Outcomes

The purpose of this course is to prepare healthcare professionals to identify child abuse and maltreatment/neglect and to comply with Pennsylvania mandatory reporting requirements.

Objectives

After completing this course, the learner will be able to:

  1. Describe the Child Welfare System in Pennsylvania
  2. Know the provisions and responsibilities for reporting suspected child abuse
  3. Discuss the process for reporting suspected child abuse
  4. Recognize physical and behavioral indicators associated with child abuse
  5. Evaluate situations to determine reasonable cause to suspect child abuse

Prevalence and Demographics

Violence is an important public health issue. The World Health Organization (WHO) estimates that nearly 53,000 children are murdered each year, and the prevalence of forced sexual intercourse and other forms of sexual violence involving touch, among boys and girls under 18, is 73 million and 150 million, respectively.1

The US Department of Health & Human Services reports that there are nationally around 678,000 victims of child abuse and neglect. The victim rate is 9.2 victims per 1,000 children in the population.2

Victim demographics include:2

  • Children in their first year of life have the highest rate of victimization at 26.7 per 1,000 children of the same age in the national population.
  • The victimization rate for girls is 9.6 per 1,000 girls in the population, which is higher than boys at 8.7 per 1,000 boys in the population.
  • American Indian or Alaska Native children have the highest rate of victimization at 15.2 per 1,000 children in the population of the same race or ethnicity.
  • African American children have the second-highest rate at 14.0 per 1,000 children of the same race or ethnicity.

Child fatalities from abuse and neglect are estimated at 1,770, resulting in a rate of 2.39 per 100,000 children in the population.2

The youngest children are the most vulnerable to maltreatment, with 46.6 percent of child fatalities younger than one-year-old and died at a rate of 22.77 per 100,000 children in the population of the same age. Boys have a higher child fatality rate than girls; 2.87 per 100,000 boys in the population, compared with 2.19 per 100,000 girls in the population.2

The rate of African-American child fatalities (5.48 per 100,000 African-American children) is 2.8 times greater than the rate of White children (1.94 per 100,000 White children) and 3.4 times greater than the rate of Hispanic children (1.63 per 100,000 Hispanic children).2

Studies conclude that professionals that have contact with children report only half of the incidents that may be abuse.3 The reasons for this low report rate were:

  • Confusion or misunderstanding about the laws and procedures
  • A lack of knowledge or awareness of warning signs

The study also found the professionals are often influenced by their professional beliefs, values, and past experiences.3

Protecting Pennsylvania's children from abuse and neglect is a shared responsibility. It requires collaboration from the formal child protective services system, community partners, and our citizens to provide local safety nets for children and families that are facing challenges within our communities and neighborhoods.

Recently, 23 pieces of legislation were enacted, changing how Pennsylvania responds to child abuse. These changes significantly impact the reporting, investigation, assessment, prosecution, and judicial handling of child abuse and neglect cases.

These changes:

  • Strengthen our ability to better protect children from abuse and neglect by amending the definitions of child abuse and perpetrator
  • Streamline and clarify mandatory child abuse reporting processes
  • Increase penalties for failure to report suspected child abuse and protect persons who report child abuse
  • Promote the use of multi-disciplinary investigative teams (MDITs) to investigate child abuse related crimes
  • Support the use of information technology to increase efficiency and tracking of child abuse data

This website, KeepKidsSafe.pa.gov, is designed to serve as the hub for information related to critical components impacting child protection including a link for mandated reporters to make reports of suspected child abuse electronically, training on child abuse recognition and reporting, information related to clearances and general information related to child protection.4

Description of Child Welfare in Pennsylvania (PA)

The Pennsylvania Child Protective Services Law (CPSL) was enacted in 1975 to protect children from abuse, allow the opportunity for healthy growth and development, and, whenever possible, preserve and stabilize the family.

The primary focus of Pennsylvania's Child Welfare System is the safety, permanency, and well-being of the children we serve. We operate from the assumption that children belong with their own families and should receive necessary services in the community rather than being placed outside of their homes. Although placement away from their families should be the last resort, if it is necessary, children should be placed in the most appropriate setting to meet their needs; preferably, a location that promotes reunification with the family where, and as soon as, possible.

The Child Welfare System (CWS) in Pennsylvania is state-supervised and county-administered.

The Department of Public Welfare is responsible for:

  • Assuring the availability and provision of public child welfare services
  • Providing oversight and technical assistance to each county agency
  • Establishing and enforcing policies and regulations that support the achievement of child welfare goals and outcomes
  • The licensure of public and private child welfare agencies
  • Investigation of complaints received regarding these agencies

The county children and youth agency is responsible for:

  • Investigating suspected child abuse and neglect
  • Assessing the need for general protective services
  • Providing services to children and families to prevent further harm to children

Each county's children and youth social service (CYS) agency is responsible for administering a program of children and youth social services to children and their families. This agency includes services designed to:

  • Protect children from abuse and neglect and enable children to remain safely in their own homes and communities
  • Prevent dependency and delinquency of children and help them overcome problems that result in dependency and delinquency
  • Provide permanency and stability for children in their homes or in placement and preserve relationships and connections for children with their families and communities
  • Enhance the family's capacity to provide for their children's educational, physical, and behavioral health needs
  • Provide balanced attention to the protection of the community, the imposition of accountability for offenses, and the development of competencies to enable youth to become responsible and productive members of the community

Reports of child abuse will be made through ChildLine, but for your information, the following is the contact information for the regional state CWS agencies.

