________________________ #97531 Child Abuse Identification and Reporting: The New York Requirement

COURSE #97531 — 2 CONTACT HOURS/CREDITS Release Date: 10/01/14 Expiration Date: 09/30/17

Child Abuse Identification and

Reporting: The New York Requirement
Accreditations & Approvals
HOW TO RECEIVE CREDIT NetCE is accredited by the Accreditation Council for
Continuing Medical Education to provide continuing
• Read the enclosed course.
medical education for physicians.
• Complete the questions at the end of the course.
NetCE is accredited as a provider of continuing nursing
• Return your completed Evaluation to NetCE by
mail or fax, or complete online at www.NetCE.
education by the American Nurses Cre­dentialing Center’s
com. (If you are a physician, behavioral health Commission on Accreditation.
professional, or Florida nurse, please return NetCE, #1092, is approved as a provider for social work
the included Answer Sheet/Evaluation.) Your continuing education by the Association of Social Work
postmark or facsimile date will be used as your Boards (ASWB) www.aswb.org through the Approved
completion date. Continuing Education (ACE) Program. NetCE maintains
• Receive your Certificate(s) of Completion by mail, responsibility for the program. ASWB Approval Period:
fax, or email. 3/13/2016 to 3/13/2019. Social workers should contact
their regulatory board to determine course approval for
continuing education credits.

Faculty NetCE has been approved by NBCC as an Approved Con-

Alice Yick Flanagan, PhD, MSW, received her Master’s tinuing Education Provider, ACEP No. 6361. Programs
in Social Work from Columbia University, School of that do not qualify for NBCC credit are clearly identified.
Social Work. She has clinical experience in mental health NetCE is solely responsible for all aspects of the programs.
in correctional settings, psychiatric hospitals, and com- This course is approved by the Association of Social
munity health centers. (A complete biography appears at Work Boards - ASWB NJ CE Course Approval Program
the end of this course.) Provider #14 Course #300. Social workers will receive
Faculty Disclosure the following type and number of credit(s): General
Contributing faculty, Alice Yick Flanagan, PhD, MSW, Social Work Practice 2 for the approval period starting
has disclosed no relevant financial relationship with any 04/23/2015 and ending 04/23/2017.
product manufacturer or service provider mentioned. Designations of Credit
Division Planners NetCE designates this enduring material for a maximum
John V. Jurica, MD, MPH of 2 AMA PRA Category 1 Credit(s)™. Physicians should
Jane C. Norman, RN, MSN, CNE, PhD claim only the credit commensurate with the extent of
their participation in the activity.
Division Planners Disclosure
The division planners have disclosed no relevant financial Successful completion of this CME activity, which in-
relationship with any product manufacturer or service cludes participation in the evaluation component, en-
provider mentioned. ables the participant to earn up to 2 MOC points in the
American Board of Internal Medicine’s (ABIM) Main-
Audience tenance of Certification (MOC) program. Participants
This course is designed for all New York physicians, phy- will earn MOC points equivalent to the amount of CME
sician assistants, nurses, social workers, and counselors credits claimed for the activity. It is the CME activity
required to complete child abuse education. provider’s responsibility to submit participant comple-
tion information to ACCME for the purpose of granting

Copyright © 2014 NetCE

A complete Works Cited list begins on page 15. Mention of commercial products does not indicate endorsement.
NetCE • Sacramento, California Phone: 800 / 232-4238 • FAX: 916 / 783-6067 1
#97531 Child Abuse Identification and Reporting: The New York Requirement ________________________
ABIM MOC credit. Completion of this course consti- About the Sponsor
tutes permission to share the completion data with AC- The purpose of NetCE is to provide challenging curri-
CME. cula to assist healthcare professionals to raise their levels
NetCE designates this continuing education activity for of expertise while fulfilling their continuing education
2 ANCC contact hours. requirements, thereby improving the quality of healthcare.

