REPORTS OF CHILD ABUSE AND NEGLECT May 20, 2002 PT APPENDIX B THE ALLEGATIONS SYSTEM

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1 APPENDIX B THE ALLEGATIONS SYSTEM a) Statewide Automated Child Welfare Information System (SACWIS) Incidents of suspected child abuse or neglect reported to the Department are classified as physical abuse, sexual abuse, neglect or a combination of the preceding three and recorded in the State Central Register s Statewide Automated Child Welfare Information System (SACWIS). The SACWIS enables the Department to identify and locate prior reports of child abuse or neglect; monitor the current status of reports of child abuse or neglect being provided services under the Child Abuse and Neglect Reporting Act; and regularly evaluate the effectiveness of existing laws and programs through statistical analysis and other information. During the course of an investigation the CPSW is required to contact various subjects and collaterals to obtain information to use as evidence to prove or disprove the pending allegation. Information received may or may not be relevant, and may or may not be true. The mandate of the CPSW is to determine what information is relevant so that it may be used as evidence to indicate or unfound an investigation. b) Credibility of Evidence For purposes of making child abuse and neglect investigation decisions, credibility of evidence means the likelihood that the information is accurate. The CPSW will use two types of evidence to support an investigative finding. The first is direct evidence. An example of direct evidence is a statement taken from an eyewitness. The second type of evidence is indirect or circumstantial. This type of evidence infers the existence or nonexistence of certain facts. For example, circumstances infer that a child s caretaker is the perpetrator of abuse when a child diagnosed with shaken baby syndrome has not been out of the care and custody of the caretaker. Evidence is that information that proves or disproves the allegation at issue. Information that does not prove or disprove the allegation is irrelevant. The CPSW and supervisor must evaluate the value and relevancy of case information to determine which information will be used as evidence, and which evidence is more or less credible. The CPSW and the supervisor must assess the credibility of evidence using the following factors and the SACWIS Child Abuse and Neglect Finding Matrix. The SACWIS Child Abuse and Neglect Finding Matrix, which will become part of the investigative file, will facilitate and document the assessment process. Appendix B - Procedures 300 (1)

2 1) Factors Affecting the Credibility of Evidence Obtained from All Sources Factors affecting the credibility of all evidence include, but are not limited to, the following: Corroborating Evidence: This is evidence that supports someone s prior statements or other evidence that may point to a certain determination of fact. This type of evidence is more credible than information that has not been verified or supported by independent sources. For example, a mother s statement that a physician has seen her child is made far more credible when the physician (corroborating witness) verifies that he or she has seen the child. Another example would be the child s statement that they were hit by an extension cord, and by observing the child s back you observe linear loop marks on the child s back (corroborating physical evidence). Source of Information: The more direct the source of information that serves as the basis for a source s opinion, the more credible the opinion. For example, a physician rendering an opinion based on a review of medical records is more credible than one rendering an opinion based on a caseworker s description of an injury. A physician rendering an opinion based on her or his direct physical evaluation is more credible still. Direct Interest: Information from a source who has something to lose or gain from a particular investigative outcome is less credible than information from one who has no direct interest in providing an account that may not be accurate. For example, a neighbor who has had no previous relationship to family and who reports that the young children have been left alone is more credible than a neighbor who has been feuding with the family and makes the same report. It should not be surprising that adults named as alleged perpetrators of abuse or neglect would want to present themselves in the best possible light during the investigation. Self reports concerning possible CA/N risk indicators such as use of alcohol/drugs; the extent to which they use corporal punishment/instruments in disciplining their children; their involvement in a domestic violence relationship; or the extent and nature of a relationship with a paramour/convicted sexual offender may be denied or minimized by the alleged perpetrators during interviews. Additionally these adults may give inaccurate characterizations of why they and their children are not regularly in contact with extended family members, when in fact these adults are estranged from extended family members because extended family members have concerns about the adults care of the involved children. It is imperative that the CPSW seeks objective corroboration of these self-reports. Family members and extended family members may even be consistent in denying or minimizing possible CA/N risk indicators (e.g., subject family and extended family members may be substance abusers). The CPSW must seek out additional collaterals to verify self-reports and consider information developed through personal observation, reports from professionals, or required interviews that will establish the accuracy of self- Appendix B - Procedures 300 (2)

3 reports. While information provided by potential perpetrators may be accurate, it must considered carefully since there is always motivation to present information that will lead to unfounding. There is no substitute for independent verification of this sort of information. 2) Factors Affecting the Credibility of Evidence Obtained from Professional Sources Those individuals classified as professionals may be viewed as credible witnesses. However, not all professionals are equal in terms of the credibility of the information they provide in specific situations. Factors influencing the degree to which a professional s information is credible include: Training: A professional who has more training is more credible than one who has less. For example, information about the mental state of a parent obtained from a psychiatrist is more credible than information obtained from a Bachelor Social Work counselor. Experience: A medical professional with more training/experience is more credible than one with less training/experience. For example, a pediatrician who is a member of the hospital staff is more credible than a pediatric resident. Specialization: An opinion provided by a professional may be considered more credible when he or she has a specialization relevant to the issue being considered. For example, a radiologist s opinion about the cause of a bone fracture is more credible than an opinion provided by a pediatrician; and an opinion provided by a pediatric radiologist with a specialization in the identification of child abuse is more credible than an opinion provided by a radiologist without that specialization. 3) Factors Affecting the Credibility of Evidence Obtained from Non- Professional Sources (Adult) The credibility of information obtained from non-professional sources, especially subjects of investigations, must be carefully evaluated. Particular consideration must be given to any direct interest non-professional sources may have in the outcome of an investigation. When weighing the credibility of non-professional sources of evidence, there is no substitute for independent verification of the evidence with additional sources. Factors influencing the degree of credibility of information provided by non-professional source s include: Consistency: Information reported in a consistent manner is more credible than information reported inconsistently. For example, a non-professional source that provides a significantly different description of an incident to a Appendix B - Procedures 300 (3)

4 police officer or a physician from that given to the CPSW is less credible than a person whose description of the incident remains constant. In order to verify the consistency of the previous obtained statements it is crucial that the CPSW not share information obtained from other sources with a source being interviewed. Plausibility: A plausible statement is one that is seemingly true based on the facts and circumstances. For example, the statement that a hand shaped bruise on a child s face was caused by a fall is obviously implausible. As a rule, qualified physicians must verify whether explanations given for physical injuries are plausible. 4) Factors Affecting the Credibility of Evidence Obtained from Non- Professional Sources (Children) The factors above in subsection (3) and the following factors should be applied to evidence obtained from children: Child s Age and Developmental State: Information provided by an older child is usually more credible than information obtained from a younger child with less developed cognitive abilities. For example, a detailed description of a complex chain of events given by a twelve year old is generally more credible than a description of the same series of events given by a verbal three year old. However, the opposite is true when a young child is able to give a plausible and specific description of situations that would normally be beyond his or her experiences (e.g., sexual acts). Plausibility: The plausibility of information gathered from children should generally be evaluated in the same manner as information gathered from adults. However, the evaluation must take into consideration the development of the child s communication skills and abilities. A young child may tell a true story in a way that would make the information seem implausible. For example, the child may describe ejaculation as a snake spitting. Evidence that an Account of the Facts Has Been Influenced by Others: A child s information is more credible when the child is interviewed out of the presence of adults with the ability and motivation to coerce, pressure or otherwise influence the child s statement; and the child has not been in the care of those same adults since the incident. For example, information about abuse allegedly committed by a father obtained from a young child who has been in the custody of the mother involved in a bitter divorce with the father may be less credible because the mother may have intentionally or unwittingly pressured the child into giving inaccurate information. Note: When making investigative findings, the credibility of each piece of evidence must be evaluated according to the above factors. The more Appendix B - Procedures 300 (4)

5 credible the information, the more weight it is to receive in reaching a decision. c) Using Evidence to Reach an Investigative Finding The final step in determining whether SCR reports will be indicated or unfounded is to consider all information obtained during the investigation and determine which information is relevant to be used as evidence to make a determination. It is of critical importance that all evidence suggesting that an incident of abuse or neglect did not occur be given the same consideration as evidence suggesting that an incident of abuse or neglect did occur. The SACWIS Child Abuse/Neglect Finding Matrix, musts be used to evaluate each piece of information to determine its relevance, credibility and weight of importance in proving or disproving the allegations presented. The supervisor is to review the matrix with the CPSW to determine whether the evidence is sufficient to lead a reasonable person to believe that the incident occurred or that the set of circumstances is or was present. Equal consideration shall be given to information entered in both columns. 1) If the answer is no the report is unfounded and consideration should be given to the need and potential for service provision. The following may never be used as the sole basis for unfounding a report: Intent to Harm the Child: The alleged perpetrator s intent to hurt a child, leave a mark, or endanger him or her by leaving him or her alone in a car is not a factor to be considered in making a finding. The law is clear that the showing of intent is not required to find abuse, but that the abuse occurred by other than accidental means. In reviewing the specific circumstances surrounding the allegation, the focus must be on whether the caretaker failed to exercise the care that circumstances required - what happened to the child not what was the adult s intent. One Time Incident: There is nothing in Illinois CA/N law that allows a report to be unfounded solely because the abusive/neglectful incident was a one-time incident. The incident must be evaluated giving greater weight to the other factors. It is equally inappropriate to unfound a case of an infant being left alone simply because it had not happened before. Agreement to Accept Services: The fact that a perpetrator agrees to receive services (or is already receiving them) has no effect on the decision to Indicate or Unfound an allegation. This determination is based upon the incident that occurred. Treatment can impact the safety and risk assessments, but not the finding decision. For example, a mother who hit a two-year old in the face with a belt should not be Unfounded simply because she is getting anger-management counseling. Appendix B - Procedures 300 (5)

6 Note: An exception to this rule is the failure to obtain required immunizations reported as medical neglect, which must be unfounded when the caretaker obtains the immunizations during the investigation. Economic Status or Neighborhood: Investigative decisions must never be influenced in any way by a family s economic status or by the condition of the neighborhood in which they live. The fact that families are wealthy or that they live in an affluent neighborhood plays no part in decisions to indicate or unfound reports. Attitude Toward the Worker: The attitude family members express toward the worker must not influence investigative decisions. Reports must never be unfounded because the family is compliant, agreeable, or cooperative with the worker. 2) If the answer is yes, the incident or set of circumstances is to be compared to the definitions of all relevant allegations and the established standard for indicating them to determine whether the situation fits. Relevant factors must be considered for applicable allegations [See Subsection (d)]. If the answer is yes, the report is indicated. The CERAP and risk assessment should be reviewed to determine what steps should be taken to assure the safety of involved children. The following may never be used as the basis for indicating a report: The Family s Need for Services: The decision to indicate must be based on evidence and not used as a way to get services to a family. Services can be provided to families whose reports are unfounded. Failure to Accept Services: Again, decisions about investigative decisions and service provision are separate. A family s refusal to accept services may be related to decisions about court intervention but not the decision to indicate a report. Economic Status or Neighborhood: Investigative decisions must never be influenced in any way by a family s economic status or by the condition of the neighborhood in which they live. The fact that families are poor or that they live in a disadvantaged neighborhood plays no part in decisions to indicate or unfound reports. Attitude Toward the Worker: The attitude family members express toward the worker must not influence investigative decisions. Reports must never be indicated because the family is argumentative, hostile, or uncooperative with the worker. Appendix B - Procedures 300 (6)

7 d) Factors to Be Considered REPORTS OF CHILD ABUSE AND NEGLECT Some allegations, by their very definition, presume child abuse or neglect as defined by ANCRA. For example, a child who has suffered a subdural hematoma, internal injuries, bone fractures, or burns as the result of parental action or inaction is presumed to have been abused or neglected. Other allegations do not, by their very definition, presume child abuse or neglect as defined by ANCRA. For example, bruises or welts as the result of parental action or inaction may or may not be serious enough to constitute child abuse or neglect. Whether the incident constitutes abuse or neglect depends upon the extent of the injury, the location of the injury, the age of the child, and other pertinent factors. Allegations that do not constitute child abuse or neglect in every instance include: Cuts, Bruises, Welts, Abrasions and Oral Injuries Substance Misuse Substantial Risk of Physical Injury/Environment Injurious to Health and Welfare Inadequate Supervision Inadequate Shelter Inadequate Food Inadequate Clothing Environmental Neglect Medical Neglect Failure to Thrive (Non-Organic) Medical Neglect of Disabled Infants In reports where one of these allegations of harm is included, the report-taker must first apply the "factors" to determine if the alleged harm is serious enough to constitute a report of alleged abuse or neglect. After verifying the actual harm to the child, the investigative worker must apply the factors again to determine if the harm is serious enough to indicate the report. Factors that help the investigator weigh the child's maturity; ability to make sound judgments and ability to care for or protect himself or herself including the age of the child are common to several allegations. The age of the child is associated with his/her level of vulnerability. The younger the child, the more vulnerable he/she is. The age of the child is a common indicator of risk of maltreatment. In addition, the age of the child is a strong predictor of recurrence of maltreatment. Young children are at greater risk for severe child abuse injuries. The worker needs to consider the child s age in the context of his/her physical, emotional and developmental abilities. (Note: Injuries to older children should not be disregarded because of the youth s age.) Appendix B - Procedures 300 (7)

8 In determining whether a factored report is to be indicated the worker must assess: the child s age in relation to other factors such as physical, emotional and developmental impairments; the child s level of vulnerability; how this factor contributed to the maltreatment; and the parent s perception of the child. Generally, reports involving preverbal children who are alleged vicitms of inflicted cuts, bruises, welts, or abrasions, inadequate supervision, inadequate food, medical neglect, or failure to thrive (Non-Organic) should be indicated when credible evidence is obtained. In reports where one of these allegations of harm is included, the report-taker must first apply the "factors" to determine if the alleged harm is serious enough to constitute a report of alleged abuse or neglect. After verifying the actual harm to the child, the investigative worker must apply the factors again to determine if the harm is serious enough to indicate the report. Certain principles were used to select those allegations where factors should be applied. The first principle is that although parental responsibility for the provision of protection, supervision, food, shelter, clothing, education, and a sanitary environment continues until the child attains age 18 or is a legally emancipated minor, the need for the parent to provide these things decreases as the child's own ability to protect himself or to obtain or provide these necessities increases. The second principle is very similar to the first. The risk/harm to the child decreases as the child's own ability to protect himself or herself, comprehend danger in a given situation or to obtain or provide these necessities increases. Factors that help the investigator weigh the child's maturity; ability to make sound judgments and ability to care for or protect himself or herself are common to several allegations. In addition, other factors help the investigator weigh the seriousness of each incident. These two types of factors separate true allegations of child abuse or neglect from examples of poor parenting. e) Allegations The allegation definitions focus upon the harm or the risk of harm to the child. Many of the allegations of harm can be categorized as resulting from either abuse or neglect. All abuse allegations of harm are coded with a one or two digit number under thirty. All neglect allegations of harm are coded with a two-digit number greater than fifty. The allegations of harm are categorized and coded as follows: Appendix B - Procedures 300 (8)