Southeast Region
Office of Children, Youth, and Families
801 Market Street, 6th Floor
Philadelphia, PA 19107
(215) 560-2249 or (215) 560-2823

Counties Served: Bucks, Chester, Delaware, Montgomery, Philadelphia

Western Region
Office of Children, Youth, and Families
11 Stanwix Street, Room 260
Pittsburgh, PA 15222
(412) 565-2339

Counties Served: Allegheny, Armstrong, Beaver, Butler, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Venango, Warren, Washington, Westmoreland

Northeast Region
Office of Children, Youth, and Families
Scranton State Office Building
100 Lackawanna Avenue, 3rd Floor
Scranton, PA 18503
(570) 963-4376

Counties Served: Berks, Bradford, Carbon, Lackawanna, Lehigh, Luzerne, Monroe, Northampton, Pike, Schuylkill, Sullivan, Susquehanna, Tioga, Wayne, Wyoming

Central Region
Office of Children, Youth, and Families
Bertolino Building
1401 North Seventh Street, Fourth Floor
Harrisburg, PA 17120
(717) 772-7702

Counties Served: Adams, Bedford, Blair, Cambria, Centre, Clinton, Columbia, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Lycoming, Mifflin, Montour, Northumberland, Perry, Snyder, Somerset, Union, York

Child Protective Services vs. General Protective Services

General Protective Services: Services and activities that are related to the safety of children, including, but not limited to, inadequate housing, clothing, and supervision.

Child Protective Services: Services and activities that are provided for concerns of child abuse. Ways to identify abuse and the reporting processes are discussed later in this course.

Definitions

The following are legal definitions that are important to understand in order to identify child abuse.

Child: An individual under 18 years of age.

The definition of perpetrator is used to determine if the case is child abuse. As a mandatory reporter, you should report any situation that is not clear to you. If the abuser does not meet the definition of perpetrator, the case will be referred to the appropriate agency or services by the CWS.

Perpetrator of Child Abuse:

  • Child's parent
  • Spouse or former spouse of the parent
  • Paramour or former paramour of the parent
  • Person 14 years of age or older responsible for the welfare of a child such as a babysitter or daycare staff person, (including school employees)
  • An individual residing in the same home as the child who is at least 14 years of age
  • Relative who is 18 years of age or older who does not reside in the same home as the child, but is related within the third degree of consanguinity or affinity by birth or adoption to the child

Perpetrator of child abuse for failure to act:

  • Child's parent
  • Spouse or former spouse of the parent
  • Paramour or former paramour of the parent
  • Person 18 years of age or older who is responsible for the child's welfare or who resides in the same home as the child (including school employees)

School Employee: An individual who is employed by a school or who provides a program, activity, or service sponsored by a school. The term excludes an individual who has no direct contact with children.

If the alleged perpetrator is a school employee or childcare service employee, the administrator or employer will receive notice of a pending allegation and the final status of the report following the investigation as to whether the report is indicated, founded or unfounded. If the perpetrator is a school employee, the notice of the final status of the report shall be sent to the Department of Education within 10 days of the completion of the investigation.

Act or failure to act: A perpetrator can cause the abuse (act) or can allow the abuse through negligence.

Child abuse means intentionally, knowingly, or recklessly doing any of the following:

  • Causing bodily injury to a child through any recent act or failure to act
  • Fabricating, feigning or intentionally exaggerating or inducing a medical symptom or disease which results in a potentially harmful medical evaluation or treatment to the child through any recent act
  • Causing or substantially contributing to serious mental injury to a child through any act or failure to act or a series of such acts or failures to act
  • Causing sexual abuse or exploitation of a child through any act or failure to act
  • Creating a reasonable likelihood of bodily injury to a child through any recent act or failure to act
  • Creating a likelihood of sexual abuse or exploitation of a child through any recent act or failure to act
  • Causing serious physical neglect of a child
  • Engaging in any of the following recent acts:
    • Kicking, biting, throwing, burning, stabbing, or cutting a child in a manner that endangers the child
    • Unreasonably restraining or confining a child, based on consideration of the method, location, or the duration of the restraint or confinement. Forcefully shaking a child under one year of age
    • Forcefully slapping or otherwise striking a child under one year of age
    • Interfering with the breathing of a child
    • Causing a child to be present at a location while a violation (relating to the operation of methamphetamine laboratory) is occurring, provided that the violation is being investigated by law enforcement
    • Leaving a child unsupervised with an individual, other than the child's parent, who the actor knows or reasonably should have known:
      • Is required to register as a Tier II or Tier III sexual offender, where the victim of the sexual offense was under 18 years of age when the crime was committed
      • Has been determined to be a sexually violent predator
      • Has been determined to be a sexually violent delinquent child
  • Causing the death of the child through any act or failure to act

Recent act or failure to act: Any act or failure to act committed within two years of the date of the report to the Department or county agency.

