Unexplained Injuries in Care – 3 Tips for Investigators

Harriet Witchell - Wednesday, March 29, 2017
unexplained injuries in care

It goes without saying that injuries occur in all workplaces, not just the community sector. Yet there are certain unexplained injuries within care environments that should receive particular attention.

We set out our top three 3 tips for investigators when confronted with an unexplained injury allegation in aged or disability care contexts.

1. FULLY UNDERSTAND THE CARE ENVIRONMENT

Those charged with investigating claims of abuse by carers have a challenging task. Both circumstances and injuries can be ill-defined, with sometimes little to go on in terms of firm evidence. This is due primarily to the nature of childcare and other care environments – vulnerable people often have difficulty explaining that workplace violence hasoccurred.

Patients can be in a frail or vulnerable state for example, with high dependency on assistance with personal care. Bathing, dressing and feeding in sometimes tight spaces with over-worked staff can lead to a number of unintended injuries for both carers and patients alike. The complexities are substantial. However, the need to fully understand when an injury is a reportable incident under new legislation is vital.

Clients and family members might point to an unexplained injury and assume that the care environment is to blame. Yet investigators should assume nothing as they take careful stock of the facilities, mechanisms and personnel involved in that particular care arrangement.

2. INVESTIGATE FAIRLY THROUGH EMOTIONAL TERRAIN

Good investigators know to treat everyone equally during workplace investigations. We maintain a professional demeanour and ensure that all relevant people are heard. Yet communication by investigators in the aged and disability care can require a unique approach to objectivity.

Clients or family members in these environments can express shock, outrage and complete certainty when it comes to the investigation of an unexplained injury. And investigators themselves might be emotionally swayed when faced with allegations of child abuse, elder abuse or disability abuse.

However, an unexplained injury is exactly that – unexplained. Taking into account the communication needs of the client, the tangle of information supplied by families, plus available documentation at the workplace, it is critical to refrain from drawing any inferences throughout the investigation.

3. ComMUNICATE APPROPRIATELY WHEN nEEDS ARE UNIQUE

We need to take into account the particular communication needs of those vulnerable individuals claiming elder abuse, child abuse or disability abuse by a carer. For example, specific communication technologies, scribing assistance, emotional support and/ or advocacy services might form an integral part of investigations into unexplained injuries.

It is essential to understand the nature of the assistance and make objective determinations around interviewing methods. Questions might include: is the scribe or support person related to the injured client? Does the client appear both willing and able to engage with the interviewer? Is there any visible fear, withdrawal or discomfort?

As a corollary, it is vital to avoid any dismissive or patronising communication techniques when interviewing the person in aged, child or disability contexts. We should never assume that they cannot or won’t communicate – particularly if someone else in the room tells us this! As well as having to sport an unexplained injury, it would be disappointing indeed if the injured party leaves an interview feeling ignored, pressured or misunderstood.

THE UNEXPLAINED INJURY – TAKING CARE

Workplace investigators must be extremely careful not to jump to any conclusions when an unexplained injury arises in aged or disability contexts. Keep in mind our three top tips on understanding, fairness and communication in care environments. This will help you to create and manage the best possible workplace investigation. After all, Australians are known for looking after each other well, and a good investigation can ensure that unexplained injuries in the caring sector are dealt with fairly at every turn. 

Our upcoming must-do 2017 investigation training will give you the best possible tools for tackling unexplained injuries in aged and disability care. Join is there, or get in touch to access our top-selling Workplace Investigation Toolkit, plus other professional resources to assist your investigations. 

The Key Warning Signs of Grooming and Sexual Manipulation

Harriet Witchell - Wednesday, March 22, 2017

warning signs of grooming

As the Royal Commission into Institutional Responses to Child Sexual Abuse has painfully revealed, our most trusted institutions have at times mishandled some of the worst cases of child abuse imaginable.

It is becoming clear to us as a nation that the trust given by children and other vulnerable people to individuals in positions of power is boundless. And it is this trust that can become hijacked via the insidious tactics of grooming and sexual manipulation.

Standing outside of the abhorrent situation, we might ask – how on earth could this happen? Wouldn’t a sexual predator be immediately visible to an employer in a child-focused setting? However, grooming and sexual manipulation work in such a subtle way that even other adults close to the situation can be lulled into a false sense of security.