9 ABUSE #1 Death #51 Death #2 Head Injuries #52 Head Injuries NEGLECT #4 Internal Injuries #54 Internal Injuries #5 Burns #55 Burns #6 Poison/Noxious Substances #56 Poison/Noxious Substances #7 Wounds #57 Wounds #9 Bone Fractures #59 Bone Fractures #10 Substantial Risk of Physical Injury/Environment Injurious to Health and Welfare #11 Cuts, Bruises, Welts, Abrasions and Oral Injuries #60 Substantial Risk of Physical Injury/Environment Injurious to Health and Welfare #61 Cuts, Bruises, Welts, Abrasions and Oral Injuries #12 Human Bites #62 Human Bites #13 Sprains/Dislocations #63 Sprains/Dislocations #14 Tying/Close Confinement Abuse Only #15 Substance Misuse #65 Substance Misuse #16 Torture Abuse Only #17 Mental and Emotional Impairment #67 Mental and Emotional Impairment #18 Sexually Transmitted Diseases Abuse Only #19 Sexual Penetration Abuse Only #20 Sexual Exploitation Abuse Only #21 Sexual Molestation Abuse Only #22 Substantial Risk of Sexual Injury Abuse Only Neglect Only #74 Inadequate Supervision Neglect Only #75 Abandonment/Desertion Neglect Only #76 Inadequate Food Neglect Only #77 Inadequate Shelter Neglect Only #78 Inadequate Clothing Neglect Only #79 Medical Neglect Neglect Only #81 Failure to Thrive (Non-Organic) Neglect Only #82 Environmental Neglect Neglect Only #83 Malnutrition (Non-Organic) Appendix B - Procedures 300 (9)

10 Neglect Only #84 Lock-out Neglect Only #85 Medical Neglect of Disabled Infants f) Purpose of the Allegation System The allegation-based system provides specific allegations to assist in focusing the investigator's attention on the incident/circumstances at hand. The system eliminates the need for investigators to review every aspect of a family's life and environment. The allegations also provide a framework for decision-making by SCR and investigative staff and provide an important investigation tracking and record keeping function. In order to fulfill the purposes of the allegation-based system, it is essential that the allegations be narrowly defined and used consistently throughout the state. In the past, there has been a tendency to mark too many allegations in completing the SACWIS reports, thus thwarting the goal of focusing the investigation on specific issues and concerns. Accordingly, the allegations have been redefined and revised to allow only limited interpretation and usage. To verify the existence of specific injuries or a medical condition, a doctor's diagnosis is frequently required. (See allegation definitions for specific requirements.) If a doctor, or other medical source, will not or is not able to share information or speak with an investigator, the diagnosis may be documented through a police report or an interview with a police officer, which details the doctor's findings. Medical sources are preferred and are absolutely required for several allegations. g) Reasonable Efforts to Stop Abuse It is important to note that a significant change has been made in the usage of many of the allegations of harm. Henceforth, if "a parent, caretaker, immediate family member, other person residing in the home, or the parent's paramour" fails "to make reasonable efforts to stop an action by another person which resulted in" a specific allegation of harm to the child, that person is alleged to be the perpetrator of ABUSE, not neglect as in the past. The practice of alleging that a person is the perpetrator of neglect was not in keeping with the Abused and Neglected Child Reporting Act (ANCRA). ANCRA includes persons who allow injury to be inflicted in its definition of abuse. "Reasonable efforts to stop abuse" is defined as those actions that could have stopped abuse of the child without posing an imminent threat to the person s own safety. Minors are not expected to intervene between an adult and another child. Appendix B - Procedures 300 (10)

11 h) Injuries Caused by Blatant Disregard of Parental or Caretaker Responsibilities Another important change is the way in which NEGLECT is defined and used in those allegations of harm, which may be attributable to either abuse or neglect. A child may sustain a harm (e.g., brain damage, death, etc.) because of the "blatant disregard" of the parent or caretaker in his or her responsibility to oversee and protect the child. In such instances, the harm is the same to the child, but the cause is attributable to NEGLECT, not abuse. To constitute neglect, the allegations require that the harm to the child must have been the result of a blatant disregard of parental or caretaker responsibilities. "Blatant disregard" is defined as incidents where the risk of harm to the child was so imminent and apparent that it is unlikely that a parent or caretaker would have exposed the child to such obvious danger without exercising precautionary measures to protect the child from harm. i) Use of Factors Must Be Documented The investigative worker must document the following information on a SACWIS Investigative Summary for those allegations where factors have been applied: which factors were considered in deciding whether to indicate or unfound the report; the information relevant to each factor; and the reasons for recommending the finding. j) Persons Who May Be Considered Perpetrators of Child Abuse or Neglect The following guidelines clarify which persons may be considered perpetrators of child abuse or neglect. RELATIONSHIP PARENTS Legal and/or Biological Parents (Includes Non-Custodial Parents) Step Parents Adoptive Parents IMMEDIATE FAMILY MEMBERS Biological Brothers and Sisters Step-Brothers and Sisters ABUSE X X X X X NEGLECT X X X See Note See Note Appendix B - Procedures 300 (11)

12 Adopted Brothers and Sisters Biological Grandfather and Grandmother Step-Grandfather and Grandmother Adopted Grandfather and Grandmother INDIVIDUALS RESIDING IN THE SAME HOME AS THE CHILD May Include Foster Brothers and Sisters (To determine residency, the person should maintain clothing and personal effects at the address, receive mail at or have identification using the address or otherwise identify the residence as his or her home. Visitors or short-term quests are not included in this category.) May Include Foster Brothers and Sisters PARAMOUR Parent s Boyfriend or Girlfriend Paramour means a significant other (e.g., boyfriend, girlfriend, lover, partner, friend or putative father) who is involved in an intimate/romantic relationship with one of the custodial parents of the children who come to the official attention of the Department through a child abuse or neglect investigation and/or open case; does not have a legally recognized and/or significant, continuous and stable relationship with all of the children; and may or may not live in the same household of the custodial parent of the involved children. PERSON RESPONSIBLE FOR THE CHILD'S WELFARE (CARETAKER) Legal Guardian of the Child Foster Parents Appendix B - Procedures 300 (12) X X X X X X X X X See Note See Note See Note See Note See Note See Note See Note X X

13 Relative Caretakers Day Care Home Caregivers (Regardless of whether licensed or license-exempt. Includes home other persons residing in the home.) Day Care Center Employees (Includes all employees and volunteers who have direct contact with children) Residential Care Facility Employees (Includes all employees and volunteers who have direct contact with children) Other Caretakers or Baby-Sitters (When the child's parents or legal guardian has a verbal or written agreement for the person to assume responsibility for the child s care during the parent or guardian s absence. Includes home caregiver and other persons residing in the home.) Other Persons Any other person responsible for the child s welfare at the time of the alleged abuse or neglect. Included in this category are health care professionals, educational personnel, recreational supervisors, and volunteers or support personnel in any setting where children may be subject to abuse or neglect. X X X X X X X X X X X X Note: In accordance with ANCRA, an immediate family member, other person residing in the same home as the child or the parent's paramour cannot be alleged as the perpetrator of child neglect unless they were acting as the child's caretaker when the incident occurred. k) Expanded Allegation Definitions The requirements and guidelines for completing investigations are delineated in the expanded allegation definitions. Each allegation contains the following information: Definition of Allegation Appendix B - Procedures 300 (13)

14 Taking a Report Acceptable Reporter/Source Usage Factor to Be Considered (Not applicable to all allegations.) Investigating the Report Documentation/Evidence to Support a Finding Requirements for Initial Investigation Requirements for Proceeding to a Formal Investigation Requirements for Formal Investigation Required Medical Information and/or Consultations Law Enforcement/State s Attorney Notification and Involvement Notification of Findings l) Retention Schedule Identifying information contained in indicated reports is retained in the State Central Register for 5, 20 or 50 years depending on the Allegation. See Procedures 300, Subsection (c) for information on how to assign a case retention schedule for indicated cases. If there are multiple indicated allegations in a report, all of the allegations will be retained for the longest length of time assigned to an allegation in the report. m) References Definitions of the allegations were taken in part from: Taber's Cyclopedic Medical Dictionary. Edited by Clayton L. Thomas. M.D., M.P.H., Philadelphia: F.A. Davis Company, Interdisciplinary Glossary on Child Abuse and Neglect: Legal, Medical, Social Work Terms, Washington, D.C.: U.S. Government Printing office, Appendix B - Procedures 300 (14)

15 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT DEATH Death means the permanent cessation of all vital functions. The following definitions of death are also commonly used: Allegation of Harm #1/51 Total irreversible cessation of cerebral function, spontaneous function of the respiratory system, and spontaneous function of the circulatory system. The final and irreversible cessation of perceptible heart beat and respiration. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child has died as the result of abuse or neglect may be the Reporter or Source of a CA/N report. The Reporter/Source has reason to believe that the child s death resulted from the following: A) A direct action of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in the child s death. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child s death. (NEGLECT) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Support Finding A) Verification that the child is dead (such verification must come from a physician or coroner). B) Police finding of the case and any reports generated by the police. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal Allegation: Death (1)

16 statements. The supervisor must review the police report when it is received to ensure that reported findings do not conflict with previously documented information received verbally. C) Autopsy results and findings including a copy of the autopsy report. If the autopsy report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements regarding the cause and manner of death. The supervisor must review the autopsy report when it is received to ensure findings do not conflict with previously documented information received verbally. D) Medical reports that detail any medical procedure just prior to death and relevant medical reports of past treatment. E) Photographs (if available) of fatal injuries. F) Detailed explanatory statements of the alleged perpetrator, witnesses and any other person with knowledge of the injury. G) Circumstantial evidence, which points to a specific perpetrator. H) Evidence obtained that supports the finding that the death was a direct result of some action by an eligible perpetrator or the failure of an eligible perpetrator to make reasonable efforts to stop an action by another person that resulted in the child s death. (ABUSE) I) If multiple alleged perpetrators are identified, circumstantial evidence, which identifies the most likely perpetrator. J) Evidence that the death was a result of blatant disregard of parental (or other person responsible for the child s welfare) responsibilities that resulted in the child s death. (NEGLECT) K) Any conflicting evidence has been resolved or detailed analysis of the evidence. L) Waiver of any of the above must be given by the Child Protection Manager and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Ensure safety of other children in the environment where the child died. B) Complete SCR data check, LEADS check, and Soundex of household members and other subjects regularly frequenting or living in the home. C) Thoroughly read and review prior investigations. D) Notify law enforcement and the State s Attorney. Allegation: Death (2)

17 E) Interview reporter, source and the other persons with information (OPWI) identified in the current report or related information. F) Interview the physician who treated current condition if other than reporter/source. G) Interview with the Coroner/Medical Examiner. H) Interview the DCFS or private agency caseworker if a service case is currently open. I) In person, individual interviews with the parents/caretakers. Parents should be contacted on the same day as contact with the child victim if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. J) Observe environment where maltreatment occurred. K) Notify Guardian ad litem if alleged child victim is DCFS ward or ward of the court (e.g., a child home with the parent under an order of protection). L) Waiver of any of the above contacts must be made by the Child Protection Manager and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) there is a determination that a child victim has died; and ii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) Interview Medical Examiner and/or Coroner to determine cause of death/autopsy results. B) Interview Hospital personnel if victim was transported to the hospital for treatment. C) Interview paramedics who were called to the scene. D) Individual and in person interviews with other children who lived in the environment in which the child died, to determine if they witnessed the Allegation: Death (3)

18 incident and to assess for safety issues and grief therapy. Interview should be conducted using the Victim Sensitive Interview protocol. E) Individual and in person interview with parent/caretakers. F) Interview initial response law enforcement personnel if called to the scene of death. G) Interview investigative law enforcement officers if not involved in cooperative investigation. H) Individual and in person interview with alleged perpetrator to determine culpability. I) Interview DCFS or private agency caseworker if the service case is currently closed but has been open within the past two years. J) Individual and in person interviews with all other adults and verbal children of the victim s household. Non-verbal children must be observed. K) Individual and in person interviews with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. L) Interview all identified witnesses who are reported to have knowledge of the incident that resulted in the child s death. M) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed by phone or in person. This includes character witnesses. N) For children 12 and under, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. O) Interview the victim s primary care physician and other physicians that treated the child within the past six months. P) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. Q) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. Allegation: Death (4)

19 5) Required Medical Information and/or Consultations A) Reports of attending physician, coroner, medical examiner regarding cause and manner of death including the autopsy report and report of the coroner s inquest. B) Medical exam of all other children residing in the home where the child died. C) Information relevant to history of maltreatment should be provided to pathologist doing autopsy. D) Victim s medical records, if relevant. E) Medical records of other surviving children if potentially germane to the case decision. F) If a DCFS nurse has had prior involvement, the nurse must be interviewed. G) A second medical/medical examiner or coroner s opinion must be obtained when: i) the coroner is unable or unwilling to offer an opinion regarding the cause of the death; or ii) iii) iv) there are conflicting opinions among authorities; or the case has been staffed with a supervisor and, based on the totality of the information gathered, the Child Protection Investigator is unable to make a well-supported finding. The local Child Death Review Team shall be consulted when a disagreement exists. 6) Law Enforcement/State s Attorney Notification and Involvement A) Every effort should be made to coordinate investigative activities with local law enforcement officials, at the minimum local authorities must be notified. B) Investigations must be coordinated with the Child Advocacy Centers in areas served by a center if the center is willing to work with this allegation. C) Notify State s Attorney upon receipt of the report. D) Notify the Illinois State Police at the time of the report. Allegation: Death (5)

20 7) Assessment of Factors to be Considered to Support Case Finding Not Applicable 8) Notification of Findings A) Verbally notify the subjects of the report of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify interviewed collateral contacts when the case is unfounded. D) Notify the Guardian ad litem of the investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with the parent under an order of protection). Allegation: Death (6)