Serious bodily injury: Bodily injury, which creates a substantial risk of death or which causes serious permanent disfigurement or protracted loss or impairment of the function of any bodily member or organ.

Serious mental injury: A psychological condition, as diagnosed by a physician or licensed psychologist, including the refusal of appropriate treatment, that:

  • Renders a child chronically and severely anxious, agitated, depressed, socially withdrawn, psychotic or in reasonable fear that the child's life or safety is threatened; or
  • seriously interferes with a child's ability to accomplish age-appropriate developmental and social tasks

Serious physical neglect: Any of the following when committed by a perpetrator that endangers a child's life or health, threatens a child's well-being, causes bodily injury or impairs a child's health, development or functioning:

  • A repeated, prolonged, or egregious failure to supervise a child in a manner that is appropriate considering the child's developmental age and abilities
  • The failure to provide a child with adequate essentials of life, including food, shelter, or medical care

Sexual abuse or exploitation: Any of the following:

  • The employment, use, persuasion, inducement, enticement or coercion of a child to engage in or assist another individual to engage in sexually explicit conduct, which includes, but is not limited to, the following:
    • Looking at the sexual or other intimate parts of a child or another individual for the purpose of arousing or gratifying sexual desire in any individual
    • Participating in sexually explicit conversation either in person, by telephone, by computer, or by a computer-aided device for the purpose of sexual stimulation or gratification of any individual
    • Actual or simulated sexual activity or nudity for the purpose of sexual stimulation or gratification of any individual
    • Actual or simulated sexual activity for the purpose of producing visual depiction, including photographing, videotaping, computer depicting, or filming

This paragraph does not include consensual activities between a child who is 14 years of age or older and another person who is 14 years of age or older and whose age is within four years of the child's age.

  • Any of the following offenses committed against a child:
    • Rape
    • Statutory sexual assault
    • Involuntary deviate sexual intercourse
    • Sexual assault
    • Institutional sexual assault
    • Aggravated indecent assault
    • Indecent assault
    • Indecent exposure
    • Incest
    • Prostitution
    • Sexual abuse
    • Unlawful contact with a minor
    • Sexual exploitation

Exclusion to Child Abuse

Environmental factors: No child shall be deemed to be physically or mentally abused based on injuries that result solely from environmental factors, such as inadequate housing, furnishings, income, clothing and medical care, that are beyond the control of the parent or person responsible for the child's welfare with whom the child resides. This subsection shall not apply to any childcare service, as defined in this chapter, excluding an adoptive parent.

Practice of religious beliefs: If, upon investigation, the county agency determines that a child has not been provided needed medical or surgical care because of sincerely held religious beliefs of the child's parents or relative within the third degree of consanguinity and with whom the child resides, which beliefs are consistent with those of a bona fide religion, the child shall not be deemed to be physically or mentally abused.

  • This subsection shall not apply if the failure to provide needed medical or surgical care causes the death of the child
  • This subsection shall not apply to any childcare service, as defined in this chapter, excluding an adoptive parent

Use of force for supervision, control and safety purposes: The use of reasonable force on or against a child by the child's own parent or person responsible for the child's welfare shall not be considered child abuse if any of the following conditions apply:

  • The use of reasonable force constitutes incidental, minor, or reasonable physical contact with the child or other actions that are designed to maintain order and control
  • The use of reasonable force is necessary
    • To quell a disturbance or remove the child from the scene of a disturbance that threatens physical injury to persons or damage to property
    • To prevent the child from self-inflicted physical harm
    • For self-defense or the defense of another individual
    • To obtain possession of weapons or other dangerous objects or controlled substances or paraphernalia that are on the child or within the control of the child

Rights of parents: Nothing in this chapter shall be construed to restrict the generally recognized existing rights of parents to use reasonable force on or against their children for the purposes of supervision, control, and discipline of their children. Such reasonable force shall not constitute child abuse.

Participation in events that involve physical contact with the child: An individual participating in a practice or competition in an interscholastic sport, physical education, a recreational activity or an extracurricular activity that involves physical contact with a child does not, in itself, constitute contact that is subject to the reporting requirements of this chapter.

Child-on-child contact: Harm or injury to a child that results from the act of another child shall not constitute child abuse unless the child who caused the harm or injury is a perpetrator.

No child shall be deemed to be a perpetrator of child abuse based solely on physical or mental injuries caused to another child in the course of a dispute, fight or scuffle entered into by mutual consent.