NetCE designates this continuing education activity for Our contributing faculty members have taken care to
2.4 hours for Alabama nurses. ensure that the information and recommendations are
accurate and compatible with the standards generally
AACN Synergy CERP Category B. accepted at the time of publication. The publisher dis-
Social Workers participating in this intermediate to claims any liability, loss or damage incurred as a conse-
advanced course will receive 2 Clinical continuing educa- quence, directly or indirectly, of the use and application of
tion clock hours, in accordance with the Association of any of the contents. Participants are cautioned about the
Social Work Boards. potential risk of using limited knowledge when integrating
new techniques into practice.
NetCE designates this continuing education activity for
1 NBCC clock hour. Disclosure Statement
It is the policy of NetCE not to accept commercial support.
Individual State Nursing Approvals Furthermore, commercial interests are prohibited from
In addition to states that accept ANCC, NetCE is distributing or providing access to this activity to learners.
approved as a provider of continuing education in
nursing by: Alabama, Provider #ABNP0353 (valid Course Objective
through December 12, 2017); California, BRN Provider The purpose of this course is to enable healthcare profes-
#CEP9784; California, LVN Provider #V10662; Califor- sionals in all practice settings to define child abuse and
nia, PT Provider #V10842; Florida, Provider #50-2405; identify the children who are affected by violence. This
Iowa, Provider #295; Kentucky, Provider #7-0054 through course describes how a victim can be accurately diagnosed
12/31/2017. and identifies the community resources available in the
state of New York for child abuse victims.
Individual State Behavioral Health Approvals
In addition to states that accept ASWB, NetCE is Learning Objectives
approved as a provider of continuing education by the Upon completion of this course, you should be able to:
following state boards: Alabama State Board of Social 1. Summarize the historical context of child abuse.
Work Examiners, Provider #0515; Florida Board of 2. Define child abuse and neglect and identify
Clinical Social Work, Marriage and Family Therapy and the different forms of child abuse and neglect.
Mental Health, Provider #50-2405; Illinois Division
3. Discuss the scope of child abuse and neglect
of Professional Regulation for Social Workers, License
in New York State and in the United States.
#159.001094; Illinois Division of Professional Regulation
for Licensed Professional and Clinical Counselors, License 4. Describe warning signs and consequences of
#197.000185; Illinois Division of Professional Regulation child abuse and neglect.
for Marriage and Family Therapists, License #168.000190; 5. Review the mandatory reporting process and
Texas State Board of Social Work Examiners, Approval mandated reporters in New York State, including
#3011; Texas State Board of Examiners of Professional possible barriers to reporting suspected cases of
Counselors, Approval #1121; Texas State Board of Exam- child abuse.
iners of Marriage and Family Therapists, Approval #425.
Special Approvals
This activity is designed to comply with the requirements Sections marked with this symbol include
of California Assembly Bill 1195, Cultural and Linguistic evidence-based practice recommen­dations.
Competency. The level of evidence and/or strength
This course is approved by the New York State Education of recommendation, as provided by the
Department to fulfill the requirement for 2 hours of train- evidence-based source, are also included
ing in the Identification and Reporting of Child Abuse so you may determine the validity or relevance of the
and Maltreatment. Provider #80673. information. These sections may be used in conjunc-
tion with the course material for better application to
your daily practice.

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________________________ #97531 Child Abuse Identification and Reporting: The New York Requirement
The first public case of child abuse in the United
HISTORICAL CONTEXT States that garnered widespread interest took place
in 1866 in New York City. Mary Ellen Wilson was
There is an established system in the United States
an illegitimate child, 10 years of age, who lived
to respond to reports of child abuse and neglect;
with her foster parents [3]. Neighbors were con-
however, this has not always been the case. This is
cerned that she was being mistreated; however, her
not because child abuse, neglect, and maltreatment
foster parents refused to change their behaviors and
are new social phenomena. Rather, the terms “child
said that they could treat the child as they wished
abuse,” “child neglect,” and “child maltreatment”
[2]. Because there were no agencies established to
are relatively new, despite the fact that this social
protect children specifically, Henry Berge, founder
problem has existed for thousands of years [1].
of the Society for the Prevention of Cruelty to Ani-
Cruelty to children by adults has been documented
mals, intervened on Mary’s behalf [3]. He argued
throughout history and across cultures. In China,
that she was a member of the animal kingdom
infant girls were often neglected during times of
and deserved protection. The case received much
famine or sold during times of extreme poverty.
publicity, and as a result, in 1874 the New York
There is also historical evidence that cultures
Society for the Prevention of Cruelty to Children
have taken steps to stop child abuse and cruelty.
was formed [3]. Because of this case, every state
For example, 6000 years ago in Mesopotamia,
now has a child protective services (CPS) system
orphans had their own patron goddesses for help
in place.
and protection [2].
As a result of Berge’s advocacy for children’s safety,
In many cases, the physical abuse of children has
other nongovernmental agencies were formed
been linked to physical punishment. Throughout
throughout the United States, and the establish-
history, physical child abuse was justified because
ment of the juvenile court was a direct result of the
it was believed that severe physical punishment
Prevention of Cruelty to Children [13]. By 1919,
was necessary either to discipline, rid the child of
all but three states had juvenile courts. However,
evil, or educate [2; 13].
many of these nongovernmental agencies could
It was not until 1861 that there was a public out- not sustain themselves during the Depression [13].
cry in the United States against extreme corporal
The topic of child abuse and neglect received
punishment. This reform was instigated by Samuel
renewed interest in the 1960s, when a famous
Halliday, who reported the occurrence of many
study titled “The Battered-Child Syndrome” was
child beatings by parents in New York City [2].
published [1; 4]. In the study, researchers argued
Sexual abuse of children, particularly incest that the battered-child syndrome consisted of
(defined as sex between family members), is very traumatic injuries to the head and long bones,
much a taboo. The first concerted efforts to protect most commonly to children younger than 3 years
children from sexual abuse occurred in England of age, by parents [1; 4]. The study was viewed as
during the 16th century. During this period, boys the seminal work on child abuse, alerting both
were protected from forced sodomy and girls the general public and the academic community
younger than 10 years of age from forcible rape [2]. to the problems of child abuse [1; 2]. Soon, all 50
However, in the 1920s, sexual abuse of children was states required physicians to report child abuse
described solely as an assault committed by “strang- [14]. In the early 1970s, Senator Walter Mondale
ers,” and the victim of such abuse was perceived as noted that there was no official agency that spent
a “temptress” rather than as an innocent child [2]. its energies on preventing and treating child mal-
treatment [13]. Congress passed the Child Abuse