21 REPORTS OF ABUSE AND NEGLECT HEAD INJURIES Allegation of Harm #2/52 a) DEFINITION A serious head injury causing skull fracture, brain damage or bleeding on the brain such as a subdural hematoma. Brain Damage Option A Injury to the large, soft mass of nerve tissue contained within the cranium/skull. Skull Fracture Option B A broken bone of the skull. Subdural Hematoma Option C Hematoma A swelling or mass of blood (usually clotted) confined to an organ, tissue or space and caused by a break in a blood vessel. Subdural Beneath the dura mater (the outer membrane covering the spinal cord and brain). A subdural hematoma is located beneath the membrane covering the brain and is usually the result of traumatic head injuries or the shaking of a small child or infant. It may result in loss of consciousness, seizures, mental or physical damage, or death. Shaken Baby Syndrome - Whiplash Shaken Infant Syndrome (WSIS) Option D Shaking of an infant causes stretching and tearing of blood vessels in the brain causing subdural hematoma, bleeding in the brain and/or retinal hemorrhage. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child sustained a head injury as the result of abuse or neglect may be the Reporter or Source of a CA/N report. The Reporter/Source has reason to believe that the head injury resulted from one of the following: Allegation: Head Injuries (1)

22 REPORTS OF ABUSE AND NEGLECT A) A direct action of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in the child sustaining a head injury. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child sustaining a head injury. (NEGLECT) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Support a Finding A) Evidence that the head injury is a direct result of some action by an eligible perpetrator (abuse), the failure of a caretaker to stop the action of another person that results in head injury (ABUSE), or the blatant disregard of a harmful situation which results in the injury (neglect). B) Medical documentation that the head injury exists, and an exact description of the injury. C) If police have conducted an investigation; the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. D) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the injury have been obtained. E) If multiple possible perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. F) For abuse (allegation 2), a medical opinion has been obtained that states the explanation given for the head injury is inconsistent, and the most likely manner in which this injury occurred was abuse or the alleged perpetrator has admitted causing the injury. G) For neglect (allegation 52), a medical opinion has been obtained and states that the explanation given for the head injury is consistent, or that the injury is not likely to have been caused by abuse. The investigative file documentation must include evidence that the alleged perpetrator Allegation: Head Injuries (2)

23 REPORTS OF ABUSE AND NEGLECT exposed the child to such a high a risk of receiving a head injury that a reasonable person would have taken action to avoid it. H) An explanation or proof that conflicting evidence has been resolved, or detailed analysis of the evidence. I) Waiver of any of the above must be given by the Child Protection Manager and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) SCR data check, LEADS check, and Soundex of household members and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person or phone notification to law enforcement. E) In person, individual interview with alleged child victim(s), assessment of the physical injury including photographs or body chart, and completion of CERAP. F) Observation of environment where maltreatment occurred. G) Medical exam is required (waiver of the exam can only be granted by the DCFS medical director or a DCFS nurse). H) Interview physician who treated current injury if other than reporter/source. I) Interview DCFS or private agency caseworker if a service case is currently open. J) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. K) Interview alleged perpetrator either in person or by phone. L) Notify Guardian ad Litem if alleged child victim is a DCFS ward or ward of the court (e.g., a child home with a parent under an order of protections). M) Waiver of any of the above contacts must be made by the Child Protection Manager and documented on a SACWIS Case Note. Allegation: Head Injuries (3)

24 REPORTS OF ABUSE AND NEGLECT 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a determination that the child victim has a head injury and there is reasonable cause to suspect that the injuries may have been the result of an action (abuse) or blatant disregard (neglect) by an eligible perpetrator; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. C) The allegation cannot be unfounded at Initial Investigation without medical consultation if the child has any injury related to the allegation. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) Interview person who last saw the victim before the onset of symptoms. C) In person, individual interview with alleged perpetrator. D) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. E) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. F) Interview physicians directly involved with treatment of the reported injury (e.g. attending physician, radiologist or neurologist). G) Interview all identified witnesses who are reported to have knowledge of the incident that resulted in the head injury. H) If the family or subjects identify two or more possible collateral contacts, at least two must be interviewed by phone or in person. This includes character witnesses. I) Interview DCFS or private agency caseworker if the service case is currently closed but has been open within the past two years. J) Interview other community professionals who have knowledge of the incident. Allegation: Head Injuries (4)

25 REPORTS OF ABUSE AND NEGLECT K) Interview primary care physician or physician who has seen child in past six months. L) For children 12 and under, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. M) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. N) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the victim receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and relevant past treatment. C) A medical examination is required for all formal investigations. D) Provide medical records to the treating physician and/or consultant when the records are requested or when there is a history of child injuries. E) Expert opinion to match injuries with a potential cause (etiology) if nature of the injury is unknown or contested. F) Consultation with physicians to assess appropriateness of bone scan to identify any possible past maltreatment. Long bone X-rays are strongly encouraged for a child under two with any suspicion for abuse. G) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding the cause of the injury; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with a supervisor and, based on the totality of the information gathered, the CPSW is unable to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest weight. Allegation: Head Injuries (5)

26 REPORTS OF ABUSE AND NEGLECT 6) Law Enforcement/State s Attorney Involvement or Notification A) It is mandatory that the State s Attorney and law enforcement be notified at the time of the report. B) In areas served by a Child Advocacy Center, investigations must be coordinated with the center if the center is willing to work with this allegation. C) DCFS and local law enforcement should cooperate in conducting investigations. 7) Assessment of Factors to be Considered to Support Case Finding Not applicable to this allegation. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad litem of the investigation finding if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Head Injuries (6)

27 REPORTS OF ABUSE AND NEGLECT INTERNAL INJURIES Allegation of Harm #4/54 a) DEFINITION An internal injury is an injury that is not visible from the outside, e.g. an injury to the organs occupying the thoracic or abdominal cavities. Such injury may result from a direct blow or a penetrating injury. A person so injured may be pale, cold, perspiring freely, have an anxious expression, or may seem semi comatose. Pain is usually intense at first, and may continue or gradually diminish as patient grows worse. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child sustained internal injuries as the result of abuse or neglect may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the internal injuries resulted from one of the following: A) A direct action of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in internal injuries. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child sustaining internal injuries. (NEGLECT) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Support a Case Finding A) Evidence that the injuries are a direct result of some action by an eligible perpetrator (ABUSE), the failure of a caretaker to stop the action of another person that results in internal injuries (ABUSE), or the blatant disregard of a harmful situation that results in internal injuries (NEGLECT). Allegation: Internal Injuries (1)

28 REPORTS OF ABUSE AND NEGLECT B) Medical documentation that an internal injury exists, and an exact description of the injury. C) If police have conducted an investigation; the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. D) If multiple possible perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. E) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the injury have been obtained. F) All other required contacts made, or documentation as to why they were not. G) Consults have been obtained as required. H) For abuse (allegation 4), a medical opinion has been obtained that states the explanation given for the injury is inconsistent, and the most likely manner in which this injury occurred was abuse or the alleged perpetrator has admitted causing the injury. I) For neglect (allegation 54), a medical opinion has been obtained and states that the explanation given for the internal injury is consistent, or that the internal injury is not likely to have been caused by abuse. And the investigative file documentation must include evidence that the alleged perpetrator exposed the child to such a high a risk of receiving an internal injury that a reasonable person would have taken action to avoid it. J) Any other conflicting evidence has been resolved, or detailed analysis of evidence. K) Additional allegations should be added as appropriate. L) Waiver of any of the above must be given by the Child Protection Manager and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of household members and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. Allegation: Internal Injuries (2)

29 REPORTS OF ABUSE AND NEGLECT C) Interview reporter, source and OPWI identified in the current report or related information. D) Individual and in person interviews with alleged child victim(s), assessment of the physical injury including photographs or body chart, and completion of CERAP. E) Observation of environment where maltreatment occurred. F) Interview physician who treated current injury if other than reporter/source. G) Medical exam is required (waiver of the exam can only be granted by the DCFS medical director or a DCFS nurse). H) In person or phone interview with law enforcement, if police have had contact on report. This contact is to help establish the need to move to formal investigation phase. I) Interview DCFS or private agency caseworker if a service case is currently open. J) Individual and in person interviews with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. K) Interview alleged perpetrator either in person or by phone. L) Notify Guardian at litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). M) Waiver of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) If the CERAP is marked unsafe; or ii) iii) there is a determination that the child victim has internal injuries and there is reasonable cause to suspect that the injuries may have been the result of an action (abuse) or blatant disregard (neglect) by an eligible perpetrator; and the alleged victim is under the age of 18, a formal investigation must be commenced. Allegation: Internal Injuries (3)

30 REPORTS OF ABUSE AND NEGLECT B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. C) The allegation cannot be unfounded at Initial Investigation without medical consultation if the child has any injury related to the allegation. 4) Requirements for Formal Investigation A) In person and individual interviews with parents/caretakers. B) In person and individual interview with alleged perpetrator. C) In person and individual interviews with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person and individual interviews with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview physicians directly involved with treatment of the reported injury (e.g. attending physician, radiologist or surgeon). F) Interview all identified witnesses who are reported to have knowledge of the incident that resulted in internal injuries. G) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. This includes character witnesses. H) Interview DCFS or private agency caseworker if a service case is currently closed but has been open within the past two years. I) Interview other community professionals who have first hand knowledge of the incident. J) For children 12 and under, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. K) Interview primary care physician or physician who has seen the child in the past six months. L) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. Allegation: Internal Injuries (4)

31 REPORTS OF ABUSE AND NEGLECT M) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the victim receives an immediate medical exam if evidence exists that the child is in need of urgent medical care. B) A medical exam is required for all formal investigations. C) Medical records of current treatment/diagnosis and relevant past treatment. D) Expert opinion to match injuries with a potential cause (etiology) if nature of the injury is unknown or contested. E) Consultation with physicians to assess appropriateness of further diagnostic testing. F) Interview a DCFS registered nurse if they have prior case involvement. G) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding the cause of the injury; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with a supervisor and, based on the totality of the information gathered, the CPSW is unable to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest weight. 6) Law Enforcement/State s Attorney Involvement or Notification A) It is mandatory that State s Attorney and law enforcement be notified at the time of the report. B) In areas served by a Child Advocacy Center, investigations must be coordinated with the center if the center is willing to work with this allegation. C) DCFS and local law enforcement should cooperate in conducting investigations. 7) Assessment of Factors to Be Considered to Support Case Finding Not Applicable Allegation: Internal Injuries (5)

32 8) Notification of Findings REPORTS OF ABUSE AND NEGLECT A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad litem of the investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with the parent under an order of protection). Allegation: Internal Injuries (6)

33 REPORTS OF ABUSE AND NEGLECT BURNS Allegation of Harm #5/55 a) DEFINITION Burns Tissue injury resulting from excessive exposure to thermal, chemical, electrical or radioactive agents. The effects vary according to the type, duration and intensity of the agent and the part of the body involved. Burns are usually classified as: First Degree (Partial Thickness) Superficial burns, damage being limited to the outer layer of the epidermis (skin). Characterized by scorching or painful redness of the skin. Second Degree (Partial Thickness) Burns in which the damage extends through the outer layer of the skin into the inner layers (dermis). Blistering will be present within 24 hours. Third Degree (Full Thickness) Burns in which both layers of skin (epidermis and dermis) are destroyed with damage extending into underlying tissues. Tissue may be charred or coagulated. Fourth Degree (Full Thickness) Burns extend beyond skin and underlying tissues into bone, joints and muscles. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child sustained a burn or was scalded as the result of abuse or neglect may be the reporter or source of the CA/N report. The reporter/source has reason to believe that the burn or scalding resulted from one of the following: A) A direct action of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) Allegation: Burns (1)

34 REPORTS OF ABUSE AND NEGLECT B) The failure of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in the burn or scalding. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child sustaining a burn or scalding. (NEGLECT) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Support a Case Finding A) Evidence that the injuries are a direct result of some action by an eligible perpetrator (ABUSE), the failure of a caretaker to stop the action of another person that results in the burn or scalding (ABUSE), or the blatant disregard of a harmful situation that results in the burns or scalding (NEGLECT). B) Medical documentation that a burn exists and an exact description of the location, pattern, degree, percent of body affected and cause of burn. C) If police have conducted an investigation; the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. D) If multiple possible perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. E) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the injury have been obtained. F) All other required contacts made, or documentation as to why they were not. G) Consultations have been obtained as required. H) For abuse (allegation 5), a medical opinion has been obtained that states the explanation given for the injury is inconsistent or suspicious, and the more likely manner in which this injury occurred was abuse or the alleged perpetrator has admitted causing the injury. I) For neglect (allegation 55), a medical opinion has been obtained and states that the explanation given for the injury is consistent, or that the injury is not likely to have been caused by abuse. And the investigative file documentation must include evidence that the alleged perpetrator Allegation: Burns (2)

35 REPORTS OF ABUSE AND NEGLECT exposed the child to such a high a risk of receiving an injury that a reasonable person would have taken action to avoid it. J) The temperature of the water at the site of the scalding incident must be measured and documented. K) Photographs of burns when possible. L) Waiver of any of the above must be given by the Child Protection Manager and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of household members and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with the alleged child victim(s), assessment of physical injury including photographs and/or body charts, and completion of CERAP. E) Observation of environment where maltreatment occurred. F) Interview physician who treated current injury if other than reporter/source. G) In person or phone interview with Law Enforcement, if police have had contact on current report. This contact is to help establish the need to move to formal investigation phase. H) Interview DCFS or private agency caseworker if a service case is currently open. I) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. J) Interview alleged perpetrator either in person or by phone. K) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with the parent under an order of protection). L) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. Allegation: Burns (3)

36 REPORTS OF ABUSE AND NEGLECT 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a determination that the child victim has sustained burns or was scalded and there is reasonable cause to suspect that the injuries may have been the result of an action (abuse) or blatant disregard (neglect) by an eligible perpetrator; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. C) The allegation cannot be unfounded at the Initial Investigation phase without medical consultation when the child has any injury related to the allegation. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged perpetrators. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview physicians directly involved with the treatment of the reported injury. F) In person or phone interview with Law Enforcement. G) Interview all identified witnesses who are reported to have knowledge of the incident that resulted in burns. H) If the family identifies two or more possible collateral contacts; at least two must be interviewed either by phone or in person. This includes character witnesses. I) Interview DCFS or private agency caseworker if a service case is currently closed but has been open within the past two years. J) Interview other community professionals who have knowledge of the incident. Allegation: Burns (4)

37 REPORTS OF ABUSE AND NEGLECT K) For children 12 and under, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. L) Interview primary care physician or physician who has seen the child in the past six months. M) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. N) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 5) Required Medical Documentation and/or Consultations A) The worker must ensure that the victim receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and relevant past treatment. C) Medical attention is required for a formal investigation of a burn if: i) the burn breaks the skin or blisters; or ii) iii) iv) the burn occurred to the face, head, feet, and/or genitalia; or there were multiple burns (more than 1); or the burn covers a large surface of the body; or v) if the burn shows signs of infection. D) A second medical opinion must be obtained when: i) the treating physicians are unable or unwilling to offer an opinion regarding the likelihood that this burn was caused by abuse or neglect; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with the supervisor and, based on the totality of information gathered, the CPSW is not yet able to make a well supported finding (e.g. the treating physician is inexperienced in abuse diagnosis). Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest weight. Allegation: Burns (5)

