her daughter, was not able to finish grade 12. With Marga’s determination to finish her studies, she worked in a club as a waitress. One night, she was raped and murdered by Daniela’s gunman. What was/were the abuse/s committed by Daniela? A. Educational neglect B. Sexual abuse C. Physical abuse D. Both A and B

14. Child Neglect

15. DEFINITION “… the inattention or omission on the part of the caregiver to provide for the development of the child in all spheres: health, education, emotional development, nutrition, shelter safe living conditions, in the context of resources reasonable available to the family or caretakers ; and causes, or has a high probability of raising harm to the child’s health or physical, mental, spiritual, moral, or social development. This includes the failure to properly supervise and protect children from harm as much as is feasible.” Kleigman , R., et al. 2016. Nelson Textbook of Pediatrics 20th ed. Navarro, X., et al. 2014. Fundamentals of Pediatrics Competency-based

16. Failure to meet children’s physical and psychological needs, protect them from danger, or obtain medical, birth registration or other services when those responsible for children’s care have the means, knowledge and access to services to do so. Includes: physical neglect, psychological or emotional neglect, neglect of children’s physical or mental health, educational neglect and abandonment UN General Comment No. 13 on UN Convention on the Rights of the Child (CRC) Article No. 19

17. Chronic child neglect A parent or caregiver’s ongoing, serious pattern of deprivation of a child’s basic physical, developmental, and/or emotional needs for healthy growth and development Indicators: One or more needs basic to a child’s healthy development are not met The neglect happens on a recurring or enduring basis The neglect is perpetrated by a parent or a caregiver Chronic Child Neglect. 2019. https://www.childwelfare.gov

18. When the CHILD… frequently absents from school begs or steals food or money consistently dirty and has severe body odor uses alcohol or other drugs states that there is no one at home to provide care untreated illnesses and physical injuries When the CAREGIVER… feels overwhelmed addressing a range of challenges appears to be indifferent to the child seems apathetic or depressed behaves irrationally or in a bizarre manner Acts of Omission: An Overview of Child Neglect. 2018. https://www.childwelfare.gov Smith M, Robinson L, Segal J. 2019. Child Abuse and Neglect RECOGNITION

19. Management EARLY HELP Provide concrete services first Child care; Health care and public benefits; Food and clothing; Transportation; Housing and utilities; Attention to past trauma affecting the parent’s life Ensure safety MULTIDISCIPLINARY PRACTICES FAMILY SUPPORT APPROACHES Training in parenting / Parenting classes Home visitation Enhancement of parenting skills Raising the parent’s level of coping Emotional support Acts of Omission: An Overview of Child Neglect. 2018. https://www.childwelfare.gov

20. Case 3 Connor, grade 2 student, was very talkative in a class. One day, he was laughing very hard while playing a joke to his seatmate. Miss Lupita, his teacher, hit his mouth with a stick. Connor cried hard. Connor’s mother filed a complaint to school. However, Miss Lupita said that she was only disciplining the loud student. 1. Was there an abuse present? 2. If yes, what was the type of abuse?

21. Physical Abuse

22. DEFINITION WHO Intentional use of physical force against a child that results in, or has a high likelihood of, resulting in harm to the child’s health, survival, development, or dignity Includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning, poisoning, and suffocating Navarro, X., et al. 2014. Fundamentals of Pediatrics: Competency-based.

23. Discipline or Abuse? Corporal Punishment An act or acts which involve PHYSICAL FORCE and HUMILIATING OR DEGRADING ACTS imposed upon a child as punishment for an alleged or actual offense inflicted by an adult or another child, who has been given or has assumed AUTHORITY or RESPONSIBILITY for punishment or discipline Positive Discipline Non-violent, solution-focused, respectful and based on child development principles approach to enabling children learn or develop appropriate thinking and behavior Department of Social Welfare and Development AO No.7, Series of 2015. DSWD Child Protection Policy in the Workplace.

24. Corporal Punishment Blows including beating, kicking, slapping, lashing or any part of a child’s body, with or without use of instrument such as cane, broom, stick, whip or belt Pulling hair, shaking, twisting joints, cutting or piercing skin, dragging or throwing a child Forcing a child through the use of power, authority of threats to perform physically painful or damaging acts such as holding a weight or weights for an extended period, kneeling on stones, salt or pebbles Refusal to provide the child’s physical needs Tying up of a child Department of Social Welfare and Development AO No.7, Series of 2015. DSWD Child Protection Policy in the Workplace.