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#97531 Child Abuse Identification and Reporting: The New York Requirement ________________________
Prevention and Treatment Act (CAPTA) of 1974, FORMS OF CHILD
which targeted federal funds to improve states’ ABUSE AND NEGLECT
interventions for the identification, reporting and There are several acts that may be considered abu-
training for child abuse [13]. sive, and knowledge of what constitutes abuse is
Today, child abuse and neglect are considered vital for healthcare providers and other mandated
significant social problems with deleterious conse- reporters. In this section, specific behaviors that
quences. As noted, a system has been implemented fall under the category of abuse and neglect will
in all 50 states to ensure the safety of children, with be reviewed.
laws defining what constitutes abuse and neglect Physical Abuse
and who is mandated to report.
Physical abuse injuries can range from minor
bruises and lacerations to severe neurological
DEFINITIONS OF CHILD trauma and death. Physical abuse is one of the
ABUSE AND NEGLECT most easily identifiable forms of abuse and the type
most commonly seen by healthcare professionals.
The federal definition of child abuse is evident in Physical injuries that may be indicative of abuse
CAPTA, published as a product of federal legisla- include bruises/welts, burns, fractures, abdominal
tion. CAPTA defines a child to be any individual injuries, lacerations/abrasions, and central nervous
younger than 18 years of age, except in cases of system trauma [8].
sexual abuse. In cases of sexual abuse, the age speci- Bruises and welts are of concern, particularly those
fied by the child protection laws varies depending that appear on:
on the state in which the child resides [5]. CAPTA
defines child abuse as, “any recent act or failure • The face, lips, mouth, ears, eyes,
to act on the part of a parent or caretaker, which neck, or head
results in death, serious physical or emotional • The trunk, back, buttocks, thighs,
harm, sexual abuse, or exploitation, or an act or or extremities
failure to act which presents an imminent risk of • Multiple body surfaces
serious harm” [6]. The state of New York defines
child abuse and neglect as follows [7]: Patterns such as the shape of the article (e.g., a
cord, belt buckle, teeth, hand) used to inflict the
“The term abuse encompasses the most bruise or welt should be noted. Cigar or cigarette
serious harms committed against children. burns are common, and they will often appear on
An ‘abused child’ is a child whose parent the child’s soles, palms, back, or buttocks. Pat-
or other person legally responsible for his/ terned burns that resemble shapes of appliances,
her care inflicts upon the child serious such as irons, burners, or grills, are of particular
physical injury, creates a substantial risk concern.
of serious physical injury, or commits a sex
offense against the child. Not only can a Fractures that result from abuse might be found on
person be abusive to a child if they perpe- the child’s skull, ribs, nose, or any facial structure.
trate any of these actions against a child These may be multiple or spiral fractures at vari-
in their case, they can be guilty of abusing ous stages of healing. When examining patients,
a child if they allow someone else to do note bruises on the abdominal wall, any intestinal
these things to that child.” perforation, ruptured liver or spleen, and blood ves-
sel, kidney, bladder, or pancreatic injury, especially

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________________________ #97531 Child Abuse Identification and Reporting: The New York Requirement
if accounts for the cause do not make sense. Look • Child pornography: Taking photos of a
for signs of abrasions on the child’s wrists, ankles, child in sexually explicit poses or acts
neck, or torso. Lacerations might also appear on • Exhibitionism: Exposing his/her genitals
the child’s lips, ears, eyes, mouth, or genitalia. to the child or forcing the child to observe
If violent shaking or trauma occurred, the child the adult or other children in sexual acts
might experience a subdural hematoma [8]. • Molestation: Touching, fondling, or kiss-
ing the child in a provocative manner; for
According to the American College of example, fondling the child’s genital area
Radiology, fractures that are highly specific or long, lingering kisses
for nonaccidental trauma in the normal
child include those involving the ribs,
• Sexual penetration: The penetration of part
metaphyseal or epiphyseal injuries, and of the perpetrator’s body (e.g., finger, penis,
avulsive fractures acromium process. tongue) into the child’s body (e.g., mouth,
(http://www.guideline.gov/content.aspx?id=37948. vagina, anus)
Last accessed September 11, 2014.) • Rape: Usually involves sexual intercourse
Level of Evidence: Expert Opinion/Consensus without the victim’s consent and usually
Statement involves violence or the threat of violence
Physical Neglect
Sexual Abuse Due to the ambiguity of definitions of child abuse
and neglect, CAPTA provides minimum standards
Sexual abuse is defined by CAPTA as [6]:
that each state must incorporate in its definition.
“the employment, use, persuasion, induce- Examples of child neglect may include [6; 11; 12]:
ment, enticement, or coercion of any child
• Failure to provide adequate food, clothing,
to engage in, or assist any other person to
shelter, hygiene, supervision, and protection
engage in, any sexually explicit conduct
or simulation of such conduct for the pur- • Refusal and/or delay in medical attention
pose of producing a visual depiction of and care (e.g., failure to provide needed
such conduct; or the rape, and in cases of medical attention as recommended by a
caretaker or interfamilial relationships, healthcare professional or failure to seek
statutory rape, molestation, prostitution, timely and appropriate medical care for a
or other form of sexual exploitation of health problem)
children, or incest with children.” • Abandonment, characterized by desertion of
a child without arranging adequate care and
Child sexual abuse can be committed by a stranger
supervision. Children who are not claimed
or an individual known to the child. Sexual abuse
within two days or who are left alone with
may be manifested in many different ways, includ-
no supervision and without any information
ing [9; 10]:
about their parents’/caretakers’ whereabouts
• Verbal: Obscene phone calls or talking are examples of abandonment.
about sexual acts for the purpose of sexually • Expulsion or blatant refusals of custody on
arousing the adult perpetrator the part of parent/caretaker, such as ordering
• Voyeurism: Watching a child get dressed or a child to leave the home without adequate
encouraging the child to masturbate while arrangement of care by others
the perpetrator watches • Inadequate supervision (i.e., child is left
• Child prostitution: Involving the child in unsupervised or inadequately supervised
sexual acts for monetary profit for extended periods of time)