A law enforcement official who receives a report of suspected child abuse is not required to make a report to the Department under section 6334(a) (relating to disposition of complaints received) if the person allegedly responsible for the child abuse is a non-perpetrator child.

Defensive force: Reasonable force for self-defense or the defense of another individual, shall not be considered child abuse.

Exclusions are used when evaluating a case in order to substantiate the report. However, a mandatory reporter's responsibility is to report suspected abuse. If the mandatory reporter is unsure, a report should be filed. The CWS will investigate and determine that child abuse did not occur if the case meets the exclusion criteria.

The Pennsylvania Consolidated Statutes provides for additional grounds for involuntary termination of parental rights; providing for an additional grounds for aggravated circumstances; allowing for the release of information in confidential reports to law enforcement when investigating cases of severe forms of trafficking in persons or sex trafficking; adding a category of child abuse to include: engaging a child in a severe form of trafficking in persons or sex trafficking.

  • Definition of Human Trafficking
    • The recruitment, harboring, transportation, provision, or obtaining of a child for labor or services through the use of force, fraud, or coercion. Under federal law, sex trafficking (such as prostitution, pornography, exotic dancing, etc.) does not require there be force, fraud, or coercion if the victim is under 18
  • Perpetrator
    • An individual 18 years of age or older who engages a child in severe forms of trafficking in persons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000
  • Child Abuse
    • Engaging a child in a severe form of trafficking in persons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000
  • Discussion and examples of Labor Trafficking
    • Labor trafficking is labor obtained by the use of threat of serious harm, physical restraint, or abuse of legal process.
    • Examples: Being forced to work for little or no pay from (frequently in factories or farms); domestic servitude (providing services within a household from 10-16 hours per day such as but not limited to: child care, cooking, cleaning, yard work, gardening).
  • Discussion and examples of severe forms of trafficking in persons
    • Sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age
    • The recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, coercion for the purpose of subjection to involuntary servitude, peonage (paying off debt through work), debt bondage (debt slavery, bonded labor or services for a debt or other obligation), or slavery (a condition compared to that of a slave in respect of exhausting labor or restricted freedom)
  • Commercial sex act definition
    • Means any sex act on account of which anything of value is given to or received by a person
  • At risk youth populations for human trafficking
    • Youth in the foster care system
    • Youth who identify as LGBTQ
    • Youth who are homeless or runaway
    • Youth with disabilities
    • Youth with mental health or substance abuse disorders
    • Youth with a history of sexual abuse
    • Youth with a history of being involved in the welfare system
    • Youth who identify as native or aboriginal
    • Youth with family dysfunction
  • Victim identification/warning signs are but not limited to:
    • A youth that has been verified to be under 18 and is in any way involved in the commercial sex industry, or has a record of prior arrest for prostitution or related charges
    • Has an explicitly sexual online profile
    • Depicts elements of sexual exploitation in drawing poetry, or other modes of creative expression
    • Frequent or multiple sexually transmitted diseases or pregnancies
    • Lying about or not being aware of their true age
    • Having no knowledge of personal data, such as but not limited to age, name, and/or date of birth
    • Wearing sexually provocative clothing
    • Secrecy about whereabouts
    • Having late nights or unusual hours
    • Having a tattoo that he/she is reluctant to explain
    • Being in a controlling or dominating relationship
    • Not having control of won finances
    • Exhibit hyper-vigilance or paranoid behaviors
    • Express interest in or in relationships with adults or much older men/women

Provisions and Responsibilities for Reporting Suspected Child Abuse

Mandated Reporters

Anyone (permissive reporter) may report suspected abuse at any time and are encouraged to do so.6

The following adults are mandated to report suspensions of child abuse:

  • A person licensed or certified to practice in any health-related field under the jurisdiction of the Department of State
  • A medical examiner, coroner or funeral director
  • An employee of a health care facility or provider licensed by the Department of Health who is engaged in the admission, examination, care or treatment of individuals
  • A school employee
  • An employee of a childcare service who has direct contact with children in the course of employment
  • A clergyman, priest, rabbi, minister, Christian Science practitioner, religious healer or spiritual leader of any regularly established church or other religious organization
  • An individual paid or unpaid, who, on the basis of the individual's role as an integral part of a regularly scheduled program, activity or service, accepts responsibility for a child
  • An employee of a social services agency who has direct contact with children in the course of employment
  • A peace officer or law enforcement official
  • An emergency medical services provider certified by the Department of Health
  • An employee of a public library who has direct contact with children in the course of employment
  • An individual supervised or managed by a person listed above, who has direct contact with children in the course of employment
  • An independent contractor who has direct contact with children
  • An attorney is a mandated reporter if he/she is affiliated with an agency, institution, organization or other entity, including a school or regularly established religious organization that is responsible for the care, supervision, guidance or control of children
  • A foster parent

Privileged/confidential communications:6

  • Many mandated reporters feel there is a conflict between their legal obligation to report and their legal obligation to maintain client or patient confidentiality. Privileged communications does not apply to a situation involving child abuse. Additionally, privileged communication between a mandated reporter and a client does not relieve the mandated reporter of the duty to make a report of suspected child abuse.

