Child Abuse: Pennsylvania Mandated Reporter Training, 2 hours - License Renewal - 2 Contact Hours

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.

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

1. Describe the Child Welfare System in Pennsylvania

2. Outline the provisions and responsibilities for reporting suspected child abuse

3. Summarize the process for reporting suspected child abuse

4. Characterize the physical and behavioral indicators associated with child abuse

5. Evaluate situations to determine reasonable cause to suspect child abuse

Violence is an important public health issue. The World Health Organization (WHO) estimates that nearly 53,000 children are murdered each year. 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 include²:

• 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 same race or ethnicity population.
• 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 same age population. 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 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

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, 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 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 the following is the contact information for the regional state CWS agencies for your information.

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

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.

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 a 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 do 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 report's final status following the investigation as to whether the report is indicated, founded or unfounded. If the perpetrator is a school employee, the notice of the report's final status 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

Health care provider is a licensed hospital or health facility or person who is licensed, certified or otherwise regulated to proved health services under the laws of the commonwealth, including a physician, podiatrist, optometrist, psychologist, physical therapist, certified nurse practitioner, registered nurse, nurse midwife, physician's assistant, chiropractor, dentist, pharmacist, or an individual accredited or certified to provide behavioral health services.⁹

Department is the Department of Human Services of the Commonwealth.⁹
 

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 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 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

Mandated Reporters

Reporting Process

Actions after a Suspected Case is Reported

Protection for Reporters

Penalties for Failure to Report

Mandated Reporters Right-to-Know

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

Indicators of Emotional abuse, maltreatment, or neglect

Sexual Abuse

Funding for state grants is authorized by the federal Child Abuse Prevention and Treatment Act (CAPTA). A grant is available for states that have policies and procedures that ensure provers refer infants with specific situations to a multidisciplinary team to develop a Plan of Safe Care.  Specific infants are identified as⁹:

• Affected by substance abuse
• Experiencing withdrawal symptoms
• Fetal Alcohol Spectrum Disorder

After the birth of a child with a specific situation, notice must be given to Pennsylvania DHS.  Notification can be made to ChildLine, electronically through the Child Welfare Portal or at 1-800-932-0313.  The notification is not a child abuse report.⁹

Before discharge, a multidisciplinary team meeting must be held.  The team will inform the needs of the child and parents and immediate caregivers to determine the appropriate lead agency for developing, implementing, and monitoring a Plan of Safe Care.  The parents and immediate caregivers must be involved to identify the need for access to treatment for any substance use disorder or other physical or behavioral health condition that may impact the safety, early childhood development, and well-being of the child.⁹

Multidisciplinary Team for the purpose of informing the Plan of Safe Care may include⁹:

• Public health agencies
• Maternal and child health agencies
• Home visitation programs
• Substance use disorder prevention and treatment providers
• Mental health providers
• Public and private children and youth agencies
• Early intervention and developmental services
• Courts
• Local education agencies
• Managed care organizations and private insurers
• Hospitals and medical providers

Health care professionals involved in the delivery or care of an infant or an infant up to age one with the specific situations identified above, in any setting, must notify the Pennsylvania DHS immediately.  This notification is mandated.  The purpose of the notification is assessing the child and the child's family for a Plan of Safe Care.⁹

Depending on the needs of the child and parents(s)/caregivers(s), ongoing involvement of the county agency may not be required.⁹

Information about Pennsylvania's Plan of Safe Care is available at: www.keepkidssafe.pa.gov/resources/PlansSafeCare/index.htm

Case Study A:

• A female, age 15, has comes to the ER with a 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 child's care 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 humerus.
  • 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

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.