198. CCA Study Notes: Cycle of Abuse, Child Abuse, Older Person Abuse, and Client Abuse

The Big Picture

Abuse involves deliberate physical or mental harm. It can happen in many kinds of relationships, and it often involves one person trying to gain power and control over another.

Abuse can affect children, older persons, and clients receiving care. Some people face greater risk because they depend on others, have limited support, face barriers to getting help, or live in situations that increase their vulnerability.

For a support worker, this topic also involves recognizing abusive behaviour and responding appropriately when concerns arise.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Important Abuse Terms

Abuse means physical or mental harm deliberately caused by another person or people.

Physical abuse involves deliberately using force against another person’s body. The force may cause a nonaccidental injury and sometimes death.

Sexual abuse involves a nonconsensual sexual act, including touching, that results from threat, coercion ⓘ, or force.

Emotional abuse, also called psychological abuse, involves words or actions that cause mental harm, especially harm to a person’s self-esteem.

Financial abuse means misusing another person’s money or property.

Neglect means a person is not properly cared for physically, emotionally, or psychologically.

The Three-Phase Cycle of Abuse

Abuse often follows a repeating pattern called the cycle of abuse. This cycle can happen in any type of relationship. It is not limited to romantic relationships.

There are three phases.

1. Tension-building phase: Tension starts to increase. Everyday events or comments irritate the abuser. The abuser becomes angrier, more stressed, and more aggressive. The victim may try to calm or please the abuser, avoid the abuser, or avoid saying or doing anything that might cause more anger.
2. Abusive phase: The tension erupts into an abusive event. The event may involve physical, sexual, emotional, or financial abuse, or neglect. The event is often triggered by something unrelated to the victim’s behaviour.
3. Honeymoon phase: The abuser feels ashamed or sorry. The abuser may apologize, promise that the abuse will never happen again, offer gifts, or become loving and attentive. Both people may believe that the abuser will change.

The cycle continues unless specific measures stop it. Days, weeks, months, or years may pass between abusive events.

Over time, the period between episodes usually becomes shorter. The abuse usually becomes more frequent and more intense. The victim and abuser need to recognize the problem and get help to stop the cycle.

Child Abuse

Child abuse means mistreatment or neglect of a child by a parent, guardian, or caregiver.

The mistreatment or neglect may cause significant emotional or psychological harm or create a serious risk of harm. It misuses the caregiver’s position of trust and authority.

Children who experience abuse tend to have more social problems and perform less well at school. Some effects can continue into adulthood.

People who experienced childhood abuse also face a greater risk of becoming violent abusers or criminals later in life. This describes increased risk, not a certainty.

Physical Abuse of a Child

Physical abuse involves deliberately applying force to any part of a child’s body. It may cause a nonaccidental injury.

Examples include:

• shaking
• choking
• biting
• kicking
• burning
• poisoning
• holding a child under water
• using harmful or dangerous force or restraint

Some people confuse punishment with physical abuse.

Emotional Abuse of a Child

Emotional abuse uses words or actions that cause mental harm.

Emotionally abusive treatment of a child can include:

• forcing the child into social isolation
• intimidating the child
• exploiting the child
• terrorizing the child
• routinely making unreasonable demands

Emotional abuse often occurs with family stress and dysfunctional parenting.

In some Canadian provinces, exposing a child to violence between parents is included as emotional abuse. One study found that children witnessed violence against their mothers in almost 40% of violent marriages.

Children who experience both emotional and physical abuse show the greatest levels of aggression, delinquency, and problems relating to other people.

Women who experienced abuse during childhood are more likely to experience depression, low self-esteem, and suicidal thoughts.

Physical abuse creates an immediate risk of injury. Psychological or emotional abuse can have serious and long-lasting effects.

Sexual Abuse of a Child

Sexual abuse of a child means using a child for sexual purposes by an adult or adolescent.

Exposing a child to sexual activity or behaviour is sexual abuse. Examples include:

• fondling
• inviting a child to touch or be touched sexually
• sexual intercourse
• juvenile prostitution
• sexual exploitation through pornography

Sexual abuse is also considered a form of emotional abuse.

Child Neglect

Child neglect means a parent or other caregiver fails to meet a child’s basic emotional, psychological, and physical development needs.

There are two forms described here.

Physical neglect occurs when needs such as food, clothing, shelter, cleanliness, medical care, and protection from harm are not adequately met.

Emotional neglect occurs when the child’s need to feel loved, wanted, safe, and worthy is not met. It can range from a caregiver being unavailable to openly rejecting the child.