Exceptions are:6

  • Confidential communications made to a member of the clergy are protected under 42 PA.C.C §5943.
  • Confidential communications made to an attorney are protected so long as they are within the scope of 42 PA.C.S. §§ 5916 (relating to confidential communications to attorney) and 5928 (relating to confidential communications to attorney), the attorney work product doctrine or the rules of professional conduct for attorneys.

Reporting Process

If a child is in immediate danger, call 911.

The mandated reporter is required to report even if their knowledge is incomplete. The role of the mandated reporter is to assess for reasonable cause to suspect abuse. The mandated reporter identifies reasonable cause and leaves the investigation to specially trained workers in the CWS.

The mandated reporter does not:

  • Investigate
  • Interrogate
  • Determine the perpetrator and their relationship to the child

When talking with children to establish reasonable cause, find a private place, and remain calm. Be honest, open, and upfront with the child. Be supportive. Listen to the child and stress that it's not the child's fault. Do not overreact, make judgments, make promises, nor interrogate or investigate.

There is no legal requirement to inform the parent or other persons legally responsible for the childcare that you are making a report to ChildLine. In fact, informing the parents of the report may place the child for the risk of harm. Do not assume that the parent will support the child.

In the case of suspected sexual abuse, avoid talking in detail with the child about the incident. There are special guidelines that apply to the case of suspected sexual abuse. Usually, CWS and law enforcement work together to interview the child at the same time using specially trained professionals.

Reasonable cause to suspect things that based on what you have observed or been told, combined with your training and experience, you feel that harm or imminent danger of harm to the child could be the result of an act or omission by the person legally responsible for the child. If there is reasonable cause to suspect the child is being abused or maltreated, you must call ChildLine immediately.3

Mandated reporters are required to make a report of suspected child abuse if they have reasonable cause to suspect that a child is a victim of child abuse under any of the following circumstances:

  • They come into contact with the child in the course of employment, occupation, and practice of a profession or through a regularly scheduled program, activity, or service.
  • They are directly responsible for the care, supervision, guidance or training of the child, or are affiliated with an agency, institution, organization, school, regularly established church or religious organization or other entity that is directly responsible for the care, supervision, guidance or training of the child.
  • A person makes a specific disclosure to the mandated reporter that an identifiable child is the victim of child abuse.
  • An individual 14 years of age or older makes a specific disclosure to the mandated reporter that the individual has committed child abuse.

It is not required that the child comes before the mandated reporter in order to make a report of suspected child abuse.

Crimes committed against the child should be reported directly to law enforcement. If you're uncertain if the incidence criminal, you can contact the CWS anyway, if the child is in imminent danger, contact law enforcement immediately. Imminent danger is when the child is placed at immediate risk or a substantial risk of harm. In other words, how direct is the threat to the child the danger must be immediate or nearly immediate.3

  • Reports must be made immediately upon the development of reasonable cause to suspect child abuse. Reports should be made by the person with knowledge of the reasonable cause.

then

  • The person in charge of the institution, school, facility or agency or the designated agent of the person in charge should be notified of the report immediately after making the report to ChildLine.

No more than one report from any institution school or agency is required, but the report should include names and contact information of everyone who has knowledge of the situation.

Reports of child abuse may be reported to ChildLine electronically at www.compass.state.pa.us/cwis if the situation does not require an emergency response.

You should call the Child Abuse Hotline, ChildLine at 1-800-932-0313 for the following situations:

  • If you are not a mandated reporter
  • You prefer to remain anonymous
  • You do not know the county where the incident occurred
  • The suspected abuse and/or neglect you are reporting occurred outside the state of Pennsylvania
  • You are unsure if the child is at imminent risk of harm
  • You have more than eight alleged perpetrators and/or the child has a list of extensive injuries

If an oral report is made to ChildLine, a report of suspected child abuse, form CY-47, must also be completed and forwarded to the county children and youth agency within 48 hours after making the report. This form can be obtained at www.KeepKidsSafe.pa.gov under the forms tab or from the children and youth agency. If a report is made electronically, no form CY-47 is required to be completed.

