Washington State Mandated Reporter v2.1 (Child Abuse and Neglect)

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1 Washington State Mandated Reporter v2.1 (Child Abuse and Neglect) Identification and Management of Concerns at Seattle Children s Click to navigate through this course.

2 During this course you will review: Seattle Children s response system for managing concerns of child abuse and neglect State of Washington mandatory child abuse and neglect reporting laws When a child abuse or neglect report needs to made to the appropriate agency Seattle Children s Child Abuse and Neglect Policies and Procedures How to access resources to assist you with managing these concerns You must complete every section of this course. You must also pass the test at the end of the course.

3 Seattle Children's and Your Responsibility Children's has a legal and ethical obligation to protect children. This obligation extends to every employee, volunteer, student and medical staff member. It means that each of us must act if we observe physical and/or verbal abuse and neglect, or are told something by a child or an adult that makes us concerned for the child's safety and well-being. ect.asp

4 Seattle Children's Approach Emphasizes Team Work The multiple medical, legal, social, and psychiatric problems that may be present in cases of child abuse and/or neglect are complex to handle. It requires the input of a variety of skilled professionals.

5 Seattle Children s Seattle Children s (SCPP) coordinates risk management and resources within Children's when there is a concern or question about possible child abuse and neglect and domestic violence. Seattle Children's staff and team members are Children s employees, and their role is to provide support and consultation to both the provider and family. SCPP is an internal program and is not part of Washington State Child Protective Services (CPS), which is a state agency.

6 Seattle Children s Social Work Involvement NOTE: A Seattle Children s Social Worker should always be contacted if abuse, neglect or domestic violence is suspected. Social Workers provide the psychological, social and protection assessment of the family and provide liaison with the legal, hospital and all other involved systems. Daytime coverage is from 8:30 AM to 5:00 PM. Place a social work order in CIS or call Social Work Intake during daytime coverage. After hours, weekends and holidays call the hospital operator.

7 REMEMBER: If you have a question or are not sure what to do about a concern, do not hesitate to call Seattle Children s to consult at

8 Seattle Children's Reporting Protocol Children's six step protocol clearly outlines policies and procedures for responding to possible child abuse and neglect: Step One: Contact the patient's Attending physician. Step Two: Contact the Social Worker, or, if one is not assigned, place a social work order in CIS or call Social Work Intake. Step Three: Consider if consultation with a SCAN (suspected child abuse or neglect) Physician or SCAN Social Worker is needed. If clearly indicated or uncertain, place an order in CIS. You must also call the Seattle Children s, ext

9 Protocol Continued Step Four: If reasonable cause exists to believe a child has suffered abuse or neglect, ensure (consult with the assigned SCH social worker) that a report to CPS and/or law enforcement is made. Step Five: Document concerns in the child's medical record in CIS. Step Six: Complete a Patient/Family Risk Assessment form on CIS if you made a CPS referral. If a SCH Social Worker is assigned, this form is often completed by them.

10 Seattle Children's A Resource for You Seattle Children's (SCPP) Clinical Services Our Suspected Child Abuse and Neglect (SCAN) medical and social work professionals are specialists in issues of abuse and neglect. They are available 24/7 for consultation whenever there is a question about what needs to be done when there is a concern about child abuse and neglect. Contact ext during regular work hours and after hours, holidays and weekends, contact the switchboard.

11 SCAN (Suspected Child Abuse and Neglect) Medical Consultants/Clinicians SCAN (Suspected Child Abuse and Neglect) Medical Consultants/Clinicians are physicians who specialize in providing medical evaluations in child abuse and neglect cases. They become involved in cases of suspected abuse and/or neglect when their services are requested by the child's attending physician or resident. SCAN medical consultants are available 24/7 and may be contacted weekdays through Seattle Children's ext or, after hours, through the hospital operator.