The new NSW legislation on Reportable Conduct has commendably included grooming as a distinct behaviour that must be reported in child care contexts. It is therefore essential that all child-related employers become aware of the warning signs of child grooming and sexual manipulation in the workplace.

Warning Sign 1: The special relationship

Grooming behaviour can manifest as the slow development of a special relationship between a worker and a particular child or children in care. This might involve the giving of privileges, compliments or treats that might be held back from other children. The child can develop a strong sense of trust and even enjoyment from this relationship, particularly if fun and friendship appear to be the key drivers. Such children might previously have been at the less-confident or lonely end of development, with the perpetrator appearing to have commendably ‘drawn out’ the child.

Warning Sign 2: Returning favours

Once a seemingly trust-based relationship is in place, the perpetrator of child abuse will often connect their special gifts and words with requests for touching and/or emotional favours from the child in return. At first this might not seem like an unpleasant or abusive situation in the mind of an innocent child – after all, they have identified this adult as a friend to be trusted. Observers might in fact see a child drawn to a particular carer quite intensely. It can be heartbreaking to think that this could be the middle stages of a targeted grooming strategy.

Warning Sign 3: The conflicted or ‘acting out’ child

When behaviours gradually move into sexual talk, touching or more overt acts, the perpetrator of child abuse can take a more sexually manipulative stance against the child. The child might resist the abuser, but can be manipulated into continuance of the inappropriate relationship through emotional blackmail. One of the earlier favours granted to the child such as gifts, treats or special games might be threatened or recalled. The child can then become anxious and in some cases will actively seek to appease the sexual abuser. Observers of the situation might see contradictory signs between the once-friendly employee and child. Behaviourally, the child could lash out at others or experience a regression in development.

Make knowledge your strength

Thankfully there is now so much research occurring around grooming behaviours and sexual manipulation in care settings. Further, Australian legislatures are slowly but determinedly developing laws to protect children and to enable the effective reporting of inappropriate conduct in the workplace.

Child sexual abuse tends to arise not from some caricature of an evil villain but in fact via a subtle conflation of grooming, manipulation, child vulnerability and institutional ‘blind spots’. Codes of conduct and training on professional boundaries are just some of the methods that can assist employers in combating the scourge of child sexual abuse by carers.

We actively investigate and advise upon issues within child-focused workplaces. In addition, we have handled grooming complaints between remote student teacher networks, top sporting organisers and athletes, elderly residents in a mixed care facility, bus drivers and passengers, disabled individuals and in-home carers. Every case requires skill, sensitivity and an unbiased examination of the evidence.

Join us in our enduring quest to make workplaces safe for all concerned - not just owners and workers, but for those precious Australian children who inherently trust the adults around them. We are proud to be presenting purpose-built training on Abuse in Care in coming months. Give us a call for further details.

Criminal Conduct and the Likelihood of Conviction in Care

Harriet Witchell - Wednesday, March 15, 2017




It is a great tragedy that the most vulnerable people in society – children, the elderly and the disabled – often fall victim to the most heinous types of abuse in care settings.  
In some cases, the abuse can be obvious, such as when there is physical assault that results in visible injuries. At other times, the abuse is much subtler and more difficult to detect, as is the case where there is grooming for intended sexual abuse, financial abuse or general neglect.
Regardless of the type of criminal conduct perpetrated against the disabled, the elderly or children, an even greater tragedy is that it can be extremely difficult to record convictions against the abusers.

Obstacles to conviction

One obstacle which arises in the care sector is that there is an apparent reluctance to report abuse or other criminal actions such as fraud or theft. In part, this may be due to the power imbalance between carer and client, a fear that the reporter may not be believed or taken seriously or, perhaps worse, because for one reason or another, the client may not actually realise that what has happened to them constitutes criminal conduct. Another potential reason for non-disclosure of criminal conduct may be because the client is legitimately concerned that they will lose access to a care worker who is providing them with much needed assistance and support, regardless of the criminal conduct they are also committing.

Many cases of elder abuse, disability abuse or child abuse are heavily reliant on the victim's version of events and, if this is not provided, there is a significant dearth of information upon which a conviction can be secured.
A further hurdle is that forms of abuse or criminal conduct committed in the care setting are so abhorrent that employers or co-workers of those who are accused seldom wish to believe the allegations, especially when they involve sexual grooming or child abuse.