25. Imprisoning of a child Use or exposure to substance that can cause discomfort or threaten the child’s health including fore, ice, water, smoke, pepper, alcohol, dangerous chemicals such as bleach or insecticides, excrement or urine Verbal abuse or assaults including intimidation or threat or bodily harm, swearing or cursing, ridiculing or denigrating the child Making the child look or feel foolish in front of one’s peers or the public such as shaving hair or other analogous acts Department of Social Welfare and Development AO No.7, Series of 2015. DSWD Child Protection Policy in the Workplace.

26. Case 4 Mic-mic, 4-month old girl, was brought to PER due to seizures. According to the Mic-mic’s father, he left her daughter on the bed, but later found her cyanotic at the floor. There were no other persons at the house that time. He immediately brought the patient to PER. At the PER, the ROD noticed right periorbital bruise. What diagnostic test/s should be requested? A. CBC B. Cranial CT scan C. Skeletal survey D. A and B only E. All of the above

27. Red Flags of Physical Abuse The child fell from a low height less than 4 feet. The child feel and struck head on the floor or furniture, or a hard object fell on the child. Unexpectedly found dead. The child choked; was shaken to dislodge object. The child turned blue; was shaken to revive The sudden seizures Resuscitation efforts caused injuries The caretaker tripped and slipped while carrying the child A sibling did it The child left alone for a short time in a dangerous situation The child fell down the stairs Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016 Navarro, X., et al. 2014. Fundamentals of Pediatrics Competency-based BIOMECHANICS Those who don’t cruise, don’t bruise.

28. FRACTURES Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016 Kliegman , R., et al. 2016. Nelson Textbook of Pediatrics 20 th ed.

29. BRUISING and lacerations Accidental bruising pattern Abusive bruising pattern Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016 Navarro, X., et al. 2014. Fundamentals of Pediatrics Competency-based Patterns of bruising that are suggestive of physical child abuse include: Bruising in babies and young children who are not independently mobile Bruises that are seen away from bony prominences Bruises to the face, back, abdomen, arms, buttocks, ears and hands Multiple bruises in clusters Multiple bruises of uniform shape Bruises that carry the imprint of implement used Bruises indicating a ligature (wrists, ankles)

30. Fingertip Bruise Petechial Bruise Patterned (Imprint) Bruise Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016

31. BITE MARKS Adult Bite Child Bite Canine to canine To second molar Involves 1 arch Both arches Intercanine distance: 3 – 4.5cm Intercanine distance: <2.5 cm Human Bite Canine Bite Compress flesh Tear flesh Abrasion, contusion or laceration Punctures, laceration, avulsion 4 incisors and smaller canines 6 incisors and 2 very large canines Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016 Navarro, X., et al. 2014. Fundamentals of Pediatrics Competency-based Bite Mark

32. Burns Patterns of burns that are suggestive of physical child abuse include: Scalding immersion burns: no splash marks, clear tide levels, and well-demarcated outline of the contacted surface; stocking or glove-pattern burn Doughnut pattern: burns localized to the perineum buttocks with central sparing of buttocks Skinfold sparing Symmetrical distribution Burns consistent with the mechanism of injury Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016 Navarro, X., et al. 2014. Fundamentals of Pediatrics Competency-based

33. Abusive head trauma caused by direct impact, asphyxia, or shaking may lack external signs of injury, even with serious intracranial trauma Signs and symptoms (nonspecific): lethargy, vomiting (without diarrhea), changing neurologic status or seizures, and coma Clinical features: severe acute encephalopathy, extracranial features (70%), retinal hemorrhages (65-90%) Kliegman , R., et al. 2016. Nelson Textbook of Pediatrics 20 th ed. Navarro, X., et al. 2014. Fundamentals of Pediatrics Competency-based

34. DIAGNOSTICS Tests for hematologic disorders CT Scan Skeletal survey Appendicular skeleton: Humeri (AP); Forearms (AP); Hands (PA); Femurs (AP); Lower legs (AP); Feet (AP) Axial skeleton: Thorax (AP, lateral, right and left obliques), to include ribs, thoracic and upper lumbar spine; Pelvis (AP), to include the mid lumbar spine; Lumbosacral spine (lateral); Cervical spine (lateral); Skull (frontal and lateral) Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016 Navarro, X., et al. 2014. Fundamentals of Pediatrics Competency-based Kliegman , R., et al. 2016. Nelson Textbook of Pediatrics 20 th ed.

