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Indicators of abuse & neglect of vulnerable adults

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How to use the indicators of abuse

The presence of indicators of abuse does not prove a vulnerable adult has been or is being abused.

Indicators of abuse provide guidance on possible concerns and potential causal relationships. They should act as a trigger, encouraging people to consider whether an injury, behaviour or disclosure raises the possibility that a vulnerable adult may be at risk of significant harm from abuse or neglect.

Some indicators are sufficient as single signs to prompt you to make a report to the relevant authorities. Other indicators are meaningful when they co-exist with other indicators.

The absence of indicators does not necessarily mean a vulnerable adult is safe. Some maltreated vulnerable adults will not display any noticeable symptoms. Equally, many of the indicators listed may be the consequence of other factors aside from abusive or neglectful care.

Vulnerable adults who have experienced abuse will often experience more than one type of maltreatment. For example, there is a strong propensity for carer neglect to co-exist with psychological or emotional abuse.

Indicators of abuse need to be considered in the context of a vulnerable adult’s circumstances and other vulnerabilities. 

Interpretation of indicators always involves adopting the vulnerable adult’s perspective and placing the individual at the centre of consideration. The focus is on the possible consequences of the actions or inactions of the vulnerable adult’s parents, carers or other responsible persons.

It is important to discuss your concerns for a vulnerable adult with a person experienced with and trained in interpreting the indicators of abuse.  As a diocesan worker or member of our faith communities or parent or carer of a vulnerable adult in receipt of a diocesan service, you are able to contact the Office of Safeguarding to discuss your child related concerns:

P:   4979 1390 (Mon-Friday 9am-5pm)

E:   child.protection@mn.catholic.org.au

Indicators of abuse of a vulnerable adult

The following section provides detailed information on the indicators of abuse of vulnerable adults, described in terms of the five generally used classifications of abuse, with a preliminary section on the factors that make vulnerable adults at higher risk of abuse. Each sub-heading has detailed information when you expand the relevant classification.

  • Social and geographical isolation
  • Confusion regarding property, belongings or surroundings
  • Inability to self-advocate
  • Families taking advantage of the vulnerable adult or their assets
  • Domestic and family violence
  • Sudden or significant increase in the vulnerable adult’s level of dependence
  • Carer stress — sudden changes to circumstances affecting the carer’s capacity to cope (workplace, private life, financial)

Physical indicators:

  • Direct or indirect disclosure
  • Sexual act described by vulnerable adult
  • Trauma to the breasts, buttocks, lower abdomen or thighs
  • Difficulty in walking or sitting
  • Injuries (tears or bruising), pain or itching to genitalia, anus or perineal region
  • Human bite marks
  • Torn, stained or blood-stained underwear or bedclothes
  • Unexplained STD or incontinence (bladder or bowel)
  • Unexplained accumulation of money or gifts
  • Pregnancy (for younger vulnerable adults)
  • Anxiety around the perpetrator and other psychological symptoms

Victim behavioural signs:

  • Repeat use of words, for example, “bad”, “dirty”
  • Self-destructive behaviour, self-mutilation
  • Sudden changes in behaviour or temperament, for example, depression, anxiety attacks including crying, sweating and trembling, withdrawal, agitation, anger, violence, absconding, seeking comfort and security
  • Inappropriate advances to others
  • Sleep disturbances, refusing to go to bed, going to bed fully clothed
  • Eating disorders
  • Refusing to shower, or constant showering
  • Changes in social patterns, refusing to attend usual places
  • Excessive compliance

Perpetrator indicators:

  • Non-consensual sexual contact, language or exploitative behaviour
  • Rape and sexual assault
  • Cleaning or treating the vulnerable adult’s genital area roughly or inappropriately
  • Enforced nudity of the vulnerable adult against their wishes / without their consent

Physical indicators:

  • Facial, head and neck injuries, for example, lacerations to mouth, lips, gums, eyes or ears, missing teeth and/or eye injuries
  • Drowsiness, vomiting, fits (associated with head injuries)
  • Repeated, unexplained, or poorly explained internal or external injuries, for example, sprains, dislocations and fractures, pressure sores, bruises or marks on different areas of the body, pain on touching
  • Other bruising and marks suggesting the shape of the object that caused it, for example, “straight-line” bruising, finger-print bruising around wrists
  • Evidence of assault including, bite marks, scratches, bruises, lacerations, choke marks, hair loss or welts
  • Unexplained burns or scalds, for example, rope, cigarettes, matches, iron or hot water
  • Unexplained fractures, dislocations, sprains

