Child Abuse Recognition and Reporting 2017

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Child Abuse Recognition and Reporting 2017

Transcript Of Child Abuse Recognition and Reporting 2017

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Child Abuse Recognition and Reporting 2017
Introduction
According to a U.S. Department of Health and Human Services Report issued in 2014, an estimated 702,000 children across the country were victims of abuse or neglect (U.S. Department of Health and Human Services, 2014). Comparing the national estimate of victims from 2010 (698,000) to 2014 (702,000) show an increase of less than 1 percent. Three-quarters (75.0%) of victims were neglected, 17.0 percent were physically abused, and 8.3 percent were sexually abused. Sadly, an estimated 1,580 children died of abuse and neglect at a rate of 2.13 per100,000 children in the national population.
Most mental health professionals have encountered abused children throughout the course of their practice. Psychologists, counselors and social workers are in unique positions to observe and interact with children and elders. They often see individuals struggling with serious emotional problems. In being able to assess the reasons for these problems, mental health professionals are often pivotal in noticing changes in clients that may indicate abuse or neglect. Such professionals are mandated to report suspected child abuse. Most States definitions of mandated reporters include mental health and medical professionals, teachers, clergy, child and foster care workers among those individuals who are required to report child maltreatment.
All 50 states, the District of Columbia, and the U.S. Territories have child abuse and neglect reporting laws that mandate mental health professionals to report suspected maltreatment to a child protective services (CPS) agency. Each state has its own definitions of child abuse and neglect that are based on standards set by federal law. Federal legislation provides a foundation for states by identifying a set of acts or behaviors that define child abuse and neglect. The laws apply to mental health providers working in private practice and institutional settings. In addition to child abuse reporting laws, many states also have laws pertaining to mandatory reporting of elder abuse and sexual exploitation between therapists and clients.
The Child Abuse Prevention and Treatment Act (CAPTA) defines child abuse and neglect as:
Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm.
There are four major categories of child abuse: neglect, physical abuse, psychological or emotional abuse, and sexual abuse.
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Despite mandates to report child abuse, many professionals are uncertain when a report is required and practitioners vary in their understanding and opinions of these laws. Unlike the case report, researchers have found a tendency to err on the side of overreporting (Kalichman & Brosig,1993). Renninger et al. (2002) conducted a survey of licensed psychologists. Although they had knowledge of reporting laws, their performance on a knowledge measure suggested information deficits and a tendency to overreport suspected abuse. Legal considerations were the strongest factor that encouraged reporting. Opinions of the mandatory reporting laws were generally favorable, with some concerns about child protection systems and the impact of reporting on the therapeutic alliance. The latter issue is explored in more detail by Steinberg et al. (1997). There are consequences to both the overreporting and underreporting of abuse.
Once a mandated reporter files a report of suspected abuse, the family often become eligible to receive a variety of services that will improve the family’s ability to care for the child or elder. These services may include parenting classes, counseling, treatment for substance abuse, medical services and anger management classes.
This training will provide an overview of issues related to mandated reporting and support the mental health professional in fulfilling this important role.
Objectives:
After finishing this course, the participant will be able to:
- Define the Child Abuse Prevention and Treatment Act (CAPTA) - Define the major categories of child abuse (physical abuse, neglect,
sexual abuse, emotional abuse) and provide examples of each one - Define child abuse including characteristics that may lead the
practitioner to believe that a child is being abused - Describe their role as a mandated reporter - Discuss ethical standards pertaining to confidentiality - Discuss the concept of a “good faith” report and the consequences of
failing to report - Discuss making a report - Describe the role of child protective services and the steps in an
investigative report - Discuss the role that culture and ethnicity play in child maltreatment
interventions including false positive and negative reporting