38 REPORTS OF ABUSE AND NEGLECT 6) Law Enforcement/State s Attorney Involvement or Notification A) It is mandatory that law enforcement and the State s Attorney be notified if the victim is under six years old, or any age victim with a third or fourth degree burn. B) Notify the State s Attorney if report constitutes second, or more, indicated report of abuse. C) Every effort should be made to coordinate investigative activities with local law enforcement officials. D) Where available, these investigations must be conducted under the auspices of the local Child Advocacy Centers if they are willing to work with this allegation. 7) Assessment of Factors to Be Considered to Support Case Finding Not Applicable 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of the investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with the parent under an order of protection). Allegation: Burns (6)

39 a) DEFINITION Poison REPORTS OF CHILD ABUSE AND NEGLECT POISON/NOXIOUS SUBSTANCES Allegation of Harm #6/56 Any substance, other than mood altering chemicals or alcohol, taken into the body by ingestion, inhalation, injection, or absorption that interferes with normal physiological functions. Virtually any substance can be poisonous if consumed in sufficient quantity; therefore, the term poison more often implies an excessive amount rather than the existence of a specific substance. Noxious Any substance deemed to be harmful (injurious); not wholesome. NOTE: Ingestion of mood altering chemicals or alcohol should be coded as Allegation of Harm #15/65, Substance Misuse. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child consumed poison or a noxious substance as the result of abuse or neglect may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that a child was poisoned or ingested a noxious substance as the result of one of the following: A) A direct action of the parent, caretaker, immediate family member, other persons residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in the child consuming poison or a noxious substance. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child consuming poison or a noxious substance. (NEGLECT) Allegation: Poison/Noxious Substances (1)

40 c) INVESTIGATING A REPORT REPORTS OF CHILD ABUSE AND NEGLECT 1) Documentation/Evidence Needed to Support a Case Finding A) Medical documentation that the child consumed a poison or noxious substance. B) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. C) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the incident have been obtained. D) All other required contacts made, or documentation as to why they were not. E) Consults have been obtained as required. F) For abuse (allegation 6) a medical opinion has been obtained that verifies the consumption of a poison or noxious substance was a direct action of the perpetrator or the alleged perpetrator has admitted to poisoning the child. G) For neglect (allegation 56) a medical opinion has been obtained and states the child ingested a poison or noxious substance as a result of blatant disregard by an eligible perpetrator. H) Any conflicting evidence has been resolved or detailed analysis of the evidence. I) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check and Soundex of household members and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with the alleged child victim(s), assessment of physical injuries including photographs and/or body chart, and completion of CERAP. Allegation: Poison/Noxious Substances (2)

41 E) Interview physician who treated current incident if other than reporter/source. F) In person or phone interview with law enforcement, if police have had contact on report. This contact is to help establish the need to move to the formal investigation phase. G) Interview DCFS or private agency caseworker if a service case is currently open. H) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. I) Interview alleged perpetrator either in person or by phone. J) Notify Guardian ad litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with the parent under an order of protection). K) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is reasonable cause to suspect that the child has consumed poison or a noxious substance as a result of a direct action (ABUSE) or failure of an eligible perpetrator to make a reasonable effort to stop an action by another person which resulted in the child abuse or blatant disregard (NEGLECT) by an eligible perpetrator; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged perpetrators. Allegation: Poison/Noxious Substances (3)

42 C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Observation of environment where maltreatment occurred. F) Interview physicians directly involved with the treatment of the reported incident. G) Interview all identified witnesses who are reported to have knowledge of the incident. H) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. This includes character witnesses. I) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. J) Interview other community professionals who have first hand knowledge of the incident. K) For children 12 and under, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. L) Interview primary care physician or physician who has seen the child in the past six months if past history of maltreatment is alleged. M) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. N) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the victim receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and relevant past treatment. C) A medical exam is required for all formal investigations. Allegation: Poison/Noxious Substances (4)

43 D) Expert opinion to verify the consumption of the poison or noxious substance. E) A second opinion is required when: i) the treating physicians are unable or unwilling to verify the consumption of a poison or noxious substance; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with a supervisor and, based on the totality of the information gathered, the CPSW is unable to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney Involvement or Notification A) Notification to the State s Attorney is mandatory if protective custody is taken, or the alleged perpetrator is a paramour. B) Notification to the State s Attorney is mandatory on second indicated case of abuse. 7) Assessment of Factors to Be Considered to Support Case Finding Not applicable to this allegation. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with the parent under an order of protection). Allegation: Poison/Noxious Substances (5)

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45 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT A gunshot or stabbing injury. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage WOUNDS Allegation: Wounds (1) Allegation of Harm #7/57 Any person who has reason to believe that a child sustained a wound as a result of abuse or neglect may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the wound resulted from one of the following: A) A direct action of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in a wound. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child sustaining a wound. (NEGLECT) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Support a Finding A) Verify that the victim currently has a wound, or has been wounded in the past. Documented supervisory approval is necessary to indicate a case based on wounds not observed by the investigator (past wounds). B) Verify the typology of the injury including the exact location of the wound, age, pattern, color, and percent of body affected. C) Identify possible/plausible etiology (cause) based on available information (knife or gunshot). D) Document parent/caretaker explanation including scene observation and mock demonstration.

46 E) Carefully document victim s statement. F) Document match of injury and explanations. G) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. H) If multiple alleged perpetrators are identified, circumstantial evidence that identifies the most likely perpetrator. I) Secure evidence that the wounds are a direct result of some action by an eligible perpetrator (ABUSE) or the failure of a caretaker to stop the action of another person which results in wounds (ABUSE), or blatant disregard by a caretaker which results in wounds (NEGLECT). J) Any other conflicting evidence has been resolved, or detailed analysis of evidence. K) Waiver of any of the above must be given by the Child Protection Manager and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of household members and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) Interview primary care physician or physician who has seen child in past six months. E) In person, individual interview with the alleged child victim(s), assessment of the physical injury including photographs or body chart, and completion of CERAP. F) Observation of environment where maltreatment occurred. G) Interview physician who treated current injury if other than reporter/source. H) In person or phone interview with law enforcement and State s Attorney Office. Allegation: Wounds (2)

47 I) Interview DCFS or private agency caseworker if a service case is currently open. J) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety and the formal investigation must be commenced. K) Interview alleged perpetrator either in person or by phone. L) Notify Guardian ad litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with the parent under an order of protection). M) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a determination that the child victim has a wound and there is reasonable cause to suspect that the injuries may have been the result of an action (abuse), or blatant disregard (neglect) by an eligible perpetrator; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. C) The allegation cannot be unfounded at the Initial Investigation without medical consultation if the child has any injury related to the allegation. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged perpetrators. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview physicians with knowledge of reported injury. Allegation: Wounds (3)

48 F) Interview all identified witnesses who are reported to have knowledge of the incident that resulted in a wound. G) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. This includes character witnesses. H) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. I) Interview other community professionals who have knowledge of the incident. J) For children 12 and under, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. K) Interview primary care physician or physician who has seen the victim within the past six months if past history of maltreatment is alleged. L) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. M) Any conflicting evidence has been resolved or detailed analysis of the evidence. N) Waiver of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the victim receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) Medical examination required if there is a current injury. C) Medical records of current treatment/diagnosis and relevant past treatment. D) Interview a DCFS registered nurse if they have prior knowledge. E) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding the cause of the injury; or ii) there are conflicting opinions among treating physicians; or Allegation: Wounds (4)

49 iii) the case has been staffed with a supervisor and, based on the totality of the information gathered, the CPSW is unable to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney Involvement or Notification A) It is mandatory that the State s Attorney and law enforcement be notified at the time of the report. B) In areas served by a Child Advocacy Center, the investigation must be coordinated with the center if the center is willing to work with this allegation. 7) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Wounds (5)

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51 a) DEFINITION A fracture is a broken bone. Metaphyseal Epiphyeal Fractures REPORTS OF CHILD ABUSE AND NEGLECT BONE FRACTURES Allegation of Harm #9/59 Fractures located at the ends of bones. They are commonly described as corner fractures, chipped fractures or bucket handle fractures. Diaphyseal Fractures Diaphyseal fractures are located in the bone shaft. Fractures in the shaft of long bones of the extremities are spiral (oblique) or transverse. Spiral fracture is caused by twisting or rotational force. Transverse fracture results from a direct blow or bending force. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child sustained a bone fracture as the result of the abuse or neglect may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the bone fracture resulted from one of the following: A) A direct action of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in a bone fracture. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child sustaining a bone fracture. (NEGLECT) Allegation: Bone Fractures (1)

52 c) INVESTIGATING A REPORT REPORTS OF CHILD ABUSE AND NEGLECT 1) Documentation/Evidence Needed to Support a Finding A) Secure evidence that the fractures are a direct result of some action by an eligible perpetrator (abuse), the failure of a caretaker to stop the action of another person which results in fractures (abuse), or the blatant disregard of a harmful situation which results in bone fractures (neglect). B) Medical documentation that a fracture exists, and an exact description of the fracture. C) When police have conducted an investigation the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings reported reflect the verbal information received previously and documented. D) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the injury have been obtained. E) If multiple possible perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. F) All other required contacts made, or documentation as to why they were not. G) Required consultations have been obtained. H) For abuse (allegation 9), a medical opinion has been obtained that states the explanation given for the fracture is inconsistent, and the most likely manner in which this fracture occurred was abuse or the alleged perpetrator has admitted causing the injury. I) For neglect (allegation 59), a medical opinion has been obtained and states that the explanation given for the fracture is consistent or that the fracture is not likely to have been caused by abuse. The investigative file documentation must include evidence that the alleged perpetrator exposed the child to such a high a risk of receiving a bone fracture that a reasonable person would have taken action to avoid it. J) Any conflicting evidence has been resolved or detailed analysis of evidence. Allegation: Bone Fractures (2)

53 K) Waiver of any of the above must be given by the Child Protection Manager and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of household members and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with the alleged child victim(s), assessment of physical injury including photographs and/or body charts and completion of CERAP. E) Observe environment where maltreatment occurred. F) Interview the physician who treated current injury if other than reporter/source. G) In person or phone interview with law enforcement, if police have had contact on report. This contact is to help establish the need to move to formal investigation phase. H) Interview DCFS or private agency caseworker if a service case is currently open. I) In person, individual interview with parents/caretakers. Parents should be contacted on the some day as contact with child victim(s) if at all possible. When the CERAP is marked unsafe the parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. J) Interview alleged perpetrator either in person or by phone. K) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). L) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or Allegation: Bone Fractures (3)

54 ii) there is a determination that the child victim has broken bones and there is reasonable cause to suspect that the injuries may have been the result of an action (abuse) or failure of an eligible perpetrator to make a reasonable effort to stop an action by another person which resulted in the child abuse or blatant disregard (neglect) by an eligible perpetrator; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. C) This allegation cannot be unfounded at the Initial Investigation without medical consultation when the child has any injury related to the allegation. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged perpetrators. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview all physicians directly involved with the treatment of the reported injury (e.g., attending physician, radiologist or orthopedist). F) Interview all identified witnesses who are reported to have knowledge of the incident that resulted in a bone fracture. G) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. H) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. I) Interview other community professionals who have knowledge of the incident. J) For children 12 and under, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. Allegation: Bone Fractures (4)

55 K) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. L) Interview primary care physician or physician who has seen child in past six months. M) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the victim receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) A medical examination is required for all formal investigations. C) Medical records of current treatment/diagnosis and relevant past treatment. D) Expert opinion to match fractures with a potential cause (etiology) if nature of the injury is unknown or contested. E) Consultation with physicians to assess appropriateness of bone scan to identify any possible past maltreatment. X-rays are mandatory for a child under two with any suspicion for abuse. F) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding the cause of the injury; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with a supervisor and, based on the totality of the information gathered, the CPSW is unable to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. G) Interview a DCFS Nurse if they have had prior involvement. 6) Law Enforcement/State s Attorney Involvement or Notification A) It is mandatory that the State s Attorney and law enforcement be notified if child is under the age of six. Allegation: Bone Fractures (5)

56 B) Notify the State s Attorney if report constitutes second or more indication of abuse. C) Every effort should be made to coordinate investigative activities with local law enforcement officials. D) Where available these investigations musts be coordinated with the Child Advocacy Centers if they are willing to work with this allegation. E) The State s Attorney shall be notified if the child is taken into protective custody or when the alleged perpetrator is a paramour. 7) Assessment of Factors to Be Considered to Support Case Finding Not Applicable 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts who were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with the parent under an order of protection). Allegation: Bone Fractures (6)

57 April 3, 2015 P.G SUBSTANTIAL RISK OF PHYSICAL INJURY (ABUSE)/ENVIRONMENT INJURIOUS TO HEALTH AND WELFARE (NEGLECT) Allegation of Harm #10/60 #10 Substantial Risk of Physical Injury (Abuse) Please refer to Rule 300 Appendix B Allegation 10 at #60 Environment Injurious to Health and Welfare (Neglect) Please refer to Policy Guide filed immediately after this Procedure section. Allegation 10/60: Substantial Risk of Physical Injury (Abuse)/Environment Injurious to Health and Welfare (Neglect) (1)

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59 DEPARTMENT OF CHILDREN AND FAMILY SERVICES POLICY GUIDE PROCEDURES 300 REPORTS OF CHILD ABUSE AND NEGLECT APPENDIX B THE ALLEGATIONS SYSTEM DATE: April 3, 2015 TO: FROM: EFFECTIVE: DCFS and Purchase of Service Staff and Supervisors George H. Sheldon, Acting Director Immediately I. PURPOSE The purpose of this Policy Guide is to provide DCFS and Purchase of Service staff with information regarding recent changes to Allegation #60 Environment Injurious to Health and Welfare (Neglect). This Policy Guide also updates SCR Hotline and Child Protection staff regarding the separation of Allegation #10 Substantial Risk of Physical Injury (Abuse) from Allegation #60 Environment Injurious to Health and Welfare (Neglect) and formally implements the revised Allegation #60 into procedure and investigative practice. This Policy Guide is effective immediately and shall remain in effect pending the completion of the revision of Procedures 300 later this year. II. PRIMARY USERS Primary users of this Policy Guide are Child Protection Specialists and Supervisors and State Central Register (SCR) Child Welfare Specialists and Supervisors, III. BACKGROUND In recent years, Allegation 60 has been the subject of litigation, and in light of this litigation, the Abused and Neglected Child Reporting Act (ANCRA) was amended. The amendments to ANCRA reinserted the environment injurious language to the definition of neglected child and added a definition for blatant disregard. The changes to ANCRA have been codified in DCFS Rule 300, Appendix B and as of this policy guide are now set forth in DCFS Procedure 300, Appendix B. 1