Victim behavioural signs:

  • Explanation inconsistent with the injury; explanation varies
  • Avoidance or fearfulness of a particular person or staff member
  • Sleep disturbance such as nightmares or bedwetting
  • Changes in behaviour including out-of-character aggression, withdrawal, excessive compliance

Perpetrator Indicators:

  • Pushing, shoving, rough handling
  • Kicking, hitting, punching, slapping, biting, and/or burning
  • Restraining; physical or medical
  • Locking the person in a room or home or tying to a chair or bed
  • Intentional injury with a weapon or object
  • Overuse or misuse of medications

Physical indicators:

  • Unexplained weight loss, dehydration, poor skin integrity, malnutrition and persistent hunger
  • Poor hygiene, unkept appearance
  • Poor hair texture
  • Inappropriate or inadequate clothing for climatic conditions
  • Inappropriate or inadequate shelter or accommodation
  • Unattended physical problems or medical needs or absence of prescribed or required aids
  • Health or dietary practices that endanger wellbeing or development
  • Social isolation
  • Lack of medical or dental care, or injuries that have not been properly cared for
  • Exposure to unsafe, unhealthy, and/or unsanitary conditions

Victim behavioural signs:

  • Requesting, begging, scavenging or stealing food
  • Constant fatigue, listlessness or falling asleep
  • Direct or indirect disclosure
  • Extreme longing for company
  • Anxiety about being alone or abandoned
  • Displaying inappropriate or excessive self-comforting behaviours

Perpetrator indicators:

  • Failure to provide basic needs such as food, adequate or clean clothing, heating, medicines
  • Under or over-medication
  • Exposure to danger or lack of supervision, such as leaving the vulnerable adult in an unsafe place or in isolation
  • An overly attentive carer in the company of others
  • Refusal to permit others to provide appropriate care

Physical indicators:

  • Speech disorders
  • Weight loss or gain

Victim behavioural signs:

  • Resignation, shame
  • Depression, tearfulness
  • Confusion, agitation
  • Feelings of helplessness
  • Unexplained paranoia or excessive fear
  • Disrupted appetite or sleep patterns, such as insomnia
  • Unusual passivity or anger
  • Sadness or grief at the loss of interactions with others
  • Withdrawal or listlessness due to people not visiting
  • Changes in levels of self-esteem
  • Worry or anxiety after a visit by specific person/people
  • Social isolation, feelings of worthlessness about life and self, extreme low self-esteem self-abuser, self-destructive behaviour
  • Extreme attention-seeking behaviour and other behavioural disorders, for example, disruptiveness, aggressiveness, bullying
  • Excessive compliance

Perpetrator indicators:

  • Pressuring, intimidating or bullying
  • Name calling, and verbal abuse
  • Treating the vulnerable adult like a child
  • Threatening to harm the person, other people or pets
  • Engaging in emotional blackmail such as threatening to withdraw access to family, friends, services, telephone or activities
  • Preventing contact with family and friends, or denying access to the phone or computer
  • Withholding mail
  • Preventing the vulnerable adult from engaging in religious or cultural practices
  • Moving the vulnerable adult far away from family or friends

Physical indicators:

  • Restricted access to, or no control over, personal funds or bank accounts
  • No records or incomplete records kept of expenditure and purchases
  • Missing money, valuables or property
  • Forced changes to wills or other legal documents

Victim behavioural signs:

  • Unexplained disappearance of belongings
  • Unexplained inability to pay bills
  • Significant bank withdrawals and/or changes to wills
  • Inability of the vulnerable adult to access bank accounts or statements
  • Stockpiling of unpaid bills or an empty fridge
  • Disparity between living conditions and money
  • No money to pay for essentials for the home including food, clothing, and utilities
  • Changes to the vulnerable adult’s behaviour towards others/peers indicative of financial distress, for example, stealing from others, borrowing money or begging

Perpetrator indicators:

  • Threatening or coercing in relation to assets or wills
  • Taking control of the vulnerable adult’s finances against their wishes and denying access to their own money
  • Abusing powers of attorney
  • Stealing goods, for example, jewellery, credit cards, cash, food, and other possessions
  • Unauthorised use of banking and financial documents
  • The recent addition of a signature on a bank account