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#97531 Child Abuse Identification and Reporting: The New York Requirement ________________________
Emotional Abuse/Neglect CHILD ABUSE VICTIMIZATION
The following behaviors constitute emotional ACCORDING TO RACE/ETHNICITY, 2012
abuse and neglect [6; 11; 12]: Race/Ethnicity Child Abuse Rate
Per 1,000 Children
• Verbal abuse: Belittling or making pejorative
African American 14.2
statements in front of the child, which results
Native American/Alaska Native 12.4
in a loss or negative impact on the child’s
Asian American 1.7
self-esteem or self-worth
Hispanic 8.4
• Inadequate nurturance/affection:
Multi race 10.3
Inattention to the child’s needs for
affection and emotional support Pacific Islander 8.7
White 8.0
• Witnessing domestic violence: Chronic
spousal abuse in homes where the child Source: [15] Table 1
witnesses the violence
• Substance and/or alcohol abuse: The parent/
caretaker is aware of the child’s substance EPIDEMIOLOGY OF CHILD
misuse problem but chooses not to intervene ABUSE AND NEGLECT
or allows the behavior to continue
• Refusal or delay of psychological care: NATIONAL PREVALENCE
Failure or delay in obtaining services for In 2012, there were 3.4 million referrals to CPS
the child’s emotional, mental, or behavioral agencies in the United States [15]. Almost 2.1 mil-
impairments lion (or 62%) were assessed to be appropriate for
• Permitted chronic truancy: The child a response, and the majority of reports were made
averages at least 5 days a month of school by health and mental health professionals [15].
absence and the parent/guardian does not Girls tend to be victims at a slightly higher rate
intervene (50.9%) compared with boys (48.7%) [15]. The
• Failure to enroll: Failure to enroll or most common perpetrators were parents (80.3%),
register a child of mandatory school age and specifically, mothers are more often perpetra-
or causing the child to remain at home tors compared with fathers (53.5% vs. 45.3%) [15].
for nonlegitimate reasons As of 2012, 9.2 of every 1,000 children in the
• Failure to access special education services: United States were victims of abuse and/or neglect
Refusal or failure to obtain recommended [15]. This is the unique rate, meaning each child is
services or treatment for remedial or special counted only once regardless the number of times a
education for a child’s diagnosed learning report may have been filed for abuse/neglect. The
disorder fatality rate for 2012 was 2.2 deaths per 100,000
children [15].
Research has shown that racial and ethnic minority
children (particularly African American, Native
American/Alaska Native, and multi-racial chil-
dren) tend to have higher rates of reported child
maltreatment compared to their white counterparts
(Table 1) [15]. However, the lowest reported rate
is among Asian American children [15].

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________________________ #97531 Child Abuse Identification and Reporting: The New York Requirement
NEW YORK STATE PREVALENCE Child risk indicators include [8; 10; 12; 16]:
In 2010, the rate of child abuse and neglect in New • Multiple school absences
York State was 18.0 per 1000 children, which is
• Learning or developmental disabilities
higher than the national rate [22]. This translates
to approximately 79,668 cases of child abuse and • History of multiple, unexplained illnesses,
neglect in New York annually [22]. In terms of hospitalizations, or accidents
fatalities, 114 children in New York died in 2010 as • Poor general appearance (e.g., fearful,
a result of child abuse and neglect, a 4.4% increase poor hygiene, malnourished appearance,
compared with 2009 [22]. inappropriate clothing for weather
conditions)
• Stress-related symptoms, such as headaches
RECOGNIZING WARNING SIGNS or stomachaches
It is crucial that practitioners become familiar with • Frozen watchfulness
the indications of child abuse and neglect. These • Mental illness or symptoms, such as
factors do not necessarily conclusively indicate psychosis, depression, anxiety, eating
the presence of abuse or neglect; rather, they are disorders, or panic attacks
clues that require further interpretation and clini- • Regression to wetting and soiling
cal investigation. Some parental risk indicators • Sexually explicit play
include [8; 10; 12; 16]:
• Excessive or out-of-the-ordinary clinging
• Recounting of events that do not conform behavior
either with the physical findings or the • Difficulties with concentration
child’s physical and/or developmental
• Disruptions in sleep patterns and/or
capabilities
nightmares
• Inappropriate delay in bringing the child
to a health facility Some of the types of behaviors and symptoms dis-
cussed in the definitions of physical, sexual, and
• Unwillingness to provide information or
emotional abuse/neglect are also warning signs.
the information provided is vague
For example, any of the injuries that may result
• History of family violence in the home from physical abuse, such as a child presenting
• Parental misuse of substances and/or alcohol with bruises in the shape of electric cords or belt
• Minimal knowledge or concern about buckles, should be considered risk factors for abuse.
the child’s development and care
• Environmental stressors, such as poverty,
single parenthood, unemployment, or
CONSEQUENCES
chronic illness in the family OF CHILD ABUSE
• Unwanted pregnancy The consequences of child abuse and neglect vary
• Early adolescent parent from child to child; these differences continue as
• Expression that the parent(s) wanted victims grow older. Several factors will mediate the
a baby in order to feel loved outcomes. These factors include [17]:
• Unrealistic expectations of the child • Severity, intensity, frequency, duration,
• Use of excessive physical punishment and nature of the abuse and/or neglect
• Healthcare service “shopping” • Age or developmental stage of the child
• History of parent “losing control” or when the abuse occurred
“hitting too hard”