60 IV. SUMMARY OF CHANGES TO ALLEGATION #60 ENVIRONMENT INJURIOUS TO HEALTH AND WELFARE Rule 300, Appendix B has been amended so that Allegation #10 Substantial Risk of Physical Injury (Abuse) and Allegation #60 Environment Injurious to Health and Welfare (Neglect) are completely distinguished from each other. Allegation #60 (included below) has been further amended in order to codify language from ANCRA that enhances the definition of environment injurious and blatant disregard and provides examples of both. Procedure 300, Appendix B has now been revised to include the amended version of Allegation #60 Environment Injurious to Health and Welfare (Neglect) and incorporate into procedure and practice the enhanced definition of environment injurious and blatant disregard. Section 300 Appendix B, The Allegations System 60 Environment Injurious to Health and Welfare (Neglect) Environment injurious means that a child's environment creates a likelihood of harm to the child's health, physical well-being or welfare and that the likely harm to the child is the result of a blatant disregard of parent or caretaker responsibilities [325 ILCS 5/3]. This allegation shall be used when the type or extent of harm is undefined but the totality of circumstances, including inculpatory and exculpatory evidence, leads a reasonable person to believe that the child's environment may likely cause harm to the child's health, physical well-being or welfare due to the parent's or caretaker's blatant disregard. Blatant disregard is defined as an incident where the real, significant and imminent risk of harm would be so obvious to a reasonable parent or caretaker that it is unlikely that a reasonable parent or caretaker would have exposed the child to the danger without exercising precautionary measures to protect the child from harm [325 ILCS 5/3]. This allegation of harm shall also be used when there are conditions that create a real, significant and imminent likelihood of harm to the child's health, well-being or welfare (i.e., domestic violence, intimidation, or a child's participation in a criminal act) and the parent or caretaker blatantly disregarded his/her parental responsibility by failing to exercise reasonable precautionary measures to prevent or mitigate the imminent risk of moderate to severe harm. Circumstances Examples of circumstances that may create real, significant and imminent risk of moderate to severe harm include, but are not limited to: exposure to toxic vapors resulting from flammable or corrosive chemicals used in the manufacture of illicit drugs; the circumstances surrounding the death of one child provides reason to believe that another child is at real, significant and imminent risk of harm; 2

61 exposing a child to an environment that significantly affects the health and safety of the child, based on the sale or manufacture of illegal drugs; a court has adjudicated a parent as unfit and the parent has not completed services that would correct the conditions or behavior leading to the court finding; situations that place a child at substantial risk of harm due to the effects of being subjected to participation in or the witnessing of the use of physical force or restraint of another. Examples of circumstances that may, though not by themselves, create a real, significant and imminent risk of moderate to severe harm include, but are not limited to: Domestic Violence: The Illinois Domestic Violence Act defines domestic violence as a crime in which physical abuse, harassment, intimidation of a dependent, interference with personal liberty or willful deprivation [750 ILCS 60/103(1) and (3)] is perpetrated by one family or household member against another. Family or household members include spouses, former spouses, parents, children, stepchildren and other persons related by blood or by present or prior marriage, persons who share or formerly shared a common dwelling, persons who have or allegedly have a child in common, persons who shared or allegedly share a blood relationship through a child, persons who have or have had a dating or engagement relationship, persons with disabilities and their personal assistants and caregivers as defined in Section a of the Criminal Code of 2012 [720 ILCS 5/12-4.4a]. [720 ILCS 5/12-0.1] An incident of past or current domestic violence may qualify for an allegation of environment injurious if the domestic violence creates a real, significant and imminent risk of moderate to severe harm to the child' s health, physical wellbeing, or welfare, and the parent or caregiver has failed to exercise reasonable precautionary measures to prevent or mitigate the risk of harm to the child. Domestic violence is also referred to as "intimate partner violence". The adult victim of domestic violence, who is the non-offending parent or caregiver, is presumed to not be neglectful or to have created an environment injurious to the child so long as he or she has exercised precautionary measures to prevent or mitigate the real, significant and imminent risk of moderate to severe harm to the child. Mental Health: A parent's or caregiver's mental illness and behavior may qualify for an allegation of environment injurious if an incident or behavior that is symptomatic of the mental illness creates a real, significant and imminent risk of moderate to severe harm to the child's health, physical well-being or welfare, and if the parent or caregiver has failed to exercise reasonable precautionary measures to prevent or mitigate the risk of harm to the child. To indicate an allegation based on this factor, the Investigation Specialist must rule out dependency, as defined in the Juvenile Court Act of 1987 [705 ILCS 405], as the presenting problem. 3

62 Substance Abuse/Dependence: A parent's or caregiver's substance abuse/dependence and behavior may qualify for an allegation of environment injurious if an incident or behavior caused by the substance abuse/dependence creates a real, significant and imminent risk of moderate to severe harm to a child's health, physical well-being or welfare, and if the parent or caregiver has failed to exercise reasonable precautionary measures to prevent or mitigate the risk of harm to the child. Prior Harm to a Child: Prior harm to a child may qualify for an allegation of environment injurious on behalf of another child if the prior incidents of harm create a real, significant and imminent risk of moderate to severe harm to the child's health, physical well-being or welfare and if the parent or caregiver has failed to exercise reasonable precautionary measures to prevent or mitigate the risk of harm to the child. Factors To Be Considered Whether there is a real and significant danger to justify taking a report is determined by the following factors. All factors need not be present to justify taking the report. One factor alone may present sufficient danger to justify taking the report. The list of factors does not constitute child abuse or neglect in every instance. All factors must be given consideration in order to identify potential aggravating or mitigating circumstances. The child's age; The child's medical condition, behavioral, mental or emotional problems, developmental disability or physical handicap, particularly related to his or her ability to protect himself or herself; The severity of the occurrence; The frequency of the occurrence; The alleged perpetrator's physical, mental and emotional abilities, particularly related to his or her ability to control his or her actions; The dynamics of the relationship between the alleged perpetrator and the child; The alleged perpetrator's access to the child; The previous history of indicated abuse or neglect; The current stresses or crisis in the home; The presence of other supporting persons in the home; or The precautionary measures exercised by a parent or caregiver to protect the child from harm. 4

63 V. INSTRUCTIONS State Central Register (SCR) Staff When assessing a potential report of abuse or neglect that includes information that may qualify for Allegation #60, hotline staff shall determine whether the information provided by the caller meets the standard of environment injurious and blatant disregard, as codified in Rule and set forth in DCFS procedure. Specifically, hotline staff must determine whether the information provided indicates the child s environment creates a likelihood of harm to the child s health, physical well-being or welfare and the likely harm to the child is the result of blatant disregard of parent or caretaker responsibilities, such that the parent or caretaker unreasonably exposed the child to an obvious danger without exercising precautionary measures to protect the child from harm. Hotline staff should evaluate the caller s information for applicable Circumstances and Factors To Be Considered, as set for the in DCFS Rule and Procedure. Reports that include Allegation #60 shall be processed, completed and transmitted according to current procedures. Child Protection Specialists and Supervisors Once a Child Protection Specialist determines a report that includes Allegation #60 was made in good faith, the Child Protection Specialist shall continue the investigation by applying to current investigatory practice the standards of the amended definitions of environment injurious and blatant disregard and the amended Factors To Be Considered and Circumstances, in order to reach a final finding determination. Any child abuse and neglect investigation involving Allegation #60 requires consideration of the following factors: the child s environment creates a likelihood of harm to the child s health, physical well-being or welfare; and the likely harm to the child is the result of the blatant disregard of parent or caretaker responsibilities. Child protection staff must gather, document, and consider evidence regarding whether the actions of the parent or caretaker constitutes blatant disregard. Blatant disregard means an incident where the real, significant, and imminent risk of harm would be so obvious to a reasonable parent or caretaker that it is unlikely that a reasonable parent or caretaker would have exposed the child to the danger without exercising precautionary measures to protect the child from harm. Evidence gathered of the likelihood of harm to the child s health, physical well-being or welfare and whether the likelihood of harm was due to the blatant disregard of the parent or caretaker must be documented in a supervisory note and in the final finding rationale. 5

64 VI. FILING INSTRUCTIONS Please remove Allegation 10/60 (1) (16) and replace with this Policy Guide. For Allegation 10, staff should be referring to Rule 300 Appendix B Allegation 10 that is on the website at VII. QUESTIONS Questions concerning these revisions may be directed to the Office of Child and Family Policy at 217/ or through Outlook at OCFP-Mailbox or for non-outlook users at [email protected] 6

65 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT August 7, 2008 P.T CUTS, BRUISES, WELTS, ABRASIONS & ORAL INJURIES Cut (Laceration) An opening, incision or break in the skin made by some external agent. Bruise Allegation of Harm #11/61 An injury which results in bleeding under the skin, and in which skin is discolored but not broken (A bruise is also referred to as a contusion.) Welt An elevation on the skin produced by a lash, blow, or allergic stimulus (The skin is not broken and the mark is reversible.) Abrasion A scraping away of the skin Oral Injuries Injuries to the child s mouth including broken teeth b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child sustained cuts, bruises, welts, and abrasions as a result of abuse or neglect may be the reporter or source of the CA/N report. The reporter/source has reason to believe that the cuts, bruises, welts, abrasions, or oral injuries resulted from one of the following: A) A direct action of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (1)

66 August 7, 2008 P.T action by another person which resulted in cuts, bruises, welts, and abrasions. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child sustaining cuts, bruises, welts, and abrasions. (NEGLECT) 3) Factors to Be Considered Not every cut, bruise, welt, abrasion or oral injury constitutes an allegation of abuse or neglect. The following factors should be considered when determining whether an injury that resulted in cuts, bruises, welts, abrasions or oral injuries constitutes an allegation of abuse or neglect: A) The child s age, mobility and developmental stage; Bruises on children younger than nine months are highly suspicious. B) The child s medical condition, behavioral, mental, or emotional problems, developmental disability, or physical handicap, particularly as they relate to the child s potential for victimization; C) A pattern or chronicity of similar instances; A single incident can constitute an allegation of abuse or neglect. D) The severity/extent of the cuts, bruises, welts, abrasions or oral injuries (size, number, depth, extent of discoloration); Some bruises may fade quickly such as around a young child s mouth, but still be considered serious if the type of bruise (e.g., fingerprint marks) suggest intentionality. E) The location of the cuts, bruises, welts, abrasions or oral injuries; Accidental bruises are frequently seen over boney areas such as knees, shins, the forehead, and other exposed bony surfaces. Bruises located on padded areas such as the buttocks, cheeks, genitalia; or on relatively protected areas like the ear lobes, neck or upper lip, or on soft areas such as the stomach are highly suspicious. F) The pattern of the injury; and (Whether an object /instrument was used on the child) G) Previous history of indicated abuse or neglect or history of previous injuries. Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (2)

67 c) INVESTIGATING A REPORT REPORTS OF CHILD ABUSE AND NEGLECT August 7, 2008 P.T ) Documentation/Evidence Needed to Support Finding A) Verify and document whether the victim currently has cuts, bruises, welts, abrasions, or oral injuries or has sustained them in the past. B) Verify and document the typology of the injury including the exact location of the cuts, bruises, welts, or abrasions, shape, pattern, color, percent of body affected and source on a body chart. C) Identify likely etiology (e.g., hand, belt, electrical cord, board, and switch) based on available information. Document the parent s/caretaker s explanation, including scene observation and mock demonstration in the environment where the alleged incident occurred. Document the child s statement. The scene investigation shall include inquiring and documenting the following: Environmental circumstances surrounding the incident (i.e., people, objects, times and distances involved); Events leading to the incident, including a hour timeline of sequence of events leading to the incident; Persons in the environment at the time of the incident; Extended family members or other collaterals who have had contact with the child or children and may have seen the injury; General safety conditions of the home; How the incident leading to the injury occurred (mock demonstration by the alleged perpetrator and other witnesses). Use a pro-doll if incident involved an infant; The mood of the child and alleged perpetrator, including level of stress at the scene prior to the incident; Description of the objects/instruments used; If the parent/caregiver states that the injuries took place elsewhere, (e.g., school, conduct a scene investigation at the school), interview witnesses to verify the parent s/caretaker s explanation of the incident; Other activities as may be directed by the supervisor or indicated by the circumstances of the investigation. Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (3)

68 August 7, 2008 P.T D) Document the credibility of the explanation for the injury. If there are multiple injuries, an explanation or explanations must be given for each documented injury. E) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a SACWIS contact note must be included indicating that the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. F) If multiple possible perpetrators are identified, document circumstantial evidence which identifies the most likely perpetrator. Secure evidence that the cuts, bruises, welts, abrasions or oral injuries are a direct result of some action by an eligible perpetrator (ABUSE); or the failure of a caretaker to stop the action of another person which results in cuts, bruises, welts, abrasions or oral injuries (ABUSE); or blatant disregard by a caretaker which results in cuts, bruises, welts, or abrasions or oral injuries (NEGLECT). G) There is a detailed analysis of all inculpatory and exculpatory evidence and conflicting evidence has been resolved to the extent possible. H) Apply and document the application of the Factors to Be Considered. Determine and document whether the incident was likely to have been accidental, inflicted or the result of a medical condition. If inflicted, document whether it was excessive corporal punishment. If accidental, document whether the incident was neglectful. The relevance of each factor should be assessed and the assessment should be documented on a SACWIS contact note or other form designed for this purpose. I) A waiver of any of the above contacts must be given by the supervisor. Document the reasons for the request and supervisor s decision on a SACWIS contact note. 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of household members and other subjects regularly frequenting or living in the home. B) Thoroughly read prior indicated and existing unfounded investigations. Note: A current report involving the same subjects of an unfounded report shall not be indicated solely on the basis of the prior unfounded report. If new details or potential witnesses provide information that could impact a previously unfounded investigation this information must be reported to the SCR to determine if a new investigation of the unfounded allegation is warrant. Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (4)