Physical assaults are more likely to be reported, but neglect can have equally serious consequences.

Report: If you witness or suspect child abuse, you are legally required to report it.

Situations That Increase the Risk for Child Abuse

Several situations are linked with increased risk.

Family Crisis

Stress from divorce, unemployment, moving, poverty, or crowded living conditions can contribute to abuse.

Nonbiological or Transient Caregivers

Risk is higher when a biological parent shares parenting with a partner who does not have a committed and loving relationship with the children.

The risk increases further when the parent or partner experienced abuse or neglect during childhood.

Isolation

Parents who mistreat or abuse children are more likely to experience isolation, loneliness, and limited social support.

Caring for Children With Special Needs

Children with physical or mental disabilities or chronic illness face greater risk.

Risk also increases for children whose personalities or behaviours an abuser considers different or unacceptable.

Failure to Thrive

Failure to thrive describes infants, babies, or children who fall below expected norms for body weight, growth, or cognitive development.

The term is also used for older persons who lose weight and experience declining health for no apparent reason.

Caregiver neglect is one known cause of failure to thrive. In extreme cases, failure to thrive can lead to permanent developmental delays or death.

Many mothers of infants described as having failure to thrive were also likely abused in the past.

Preventing Child Abuse

Several approaches can help prevent child abuse.

Most abusive parents do not consciously set out to harm their children. Better efforts to assist troubled families may reach parents at risk before they resort to violence.

Parenting Education

Education can help parents understand normal child development and develop more nurturing relationships with their children.

Positive parenting approaches can help with children of different ages.

Child Abuse Prevention Programs

Children who experience abuse have an increased risk of repeating abusive patterns as adults. Identifying potential abusers and preventing abuse are the most effective ways to stop the cycle of violence.

Supporting a Child Who Discloses Abuse

If a child tells a support worker about an abusive experience or situation:

• show the child that you believe them
• make sure the information is promptly reported to the appropriate authorities

Education for Children and Adults

Children should learn to recognize and say no to abusive or exploitative behaviour. They should know that they have the right to live free from abuse.

A support worker can help children and adults find information and assistance aimed at preventing abusive or neglectful patterns.

Abuse of Older Persons

Older persons face all forms of abuse, including:

• physical abuse
• sexual abuse
• emotional abuse
• financial abuse
• neglect

Financial and emotional abuse are the forms most commonly reported by older persons.

Abusers are usually family members, such as adult children or grandchildren. The abuser is often the older person’s primary caregiver.

Most abusers of older persons depend on the older person for financial help or housing.

Why an Older Person Might Not Report Abuse

An older person may:

• fear the abuser
• depend on the abuser
• not know where or how to get help
• fear being forced to move into a long-term care facility ⓘ
• have a physical or mental disability that affects the ability to report

People experiencing neglect are especially likely to have difficulty reporting their situation.

People at Higher Risk for Abuse

Anyone might experience abuse. Some groups face greater risk because of dependence, isolation, disability, communication barriers, social circumstances, or limited access to support.

Abuse can damage a person’s self-worth and dignity. It can also increase social isolation and make the person more vulnerable.

Marginalized Persons

A marginalized person is prevented from having control over their life or health care because of language, life circumstances, or their role in society, resulting in being shunned from mainstream society.

Factors connected with marginalization include:

• limited fluency in an official language
• belonging to some visible-minority groups
• geographical isolation ⓘ
• physical or intellectual disability
• living with a mental health disorder
• having a current or past substance abuse problem
• working in the sex trade

Marginalized people may feel powerless to report abuse. Their reports may not be understood or believed, and authorities may give their reports less attention.

Sexual assault against women is particularly prevalent in Northern Canada, where Indigenous people make up a higher proportion of the population than in the provinces.

Children

Children depend on caregivers and may be too young to know how to defend or protect themselves.

Some caregivers use abusive force or words while believing they have a right to discipline the child. Other caregivers may feel overwhelmed by parenting responsibilities or are very likely to have experienced abuse during their own childhood.

Socially or Geographically Isolated Older Persons

An older person with little contact with other people may have fewer opportunities to report abuse.

Physical signs such as bruises may also go unnoticed. The person may not know how to escape or may lack the strength to seek safety and shelter.

Older Persons With Reduced Cognitive Capacity

A person with reduced cognitive capacity may not know or remember that abuse occurred.

The person may also lack control over finances and may not realize that money or belongings are being taken.