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Historical Foundations
Prior to looking at the problem of child maltreatment, it is interesting to explore the historical foundations of child abuse reporting, including the enactment of child protection policies.
Many researchers mark the case of Mary Ellen Wilson as the beginning of the American movement to protect children. Mary Ellen was an 8-year-old girl living in New York City. A neighbor noticed evidence of child abuse, including physical beatings, malnourishment, and other deliberate cruelties and deprivations. The neighbor reported this to Etta Wheeler, a member of the Methodist Mission. Etta was frustrated at the lack of authority agencies including the police had in intervening. The only cruelty laws at this time pertained to animals.
According to legend, Henry Berge, founder of the New York SPCA intervened on her behalf, arguing that Mary Ellen was a member of the animal kingdom. She was subsequently removed from the dangerous situation, and her foster mother criminally charged. That same year saw the founding of The New York Society for the Prevention of Cruelty to Children.
CAPTA (1974)
By 1963, the United States Children’s Bureau disseminated the first legislation for mandated reporting. The initial legislation prompted similar laws in several states. In 1974, Congress passed the first Child Abuse Prevention and Treatment Act (CAPTA). This landmark legislation:
• Authorized programs and services for child maltreatment programs, including funding for states meeting CAPTA requirements
• Created the National Center on Child Abuse and Neglect and the National Clearinghouse on Child Abuse and Neglect Information (NCCANI).
• Mandates state to provide data on the number and sources of child abuse and neglect reports, investigation dispositions, types of maltreatment and related information.
• Provides for reporting of the National Incidence Study of Child Abuse and Neglect (last published in 2008). This report includes data from more than 5,600 community professionals who have had contact with maltreated children.
Indian Child Welfare Act (ICWA)
In 1978, the Indian Child Welfare Act (ICWA) was added to CAPTA. This act was designed to protect Native American children in the child welfare system. The foundation of the ICWA was based on the observation that Native American
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children removed from their homes were often placed in non-Native American homes and that judicial and social work systems were not familiar with traditional Native American value systems. As a result, these systems sometimes mislabeled Native American homes as dysfunctional. Today matters pertaining to Native American children are handled by tribal courts. While this goal was admirable, there has been criticism regarding inadequate funding and implementation (Jones, 1995).
CAPTA (2010)
CAPTA has been amended several times and was most recently amended and reauthorized on December 20, 2010, by the CAPTA Reauthorization Act of 2010. In addition to CAPTA, there are a number of other national and local policies that support child welfare. These include:
• Title-IV-B of the Social Security Act • PROTECT Act (Prosecutorial Remedies and Other Tools to End the
Exploitation of Children Today Act of 2003) • Foster Care Independence Act • Promoting Safe and Stable Families Act • Keeping Children and Families Safe Act (2003) • Adoption Promotion Act (2003)
Preventing Sex Trafficking and Strengthening Families Act (2014)
In 2014, the Preventing Sex Trafficking and Strengthening Families Act was signed. This act ensures that states implement mechanisms for reporting and collecting data on sex trafficking and identifying children who may be at risk of becoming victims of sex trafficking. Additionally the law strengthens existing laws related to adoption incentives and the provision of services to foster parents

Defining Child Abuse
Child abuse definitions vary from state to state, but most of these definitions share some similarities. Child abuse or neglect is defined as “any recent act or failure to act resulting in imminent risk of serious harm, death, serious physical or emotional harm, sexual abuse, or exploitation of a child (usually a person under the age of 18, but a younger age may be specified in cases not involving sexual abuse) by a parent or caretaker who is responsible for the child's welfare” (CAPTA, 2003; Keeping Children and Families Safe Act, 2003). Such caretakers may include anyone who has direct or regular contact with a child, including school personnel and staff of agencies or organizations. It is important to note that in many states “perpetrators” may commit abuse by acting (commission) or by failing to act (omission).

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Minimum standards for defining child abuse are set forth by CAPTA, which categorizes child abuse under four broad types: (a) physical abuse; (b) sexual abuse; (c) emotional abuse; (d) neglect.
All states must meet the minimum standards in defining abuse, however, statutes from state to state. For example, some states include a category of abuse such as child exploitation, which covers incidences that are non-sexual in nature (e.g., child labor). Other states include acts such as withholding a medical treatment or medication. It is advisable to know your state’s statutes.
Consider, for example, the Pennsylvania statutes on child abuse:
Pennsylvania Definition of Child Abuse
The term "child abuse" shall mean intentionally, knowingly or recklessly doing any of the following: (1) Causing bodily injury to a child through any recent act or failure to act. (2) 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. (3) 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. (4) Causing sexual abuse or exploitation of a child through any act or failure to act. (5) Creating a reasonable likelihood of bodily injury to a child through any recent act or failure to act. (6) Creating a likelihood of sexual abuse or exploitation of a child through any recent act or failure to act. (7) Causing serious physical neglect of a child. (8) Engaging in any of the following recent acts:
(i) Kicking, biting, throwing, burning, stabbing or cutting a child in a manner that endangers the child. (ii) Unreasonably restraining or confining a child, based on consideration of the method, location or the duration of the restraint or confinement. (iii) Forcefully shaking a child under one year of age. (iv) Forcefully slapping or otherwise striking a child under one year of age. (v) Interfering with the breathing of a child. (vi) Causing a child to be present at a location while a violation of relating to operation of methamphetamine laboratory is occurring, provided that the violation is being investigated by law enforcement. (vii) Leaving a child unsupervised with an individual, other than the child's parent, who the actor knows or reasonably should have known:
(A) Is required to register as a sexual offender, where the