69 August 7, 2008 P.T C) Interview the reporter, source and OPWI identified in the current report or related information report. D) Interview the alleged child victims individually and in person. Ask the child if there is an extended family member, another adult or caretaker that he or she feels safe with, important or special to. Persons identified by the child victim shall be interviewed. Observe and complete an assessment of the physical injury including photographs and body chart. Complete the CERAP. E) If marks are found on victim, other children in home must be individually interviewed and observed. F) Interview the physician that treated the child s current injury if other than reporter/source. Share relevant investigative facts with the physician. If the parent s/caretaker s explanation given to the physician differs from the explanation given to the Investigation Specialist, discuss the differences with the physician. If an object/instrument was used, the investigator should provide a detailed description of the object/instrument to the physician. Re-interview the physician as necessary. Always make an appointment to interview the physician. G) If the law enforcement has had contact with the involved persons of the current report, interview the involved officer by telephone or in person. If an object/instrument was used in the incident, request that the object/instrument be seized by the law enforcement officer. Obtain any other relevant information (e.g., domestic violence, 911 calls to the home, and other persons in the home under investigation). Obtain copies of the police report, and any photographs taken by law enforcement. Document verbal information obtained from law enforcement as well as any request for reports and photographic evidence. Supervisors must review obtained police reports to ensure that the previously verbal information is consistent with the written report. Contact with law enforcement will help establish the need to move the investigation to the formal phase. H) Interview DCFS or private agency caseworker and supervisor jointly if the family has an open service case. I) Complete in person and individual interviews with the parents/caregivers. Attempts to contact the parents should be made on the same day that the Investigation Specialist has contact with child victim victims if possible. If the CERAP is marked unsafe, the parents/caregivers must be interviewed immediately to develop a safety plan to ensure the child s safety and formal investigation must be commenced. If the CERAP is marked safe, the Investigation Specialist must secure corroboration of the parent s/caretaker s statements for the purpose of strengthening the safe determination. Efforts to corroborate the statements must occur as Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (5)

70 August 7, 2008 P.T soon as possible. If information obtained from collateral sources conflicts with the statements of the parent/caregiver, the Investigation Specialist shall immediately notify his or her supervisor or manager for guidance regarding the need to complete the subsequent CERAP and additional investigation activities. J) When bruising is reported and the Investigation Specialist does not see the bruise, the reporter or the person that observed the bruise must be contacted prior to the completion of the initial safety assessment. Obtain the names of other persons that may have observed the bruising from the reporter or other person with information. Obtain a description of the bruise, location and date the bruise was observed by interviewee. Determine whether the child was kept home from school, daycare or from attending other services (e.g., 0-3 services) at the time the bruising was observed by the reporter or other persons with information. Determine whether the alleged perpetrator provided and explanation for the injury to the reporter or other persons with information. K) Interview the alleged perpetrator either in person or by telephone. L) Verbally notify and interview the guardian at litem if alleged child victim is DCFS ward or ward of the court (i.e., a child home with a parent under any order of protection). M) A waiver of any of the above contacts must be given by the Investigation Supervisor. Document the reason for the request and supervisor s decision on a SACWIS case note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) The CERAP is marked unsafe; or ii) There is a determination that the child victim has cuts, bruises, welts, and/or abrasions and there is reasonable cause to suspect that the injuries may have been the result of an action by a caretaker (ABUSE), or blatant disregard (NEGLECT) by an eligible perpetrator; and iii) The alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the date of the report and documented on a SACWIS contact note. C) Apply the Factors to Be Considered to determine if there is reasonable cause to believe the bruises are a result of abuse or neglect. Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (6)

71 August 7, 2008 P.T ) Requirements for Formal Investigation A) When possible, interview the parents/caregivers in person and individually the same day that the children are interviewed. If the CERAP is marked unsafe, the parents/caregivers must be interviewed immediately to develop a safety plan to ensure the child s safety and formal investigation must be commenced. B) Interview the alleged perpetrators in person and individually. Establish whether the alleged perpetrators have minor children no living with them. C) Complete in person and individual interviews with all adults and verbal children in the victim s household. Non-verbal children must be observed. Establish with the verbal children if there is an extended family member or other adult with whom they feel safe; and/or whether there is an adult to whom the alleged victim is special or important to. D) Interview the alleged perpetrators minor children living with another parent/caregiver. Interview the parent/caregiver of those children. E) Observe the environment where maltreatment occurred and complete a scene investigation if one was not completed during the initial investigation or if there are unanswered questions. F) Interview and share relevant investigation facts with the physician or physicians directly involved with the treatment of the reported injury. Reinterview the physician or physicians when: The parent s explanation provided to the physician differs from the explanation provided to the investigator; and A new set of facts are discovered that are relevant to the physician s opinion. If the child has multiple bruises, obtain the physician s opinion as to the cause or causes for each of the bruises. Provide the physician with a detailed description of any object/instrument that is believed to have caused the bruising. If there are medical records for the injury, review the records to corroborate or identify inconsistencies in the information reported by the parent/caregiver. G) Interview all identified witnesses who are reported to have knowledge of the incident that resulted in cuts, bruises, welts or oral injuries. H) If the family or the subjects identify two or more collateral contacts, at least two must be interviewed either by phone or in person. If the child victim identifies family members, other adults or caretakers that the child feels safe with or trusts, those persons shall be interviewed. Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (7)

72 August 7, 2008 P.T I) If the family has had a service case closed within the past two years, conduct a joint interview with the DCFS or private agency caseworker and supervisor. J) Interview other community professionals who have knowledge of the incident or knowledge about the family. K) For children 12 years of age and younger, interview their school teachers, child care providers or infant/child service providers (e.g., 0-3 services) that have knowledge of the child and/or the level of care provided to the child. L) Interview the child s primary care physician or the physician who has seen the child victim within the past six months. M) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for the past five years. Establish whether the child has suffered injuries in the past, and obtain the explanations given for those injuries. N) A waiver of any of the above contacts must be given by the Investigation Supervisor. Document the reason or reasons for the request and the supervisor s decision on a SACWIS contact note. 5) Required Medical Information and/or Consultations A) The Investigation Specialist shall ensure that any child in the home that is need of medical care receives the medical care required regardless of the allegation being investigated. If the child s situation appears to be urgent, the investigator should call 911. The Investigation Specialist shall also: i) Contact the physician s office in advance of the child s appointment and provide the physician with a completed CANTS 65-A, Referral Form for Medical Evaluation of a Physical Injury to a Child; to share information about the allegation, the child and your concerns. The CANTS 65-A is to be delivered to the physician by the investigator not the parent. Contact the child s physician within 24 hours after seeing the child to confirm that the child has been seen by the physician. ii) iii) Consult with his or her supervisor immediately if the parents/caregivers refuse to obtain medical treatment for the child to determine if the child should be taken into protective custody. If applicable, call law enforcement for assistance. Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (8)

73 August 7, 2008 P.T iv) Add the medical neglect allegation (#79) to the report when appropriate. The Investigation Specialist must refer the child for nursing consultation services if the child has special health care needs (Procedures 302, Appendix O). B) Review the child s medical records of current treatment/diagnosis and relevant past treatment. C) A medical contact may be necessary to rule out naturally occurring cuetaneous marks confused with abuse such as Mongolian spots, macula caerulea, salmon patches, and strawberry marks, or if a medical examination is needed to match the injury with a potential cause (etiology). D) If a DCFS nurse has had prior involvement with the family, interview the nurse. E) A second opinion is required when: i) The treating physicians are unable or unwilling to offer an opinion regarding the likelihood of the injury being accidental versus abusive; or ii) iii) iv) There are conflicting opinions among treating physicians; or The case has been staffed with a supervisor, and based on the totality of the information gathered the Investigation Specialist is unable to make a well-supported finding. The physician offering the second opinion shall be provided the following: Scene investigation information Information obtained from the child s parents/caregivers, children, and collateral witnesses; Information concerning any discrepancies in the explanations of the child s injuries; and Descriptions of any objects/instruments use to injure the child. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. Document the medical specialization of each physician interviewed on a SACWIS contact note. Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (9)

74 August 7, 2008 P.T ) Law Enforcement/State s Attorney Notification and Involvement A) Law enforcement and the State s Attorney shall be notified if the child is taken into protective custody, or if the alleged perpetrator is a paramour. B) Notify the State s Attorney if this will be a second, or more, indicated report of abuse. C) Investigations must be coordinated with the Child Advocacy Centers in areas served by a center if the center is willing to work with this allegation. 7) Assessment of Case Information The Investigation Specialist and supervisor shall have a formal supervisory conference and use the following expanded list of factors to assess all inculpatory and exculpatory evidence obtained during the course of the investigation to reach and investigative finding. Document the supervisory conference on a SACWIS contact note. Factors to be considered include the following: A) What are the child s age, mobility and developmental stage? Is the child able to sit up, crawl or walk? The less mobile the child, the less likelihood of accidental bruising; infants do not bruise themselves on their pacifiers. B) Does the child have a medical condition; behavioral, mental or emotional problems; any disability or handicap that impacts the child s ability to protect him or herself or that significantly increases a caretaker s stress level? C) Is there a pattern of similar instances with the child or other children for whom the parent/caregiver has been responsible? Note: One incident is sufficient to indicate a report of abuse or neglect. D) What is the severity and location (i.e., size, number, depth of cut and extent of discoloration of the bruising) of the injury to the child s head, face or body? Accidental bruising usually occurs over bony prominences such as the knees, shins, forehead or elbows. Injuries to the cheeks, ears, genital, thighs and buttocks are more likely to be indicative of abusive treatment. Bruises surrounding a child s mouth may be associated with attempts to force feed or to make a child stop crying. Falls usually produce bruising Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (10)

75 August 7, 2008 P.T on a single plane of the body, while inflicted injuries generally occur over multiple planes. E) Was an object/instrument used on the child? Bruises with sharply defined borders are almost always inflicted. An electric cord produces a loop mark, belts produce strap marks and both generally wrap around multiple planes of the body. Boards and paddles leave linear injuries while other instruments leave distinctive injures. The use of an instrument does not in and of itself constitute an indicated finding but multiple injuries resulting from the use of an instrument is significant. F) Is there a previous history of abuse and/or neglect, or do persons interviewed report previous injuries to the child? More weight should be given to a documented history, and DCFS files used as a basis for identifying history should be reviewed prior to being considered a factor. History described by subjects or collaterals (e.g., child injuries, incidents of domestic violence) that is undocumented should be evaluated and factored into the overall assessment of safety. G) What dynamics are present between the child and the parent? Identify the child s level of fear of the caretaker. Does the caretaker appear to be concerned about child s welfare and protection? Is there an appropriate parent-child relationship? An apparent lack of fear of the parent/caregiver is only one factor to be considered and does not mean the child is not being abused or neglected. H) What is the level of stress/crisis in the home? Is there a positive home environment or is the environment chaotic? I) Is there an appropriate support system in place for the child and the parents/caregivers? Are there supportive people in the home? J) Was the injury inflicted through corporal punishment? Corporal punishment suggests non-accidental or intentional injury. An assessment of the intentional injury must be made to determine if the corporal punishment was excessive. K) Is the explanation of the injury consistent with the injury? Consistency may be determined either through an analysis of the injury by a medical professional, or through consistent explanations of the incident Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (11)

76 August 7, 2008 P.T obtained from witnesses of the incident across settings (i.e., 0-3 service providers, day care providers, teachers, other school personnel). 8) Notification of Findings Required notifications and supervisory consultations concerning the recommended finding shall be documented on a SACWIS contact note prior to submitting the investigation for supervisory approval. Notification of the recommended finding must occur after the supervisor and/or manager have discussed the recommended finding with the Investigation Specialist and approved the finding. A) Verbally notify the family of the recommended finding. B) Verbally notify and discuss the mandated reporter of the recommended finding. If the mandated reporter disagrees with the recommended finding, the Investigation Specialist shall immediately notify his or her supervisor of the concerns raised by the reporter. The supervisor shall contact the reporter to resolve his or her issues and/or to determine if there are additional investigation activities that need to be completed. When a resolution cannot be reached, the supervisor shall inform the reporter of his her right to appeal the investigation finding. The supervisor and the Investigation Specialist shall document all attempts to resolve the issues of the mandated reporter on a SACWIS contact note. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Verbally notify and discuss the recommended finding with the guardian ad litem if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). If the guardian ad litem disagrees with the recommended finding, the Investigation Specialist shall immediately notify his or her supervisor of the concerns raised by the guardian ad litem. The supervisor shall contact the guardian ad litem to resolve his or her issues and/or to determine if there are additional investigation activities that need to be completed. When a resolution cannot be reached, the supervisor shall inform the guardian ad litem of his her right to appeal the investigation finding. The supervisor and the Investigation Specialist shall document all attempts to resolve the issues of the guardian ad litem on a SACWIS contact note. Allegation: Cuts, Bruises, Welts, Abrasions and Oral Injuries (12)

77 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT HUMAN BITES Allegation of Harm #12/62 A bruise, cut or indentation in the skin caused by seizing, piercing, or cutting the skin with human teeth. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child sustained a human bite as the result of abuse or neglect may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the human bite resulted from one of the following: A) A direct action of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in a human bite. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child sustaining a human bite. (NEGLECT) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Support Finding A) Verify that the child currently has human bites or has sustained them in the past. Documented supervisory approval is necessary to indicate a case based on human bites not observed by the investigator (past human bites). B) Secure evidence that alleged perpetrator meets criteria of being a caretaker as defined in Appendix B, Procedures 300 (6). Allegation: Human Bites (1)

78 C) Verify the typology of the injury including the exact location of the human bites, age, pattern, color, percent of body affected, and source. Identify possible/plausible etiology (cause) based on available information. Document parent/caretaker explanation including scene observation and mock demonstration. Carefully document child s statement. Use other professionals (forensic dentist) to help match injury with explanation especially if injuries are attributed to another child. D) Secure evidence that the human bites are a direct result of some action by an eligible perpetrator (abuse) or the failure of a caretaker to stop the action of another person that results in human bites (abuse), or blatant disregard by a caretaker that results in human bites (neglect). E) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. F) If multiple possible perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. G) Photographs (A ruler should be placed along the side of the injury to document the size of the bite. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of physical injury including photographs or body chart, and completion of CERAP. E) In person or phone interview with Law Enforcement, if the report was first investigated by police. This contact is to help establish the need to move to formal investigation phase. F) Interview DCFS or private agency caseworker if a service case is currently open. Allegation: Human Bites (2)

79 G) In person, individual interview with parents/caretakers. Parents should be contacted as soon as possible following contact with child victim(s). If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and a formal investigation must be commenced. H) Notify Guardian ad litem if alleged child victim is DCFS ward or ward of the court (e.g., a child home with a parent under an order of protection). I) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) Determination that the child victim has human bites and there is reasonable cause to believe that the injury may have been the result of a direct action by an eligible caretaker (abuse), the failure by a parent/caretaker to protect a child from human bites caused by another person (abuse) or blatant disregard by an eligible caretaker (neglect); and the alleged victim is under the age of 18. B) Apply Factors to Be Considered to determine if the current information supports moving to a formal investigation. C) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety. B) In person, individual interview with alleged perpetrator. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview all physicians with knowledge of reported injury. F) Interview all identified witnesses who are reported to have knowledge of the incident that resulted in human bites. G) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. Allegation: Human Bites (3)