35. Case 5 Camila, 15-year old Grade 6 student, was brought by her father to the Bagong barangay health center because of dysuria. The pedia resident interviewed the patient first. She noticed that the patient was anxious. On probing, Camila disclosed that her twin brother Camilo was touching her breast and genital area when they were left alone in their house. Camila also said that, according to her brother, it was to show their love as twins. What is the type of abuse present? A. Educational neglect B. Emotional abuse C. Physical abuse D. Sexual abuse

36. Sexual Abuse

37. Definition WHO (2006) Activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person Navarro, X., et al. 2014. Fundamentals of Pediatrics: Competency-based.

38. Factors to Consider in Performing an Immediate Examination History of abusive incident within 72 hours Genital trauma heals rapidly and may heal completely thus there are less chances of identifying injuries among children examined 72hrs after the incident History of acute genital, anal or extragenital trauma particularly bleeding or injury History of bleeding or pain, such as dysuria, increases the chances of identifying injuries when the child is examined Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016 Navarro, X., et al. 2014. Fundamentals of Pediatrics Competency-based

39. Pregnancy evaluation and prevention Emergency contraception may be given to female adolescents who are seen within 72 hours to 120 hours of the most recent sexual contact Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016 Navarro, X., et al. 2014. Fundamentals of Pediatrics Competency-based

40. Diagnosis and management and/or prevention of sexually transmitted infections (STIs) Indication: The child has or has had symptoms or signs of an STD or of an infection that can be sexually transmitted, even in the absence of suspicion of sexual abuse. A suspected assailant is known to have an STD or to be at high risk for STDs (e.g., has multiple sex partners or a history of STDs). A sibling or another child or adult in the household or child’s immediate environment has an STD. The patient or parent requests testing. Evidence of genital, oral, or anal penetration or ejaculation is present. Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016 Navarro, X., et al. 2014. Fundamentals of Pediatrics Competency-based

41. Safety issues Alternative placement must be done if it is dangerous for the child to go home because of the perpetrator’s access to the child. Suicide risk If the child is suicidal, the child must not be sent home without being seen by a psychiatrist. Child Maltreatment Medico-legal Terminology and Interpretation of Medical Findings: A Consensus of Medical and Legal Child Protection Practitioners in the Philippines 4 th ed. 2016

42. Risk Factors

43. Child’s characteristics Age (younger than 4 years old) Sex Special characteristics: low birth weight, prematurity, behavioral problems, or physical or mental handicaps; children with special needs World Report on Violence and Health. Child abuse and neglect by parents and other caregivers. Navarro, X., et al. 2014. Fundamentals of Pediatrics: Competency-based.

44. Caregiver and family characteristics Domestic violence Alcohol and drug abuse Untreated mental illness Lack of parenting skills Stress and lack of support Larger family size Multiple births Having several siblings in the family Smith M, Robinson L, Segal J. 2019. Child Abuse and Neglect. Damashek A, et al. 2013. Fatal child maltreatment: characteristics of deaths from physical abuse versus neglect. Child Abuse & Neglect. 37: 735–744. Yamaoka Y, et al. 2015. Child deaths with persistent neglected experiences from medico-legal documents in Japan. Pediatrics International. 57: 373–380. Navarro, X., et al. 2014. Fundamentals of Pediatrics: Competency-based.

45. Community factors Poverty Social capital: degree of cohesion and solidarity that exists within communities Societal factors: includes culture, policies, social welfare system, preventive health care, and justice system World Report on Violence and Health. Child abuse and neglect by parents and other caregivers.