Be prepared to articulate your concerns in a clear and concise manner when you call ChildLine. The following is a list of information the mandated reporter is asked to provide if known:3

  • The names and addresses of the child, the child's parents, and any other person responsible for the child's welfare
  • Where the suspected abuse occurred
  • The age and sex of each subject of the report
  • The nature and extent of the suspected child abuse, including any evidence of prior abuse to the child or any sibling of the child
  • The name and relationship of each individual responsible for causing the suspected abuse and any evidence of prior abuse by each individual
  • Family composition
  • The source of the report
  • The name, telephone number and e-mail address of the person making the report
  • The actions taken by the person making the report, including those actions:
    • Relating to photographs, medical tests, and X-rays of child subject to report
    • Relating to taking child into protective care
    • Relating to admission to private and public hospitals
    • Relating to mandatory reporting and postmortem investigation of deaths
  • Any other information required by Federal law or regulation
  • Any other information that the Department requires by regulation

The law requires that mandated reporters identify themselves and where they can be reached. This information is helpful if the caseworker needs additional information. However, the identity of the person making the report is kept confidential, with the exception of being released to law enforcement officials or the district attorney's office.

Mandatory reporting and postmortem investigation of deaths.6

A person or official required to report cases of suspected child abuse, including employees of a county agency, who has reasonable cause to suspect that a child died as a result of child abuse shall report that suspicion to the appropriate coroner or medical examiner. The coroner or medical examiner shall accept the report for investigation and shall report his findings to the police, the district attorney, the appropriate county agency, and, if the report is made by a hospital, the hospital.7

Actions after a Suspected Case is Reported

ChildLine forwards the report of suspected child abuse to the local county children and youth agency, which investigates the report to determine if the allegations can be substantiated as child abuse/neglect and also arranges for or provides the services that are needed to prevent the further maltreatment of the child and to preserve the family unit.7 Services that are available include :

  1. Counseling
  2. Classes to strengthen parenting skills
  3. Self-help groups
  4. Emergency medical services

The county children and youth agency must begin an investigation within 24 hours. A thorough inquiry is conducted to determine if the child was abused and what services are appropriate for the child and family. This must be completed within 30 days unless the agency provides justification as to why the investigation cannot be completed, including attempts being made to obtain medical records or interview subjects of the report.7

If the alleged perpetrator report does not meet the definition of perpetrator but does suggest the need for an investigation, ChildLine will forward the information to the district attorney's office in the respective county.7

Protection for Reporters

Mandated reporters are immune from any criminal or civil liability if the report was made in good faith. Good faith for the mandated reporter is presumed. This means if someone accuses you of making a false report that they have to prove to you acted with gross negligence or willful misconduct.3

Failure to Report Child Abuse

A mandated reporter who willfully fails report can be found guilty of a misdemeanor of the second degree up to a felony of the first degree or higher. Failing to report may also result in a lawsuit in civil court for monetary damages for any harm that was caused by the mandated reporter's failure to make a report to ChildLine, including wrongful death.3

Mandated Reporters Right-to-Know

Mandated reporters will receive information from the Department regarding the final status of the report, whether it was unfounded, indicated or founded, and the services planned or provided to protect the child.7

Recognition of Child Abuse

Indicators of abuse warn the mandated reporter to pay more attention to a particular situation. Sometimes there are no indicators even though the child is being abused. There are three types of indicators of abuse or maltreatment/neglect:

  1. Physical indicators
  2. Child behavioral indicators
  3. Parent behavioral indicators

Indicators should not be viewed in isolation; they must be considered in relation to the child's condition. Indicators should be considered in the overall context of the child's physical appearance and behavior. Sometimes a single indicator is self-evident or points to abuse or maltreatment/neglect. Often several indicators must be pulled together, or clusters of indicators used to develop reasonable cause.3

Some mandated reporters see a child only once are very infrequently. Others see them more often. In looking for reasonable cause, you need to consider what you know about the child's normal behavior. No two children will respond the same way to the same situation.

Indicators of Physical Abuse, Maltreatment, or Neglect

Common physical indicators are severe unexplained or suspicious bruises and welts, fractures, burns, lacerations, or abrasions. Specific physical indicators of abuse, maltreatment, or neglect are:3

  1. Unexplained bruises and welts
    1. On face, lips, mouth, torso, back, buttocks or thighs.

Handprint Injury

Handprint Injury8
(AbuseWatch.net, 2012)

Bruising of torso, buttocks  and thighs

(AbuseWatch.net, 2012)8

  1. Bruises in various stages of healing clustered bruises forming regular patterns that might reflect the shape of an article used to inflict the injury
  2. Bruises on several different areas
  3. Bruises regularly appear after absence, weekend, or vacation
  1. Unexplained fractures
    1. To nose, skull, or facial structure
    2. In various stages of healing
    3. Multiple or Spiral fractures

Spiral Fracture

Spiral Fracture8
(AbuseWatch.net, 2012)

  1. Swollen or tender lambs
  1. Unexplained burns
    1. Cigar, cigarette burns especially on the soles of feet, palms, back and buttocks

Cigarette burn

Cigarette burn8
(AbuseWatch.net, 2012)

  1. Immersion burns: sock-like, glove-like, doughnut shaped on buttocks or genitalia

Glove like burn

Glove like burn8
(AbuseWatch.net, 2012)

Sock like burn

Sock like burn8
AbuseWatch.net, 2012)

  1. Patterned like electric burner or iron

Steam iron injury

Steam Iron Injury8
(AbuseWatch.net, 2012)