This may subconsciously cause employers or investigators to develop a bias against the complainant and, in the case of investigators, may mean that the inquiry is not conducted as thoroughly as possible. This in turn may mean that there is insufficient evidence to provide to a court in order to secure a conviction.

A lack of physical evidence

Perhaps most crucially, many types of criminal conduct in the disability and care context are difficult to secure convictions for because there is often very little physical evidence which can be presented before a court. It is incredibly difficult to obtain proof of somebody grooming a child, elderly or disabled person for intended sexual or other abuse. Similarly, even injuries such as might be sustained through physical abuse can often be apparently legitimately explained in the care context because of the vulnerable nature of the victims – children often hurt themselves in play or by being careless, while the elderly can be infirm and become easily injured in the ordinary course of events.

Safeguarding investigation services

The most powerful weapon against criminal conduct in care settings is to ensure that any investigation is undertaken objectively, skilfully and with consideration for what requirements the courts may need to secure a conviction.
At Wise, we are experienced in the complexities of conducting investigations into alleged criminal conduct, particularly in child protection settings. Contact us for more information.  



Does the NDIS Complaints System Have Enough Reach?

Harriet Witchell - Wednesday, March 08, 2017


For those vulnerable people across Australia living with disability, the introduction of the National Disability Insurance Scheme (NDIS) has been heralded as a much-needed security net. And for those caring for disabled individuals, the NDIS provides a framework for sustainable care arrangements. 
 
In many ways, the introduction of the NDIS is the ultimate ‘good news’ story. Essential services and funds for disabled individuals can now be accessed. Particularly, the types of care that exhausted families have provided around the clock can now be augmented by paid carers under the scheme. 

Yet such a vast and complex scheme necessarily requires safeguards against unfortunate phenomena that can arise in care environments, such as child abuse, elder abuse or other forms of abuse by carers. 

A responsive and effective complaints system is an essential adjunct to the NDIS, which will eventually sustain some 460,000 disabled Australians under the age of 65. As at February, 61,000 Australians have been brought into the scheme.

How the NDIS complaints system operates

The NDIS complaints system is intended to help participants in the scheme provide feedback, or make complaints about their own experiences or the system in general.   

There is some concern, however, that the complaints system is a somewhat toothless watchdog. Individuals suffering with a disability can lodge a formal complaint about a care provider, for example, but the care provider can at most be removed from the list of scheme-approved providers. There is no mechanism under the system for more significant sanctions.    

This may be appropriate in circumstances where the care provider has simply provided poor treatment or has an unpleasant manner or clash of personalities with the recipient of care, but falls far short of the mark in circumstances where, for example, there is abuse or unexplained injury.  

On such occasions, the scheme participant may have to look to other procedures to try and address any serious grievances.

What other mechanisms for complaint are available?

In NSW, if a person living with a disability in a residential facility suffers a reportable incident at the hands of a care service provider, that incident must be investigated and reported to the appropriate Ombudsman, in accordance with the Ombudsman Act 1974.

A reportable incident includes the commission of sexual offences or misconduct (including those committed in the presence of the person suffering the disability), assault, fraud or financial abuse, and ill-treatment or neglect by a carer. Unexplained injuries also fall within the same category of reportable incidents.  

However, this only covers those clients who are living in residential care – and misses the many participants of the NDIS who rely only on in-home services.  Similarly, there is no legislation which provides any requirement for a ‘suitability to work with disability services’ check, unlike the child protection legislation now effective in NSW, the ACT and Victoria. 

Those utilising aged care services are able to rely on national reporting schemes, but regrettably even a carer who has been conclusively found to be abusive or otherwise guilty of misconduct is not restricted from being able to obtain employment with another care service provider in the future.
 

Effectiveness of the system still uncertain

Given the potential risks of abuse within the system of allocating a carer to a disabled Australian, it is essential that the NDIS is paired with an effective and efficient complaint and resolution scheme. 

Ultimately, the current NDIS complaint service has significant room for growth before it can be considered to be effectively safeguarding the rights of disabled Australians. True improvement will play out most importantly by imposing greater penalties and consequences on carers who are found to have transgressed against their clients in any serious fashion. 

As the NDIS matures as a scheme, it is to be hoped that many teething issues with the complaint management system will be ironed out naturally.  

However effective investigation of incidents relating to abuse as soon as they are reported or otherwise come to light will remain the most important safeguard of the rights of disabled Australians, along with general prevention of potential abuse or misconduct by carers through a strong governance and policy regime.   Contact us about our specialised Investigating Abuse in Care training courses.  