12 SCAN (Suspected Child Abuse and Neglect) Social Work Consultants/Clinicians SCAN Social Workers with the Seattle Children s provide consultation, risk assessments and manage serious physical abuse and serious neglect cases. They review all hospital documented assessments of child abuse and neglect. SCAN Social Workers become involved in cases of suspected abuse and/or neglect when their services are requested by the SCAN physician or when ordered through CIS and triaged by Social Work Intake. For neglect cases, they frequently provide consultations to the primary assigned psycho-social clinician.

13 Children's Protection Team (a multidisciplinary team) for reviewing systems issues and complex neglect cases Children s Protection Team (CPT) The Children s Protection Team (CPT) is a multi-disciplinary advisory group in the area of family violence including child maltreatment and domestic violence. The team is a specialty service of Seattle Children s. The team: Formulates hospital-wide policy regarding abuse and neglect and domestic violence. Monitors that Seattle Children s child maltreatment and domestic violence evaluation and management protocols are followed. Reviews cases, particularly neglect cases, in an advisory capacity, with direct health care providers. Provides education to staff on issues pertaining to abuse and neglect and domestic violence. Ensures that staff understands when and how to utilize the CPT and which cases are required to be reported to the CPT for review.

14 When to Consider Presenting a Case to the Children s Protection Team (CPT) The CPT is a resource for any questions regarding child abuse, neglect and domestic violence including whether or not a Child Protective Services (CPS) or law enforcement referral is appropriate. Examples include: 1. Confounding child neglect cases 2. Discordant opinions, internally or with external agencies, on the best approach for keeping the patient safe and protected 3. Allegations of abuse against a staff member 4. Concerns for Medical Child Abuse How to access: Contact SCPP at ext to request a case staffing

15 Required Children s Protection Team Consultations Two types of cases must immediately be referred to Seattle Children s at ext during regular work hours and, if after hours, weekends or holidays call the switchboard and request to speak with a SCAN physician Allegations that a staff member has abused or neglected a patient Concerns for Medical Child Abuse (also known as Pediatric Condition Falsification or Munchausen syndrome by Proxy)

16 Recommended Consultations For all serious physical abuse and serious neglect (ex. starvation) cases, it is highly recommended that staff consult with the SCAN Physician and SCAN Social Worker.

17 Suspected Child Abuse and Neglect Case Conferences SCAN Case Conferences Purpose To review the SCAN physician findings on serious physical nonaccidental injuries and psycho-social risk factors of the family Discuss future medical care needed for the child CPS and law enforcement provide updates on their respective investigations Make recommendations for protective steps on behalf of the child SCAN physicians, clinicians involved in the care of the child, and community collaterals are participants of this review process. How to access: Contact the SCAN Social Worker through the Seattle Children s at ext

18 Can the hospital keep a child in-house if staff fears for a child's safety? Yes. A medical or administrative hold is when Children's temporarily detains a child who might otherwise be removed by a parent or guardian. A physician or administrator places the medical hold. Always consult with a SCAN physician when considering a medical hold and notify the patient s social worker of the concern. y_protective_detention_or_custody.asp

19 Tell Me More Keep the following in mind when considering whether or not to put a medical hold on a child: 1. If there is reasonable cause to believe that permitting a child to be released to a person legally responsible for the child presents an imminent risk for abuse or neglect to the child's safety, a medical hold may be enacted. A hold may be placed whether or not medical treatment is required for the child. 2. The administrator on call (AOC) or any licensed physician may make the decision to detain a child. 3. A hold requires immediate notification of CPS or law enforcement; SCPP and hospital security should also be informed. 4. The hold is documented in the medical chart on CIS and a CASPER is issued. For more detailed information, consult the CASPER protocol under Policy & Procedures on CHILD.

20 Seattle Children s Services For detailed information about other SCPP services access Children s website: Policy development and monitoring Education and training Research Advocacy Specialty programs

21 Child Abuse and Neglect Reporting Law In 1965, Washington State enacted the Washington State Child Abuse and Neglect Reporting Law, known as RCW

22 The purpose of the Washington State child abuse and neglect reporting law is to protect children who have been Non-accidentally injured Sexually exploited or assaulted Deprived of their right to minimal nurture, health, and safety by their parent, custodian, or guardian. Did you know?!? An important statement in the Washington State reporting law reads "...the state does not intend to interfere with reasonable parental discipline and child rearing practices that are not injurious to the child."