80 H) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. I) Interview other community professionals who have knowledge of the incident. J) For children under age 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. K) Interview primary care physician or physician who has seen child in past six months. L) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. M) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the child receives an immediate medical exam if evidence exists the child is in need of urgent medical care. B) Medical records (if medical attention has been sought or there is past history of medical attention). Expert opinion to match injury with a potential cause (etiology) if nature of the injury is unknown or contested. C) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding the cause of the injury; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with a supervisor and, based on the totality of the information gathered, the CPI is unable to make a well supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney Notification and Involvement A) Law enforcement and the State s Attorney shall be notified if protective custody is taken, or the alleged perpetrator is a paramour. Allegation: Human Bites (4)

81 B) The State s Attorney shall be notified if the current report is a second, or more, indicated report of abuse. 7) Assessment of Factors to Be Considered to Support Case Finding Not applicable to this allegation. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Human Bites (5)

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83 REPORTS OF ABUSE AND NEGLECT SPRAINS/DISLOCATIONS Allegation of Harm #13/63 a) DEFINITION Sprain Trauma to a joint that causes pain and disability depending upon the degree of injury to ligaments and/or surrounding muscle tissue. In a severe sprain, ligaments and/or muscle tissue may be completely torn. The signs are rapid swelling, heat and disability, often discoloration and limitation of function. Dislocation The displacement of any part, especially the temporary displacement of a bone from its normal position in a joint. Types include: Complicated A dislocation associated with other major injuries. Compound Closed Dislocation in which the joint is exposed to the external air. A simple dislocation. Complete A dislocation which completely separates the surfaces of a joint. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child sustained a sprain or dislocation as the result of abuse or neglect may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the sprain or dislocation resulted from one of the following: Allegation: Sprains/Dislocations (1)

84 REPORTS OF ABUSE AND NEGLECT A) A direct action of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in the child sustaining a sprain or dislocation. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child sustaining a sprain or dislocation. (NEGLECT) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Support Finding A) Verify that the child currently has a sprain/dislocation (medical diagnosis). B) Secure evidence that alleged perpetrator meets criteria of being a caretaker as defined in Appendix B-P300. C) Secure evidence that the sprain/dislocation is a direct result of some action by an eligible perpetrator (abuse), the failure of a caretaker to stop the action of another person which results in a sprain/dislocation (abuse), or the blatant disregard of a harmful situation which results in a sprain/dislocation (neglect). D) Verify the typology of the injury including the exact location of the sprain/dislocation, type of sprain/dislocation, age, and pattern if multiple injuries are present. E) Identify possible/plausible etiology (cause) based on available information. F) Document parent/caretaker and child s explanation including scene observation and mock demonstration. G) Carefully document statement child s statement. H) Use other professionals to help match injury with explanation. I) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must Allegation: Sprains/Dislocations (2)

85 REPORTS OF ABUSE AND NEGLECT review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. J) If multiple possible perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family, and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of physical injury including photographs or body chart, and completion of CERAP. E) In person or phone interview with Law Enforcement, if the report was first investigated by police. This contact is to help establish the need to move to formal investigation phase. F) Interview DCFS or private agency caseworker if a service case is currently open. G) In person, individual interview with parents/caretakers. Parents should be contacted as soon as possible following contact with child victim(s). If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. H) Notify Guardian ad litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). I) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements For Proceeding to Formal Investigation A) Determination that the child victim has a sprain or dislocation and there is reasonable cause to suspect that the injuries may have been the result of an action by a caretaker (abuse) or blatant disregard (neglect) by an eligible caretaker; and the alleged victim is under the age of 18. Allegation: Sprains/Dislocations (3)

86 REPORTS OF ABUSE AND NEGLECT B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. C) The allegation cannot be unfounded at the Initial Investigation without medical consultation if the child has any injury related to the allegation. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety. B) In person, individual interview with alleged perpetrator. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Observation of the environment where maltreatment occurred. F) Interview all physicians with knowledge of reported injury. G) Interview all identified witnesses who are reported to have knowledge of the incident that resulted in sprains/dislocations. H) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. I) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. J) Interview other community professionals who have knowledge of the incident. K) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. L) Interview primary care physician or physician who has seen child in past six months. M) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. Allegation: Sprains/Dislocations (4)

87 REPORTS OF ABUSE AND NEGLECT N) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the child victim receives an immediate medical exam if evidence exists the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and past treatment. C) Expert opinion to match sprain/dislocation with a potential cause (etiology) if nature of the injury is unknown or contested. D) Consultation with physicians to assess appropriateness of long bone X- rays to identify any possible past maltreatment. E) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding the cause of the injury; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with a supervisor and, based on the totality of the information gathered, the CPI is unable to make a well supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney Notification and Involvement A) Law enforcement and the State s Attorney shall be notified if the child is taken into protective custody, or if the alleged perpetrator is a paramour. B) The State s Attorney shall be notified if report is a second, or more, indicated report of abuse. 7) Assessment of Factors to Be Considered to Support Case Finding Not Applicable to this allegation. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. Allegation: Sprains/Dislocations (5)

88 REPORTS OF ABUSE AND NEGLECT D) Notify the Guardian ad litem of investigative findings if the victim is a DCFS ward or ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Sprains/Dislocations (6)

89 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT TYING/CLOSE CONFINEMENT Allegation: Tying/Close Confinement (1) Allegation of Harm #14 Unreasonable restriction of a child s mobility, actions or physical functioning by tying the child to a fixed (or heavy) object, tying limbs together or forcing the child to remain in a closely confined area, which restricts physical movement. Examples include, but are not limited to: Locking a child in a closet or small room. Tying one or more limbs to a bed, chair, or other object except as authorized by a licensed physician. Tying a child s hands behind his or her back. Putting child in a cage. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child was tied or closely confined as the result of abuse or neglect may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe the child was tied or closely confined as the result of one of the following: A) A direct action of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in a tying or close confinement. (ABUSE) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Support Finding A) Verify that the child has been tied to a fixed or heavy object, had their limbs tied together, or had been placed in a closely confined area.

90 B) Secure evidence that alleged perpetrator meets criteria of being a caretaker as defined in Appendix B of Procedures 300. C) If police have conducted an investigation; the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. D) If multiple possible perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. E) Secure evidence that the tying/close confinement is a direct result of some action by an eligible perpetrator (ABUSE), the failure of a caretaker to stop the action of another person that results in tying/ close confinement (ABUSE). F) Specifically identify the type of maltreatment and the nature of the harm experienced including statements explaining why the restriction of movement was unreasonable. G) For confinement cases, a detailed description of the confining space and the circumstances surrounding the confinement must be included in the investigation file including (the worker will document this information after viewing the space, documentation may not come from second hand information): size of the space access to help/assistance heat/ventilation present duration and frequency of confinement presence or absence of lighting reason for confinement H) For tying cases the following information must be documented in the investigation file: type of material used for tying description of object child was tied to access to help/assistance duration and frequency of tying Allegation: Tying/Close Confinement (2)

91 reason for tying I) Verify the typology of any physical harm including the exact location of the injury, type and extent of injury, age, and pattern if multiple injuries are present (i.e. rope burns, cuts, or bruises). J) Identify any mental injury present especially in cases of confinement over long periods of time. If harms are identified, additional allegations should be added to the report. K) Identify possible/plausible etiology (cause) based on available information. L) Document parent/caretaker and child s explanation including scene observation and mock demonstration. M) Carefully document child s statement. N) Use other professionals to help match injury with explanation. 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of members of the family, and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of physical injuries including photographs and/or body chart, and completion of CERAP. E) Observation of environment where child was confined, tied or placed. F) If the child was injured, interview the physician who treated the injury if other than reporter/source. G) In person or phone interview with law enforcement, if police have had contact on current report. This contact is to help establish the need to move to formal investigation phase. H) Interview DCFS or private agency caseworker if a service case is currently open. I) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. Allegation: Tying/Close Confinement (3)

92 J) Interview alleged perpetrator either in person or by phone. K) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). L) Waiver of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP determination is unsafe ; or ii) there is a determination that the child victim has been tied to a fixed or heavy object, had limbs tied together, or has been closely confined and there is reasonable cause to suspect that the actions were taken by an eligible caretaker; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged perpetrator. C) In person, individual interview with all other adults and verbal child members of victim s household. Non-verbal children must be observed. D) Interview physician who observed current injuries (if any). E) Interview all identified witnesses who are reported to have knowledge of the incident. F) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person). G) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. H) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. Allegation: Tying/Close Confinement (4)

93 I) Interview primary care physician or physician who has seen child in past six months. J) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. K) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the child victim receives an immediate medical exam if evidence exists the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and relevant past treatment. C) Expert opinion to match injuries/psychological damage with a potential cause (etiology) if nature of the harm is unknown or contested. D) Consultation with physicians to assess appropriateness of additional medical tests that may be necessary to determine extent and possible consequences of maltreatment. E) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding the cause of the injury; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with a supervisor and, based on the totality of the information gathered, the CPSW is unable to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney Notification and Involvement A) Law enforcement and the State s Attorney shall be notified if protective custody is taken, or the alleged perpetrator is a paramour. B) The State s Attorney shall be notified if the report constitutes second, or more, indicated report of abuse. Allegation: Tying/Close Confinement (5)

94 7) Assessment of Factors to Be Considered to Support Case Finding Not applicable to this allegation. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Tying/Close Confinement (6)

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99 a) DEFINITION Option A REPORTS OF CHILD ABUSE AND NEGLECT SUBSTANCE MISUSE Allegation of Harm #15/65 The consumption of a mood altering chemical, capable of intoxication, to the extent that it affects the child s health, behavior, motor coordination, judgment or intellectual capacity. Mood altering chemicals include cannabis (marijuana), hallucinogens, stimulants (including cocaine), sedatives (including alcohol and Valium), narcotics or inhalants. (ABUSE/NEGLECT) Option B Fetal Alcohol Syndrome or drug withdrawal at birth caused by the mother s addiction to drugs. (NEGLECT) Option C Any amount of a controlled substance or a metabolite thereof, found in the blood, urine or meconium (newborn s first stool) of a newborn infant. A controlled substance is defined in subsection (f) of Section 102 of the Illinois Controlled Substances Act [720 ILCS 570/102]. (NEGLECT) (Options B and C when diagnosed by a physician constitute prima facie of neglect.) b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child has ingested a mood altering substance as the result of abuse or neglect may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the substance misuse resulted from one of the following: A) A direct action of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare by giving mood altering substances to the child; or the child is misusing mood altering substances at the encouragement or insistence of one of the foregoing persons. (ABUSE) Allegation: Substance Misuse (1)

100 B) The failure of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to stop another person from giving mood altering substances to the child. (ABUSE) C) Blatant disregard of parental (or other person responsible for the child s welfare) responsibilities which resulted in the child s substance misuse. This includes the failure of the parent or caregiver to take reasonable actions to prevent the child from misusing mood altering substances. (NEGLECT) D) Blatant disregard of parental responsibilities which resulted in the child s Fetal Alcohol Syndrome or drug withdrawal at birth. (NEGLECT) E) Blatant disregard of parental responsibilities which resulted in any amount of a controlled substance or a metabolite thereof, found in the blood, urine or meconium of a newborn infant. (NEGLECT) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Option A Documented evidence that a child has consumed mood-altering chemicals that were provided by their parent or caretaker, or taken at the encouragement or insistence of one of the foregoing persons. Results of Factors to Be Considered must be incorporated in the decision. The provision of any of the substances identified in the allegation definition by a person other than the child s parent should be indicative of abuse/neglect. (Note: The consumption of alcohol at religious ceremonies or at family gatherings/celebrations under the direct auspices of the parent does not constitute abuse/neglect unless the consumption leads to intoxication.) Secure evidence that the substance misuse as defined in Option A is a direct result of some action by an eligible perpetrator (abuse), the failure of a caretaker to stop another person from giving a mood altering substance to a child (abuse), or the blatant disregard of a harmful situation which results in a substance abuse (neglect). B) Option B Medical diagnosis that the child is born suffering from Fetal Alcohol Syndrome or drug withdrawal prima facie evidence of neglect. Allegation: Substance Misuse (2)

101 C) Option C Medical diagnosis, using a confirmatory test, that a controlled substance or a metabolite thereof, was found in the blood, urine or meconium (newborn s first stool) of a newborn infant prima facie evidence of neglect. D) Secure evidence that alleged perpetrator meets eligibility criteria of being a caretaker as defined in Appendix B-P300 (6). E) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review police report when it is received to ensure findings do not conflict with previously documented information received verbally. F) If multiple possible perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. 2) Initial Investigation Requirements A) Data check, LEADS check, and Soundex of members of the family, and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) For Options B and C, medical professionals with knowledge of the child s condition must be interviewed if different from the reporter/source. E) In person, individual interview with alleged child victim(s), assessment of physical injury including photographs or body chart, and completion of CERAP. F) For Options B and C, observation of environment where maltreatment occurred. G) In person or phone interview with Law Enforcement, if the report was first investigated by police. This contact is to help establish the need to move to formal investigation phase. H) Interview DCFS or private agency caseworker if a service case is currently open. I) In person, individual interview with parents/caretakers. Parents should be contacted as soon as possible following contact with child victim. Allegation: Substance Misuse (3)

102 If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. J) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). K) Waiver of any of the above contacts must be given by the supervisor and documented on the SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP determination is unsafe, or ii) there is reasonable cause to suspect that the child victim has consumed a mood-altering chemical, was born with fetal alcohol syndrome or in drug withdrawal, or was born with a controlled substance in their system; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. Note: The CPSW shall give the parents of an involved infant a copy of Back to Sleep and ensure that the infant has a crib or bassinette with a firm mattress. B) In person, individual interview with alleged perpetrator. C) In person, individual interview with all other adults and verbal child members of victim s household. Non-verbal children must be observed. D) For Option A, observation of environment where maltreatment occurred. E) Interview with all identified witnesses who are reported to have knowledge of the incident. F) When the family or subjects identify two or more possible collateral contacts, at least two must be interviewed by phone or in person. Allegation: Substance Misuse (4)

103 G) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. H) When there are other school age children in the home, interview school personnel who have first hand knowledge of the level of parental care provided to those children. I) If applicable, interview child care provider who has knowledge of the child and/or level of care provided to the child. J) Interview the child s primary care physician or the physician who has seen child within the past six months. K) Interview child protective services in other states where family members have resided during the previous five years. When a history of maltreatment is uncovered, attempts must be made to gather abuse and/or neglect case history information for an additional five years. L) Waiver of any of the above contacts must be given by the supervisor and documented on the SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the child receives an immediate medical examination if evidence exists that he child is in need of urgent medical care. B) Medical records including relevant results of drug screening and confirmatory tests as well as documentation to determine if medical attention has been sought in the past for drug abuse/treatment. Confirmation must be obtained from the physician treating the child when parent states that the substance was provided to child as directed by a physician. D) Expert opinion as to findings of drug testing. Information may be necessary to determine if substance is present due to the fact it is a metabolite of a prescribed medication or there is evidence the screen is a false positive. E) Consultation with physicians to assess appropriateness of additional drug screening or testing. F) A second opinion is required when: i) The treating physicians are unable or unwilling to offer an opinion regarding the presence of a substance or substances in the child s or parents system. ii) There are conflicting opinions among treating physicians; Allegation: Substance Misuse (5)