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#97531 Child Abuse Identification and Reporting: The New York Requirement ________________________
• Relationship between the victim and Research findings regarding the effects of child-
the perpetrator hood physical abuse on adult survivors have been
• Support from family members and friends less consistent. Some adult survivors function
well socially and in terms of mental and physical
• Level of acknowledgment of the abuse
health, while others exhibit depression, anxiety,
by the perpetrator
post-traumatic stress, substance abuse, criminal
• Quality of family functioning behavior, violent behavior, and poor interpersonal
In examining some of the effects of physical abuse, relationships [17; 18]. A 2012 meta-analysis found
it is helpful to frame the consequences along a that victims of child abuse were more likely to
lifespan perspective [18]. During infancy, physical experience depression than non-abused counter-
abuse can cause neurological impairments. Most parts, with the rates varying according to the type
cases of infant head trauma are the result of child of abuse sustained (1.5-fold increase for physical
abuse [19]. Neurological damage may also affect child abuse, 2.11-fold increase for neglect, and
future cognitive, behavioral, and developmental 3-fold increase for emotional abuse) [24]. Similar
outcomes. Some studies have noted that, in early results were found in a longitudinal study that
childhood, physically abused children show less compared a child welfare cohort to a group with
secure attachments to their caretakers compared no child welfare involvement. The child welfare
to their nonabused counterparts [20]. group was twice as likely to experience moderate-
to-severe depression and generalized anxiety com-
By middle to late childhood, the consequences are
pared with the control group [25].
more notable. Studies have shown significant intel-
lectual and linguistic deficits in physically abused Although not all adult survivors of sexual abuse
children [18]. Other environmental conditions, experience long-term psychological consequences,
such as poverty, may also compound this effect. it is estimated that 20% to 50% of all adult sur-
In addition, a number of affective and behavioral vivors have identifiable adverse mental health
problems have been reported among child abuse outcomes [23]. Possible psychological outcomes
victims, including anxiety, depression, low self- include [10]:
esteem, excessive aggressive behaviors, conduct • Affective symptoms: Numbing, post-
disorders, delinquency, hyperactivity, and social traumatic stress disorder, anxiety, depression,
detachment [8; 10; 12; 18]. obsessions and compulsions, somatization
Surprisingly, there has been little research on the • Interpersonal problems: Difficulties trusting
effects of childhood physical abuse on adolescents others, social isolation, feelings of inad-
[18]. However, differences have been noted in equacy, sexual difficulties (e.g., difficulties
parents who abuse their children during adoles- experiencing arousal and orgasm), avoidance
cence rather than preadolescence. It appears that of sex
lower socioeconomic status plays a lesser role in • Distorted self-perceptions: Poor self-esteem,
adolescent abuse as compared to abuse during pre- self-loathing, self-criticism, guilt, shame
adolescence [21]. In addition, parents who abuse
• Behavioral problems: Risk of suicide,
their children during adolescence are less likely to
substance abuse, self-mutilation, violence
have been abused as children themselves compared
to those parents who abused their children during • Increased risk-taking behaviors: Abuse of
preadolescence [21]. It is believed that the psycho- substances, cigarette smoking, sexual risk-
social effects of physical abuse manifest similarly taking
in late childhood and adolescence.

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________________________ #97531 Child Abuse Identification and Reporting: The New York Requirement
Adult male survivors of child sexual abuse are three • Medical examiners
times as likely to perpetrate domestic violence as • Coroners
non-victims. In addition, female survivors of child • Dentists
sexual abuse are more vulnerable to bulimia, being
a victim of domestic violence, and being dependent • Dental hygienists
on alcohol [28]. • Osteopaths
• Optometrists
• Chiropractors
REPORTING SUSPECTED
• Podiatrists
CHILD ABUSE
• Medical residents
MANDATED REPORTERS • Interns
In the state of New York, certain professionals are • Psychologists
legally required or mandated to report any sus- • Registered nurses
pected cases of child abuse, maltreatment, and/or • Social workers
neglect that they encounter in their professional
roles to the New York Statewide Central Register • Emergency medical technicians
(SCR) of Child Abuse and Maltreatment. Reason- • Licensed creative arts therapists
able cause for suspicion is based upon behaviors • Licensed marriage and family therapists
that have been observed or reported that cause the • Licensed mental health counselors
professional to believe that a specific circumstance
• Licensed psychoanalysts
might involve child abuse or neglect [26]. Child
abuse laws in New York, and in all states, do not • Hospital personnel engaged in the admission,
require reporters to have absolute proof of abuse examination, care, or treatment of persons
[27]. Reporting suspected cases should be done in • Christian Science practitioners
good faith, and mandatory reporting laws give the • School officials
reporter immunity from criminal and civil liability • Social services workers
regardless of the substantiation of abuse [16]. Good
• Day care center workers
faith is defined as “the reporter, to the best of his
or her knowledge, has reason to believe that the • Providers of family or group family day care
child in question is being subjected to abuse or • Any employees or volunteers in a residential
neglect” [14]. However, if mandated reporters fail care facility for children
to report an incident of suspected child abuse or • Any other childcare or foster care workers
maltreatment, they may be charged with a Class • Mental health professionals
A misdemeanor, subject to criminal penalties, and
• Substance abuse counselors
can be sued for monetary damages for any harm in
a civil court [26]. It is vital to remember that man- • Alcoholism counselors
dated reporters are not required to provide absolute • Peace officers
evidence; this is the responsibility of CPS [29]. • Police officers
The following individuals are classified as man- • District attorneys or assistant district
dated reporters in the state of New York [26]: attorneys
• Physicians • Investigators employed in the Office of
the District Attorney
• Registered physician’s assistants
• Any other law enforcement officials
• Surgeons

