Abuse takes many forms, and the ability to recognise its indicators, understand the theoretical frameworks that explain its causes, and respond appropriately within both legal and organisational guidelines is a foundational competency for everyone working in social care, health and related professions. Abuse can be defined as “to treat wrongfully or harmfully.” There are different categories of abuse that have been recognised, and within our case study there appear to be two distinct forms: domestic abuse and child abuse. These can be subdivided in terms of physical abuse, emotional or psychological abuse, and non-organic failure to thrive. Physical abuse is the intentional inflicting of physical injury or harm or deliberately not preventing harm from occurring.
The minimum physical signs seen in our study for both Mrs Black and James are bruising with suspect excuses for their appearance. Emotional abuse is the continual failure to meet basic emotional needs, resulting in stunted emotional development and impaired well-being. The emotional signs in our case study can be seen in James by his actions of being withdrawn and non-communicative. The behavioural sign of abuse taking place to James is his aggressive behaviour. It is important to note that behavioural indicators such as sudden aggression or withdrawal rarely exist in isolation; practitioners should look for patterns across multiple domains of a child’s functioning rather than treating any single sign as definitive.
The short-term effects of physical abuse to James are bruising and pain. In the long term, recurring injuries can result in secondary illness and complications, permanent scarring and disfigurement. His emotional effects in the short term are a fear of adults or others, withdrawal and poor relationship with his peers. The long-term emotional effects for James could be low self-esteem, depression and an inability to form trusting relationships. Herrenkohl et al. (2020) conducted a longitudinal cohort study and found that children who experienced combined physical and emotional abuse before age 12 were significantly more likely to meet diagnostic criteria for PTSD, depression and substance use disorders in early adulthood, highlighting the long shadow that early abuse casts across the life course.
Abuse can arise for many reasons, and there are a number of theoretical perspectives which may be useful in clarifying why the abuse has taken place. The feminist perspective believes that gender and family roles create conditions that can approve a culture of abuse. Consider the historical and stereotypical ideas of the family, with men, women and children having definite roles, and men having power and control. In James’s case he lives in a reconstituted family with the father figure being dominant and a heavy drinker. From a psychological perspective, alcohol misuse can bring mental health problems which may increase aggression and so James is more at risk from abuse by his stepfather. The family dysfunction theory suggests that the family is not functioning due to dysfunctional family dynamics that attempt to find alternative ways of coping. The relationship between the mother and James involves a dependency of James on his mother; with other problems in James’s mother’s life, this leads to increasing stress and the inability of his mother to cope and manage the situation. The attachment theory states that significant separations of a child from the carer in the early years can have an effect on their emotional development and can lead to psychological and social difficulties in later life; the loss of both his father and his sister’s father, with whom he was close, may have contributed to his deterioration in behaviour.
If a client begins to make a disclosure of abuse it is important to ensure privacy and confidentiality. It is necessary to show that listening skills are employed and that I remain calm and receptive. I must listen without interruption and make it clear that I am taking their disclosure seriously. I must only ask questions of clarification if I am unclear as to what the vulnerable adult is saying. It is important that I acknowledge their courage in coming forward and tell them that they are not responsible for the abuse. I must let it be known to them what I will do to help them and where possible get their consent to inform my line manager. I must speak to my client in comfortable and quiet surroundings. I would ask my client to sit down where I shall use SOLER techniques, which are non-verbal aids to communication. Using the SOLER theory I would use five basic components: I would sit squarely on at the table turned towards one another. I would adopt an open posture. I would lean forward slightly to convey that I am interested and committed to actively listening. I would maintain regular but varied eye contact. I would maintain a relaxed manner. This would also let him know that I am involved in the situation. This adhered to our organisation’s policy on Confidentiality and the Data Protection Act of 1998, allowing my client to voice his concerns without worry and protecting his privacy. I would inform him that he is not responsible for the abuse. It is important that I make an immediate record of what the vulnerable adult has said, using only their own words, in the Incident Book, clearly, accurately and legibly, and then report to the Line Manager who is responsible for any further action.
As we do not supply a care service, we are not required to register with the Care Commission, but we ensure all our policies and procedures meet their standards. The policy and procedures on abuse of our organisation are underpinned by the National Care Standards which were set up under the Regulation of Care (Scotland) Act 2001. This Act came about to regulate the care and social work force and set out the principals of good care practice. The Care Commission was set up under this Act to register, regulate and inspect all care services listed in the Act. It also established The Scottish Social Services Council (SSSC). The SSSC has aims and objectives to protect service users, raise standards, and strengthen and support workforce professionalism. An example of the code of practice of the SSSC is to protect service users’ rights, promote their interests, establish and maintain trust, and promote their independence while protecting them as far as possible from danger or harm. The policy for protecting vulnerable people within our organisation is achieved through careful selection, screening, training and supervision of staff and volunteers. Under The Protection of Vulnerable Groups (Scotland) Act 2007 a code of good practice for vulnerable adults has been developed, which expects staff or volunteers suspecting or having had abuse disclosed to them to immediately report the concerns to their line manager and write up an incident report. The line manager will discuss the concerns with the person reporting the abuse, clarify the concerns and obtain all known relevant information. This will then be forwarded to the appropriate local Social Work Department stating that it concerns vulnerable adult protection. In the absence of a line manager the concerns should be reported directly to the local Social Work Department and the line manager informed as soon as possible. The social work department, after investigation, may have to inform the police to investigate further. The principal function of Registered Social Workers is the safety and support of the wellbeing of children and vulnerable adults, in compliance with the Scottish Social Services Council’s Code of Practice for Social Service Workers.