23 Mandated Reporters By law, as a mandated reporter you must make a report -- or cause a report to be made -- to Child Protective Services (CPS) or law enforcement if there is reasonable cause to believe that a child has suffered abuse or neglect. Legal definition of reasonable cause to believe : to have knowledge of facts which, although not amounting to direct knowledge, would cause a reasonable person, knowing the same facts, to reasonably conclude the same thing

24 Mandated Reporter Responsibility When any mandated reporter suspects child abuse or neglect, he or she must report such suspicions, or cause a report to be made, to the proper law enforcement agency or to CPS at the first opportunity, but in no case longer than forty-eight (48) hours after there is a reasonable cause to believe a child has suffered abuse or neglect. The report must include the identity of the accused if known.

25 Mandated Reporter Continued If other Children's staff believe there is no reason to call CPS, but you still think there is "cause to believe" abuse or neglect exists, you have a right -- and a duty -- to report to CPS or law enforcement. Notify Seattle Children s if this situation arises. Did you know?!? Failure to report suspected child abuse and/or neglect by a mandated reporter is a "gross misdemeanor" under Washington State law.

26 Reported Child Abuse and Neglect Here at Children's The Child Abuse and Neglect Policy provides guidelines when a care provider suspects abuse or neglect and includes indicators for each type of maltreatment. The Staff Roles and Responsibilities When Assessing and Reporting Concerns of Child Abuse and Neglect Policy & Procedures should be consulted whenever there is a question about what steps need to be followed. when_assessing_and_reporting_concerns_of_child_abuse_or_neglect.asp

27 Identifying Child Abuse and Neglect

28 Mandated Reporters must call, or ensure a call is made to, CPS and/or a law enforcement agency when the following are suspected: Physical Abuse: Inflicted injury, dangerous acts, cruel and inhuman treatment. Sexual Abuse: Sexual contact or exposure, intercourse, inappropriate touching, sexual exploitation. Child Neglect: Lack of provision of basic needs (food, shelter, clothing, healthcare, supervision), a pattern of neglect that constitutes a clear and present danger to the child's health, welfare, and safety. Emotional Abuse: Damage to the intellectual, psychological or emotional functioning of a child that is attributable to non-accidental acts or omissions of the parent or guardian.

29 Highlighted Policies Related to Child Abuse and Neglect For more detailed descriptions of the physical and behavioral indicators of child abuse and neglect consult the Child Abuse and Neglect Policy, Appendix I, located on CHILD under the policies and procedures tab.

30 Allegations Against Staff If there is a concern about a staff member abusing a patient, prompt reporting is critical. The designation "staff member" includes salaried staff, volunteers, students, medical staff, or any other person with patient contact who is not a family member. Example: If an injury is not well understood as to how it occurred and a concern has be raised that staff may have handled the patient roughly; immediately initiate the allegation process. Staff, parents or other caregivers may raise the concern. A staff member with concerns about another staff member should immediately discuss the situation with her or his supervisor, manager or director. As soon as possible, the supervisor, manager or director and / or the person who has the concern should consult directly with one or more of the following: Seattle Children's Manager or designee Seattle Children's Medical Director A SCAN Medical Consultant

31 Allegations Against Staff Continued The role of all of the individuals is to ensure that patient safety is maintained, to coordinate Children's response, and to provide consultation regarding whether or not an incident needs to be reported to CPS, law enforcement, and/or the Department of Health. All efforts are made to maintain confidentiality, while protecting the safety and rights of all involved. ual_or_physical_abuse_by_a_childrens_staff_member.asp

