Indicators of abuse & neglect of vulnerable adults

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.

Increased risk of abuse factors for vulnerable adults

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)

Indicators of sexual abuse

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

Indicators of physical abuse (assault)

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

Indicators of neglect

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

Indicators of psychological abuse

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

Indicators of financial abuse

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