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#97531 Child Abuse Identification and Reporting: The New York Requirement ________________________
THE PROCESS OF REPORTING Within 48 hours of reporting the suspected abuse
TO THE NEW YORK STATEWIDE to SCR, the reporter must also complete and sign
CENTRAL REGISTER (SCR) OF a written report (LDSS-2221A) and submit the
CHILD ABUSE AND MALTREATMENT report to the local department of social services
When mandated reporters suspect a case of child (LDSS) that has been assigned to the investigation
abuse or maltreatment, they must report to the [26]. The forms may be accessed on the New York
SCR at 1-800-635-1522. The general public can State of Children and Family Services website at
report suspected abuse by calling 1-800-342-3720 http://www.ocfs.state.ny.us/main/cps.
[38]. The CPS unit of the LDSS is required to begin an
The SCR is open 24 hours a day, 7 days a week [26]. investigation of the reported abuse within 24 hours
The mandated reporter is not obliged to contact [26]. A CPS specialist will ask questions about the
the parents or the legal guardians of the child either suspected abuse and the child. For example, the
before or after the call to SCR [26]. Good practice specialist will ask for the child’s name, age, and
dictates that the reporter either seek consent or home address, the name of the suspected person
notify the parent(s) that essential information is who inflicted the abuse, his or her address, and
being (and is required to be) shared, unless doing the nature of the abuse. The specialist should
so would put the child’s health or safety at risk. also evaluate the safety of the child named in the
However, even if the parent does not consent, the report as well as that of any other children in the
mandated reporter is still obligated to contact the home. If the child’s safety is at risk, the specialist
SCR [26]. (Additional child abuse hotline infor- may take the child and other children in the home
mation may be found in the Resources section of into protective custody to prevent further abuse or
this course.) maltreatment. CPS has 60 days after receiving the
report to determine whether it is “indicated” or
The worker who answers the phone will attempt “unfounded.” CPS is obligated to inform the child’s
to accumulate as much information from you as parents or other subject of the report of their rights,
possible. According to the New York State Office according to the New York State Social Services
of Children and Family Services, they will ask you Law, and must inform the SCR of the determina-
the following types of questions [26; 38]: tion of the investigation [26].
• What is the nature and extent of the child’s
injuries, or the risk of harm to the child? BARRIERS TO REPORTING
• Have there been any prior suspicious Studies have shown that many professionals who
injuries to this child or his/ her siblings? are mandated to report child abuse and neglect are
concerned and/or anxious about reporting. Identi-
• What is the child’s name, home address, age? fied barriers to reporting include [29; 30; 31; 40]:
• What is the name and address of the
parent or other person legally responsible • Professionals may not feel skilled in their
who caused the injury, or created the risk knowledge base about child abuse and
of harm to the child? neglect. In addition, they lack the
confidence to identify sexual and
• What are the names and addresses of the emotional abuse.
child’s siblings and parents if different
from the information provided above? • Professionals may be frustrated with
how little they can do about poverty,
• Do you have any information regarding unemployment, drug use, and the
treatment of the child, or the child’s intergenerational nature of abuse.
current whereabouts?
• Although professionals understand their
legal obligation, they may still feel that
they are violating patient confidentiality.