  1. Rope burns on arms, legs, neck, or torso

Looped cord Injury

Looped cord injury (AbuseWatch.net, 2012)8

  1. Unexplained lacerations or abrasions
    1. To mouth, lips, gums, or eyes
    2. To external genitalia
    3. On back of arms, legs, or torso
    4. Human bite marks
    5. Frequent injuries that are accidental or unexplained
  2. Consistent hunger, poor hygiene, inappropriate dress
  3. Consistent lack of supervision, especially in dangerous activities or for long periods
  4. Unattended physical problems or medical or dental needs
  5. Abandonment

Accidental injuries usually involve injury on a bony prominence of the body, such as elbows, knees and shins. Suspicious injuries usually occur in areas not susceptible to accidental age-appropriate areas. The following pictures indicate areas where children would normally bruises, and suspicious bruising areas, as well as other suspicious areas of injury.

Bruising areas

Bruising Areas8
(AbuseWatch.net, 2012)

Suspicious areas of bruising

Suspicious areas of bruising8
(AbuseWatch.net, 2012)

 

Mechanism of injury

Clues to the mechanism of injury8
(AbuseWatch.net, 2012)

Consider the size and shape of the injury, as well as the location of injury.3 Consider the relationship of the mechanism of injury (explanation of how the injury occurred) to the child's developmental stage. For example, toddlers fall when they learn to walk, and young children scrape their knees when learning to ride a bicycle. Consider if the story that was given as an explanation for an injury would produce the physical indicators that are present. For instance, a toddler falls to the floor while walking, not striking anything when he fell. That toddler has bruises on the back of his legs. One would expect that from a fall while walking, and the toddler would have bruises and scrapes on his hands, knees, and shins, not bruises on the back of his legs.

Child behavioral indicators of physical abuse, maltreatment, or neglect may be:3

  1. The child is wary of adult contact
  2. Apprehensive when other children cry
  3. Demonstrates behavioral extremes
  4. Frightened of parents
  5. Afraid to go home
  6. Reports injury by parent
  7. Wears long sleeve or similar clothing to hide injuries
  8. Seeks affection from adults
  9. Begging or stealing food
  10. Extended stays in school – arrives early, leaves late
  11. Attendance at school infrequent
  12. Consistent fatigue; falls asleep in class
  13. Alcohol and drug abuse
  14. States there is no caretaker

Parent behavioral indicators of physical abuse, maltreatment, or neglect may be:3

  1. Seems unconcerned about the child
  2. Takes an unusual amount of time to obtain medical care for the child
  3. Offers inadequate or inappropriate explanations for the injury
  4. Gives different explanations for the same injury
  5. Misuses drugs or alcohol
  6. Disciplines the child too harshly considering the child's age or what she has done wrong
  7. Sees the child as bad or evil
  8. Has a history of abuse as a child
  9. Attempts to conceal the child's injury
  10. Takes a child to a different hospital or doctor for each injury
  11. Has poor impulse control
  12. Misuses alcohol or other drugs
  13. Has disorganized, upsetting home life
  14. Is apathetic, feeling nothing will change
  15. Is isolated from friends, relatives, neighbors
  16. Has long-term chronic illness
  17. Cannot be found
  18. Has a history of neglect as a child
  19. Exposes a child to unsafe living conditions
  20. Evidences limited intellectual capacity

Indicators of Emotional abuse, maltreatment, or neglect

Child physical indicators of emotional abuse, maltreatment, or neglect may be:3

  1. Conduct disorders such as fighting in school, antisocial, or destructive
  2. Habit disorders such as rocking, fighting, or sucking fingers
  3. Neurotic disorders such as speech disorders, sleep problems, or inhibition of play
  4. Psychoneurotic reactions such as phobias, hysterical reactions, compulsions, or hypochondria
  5. Lags in physical development
  6. Failure to thrive

Patient marked failure to thrive

AbuseWatch.net, 20128

Child behavioral indicators of emotional abuse, maltreatment, or neglect may be:3

  1. Overly adaptive behavior such as inappropriately adult or inappropriately infantile
  2. Developmental delays, mental or emotional
  3. Extremes of behavior such as compliant, passive, aggressive, or demanding
  4. Suicide attempt or gestures or self-mutilation

Parent behavioral indicators of emotional abuse, maltreatment, or neglect may be:3

  1. Treats children in the family unequally
  2. Doesn't seem to care much about the child's problem
  3. Blames or belittles child
  4. Is cold and rejecting
  5. Inconsistent behavior toward the child

Sexual Abuse

Child physical indicators of sexual abuse may be:3

  1. Difficulty in walking or sitting
  2. Torn, sustained, or bloody underclothing
  3. Pain or itching in genitalia
  4. Pregnancy, especially in early adolescence
  5. Bruises or bleeding in external genitalia, vaginal or anal areas
  6. Sexually transmitted diseases, especially in the pre-adolescent age group, includes oral venereal infections