Abuse by Carers - Defining a Sad Reality

Harriet Witchell - Wednesday, March 01, 2017

It is quite clear that employers in aged, disability and other care environments do their best to keep staff and clients safe, yet one dark phenomenon that can raise its ugly head in care contexts is abuse by carers. For many complex reasons, vulnerable people such as the aged, children, and disability clients, can be abused by the very people who are entrusted with their wellbeing.

‘Abuse’ is a broad term that has developed multiple sub-definitions in recent decades. We have seen the basic idea of physical abuse making room for more complex forms such as emotional abuse, sexual abuse, financial abuse and disability abuse. As Australia has witnessed via the recent Royal Commission, child sexual abuse has a truly distressing history. 
When an allegation of abuse by a carer arises, investigating the abuse objectively becomes a number one priority. Reportable conduct legislation is now developing across all states and territories; it is essential to understand definitional issues as reportable incidents arise.

Physical acts and omissions

Assault is perhaps the most common of the physical offences experienced in care environments. Rough handling of a client or patient can occur in any number of scenarios such as moving, changing, bathing, providing medication/ injections and feeding. And omissions such as failing to provide food, warmth, medication or post-fall assistance can also amount to offences of neglect. We often see this neglect as a form of abuse of the disabled or elderly. Feeding and changing neglect can also occur as a form of child abuse in care environments. Establishing what is truly accidental versus what is indisputably abusive is a very difficult task indeed.

The question of intent is certainly difficult, and investigations of abuse must weigh the elements involved in defining reportable conduct. For example, what appears at first glance to be abuse might turn out to be an accident or one-off omission.

Sexual abuse and manipulation

It goes without saying that children are one of the most vulnerable subsets of society, particularly in care situations (whether due to disability or family circumstances). Children are also frequently the target of sexual abuse or its precursor, grooming.

In almost all occasions of longer-term sexual abuse, the perpetrator undertakes a grooming process, designed to obtain the trust of the intended victim.
These behaviours can include paying undue attention to one specific care client, engaging in keeping secrets, purchasing gifts or trying to establish independent communication channels.

Once the grooming has taken place, and the abuse has commenced, the child or adult care client may act out, which is demonstrated by either an overtly hostile relationship with the carer (such as avoiding them or engaging in public conflict with them) or an unnaturally close relationship, which may be based on an attempt by the client to appease or satisfy the abuser.
 
The above red flags, identified by the Royal Commission into Institutional Responses to Child Sexual Abuse, must be understood by workplace investigators in order to ensure that the most vulnerable potential victims are best protected.

Non-physical abuse by carers

Due to changing values in both public and private settings, the term ‘abuse’ now has a wider and more complex scope. Psychological, financial, and emotional abuse at the hands of carers is now a real hazard across multiple industrial contexts.

Some paid and unpaid carers of the aged, older children and the disabled have been known to trick, steal and/or cajole financial benefit from their charges. This can of course provoke angry and emotional responses from all parties involved, not least of which can be outrage from loved ones. One difficulty that investigators face is gathering material from a shaken and, in some cases, infirm victim. It is essential that specialist investigative expertise be employed in such cases.

High evidentiary standards

In the criminal realm, the evidentiary standard is quite high in cases of alleged criminal assault and/ or neglect by carers. Up-to-date legal advice on these and related issues is essential if a reportable incident is suspected.

For many employers who are made aware of alleged abuse by a carer, it can be hard not to react swiftly against this individual. However, all parties are entitled to be heard in a fair and unbiased way.
For example, an unexplained injury might not signify abuse by a carer, but an undiagnosed medical condition.

The ‘culprit’ might be assumed to be a carer who sees the elderly, disabled or young client each and every day. Yet transitory people in carer environments such as cleaners, aides and kitchen staff must also be carefully vetted whenever allegations of abuse surface during a workplace investigation. Investigators must resist the temptation to draw inferences or assumptions throughout the investigation.

Understanding the way abusers work and the nature and pressures on carers are critical for investigators. Knowing how to define and classify behaviour is a crucial component of determinations over abuse allegations.
These details and advice on what evidence to collect, and how to evaluate evidence are all covered in our new Investigating Abuse in Care course. Positions are still available for courses in March and May 2017. Book now to secure a seat!