10 NetCE • March 28, 2016 www.NetCE.com

________________________ #97531 Child Abuse Identification and Reporting: The New York Requirement
• Many professionals are skeptical about the Other suggestions for improving reporting include
effectiveness of reporting child abuse cases [32]:
given the bureaucracy of CPS and the large • Improving the relationship between CPS
caseloads. and medical providers
• Practitioners may be concerned that they • Allowing certain registered professionals
do not have adequate or sufficient evidence with demonstrated expertise in identify-
of child abuse. ing/treating child abuse “flexible reporting
• Practitioners may have a belief that options” (e.g., defer reporting when no
government entities do not have the right immediate threat exists or make the report
to get involved in matters within the family confidentially and defer an investigation
arena. until deemed necessary)
• There may be some confusion and • Improving interaction with the legal system
emotional distress in the reporting process.
• Practitioners may fear that reporting
will negatively impact the therapeutic ASSESSMENT GUIDELINES
relationship. FOR PROFESSIONALS
• Some professionals have concerns that there
Assessment for child abuse and neglect involves
might be negative repercussions against the
the systematic collection of data. Information
child by the perpetrator.
should be obtained regarding the primary reason
• Some simply underestimate the seriousness for the visit, family health history, the child’s health
and risk of the situation and may make history, history of illnesses, the parents’ attitudes
excuses for the parents. toward discipline, and the child’s pattern of nutri-
The failure to identify and report child abuse may tion, sleep, and diet [16]. If abuse is a concern after
result in continued abuse of the child and poten- the preliminary evaluation, consultation with a
tially severe consequences. Improved and ongoing child abuse specialist, pediatric specialist, or pedia-
education about child abuse and maltreatment has trician experienced in this area, if available, may
been shown to improve identification and report- be helpful in determining the best way to proceed
ing rates among physicians and other professionals. with assessment [16].
The education should include [32]:
• Management and outcomes The U.S. Preventive Services Task Force
concludes that the current evidence is
• The role of the CPS investigator insufficient to assess the balance of benefits
• The role of the physician/other reporting and harms of primary care interventions
professional to prevent child maltreatment in children
who do not have signs or symptoms of
• The benefits of CPS involvement maltreatment.
• The benefits of mandated education (http://www.guideline.gov/content.aspx?id=46511.
on identification/reporting Last accessed September 11, 2014.)
• The benefits of professional debriefing Strength of Recommendation: I (Evidence is lacking,
for the reporter of poor quality, or conflicting, and the balance of
benefits and harms cannot be measured.)
• The benefits of collaboration (e.g., with local
emergency departments, pediatric specialists)

NetCE • Sacramento, California Phone: 800 / 232-4238 • FAX: 916 / 783-6067 11

#97531 Child Abuse Identification and Reporting: The New York Requirement ________________________
It is important for professionals to ask questions in Because studies have demonstrated a correlation
a nonjudgmental manner [33]. An environment between child abuse and domestic violence, there
where support and concern facilitate an open, is a need for dual screening for both types of family
trusting relationship between the parent and the violence [16; 20]. Slightly more than half of female
practitioner should be created. By providing such victims of domestic violence live in a household
an environment, the parent has the opportunity with at least one child younger than 12 years of age,
to voice concerns and ask for help. Questions and between 3.3 million and 10 million children
that convey concern and may provide valuable witness domestic violence annually [36; 37]. When
information to the professional include, “Who a woman presents with a child whom the profes-
helps you care for your children?” or “How do you sional suspects to be at risk for child abuse, the
discipline your children?” It may be necessary to professional should ask the woman if she has ever
interview the child and parent separately; however, been hurt or injured by her spouse/intimate part-
by spending some time with the child and parent ner. Professionals should minimize the discomfort
together, practitioners can observe interactions associated with the questioning by first discussing
and communication. the prevalence of domestic violence in intimate
relationships and by stating that such questioning
Accuracy in record taking is also important. Be
is commonly done [39].
sure to record the date and time of the visit, the
sources of any information, and the date, time, In cases of child sexual abuse, the child should be
and place of the alleged abuse or assault [16; 34]. interviewed alone. The professional should try to
When talking to the child, the practitioner should keep a neutral tone of voice and manner. Open-
use developmentally appropriate language that will ended, nonleading questions should be used. For
be easily understood. Leading questions should be example, the practitioner may ask: “Has anyone
avoided [34]. Asking the following questions may ever touched you in a way that you did not like
be helpful when interacting with children [34; 35]: or that made you feel uncomfortable?” Because
the interview may be admissible in court, careful
• “Do you know why you are here today?”
documentation of the questions and responses is
• “Can you tell me what happened?” important; the exchange should be documented
• “How did it begin?” verbatim [16].
• “What happened next?”
SCREENING FOR ABUSE IN
• “Where did this happen?” CHILDREN WITH SPECIAL
• “Have you been hurt lately?” NEEDS OR DISABILITIES
It is important to note the child’s demeanor during The rates of child maltreatment for children with
questioning. Some children may be protective of disabilities are reportedly 1.7 to 7 times higher
their abuser, openly fearful of their abuser, or may compared with children without disabilities [42].
fear retribution for “telling.” Strong nonverbal cues Children with disabilities can be more vulnerable
of anxiety and reluctance to answer questions about to maltreatment if the parents/caregivers view
potential abuse are important considerations when the disability and its associated behaviors as “dif-
a safety plan for the child is necessary [16; 33]. ficult,” if the parents have unrealistic expectations
of the child’s behavior or abilities, if the parents
are facing additional caregiver stress, or if the par-
ent perceives the child as unable to defend him/
herself [43].