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victim of the sexual offense was under 18 years of age when the crime was committed. (B) Has been determined to be a sexually violent predator (C) Has been determined to be a sexually violent delinquent child (9) Causing the death of the child through any act or failure to act.
While CAPTA defines child abuse within the categories of physical abuse, neglect, sexual abuse, and emotional abuse, it is important to note that child abuse is more typically found in combination than alone. A physically abused child, for example, is often emotionally abused as well, and a sexually abused child also may be neglected.
Risk Factors for Child Maltreatment
What puts a child at risk for maltreatment? Identification of risk factors is an important question, and invaluable in implementing prevention programs. It is a question that mental health professionals have looked at for some time. Initial schemas of risk used the idea of child vulnerability, and attempted to isolate those child risk factors (Action for Child Protection, 2003). These authors recommended conducting a family safety assessment to determine whether a vulnerable child resides in the household. In a nutshell, vulnerability was equated to a child’s ability to defend him or herself. These “child risk factors” are still utilized today (CDC, n.d.) and include:
Young age (especially infants and young children). This is due to their small physical size, early developmental status, and need for constant care are more likely to experience certain forms of maltreatment, such as shaken baby syndrome and non-organic failure to thrive. There also appears to be a connection between premature/low birth weight and child abuse.
Teenagers, are at greater risk for sexual abuse.
Disabilities – Children with physical, cognitive, and emotional disabilities experience higher rates of maltreatment as do children with chronic illnesses. These children are highly dependent on others to meet their basic needs. They may also be at greater risk be due in part of caretaker demands and bonding or attachment issues. Children with cognitive disabilities may have difficulty recognizing danger, knowing who can be trusted, meeting their basic needs and seeking protection. A child’s disability often places increased demands on caregivers, which may outstrip their capacity to meet the child’s needs (i.e., neglect).
“Provocative” Children – A child's emotional, mental health,

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behavioral problems can be such that they irritate and provoke others to act out toward them or to avoid them. Emotional issues such as attention deficit disorder, disruptive behavior disorders, aggression and difficult temperament have thus been found to be risk factors. Thus “difficult temperament” may elicit frustration and stress on the part of caretakers, which may ultimately result in maltreatment.
Non-Assertive/Powerless Children – Regardless of age, a child who is so passive or withdrawn not to be able to make his or her basic needs known is vulnerable. A child who cannot or will not seek help and protection from others is vulnerable.
Gender – girls were sexually abused about three times more frequently than boys. Boys were at somewhat greater risk of serous injury (24% higher), were more likely to be victims of physical abuse, and boys significantly more likely to be emotionally neglected.
Looking at these child factors is important, but it is more likely that a combination of factors contribute to the risk of child maltreatment. These include individual, parent/caregiver factors, and family characteristics. Risk factors are those characteristics associated with child maltreatment—they may or may not be direct causes. The following are risk factors for child maltreatment (CDC, n.d.)
Parent/Caregiver Factors: Personality characteristics – Low self esteem, external locus of control, poor impulse control, depression, anxiety, antisocial behavior
History of abuse or neglect as a child
Substance abuse, leading to parental instability, diversion of money needed for child’s care to habit, inability to maintain employment, interference with parent’s need to provide care and nurturance
Younger maternal age (may be connected to lower economic status, lack of social support, and high stress levels) as is dependency
Lower parental educational attainment
Untreated depression
Adults who were maltreated during childhood

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Family Characteristics: Family structure: Single families - primarily with lower income, families with few social supports, large family or many household members (especially indicative for neglect), chaotic homes
Marital conflict and domestic violence
Stress – stressful life events, parenting stress
Parent/Child interaction – lack of parenting skills, harsh discipline, lack of recognition of positive behaviors
Low levels of parent involvement and poor parent–child interactions
Presence of a non-biological caregiver in a single-parent household (especially associated with physical abuse)
Severity of Problems – the severity of a family’s problems may predict outcomes
Environmental Factors (often in combination with parent, family, and child factors)
Unemployment or inability to provide economically Poverty (which may lead to increased caregiver strain and mental health problems, along with poorer parenting practices) Social isolation Violent communities Living in area with high population density
Community Factors
Community violence Neighborhood disadvantage (high poverty/residential instability, high unemployment rates, and high density of alcohol outlets), and poor social connections Racial and ethnic minority status
Other Increased exposure to mandated reporters through participation in social welfare programs
Two recent studies looked more closely at these risk factors (Merskey et al., 2009). The authors analyzed 1,411 participants in an inner-city (Chicago) longitudinal study of families with documented cases of child maltreatment. Receipt of public assistance and single-parent family status were significantly