Dependent Older Persons With Disabilities

Limited contact with other people can allow abuse to go unrecognized.

An abuser may explain bruises as being caused by the person’s disability, age, or general health condition.

Older Persons Cared for by Someone With Substance Abuse Problems

A caregiver with substance abuse problems may have difficulty controlling angry outbursts or responding nonviolently to challenging behaviour.

Financial problems may also lead a caregiver to steal from an older person to support an addiction.

Other Factors That Increase an Older Person’s Risk

Stress

Family caregivers are more likely to become abusive when they resent their caregiving role.

Care can become especially stressful when an older person has a physical or mental disability. Caregivers who feel unprepared or unable to meet their responsibilities may become overwhelmed.

Ageism

Ageism means bias and discrimination against older persons.

A caregiver who does not respect an older person’s dignity or abilities is more likely to become abusive.

For example, a caregiver who assumes an older person cannot manage money might take control of the person’s finances without permission. That is financial abuse.

Vulnerability

Factors that increase vulnerability and may worsen the effects of abuse include:

• poor living conditions, including inadequate housing or geographical isolation
• unemployment, including not being employed or being retired from an employer
• being new to an area
• racism ⓘ
• homophobia ⓘ
• physical, mental, or developmental disability
• limited financial resources or poverty
• social isolation
• limited language or literacy skills ⓘ
• limited access to community and health services
• limited access to housing or long-term care facilities
• limited access to the justice system

Abuse of Clients by Health Care Workers

Client abuse can happen in facilities or home care.

A client may experience abuse from a member of the health care team. In a facility, abuse may also come from a visitor or staff member.

Clients face physical, sexual, emotional, and financial abuse, as well as neglect.

All agencies have policies about what workers should do when client abuse occurs.

Examples of Abusive Behaviour Toward Clients

Abusive behaviour includes actions that are obvious and actions that are easier to overlook.

Threatening, Physical, Sexual, and Degrading Behaviour

Examples include:

• threatening to harm or frighten a client
• swearing at a client
• name calling
• using racial or cultural slurs
• inappropriate touching
• sexual assault or harassment
• using restraints inappropriately or when they were not ordered
• handling a client roughly
• force-feeding a client
• isolating a client in their room
• putting a client to bed as punishment

Neglect, Theft, and Denial of Basic Needs

Examples include:

• denying meal breaks, drinking water, bathroom use, or handwashing facilities
• stealing food or personal belongings
• failing to review the care plan regularly
• failing to answer a call for help
• moving the call bell beyond the client’s reach
• failing to check on a client for long periods
• using incontinence briefs instead of toileting a client to save time
• leaving a client in soiled linen or clothing

Violating Client Rights Is Abuse

Abuse also includes violating a client’s rights.

Examples include:

• providing care against the person’s wishes
• failing to provide privacy
• failing to keep personal or medical information confidential ⓘ
• preventing residents from visiting privately
• preventing residents from using the phone privately

Subtle Abuse Still Counts

Abuse does not have to involve obvious physical force.

Workers may demean or belittle clients by using disrespectful names such as “grandma” or “slugger.” Referring to incontinence briefs as “diapers” is another example.

These behaviours embarrass clients and violate DIPPS:

• dignity
• independence
• individualized care
• preferences
• privacy
• safety

Ignoring requests for toileting, ignoring call bells, or placing a call bell beyond a client’s reach are also abusive behaviours.

Stress Can Trigger Client Abuse

Stress sometimes contributes to abuse of clients.

Some workers lack enough training or education for difficult situations. Others face heavy workloads because too few workers are available.

A client may also hit or yell at a worker. Some workers respond by becoming abusive themselves.

Key fact: Stress can trigger abusive behaviour, but it never excuses abuse by a support worker.

Preventing Your Own Behaviour From Becoming Abusive

A support worker must recognize when stress is building.

If you start to lose your temper:

• take time out
• continue treating clients gently and respectfully, even when they resist care
• immediately discuss difficult or aggressive clients with your supervisor
• follow the supervisor’s help in deciding how to handle the situation
• ask for a change of assignment if necessary

Common Mix-Ups

Wrong Idea	Better Idea
The cycle of abuse happens only in romantic relationships.	The cycle can happen in any type of relationship.
Punishment and physical abuse mean the same thing.	People sometimes confuse them. Physical abuse involves deliberate force that may cause a nonaccidental injury.
Client abuse is always obvious.	Client abuse can be obvious or subtle.
Stress excuses abusive behaviour from a support worker.	Stress can trigger abuse, but it does not excuse it.