12 NetCE • March 28, 2016 www.NetCE.com

________________________ #97531 Child Abuse Identification and Reporting: The New York Requirement
To effectively interview a child with a disability, It may be tempting to locate a practitioner who has
the practitioner should first obtain some prelimi- some language ability to speak to the child and/or
nary data, including [33; 41]: family member; however, this should be avoided if
at all possible [44]. The language for screening for
• The child’s primary disability
child abuse requires precision as well as sensitivity,
• Accompanying disabilities, if any and professional interpreters are recommended.
• How the disability affects the child’s
In this multicultural landscape, interpreters are a
current functioning
valuable resource to help bridge the communica-
• Whether the child is highly distractible tion and cultural gap between patients and prac-
• What the appropriate method of titioners [33]. Interpreters are more than passive
communication will be (e.g., sign language, agents who translate and transmit information
language board, facilitative communication) back and forth from party to party. When they are
if communication is an issue enlisted and treated as part of the interdisciplinary
• What, if any, behavioral challenges clinical team, they serve as cultural brokers, who
(e.g., compulsive, withdrawal) the child has ultimately enhance the clinical encounter. They
should be familiar with both the nuances of the
Overall, when conducting an interview of a child
language and the cultural norms and value systems
with a disability or special need, the practitioner
of the target community [44]. When providing
should work with someone to validate impres-
care for children and parents for whom English
sions or feelings about the child, develop and use
is a second language, the consideration of the use
a multidisciplinary resource team, be aware of the
of an interpreter and/or patient education materi-
child’s vulnerabilities (e.g., behavioral challenges,
als in their native language may improve patient
accompanying disabilities), and remember that he/
understanding and outcomes.
she may be the first person able to stop the child
from being further victimized [41].
SCREENING FOR ABUSE IN NON- CONCLUSION
ENGLISH-PROFICIENT FAMILIES
Child abuse and neglect are considered significant
Communication with patients and families regard- social problems with deleterious consequences. As
ing the signs and history of abuse is a necessary noted, a system has been implemented in all 50
step in obtaining an accurate diagnosis. When states to ensure the safety of children, with laws
interviewing children whose first language is not defining what constitutes abuse and neglect and
English, it is highly recommended that they be who is mandated to report. Healthcare profession-
interviewed through the use of an interpreter. It als, regardless of their discipline or field, are in a
can cause additional stress for children who struggle unique position to assist in the identification, edu-
to find the right words in English, which can result cation, and prevention of child abuse and neglect.
in more feelings of fear, disempowerment, and
voicelessness [44].

NetCE • Sacramento, California Phone: 800 / 232-4238 • FAX: 916 / 783-6067 13

#97531 Child Abuse Identification and Reporting: The New York Requirement ________________________
New York State Office of Children and
RESOURCES Family Services Child Protective Services
Capital View Office Park
American Academy of Pediatrics
52 Washington Street
141 Northwest Point Blvd
Rensselaer, New York 12144
Elk Grove Village, IL 60007
518-473-7793
847-434-4000
http://www.ocfs.state.ny.us/main/cps
http://www.aap.org
Prevent Child Abuse New York
State Child Abuse Hotlines
33 Elk Street, Second Floor
New York Statewide Central Register (SCR) Albany, NY 12207
of Child Abuse and Maltreatment 1-800-CHILDREN
General Public: 1-800-342-3720 http://www.preventchildabuseny.org
Onondaga County
315-422-9701
FACULTY BIOGRAPHY
Monroe County
585-461-5690 Alice Yick Flanagan, PhD, MSW, received her
Master’s in Social Work from Columbia University,
Childhelp
School of Social Work. She has clinical experience
4350 E. Camelback Road, Building F250
in mental health in correctional settings, psychi-
Phoenix, AZ, 85018
atric hospitals, and community health centers. In
1-800-4-A-CHILD
1997, she received her PhD from UCLA, School
http://www.childhelp.org
of Public Policy and Social Research. Dr. Yick
Child Welfare Information Gateway Flanagan completed a year-long post-doctoral fel-
1250 Maryland Ave SW, Eighth Floor lowship at Hunter College, School of Social Work
Washington, DC 20024 in 1999. In that year she taught the course Research
1-800-394-3366 Methods and Violence Against Women to Masters
http://www.childwelfare.gov degree students, as well as conducting qualitative
Child Welfare League of America research studies on death and dying in Chinese
1726 M St NW, Suite 500 American families.
Washington, DC 20036 Previously acting as a faculty member at Capella
202-688-4200 University and Northcentral University, Dr.
http://www.cwla.org Yick Flanagan is currently a contributing faculty
National Council on Child member at Walden University, School of Social
Abuse and Family Violence Work, and a dissertation chair at Grand Canyon
1025 Connecticut Ave NW, Suite 1000 University, College of Doctoral Studies, working
Washington, DC 20036 with Industrial Organizational Psychology doctoral
202-429-6695 students. She also serves as a consultant/subject
http://www.nccafv.org matter expert for the New York City Board of Edu-
cation and publishing companies for online cur-
riculum development, developing practice MCAT
questions in the area of psychology and sociology.
Her research focus is on the area of culture and
mental health in ethnic minority communities.

14 NetCE • March 28, 2016 www.NetCE.com

________________________ #97531 Child Abuse Identification and Reporting: The New York Requirement
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Evidence-Based Practice Recommendations Citations

Meyer JS, Coley BD, Karmazyn B, et al. ACR Appropriateness Criteria: Suspected Physical Abuse—Child. Reston, VA: American College
of Radiology; 2012. Summary retrieved from National Guideline Clearinghouse at http://www.guideline.gov/content.
aspx?id=37948. Last accessed September 11, 2014.
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recommendation statement. Ann Intern Med. 2013;159(4):289-295. Summary retrieved from National Guideline Clearinghouse
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16 NetCE • March 28, 2016 www.NetCE.com