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associated with maltreatment. Among school-age indicators examined, parent participation in school was a mediating factor in maltreatment outcomes. Maternal age at the child’s birth was most strongly associated with physical abuse. Family poverty was also associated with multiple maltreatment outcomes, adding to the evidence linking poverty to child abuse and neglect. Campos et al. (2016) also looked at the effects of socioeconomic status and parental demographics in intentional pediatric burn injuries. These authors found that burns from child maltreatment often result in morbidity and mortality, and most commonly affect children under 3 years of age. More than one third of nonaccidental burns occurred in single-parent homes or have parents with history of mental illness, substance abuse, incarceration, or with families having Department of Children and Family Services (DCFS) involvement.
Another interesting study involved the role of fathers in mediating risk of child physical abuse. Guterman et al. (2009) looked at 1,480 families, conducting inhome and phone interviews. The researchers looked at the mother–father relationship status; father demographic, economic, and psychosocial variables; and other background factors. In looking at fathering factors linked with risk, the researchers found that fathers’ higher educational attainment and their positive involvement with their children most reliably predicted lower maternal physical child abuse risk. They found that Fathers’ economic factors played no observable role in mothers’ risk for physical child maltreatment. The findings of the study suggested that marriage per se does not appear to be a protective factor for maternal physical child abuse and rather it may serve as a proxy for other fatherrelated protective factors.
Physical Abuse
According to the U.S. Department of Health and Human Services (2014), approximately 17% of children reported to social services were victims of physical abuse. Nationally this represents 119,517 children.
The National Center on Child Abuse and Neglect defines child physical abuse as: "The physical injury or maltreatment of a child under the age of eighteen by a person who is responsible for the child's welfare under circumstances which indicate that the child's health or welfare is harmed or threatened.” The parent or caretaker need not have intended to hurt the child for it to constitute physical abuse. Examples of physical abuse include: beating with a belt, shoe, or other object; burning a child with matches or cigarettes; hitting a child; shaking, shoving, or slapping a child; biting, choking or hair pulling; or inflicting severe physical punishment.
Even forms of physical punishment that do not result in physical injury are considered physical abuse and are outlawed in some states. For example, in Arkansas, Minnesota, and the District of Columbia, hitting a child with a closed fist is considered physical abuse. In Arkansas, hitting a child on the face or head

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is also called physical abuse. For more information on state laws, see www.childwelfare.gov/systemwide/ laws_policies/statutes/defineall.pdf. This is just one of the things that makes it difficult for mental health professionals to determine the lines between physical abuse and “discipline.” And while spanking may not be illegal in all states. Research suggests that even spanking that does not result in serious physical harm, often causes psychological harm, and may be connected to child externalizing behaviors, other forms of family violence and intergenerational violence (MacKenzie, Nicklas, Brooks-Gunn, & Waldfogel, 2014; Zolotor, 2014).
Children of all ages, races, ethnicities, and socioeconomic backgrounds are at risk for physical abuse. Children ages 4–7 and 12–15 are at the greatest risk of being physically abused. Very young children are most susceptible to receiving serious injuries (US Department of Health and Human Services, Administration on Children, Youth and Families, 2009.)
Physical Discipline

It is difficult to accurately estimate what percentage of parents physically discipline children. Some researchers estimate the number to be as high as 70 to 90 percent (Holden, Williamson & Holland, 2014). Holden, Williamson and Holland (2014) looked at the use of corporal punishment in the home. In this small pilot study, the researchers studied 33 mothers as they put children to bed, a time when the likelihood of corporal punishment is great. The researchers used voice recorders, which they wore in sport pouches on their upper arms, to chronicle the family interactions. Forty-five percent of the families in the sample struck their children; many did so more than once over the course of four to six consecutive evenings. Holden’s study found that, on average, parents hit their children just 30 seconds after the start of a conflict, with little warning and often out of anger. Within 10 minutes of the physical discipline, 73 percent of the children misbehaved again.
This study belies the fact that many physically abusive parents and caregivers state that their actions are simply forms of discipline—ways to make children learn to behave. But there is a difference between using physical punishment to discipline and physical abuse.
While physical abuse may be the result of a deliberate attempt to hurt the child, but not always. It can also result from severe discipline. In some instances, the criteria for child abuse may not require that a child have physical injuries. For example, shaking a child under the age of 1 is considered to meet the criteria of child abuse in most states.

Physical abuse vs. Discipline (Helpguide.org)

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