46. Effects Of child abuse

47. School Impact Developmental disabilities Lack of success in school School absenteeism and dropouts 2019 Prevention Resource Guide. https://www.childwelfare.gov/topics/preventing/

48. Intellectual Profile Stanford-Binet Intelligence Scales 5th Edition (SB5) IQ scores were found to be significantly lower than the minimum average scores on the test Verbal IQ (VIQ) scores were likewise found to be significantly lower than Nonverbal IQ (NVIQ) scores; Lower scores in Knowledge (KN) Working Memory (WM) accompanied by Fluid Reasoning (FR) were likewise lower than Visual Spatial Processing (VS) and Quantitative Reasoning (QR) Regarding types of abuse, those who have experiences of neglect significantly have lower scores in all SB5 Factor Indices, compared to physical and sexual abuse Bengwasan , P. 2018. The intellectual profile of abused and neglected children in the Philippines: An analysis of SB5 IQ scores of sexually abused, physically abused and neglected children. Child Abuse & Neglect. 81: 389–395.

49. Medical Impact Physical health outcomes Teen pregnancy Depression and suicide attempts Chronic illnesses, including heart disease, cancer, and lung disease Navarro, X., et al. 2014. Fundamentals of Pediatrics: Competency-based. 2019 Prevention Resource Guide. https://www.childwelfare.gov/topics/preventing/

50. Social Impact Substance use Crime (aggression and delinquency in adolescence) High costs to child welfare systems, juvenile courts, and schools Chronic Child Neglect. 2019. https://www.childwelfare.gov 2019 Prevention Resource Guide. https://www.childwelfare.gov/topics/preventing/

51. Reporting

52. The Mandatory Reporters The following are mandated to make a report, either orally or in writing, to DSWD/LSWDO within forty-eight (48) hours, the examination and/or treatment of a child who appears to have suffered from abuse: Head of any public or private hospital, medical clinic and similar institutions, and Attending physician and nurse Failure to report a child abuse case shall be punishable with a fine of not more than two thousand pesos (P2,000.00) or as may be determined in the future by a court with jurisdiction Protocol for Case Management of Child Victims of Abuse, Neglect, and Exploitation https://doj.gov.ph/child-protection-program.html Navarro, X., et al. 2014. Fundamentals of Pediatrics: Competency-based.

53. Others who may report The following government workers have the duty to report all incidents of possible child abuse: Teachers and administrators in public schools Probation officers Government lawyers Law enforcement officers Barangay officials Corrections officers Other government officials and employees whose work involves dealing with children Protocol for Case Management of Child Victims of Abuse, Neglect, and Exploitation https://doj.gov.ph/child-protection-program.html

54. Any person who, acting in good faith, reports a child abuse case shall be FREE from any civil or administrative liability As much as possible, the persons who report should give their names and contact details for further contacts, if necessary Their protection and anonymity shall be assured The person who reports need not be the complainant but has knowledge of the incident Protocol for Case Management of Child Victims of Abuse, Neglect, and Exploitation https://doj.gov.ph/child-protection-program.html

55. The child victim may or may not be with the person reporting the incident Any person who reports MUST provide basic information on the child victim (name, age, address or whereabouts of child, the reasons that child may be at risk or in an abusive or exploitative situation) and the alleged perpetrator any relevant information to suspect that a child is being abused or exploited shall suffice to initiate any action and investigation Protocol for Case Management of Child Victims of Abuse, Neglect, and Exploitation https://doj.gov.ph/child-protection-program.html

56. Where to report Department of Social Welfare and Development (DSWD) Commission on Human Rights Local Social Welfare and Development Office (LSWDO) of the municipality, city, or province Philippine National Police National Bureau of Investigation Other law enforcement agencies Punong barangay or tribal leader Barangay kagawad Any member of the Barangay Council for the Protection of Children (BCPC) Barangay help desk person or Violence Against Women (VAW) help desk officer Protocol for Case Management of Child Victims of Abuse, Neglect, and Exploitation https://doj.gov.ph/child-protection-program.html

57. Who can be the Complainant Offended party Parent or legal guardian Ascendant or collateral relative of the child within the third degree of consanguinity Duly authorized officer or social worker of the DSWD or LSWDO Officer, social worker, or representative of a licensed childcaring institution Punong barangay At least three (3) concerned responsible citizens of the community where the abuse took place who have personal knowledge of the offense committed Protocol for Case Management of Child Victims of Abuse, Neglect, and Exploitation https://doj.gov.ph/child-protection-program.html

58. Multi-disciplinary Police Prosecutor Judge Lawyer Social worker Medical doctor Psychiatrist Psychologist Barangay officials Protocol for Case Management of Child Victims of Abuse, Neglect, and Exploitation https://doj.gov.ph/child-protection-program.html