32 Clinical Action Safety Plan Evaluation Risk (CASPER) Many children experiencing abuse and neglect also come from families under high stress. These families often experience problems with domestic violence, substance abuse, anger management, or other impulse-control issues that may disrupt medical treatment or pose a threat to patients, families or staff. When these concerns are present, Social Work or Security completes a CASPER form in the patient s medical record in CIS. plans_evaluating_risk_casper.asp

33 Frequently Asked Questions Regarding Abuse and Neglect The questions raised by potential abuse and neglect are numerous and complex. This section provides answers to some of those questions most frequently asked regarding abuse and neglect protocol:

34 If I tell my supervisor of my concern about possible child abuse and neglect, does that meet my reporting obligation under the law? No. The law states that if you have a "reasonable cause to believe" a child is being abused or neglected you must report, or cause a report to be made to Child Protective Services (CPS) or law enforcement. If there is a social worker on site, the practice is to consult and coordinate with the reporting with the social worker.

35 Tell Me More Although you may delegate reporting, each mandated reporter is individually and legally responsible to assure that a report is made in a timely manner. If someone else is going to make a report, you will want to follow up to ensure the call is made and make certain the report is documented in the medical chart.

36 What should I do if I make a report to Child Protective Services (CPS) and disagree with the action/decision they make? If you make a report to CPS and feel they did not take appropriate action, you may talk to the case worker's supervisor. If you are still not satisfied, you will want to contact the CPS Area Manager for further assistance. Consultation with Seattle Children s at ext is recommended. A meeting of the Children's Protection Team may be requested to discuss concerns.

37 If I decide to make a report, how do I decide whether to call Child Protective Services (CPS) or law enforcement? In general, CPS responds to allegations of child abuse and neglect when the alleged abuser is a family or extended family member. Abuse to a child not committed by a parent or guardian is known as "third-party abuse." These cases are usually referred to law enforcement for investigation.

38 Tell Me More In high-risk protection situations, or when there is a concern that a criminal incident has occurred (such as serious physical abuse) law enforcement is called first. CPS is also routinely contacted. Hospital security, the Care Management Team and SCPP are also notified when law enforcement has been requested to come to Children's. The on-site social worker is to consult with the SCAN social worker.

39 What should I do if a parent expresses a concern that another staff person is being abusive with her child? Say something like: "I'm glad you told me. You must be very concerned. I'll talk to my supervisor and ask him/her to look into this right away." The supervisor will contact Seattle Children's at ext to coordinate necessary information gathering.

40 Do staff at Children's satellite clinics have access to Children's? Yes. All the services offered through the Children's are available to staff at satellite clinics (e.g., Bellevue, Everett, Federal Way, Lake City, Odessa Brown, Olympia). The services are limited to phone consultation.

41 Tell Me More If there is any question or concern about possible child abuse and neglect, you are encouraged to access a Children's social worker. After hours and on weekends call the hospital operator. To request a medical consultation with a SCAN physician or a psychosocial consultation with a SCAN social worker, call Seattle Children's at ext

42 When I'm providing services in a Children's outreach clinic in Alaska, Wenatchee, Kennewick or Yakima, can I ask for a consultation with one of the SCAN physicians? Yes. All specialty services of Seattle Children's Protection Program are available to outreach clinics.

43 When I'm working at a Children's site outside of Washington State, what reporting policy do I follow if I suspect child abuse and neglect? The reporting laws are somewhat different in each state, but all states have mandatory child abuse and neglect reporting laws.

44 Tell Me More In consultation with local physicians and the patient's Care Management Team, it is important that you ensure a report is made to local law enforcement or the child protection agency if you suspect abuse or neglect. If you don't have access to the Protocol, you can call Seattle Children's weekdays at ext for assistance. To make a report, you may always call a Washington State Child Protective Services (CPS) office and they can provide you with the out-of-state CPS phone number.

45 I provide community education to physicians in the WAMI region. Am I responsible for reporting child abuse and neglect when I am in other states? Yes. If you are a mandated reporter in Washington State, you are a mandated reporter in other states. Reports should be made in consultation with local physicians and the child's Care Management Team.

46 This completes your CHEX course. Thank you.

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