Under our code of good practice in preventing abuse it is important to avoid unobserved situations of one-to-one contact with a vulnerable adult. I must never invite a vulnerable adult to my home, offer to take a vulnerable adult alone in my own vehicle, or if it is necessary to do things of a personal nature, I must have the consent and knowledge of the carers and my line manager before doing so. I must not engage in or allow any sexually provocative games involving vulnerable adults. I must never make or allow suggestive remarks or discriminatory comments. I must not engage in or tolerate bullying or inappropriate physical behaviour. I must respect all vulnerable adults regardless of age, gender, ethnicity, disability or sexual identity, and I must never trivialise abuse or let allegations of abuse go unreported, including any made against myself. The policy and procedures of our organisation adhere to the Protection of Vulnerable Groups Act (Scotland) 2007 by ensuring that every volunteer and employee has undergone a Disclosure check that reveals any convictions.
Sources of support for workers in the field of preventing abuse can be provided by statutory, voluntary, and private or independent organisations. Statutory services have a distinct concern laid down by legislation, such as social services and the NHS. The voluntary sector is run on a non-profit making basis and has arisen through a recognised need reflecting society’s values, such as Advocacy and Mencap. Support can consist of casework on a one-to-one basis, counselling, and group work bringing people together with shared issues to resolve problems collectively. Workers in the field of abuse prevention also require access to their own support structures, including supervision, reflective practice opportunities and access to professional occupational health services, as secondary traumatic stress is a recognised risk for those regularly working with disclosure and abuse scenarios.
Cultural values play a part in defining what is considered abusive conduct. What the UK considers abuse may not be considered abuse in another culture. For example, domestic abuse has only relatively recently become socially abhorrent in the UK; as recently as the 1970s and 1980s, domestic abuse was widely considered a marital problem and to be accepted within the home. Today we have little tolerance for domestic abuse. However, ethnic minority women still face the risk of prolonged periods of abuse and find it difficult to report; families may expect women to endure it, and ethnic women are sometimes regarded as their husband’s property. Honour killings are not unknown amongst ethnic minorities, with religious texts sometimes invoked as justification. Female circumcision is another culturally accepted form of abuse, still practised in 28 countries in Africa, used to control female sexuality; it is conducted on girls aged from 4 to 12, usually in unhygienic conditions with potentially fatal consequences. Forced marriages are also a serious concern, involving the removal of a potential bride from the country against her wishes and forcing her to marry a suitor selected by the family. Anitha and Gill (2020) argue that the specific cultural contexts of forced marriage and honour-based violence require social workers to move beyond culturally neutral frameworks and develop culturally responsive strategies that do not inadvertently shame communities while still holding perpetrators accountable.
Workers may sometimes have trouble accepting the motives of people who are involved in abuse. There may be a need to ask why and how someone can have abused another person. Perhaps the worker’s values and beliefs make working with an abuser distasteful; however, a professional approach to working with an abuser must always be taken. Abusive behaviour can sometimes be the result of mental health problems, an empathy deficit, brain damage or being abused oneself. Some abusers believe they are taking control or that they are not doing anything wrong and cannot stop themselves. When working with individuals who have abused it is important to be aware that they may go on to abuse again, and as well as trying to treat the underlying cause for abuse there is a need to protect the community. The use of risk assessments is therefore important when working with an abuser.
In conclusion, it is important to understand the probable risks and take appropriate action to reduce them. Effective communication and personal skills are useful to understand and reduce potential conflicts. Reflection on one’s own values and how they may affect practice, alongside awareness of the abuser’s cultural values and background, is required. This is to ensure awareness and intervention are employed when required. When dealing with abuse, it is important to listen, understand, report and keep the abused safe — and if dealing with the abuser, to maintain personal safety while supporting the investigation process.
References
- SSSC. (2009). Codes of Practice. Available: http://www.sssc.uk.com/
- Stephen Smellie. (2005). Role of the Social Worker: Protection of Title. Available: http://www.unison-scotland.org.uk/response/swrole2.html
- Elizabeth Bingham et al. (2009). Protection including safeguarding and management of risk. In HNC in Social Care. Heinemann. p. 229.
- Herrenkohl, T. I., Leeb, R. T., & Laird, R. (2020). The association between child abuse and long-term psychiatric outcomes. Child Abuse & Neglect, 107, 104497. https://doi.org/10.1016/j.chiabu.2020.104497
- Anitha, S., & Gill, A. K. (2020). Reconceptualising consent in the context of forced marriage and honour-based violence. British Journal of Social Work, 50(4), 1131–1148. https://doi.org/10.1093/bjsw/bcz172
- Kathryn Patricelli. (2005). Why do people abuse? Available: http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=8482
- Elizabeth Bingham et al. (2009). Issues involved in protection from abuse. In HNC in Social Care. Heinemann. p. 217.