Child behavioral indicators of sexual abuse may be:3

  1. Unwilling to change for or participate in a physical education class
  2. Withdrawal, fantasy, or infantile behavior
  3. Bizarre, sophisticated, unusual sexual behavior or knowledge
  4. Self-injurious behaviors, suicide attempts
  5. Poor peer relationships
  6. Aggressive or disruptive behavior, delinquency, running away, or school truancy
  7. Reports sexual assault by caretakers
  8. Exaggerated fear of closeness or physical contact

Parent behavioral indicators of sexual abuse may be:3

  1. Very protective or jealous of the child
  2. Encourages the child to engage in prostitution or sexual acts in the presence of caretaker
  3. Misuses alcohol or drugs
  4. Is geographically isolated and/or lacking in social and emotional contacts outside the family
  5. Has low self-esteem

Case Studies

Case Study A:

  • A female, age 15, has comes to the ER with the rash on her vaginal area. She discloses she has been engaging in sexual intercourse with her mother's 38-year-old boyfriend for the past two months. The boyfriend has resided in the house with the child and her mother for the past five years and is responsible for the care of the child when the mother is at work.
    • What indicators are present?
    • Is there a reasonable cost to suspect abuse or maltreatment?
    • Is there a parent or other person responsible for the suspected abuse or maltreatment?
    • What are your next steps?

Case Study B:

  • Seven-year-old Chris came to the doctor's office for a physical. He has a bruise on the right side of his face with scrapes along his right arm. The child claimed he fell off his bike. The child lives with his mother, a single parent. She says Chris is a very active child and, at times, can present challenging behaviors at school.
    • What indicators are present?
    • Is there reasonable cause to suspect abuse or maltreatment?
    • Is there a parent or other person responsible for the suspected abuse or maltreatment?
    • What are your next steps?

Case Study C:

  • A mother delivers a baby that has neonatal drug withdrawal. When talking to the mother, you learned she has not prepared for the baby to come home.
    • What indicators are present?
    • Is there reasonable cause to suspect abuse or maltreatment?
    • Is there a parent or other person responsible for the suspected abuse or maltreatment?
    • What are your next steps?

Case Study D:

  • Eight-year-old Jason comes to the ER with a broken arm. His mother says he fell off the bed. When Jason Jason's arm is x-rayed, there's a spiral fracture to his humorous.
    • What indicators are present?
    • Is there reasonable cause to suspect abuse or maltreatment?
    • Is there a parent or other person responsible for the suspected abuse or maltreatment?
    • What are your next steps?

Case Study Answers

Case Study A:

  • What indicators are present? Sexual abuse and verbal disclosure
  • Is there reasonable cause to suspect abuse or maltreatment? Yes
  • Is there a parent or other person responsible for the suspected abuse or maltreatment? 38-year-old boyfriend is an adult living in the home acting as a caregiver
  • What are your next steps? Call ChildLine

Case Study B:

  • What indicators are present? Bruises, scrapes
  • Is there reasonable cause to suspect abuse or maltreatment? No, the story is consistent with a bike injury. Injuries sustained in an accidental fall would be along one side of the child's body
  • Is there a parent or other person responsible for the suspected abuse or maltreatment? No
  • What are your next steps? Treat a child's injury.

Case Study C:

  • What indicators are present? Neonatal drug withdrawal and no plan for the baby
  • Is there reasonable cause to suspect abuse or maltreatment? Yes
  • Is there a parent or other person responsible for the suspected abuse or maltreatment? Mother
  • What are your next steps? Call ChildLine

Case Study D:

  • What indicators are present? Spiral fracture, explanation is not plausible
  • Is there reasonable cause to suspect abuse or maltreatment? Yes
  • Is there a parent or other person responsible for the suspected abuse or maltreatment? Mother
  • What are your next steps? Call ChildLine

References

  1. Prevention of Child Maltreatment. World Health Organization website. Accessed March 11, 2020. Visit Source.
  2. Child Maltreatment 2018. US Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau website. Updated January 15, 2020. Accessed March 11, 2020. Visit Source.
  3. Research foundation for SUNY. Mandated reporter trainer's resource guide; identifying and reporting child abuse and maltreatment/neglect. Buffalo State College, Center for development of human services, 2011.
  4. Keep Kids Safe By Strengthening Families. Pennsylvania Department of Human Services website. Accessed April 4, 2020. Visit Source.
  5. Pennsylvania Statutes. Title23. Chapter 63. § 6303. Domestic violence. Accessed April 4, 2020. Visit Source.
  6. Pennsylvania Statutes. Title23. Chapter 63. § 6311 (a). Accessed April 4, 2020. Visit Source.
  7. Pennsylvania Department of Human Services. Accessed April 4, 2020. Visit Source.
  8. Prevention Resources for the Community and Professionals. AbuseWatch.net website. Accessed April 4, 2020. Visit Source.