104 iii) The case has been staffed with a supervisor and based on the totality of the information gathered the CPSW is unable to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney Notification and Involvement A) Law enforcement and the State s Attorney shall be notified if protective custody is taken, or the alleged perpetrator is a paramour. B) Notify State s Attorney if the report constitutes second, or more, indicated report of abuse. 7) Assessment of Factors to Be Considered to Support Case Finding The following factors must be considered when making a case finding: A) The age of the child. B) The frequency of misuse. C) The amount of substance consumed. D) Is the substance illegal for general population use? E) The degree of behavioral dysfunction, or physical impairment linked to substance use. F) The child s culture, particularly as it relates to use of alcohol in religious ceremonies or on special occasions. G) Whether the parent s or caretaker s attempts to control an older child s substance misuse or to seek help for the child s substance misuse were reasonable under the circumstances. H) Whether the parent or caretaker knew or should have known of the child s substance abuse. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of the investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Substance Misuse (6)

105 DEPARTMENT OF CHILDREN AND FAMILY SERVICES Distribution: X & Z POLICY GUIDE Substance Affected Infants DATE: October 15, 2001 TO: FROM: EFFECTIVE: Rules and Procedures Book Holders, Child Welfare and Child Protective Staff Jess McDonald Immediately I. PURPOSE The purpose of this Policy Guide is to establish guidelines governing the investigation of reports of neglect involving substance affected infants and the provision of services to such infants and their families. II. PRIMARY USERS The primary users of this Policy Guide are child abuse and neglect investigative staff and child welfare follow-up staff. III. DEFINITIONS Controlled substances means those substances defined in subsection (f) of the Illinois Controlled Substances Act [720 ILCS 570/102] and includes such drugs as heroin, cocaine, morphine, peyote, LSD, PCP, pentazocine, and methaqualone. Marijuana, hashish, and other derivatives of the plant cannabis sativa are not controlled substances.

106 Substance affected infants means infants who are born with controlled substances in their system or who have been diagnosed with fetal alcohol syndrome. IV. BACKGROUND Current Department policy does not require the mandatory provision of services to substance affected infants and their families when a report is indicated, fetal alcohol syndrome or the presence of controlled substances in the blood, urine, or meconium of the infant is the only allegation present, and temporary protective custody of the substance affected infants has not been taken. However, statistics indicate that nearly one-third of substance affected infants will be neglected within the first year of their lives. Therefore, a more aggressive approach will be taken by the Department in the investigation, assessment, and provision of services to families with an indicated report involving infants who are born with fetal alcohol syndrome or controlled substances in their systems. V. PROCEDURES FOR CHILD PROTECTIVE INVESTIGATORS Effective immediately, when investigators indicate reports involving substance affected infants, they shall: a) conduct a thorough risk assessment (CFS 1440, Family Assessment Factor Work Sheet), which shall include an on-site assessment of the environment in which the infant will be living and an assessment of the caretaker and other adults or children residing with the caretaker, and other persons who will be frequent visitors to the environment; and b) take temporary protective custody and open a child welfare case if risk factors are present that place the child in imminent danger to the child s life or health; or c) open a child welfare case even if temporary protective custody is not taken and refer the case to child welfare staff for a comprehensive assessment as described in Administrative Procedures # 5, Child Welfare Case Record Organization and Uniform Recording Requirements, dated January 1, VI. PROCEDURES FOR CHILD WELFARE (FOLLOW-UP) STAFF Child welfare staff, upon receiving referrals involving substance affected infants shall: a) refer the parents to a treatment agency licensed by the Department of Alcohol and Substance Abuse for an assessment to determine whether they have an alcohol or other drug abuse problem and need treatment; and b) complete a client service plan (CFS 497 series) which describes the monitoring and service activities for the family, the treatment plan for the parent and other substance involved persons in the home, and the medical plan for the infant, even when the child has not been placed; and c) provide services as dictated by the assessment and service plan. 2

107 Family Refuses Services, No Imminent Risk of Harm - If the family is unwilling to accept the services described in the plan, but will allow the Department to monitor the family and the worker has determined that the child is not at imminent risk of harm because of the refusal to accept the services offered, the case shall be monitored for at least six months. Monitoring means a minimum of twice monthly face to face contacts with the infant and family, and verification that appropriate medical care is being provided to the child. The supervisor may determine, based on the circumstances present, that only monthly contact is required but the reasons for this decision must be documented on the CFS 492. Intact family cases that are being monitored may be closed after six months if it has been verified through random urinalysis testing conducted by a drug treatment professional that the parent and other members of the household are not using controlled substances and are not longer abusing alcohol. Family Refuses Services, Child in Imminent Risk of Harm If the family s refusal to accept services creates imminent risk to the child s health or safety, for example continued drug or alcohol usage by the parent or others in the household which places the child at imminent risk of harm, violent behavior, denial of access to the child for monitoring to ensure the child s safety, failure to use an apnea monitor necessary for the child s health and protection, etc., then the worker shall immediately report the incident to the State Central Register (SCR), requesting that investigative staff take temporary protective custody of the child. VII. QUESTIONS Questions regarding this Policy Guide can be referred to the Office of Child and Family Policy. VIII. FILING INSTRUCTIONS This Policy Guide replaces Policy Guide Child protective staff shall file this Policy Guide immediately following allegation #15/65, Substance Misuse, which is located in Appendix B of Procedures 300, Reports of Child Abuse and Neglect. Child welfare staff shall file this Policy Guide immediately after Subpart B of Procedures 302, Services Delivered by the Department. Remove and dispose of Policy Guide

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109 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT TORTURE Allegation of Harm #16 Inflicting or subjecting the child to intense physical and/or mental pain, suffering or agony that is either repetitive, increased and/or prolonged. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child has been tortured may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the torture resulted from one of the following: A) A direct action of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop another person from torturing the child. (ABUSE) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Verifiable documented evidence that the child victim exhibits signs of intense physical and /or mental pain, suffering, or agony, that are the result of actions by a caretaker that were repetitive, increased, or prolonged. Including a clear and concise description of the caretaker s actions. B) Evidence to support judgment that the identified injuries and/or conditions were the result of torturous act/s. C) Evidence that the act(s) was deliberately and intentionally inflicted by an eligible perpetrator or the caretaker s failure to make reasonable efforts to stop another person from torturing the child. Allegation: Torture (1)

110 D) Secure evidence that alleged perpetrator meets criteria as defined in Appendix B of Procedures 300. E) Verify the typology of the injury or condition including the exact location, type and age of injury or condition, and pattern if multiple injuries or conditions are present. F) Identify possible/plausible etiology (cause) based on available information. G) Document parent/caretaker and child s explanation including scene observation and mock demonstration. H) Carefully document child s statement. I) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review police reports when they are received to ensure findings do not conflict with previously documented information received verbally. J) If multiple possible perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. K) Use other professionals to help match injury with explanation. L) If physical injury has occurred as a result of unusual and/or cruel treatment the appropriate allegation must also be identified and investigated. 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of the physical injury including photographs or body chart, and completion of CERAP. E) Observation of environment where maltreatment occurred. F) Interview physician who treated current injury if other than reporter/source. Allegation: Torture (2)

111 G) In person or phone interview with law enforcement, if police have had contact on current report. This contact is to help establish the need to move to formal investigation phase. H) Interview DCFS or private agency caseworker if a service case is currently open. I) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. J) Interview alleged perpetrator either in person or by phone. K) Notify Guardian ad litem if alleged child victim is DCFS ward or ward of the court (e.g., a child home with a parent under an order of protection). L) Waiver of any of the above contacts must be given by the Child Protection Manager and must be documented on the SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a reasonable cause to suspect that the child victim has been deliberately and/or systematically subjected to cruel or unusual punishment; and iii) the alleged victim is under the age of 18. B) The allegation cannot unfounded at the Initial Investigation without medical consultation if the child has any injury related to the allegation. C) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. The use of corporal punishment in and of itself does not constitute the basis for investigation. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged perpetrator. Allegation: Torture (3)

112 C) In person, individual interview with all other adults and verbal child members of the victim s household. Non-verbal children must be observed. D) Interview the physician who made current diagnosis of physical or mental suffering. E) Interview all identified witnesses who are reported to have knowledge of the incident. F) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. G) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. H) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. I) Interview primary care physician or physician who has seen child in past six months. J) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. K) Waiver of any of the above contacts must be given by the Child Protection Manager and must be documented on the SACWIS Case Note. 5) Required Medical Information and/or Consultations A) Immediate referral if worker believes the child is in immediate need of medical care. B) Children who report or present with signs of physical or mental suffering as a result of torturous acts must be examined by a physician. This requirement can only be waived by the DCP Manager. C) Medical records of current treatment/diagnosis and relevant past treatment. D) Expert opinion to match physical or mental condition with a potential cause (etiology) if nature of the injury is unknown or contested. E) Consultation with physicians to assess appropriateness of long bone scans to identify any possible past maltreatment. If the torture was Allegation: Torture (4)

113 particularly violent, a recommendation should be made to the treating physician to do long bone scans. F) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding whether or not abuse occurred; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with a supervisor and based on the totality of the of information gathered the CPSW is unable to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney Involvement or Notification A) It is mandatory that the State s Attorney and law enforcement be notified at the time of the report. B) Investigations must be coordinated with the Child Advocacy Centers in areas served by a center, if the center is willing to work with this allegation. C) Notify State s Attorney upon receipt of report. 7) Assessment of Factors to Be Considered to Support Case Finding Not applicable to this allegation. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under and order of protection). Allegation: Torture (5)

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115 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT MENTAL AND EMOTIONAL IMPAIRMENT Allegation of Harm #17/67 Injury to the intellectual, emotional or psychological development of a child as evidenced by observable and substantial impairment in the child s ability to function within a normal range of performance and behavior, with due regard to his or her culture. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage A psychiatrist, registered psychologist, medical doctor, registered nurse, certified social worker, school teacher or a therapist or counselor employed in a community mental health agency or social service agency who has reason to believe that a child has sustained mental injury as the result of abuse or neglect may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the mental injury resulted from the following: A) a non-accidental physical injury or threat of injury by the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) the blatant disregard of parental (or other person responsible for the child s welfare) responsibilities in providing the proper or necessary support or other care necessary for the child s well being. (NEGLECT) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Secure verification that a child has suffered observable and substantial impairment to their ability to function within a normal range of performance or behavior due to injury to the intellectual, emotional, or psychological development. B) Verification must come from a psychiatrist, registered psychologist, medical doctor, registered nurse, certified social worker or a therapist or counselor employed by a community mental health agency. Allegation: Mental and Emotional Impairment (1)

116 C) Specific identification and documentation of parental action or behavior, which caused the mental injury (abuse), or the blatant disregard of parental responsibilities which led to mental injury (neglect). D) Identify and document the causal link between the child s mental injury and the action, behavior or blatant disregard exhibited by the parent/caretaker (e.g. the child s impairment must be directly related to the parent s action). E) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the condition have been obtained. F) All other required contacts made, or documentation as to why if they were not made. G) Consults have been obtained as required. H) Apply and document the application of the Factors to Be Considered. Each factor should be assessed as to its relevance to the specific case and that assessment should be documented on a SACWIS Case Note or other form designed for this purpose. I) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family, and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of physical injury including photographs or body chart, and completion of CERAP. E) Interview professional who treated identified the child s mental injury if different than reporter/source. F) Interview DCFS or private agency caseworker if a service case is currently open. G) In person, individual interview parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed Allegation: Mental and Emotional Impairment (2)

117 immediately to ensure the child s safety, and the formal investigation must be commenced. H) Interview alleged perpetrator either in person or by phone. I) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). J) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is reasonable cause to suspect that the child victim has a documented mental injury which may be the result of some action (ABUSE) or failure to protect (NEGLECT) by the parent/caretaker; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged perpetrator. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview all identified witnesses who are reported to have knowledge of the incident. F) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. G) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. Allegation: Mental and Emotional Impairment (3)

118 H) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. I) Interview primary care physician or physician who has seen child in past six months. J) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. K) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Documentation and/or Consultations A) The worker must ensure that the child receives an immediate medical exam if evidence exists the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and relevant past treatment. C) Expert opinion that child has suffered a mental injury as well as the suspected cause of the injury. It is necessary to document a causal relationship between the action of the caretaker and the resultant behavior of a child. D) A second medical opinion must be obtained when: i) the treating physician/therapist is/are unable or unwilling to offer an opinion regarding the likelihood that condition was caused by abuse/neglect; or ii) iii) there are conflicting opinions among treating practitioners; or the case has been staffed with the supervisor and based on the totality of information gathered; the CPSW is not yet able to make a well supported finding. Note: The opinion of the physician/therapist with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney Involvement or Notification A) Law enforcement and State s Attorney shall be notified if protective custody is taken, or the alleged perpetrator is a paramour. B) Notify the State s Attorney if the report constitutes a second, or more, indicated report of abuse. Allegation: Mental and Emotional Impairment (4)

119 7) Assessment of Factors to Be Considered to Support Case Finding Not Applicable to this allegation. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Mental and Emotional Impairment (5)

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121 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT SEXUALLY TRANSMITTED DISEASES Allegation of Harm #18 A disease which was acquired originally as a result of sexual penetration or sexual conduct with an individual who is afflicted with the disease. The diseases may include, but are not limited to: Acquired Immune Deficiency Syndrome (AIDS) AIDS Related Complex (ARC) Balanoposthitis Calymmatobacterium Granulomatis Chancroid Chlamydia Trachomatis Genital Herpes Genital Warts Gonorrhea Granuloma Inquinale Haemophilus Ducreyi HIV Infection Lymphorganuloma Venereum Neisseria Gonorrhea Nonspecific Urethritis Proctitis Syphilis Treponema Pallidum Trichomonas Vaginalis (Symptomatic) Sexual penetration is defined in the Act as any contact, however slight, between the sex organ or anus of one person by an object, sex organ, mouth or anus of another person, or any intrusion, however slight, of any part of the body of one person or any animal or object into the sex organ or anus of another person, including but not limited to cunnilingus, fellatio or anal penetration. Sexual conduct is defined in the Act as any intentional or knowing touching or fondling of the victim or the perpetrator, either directly or through clothing of the sex organs, anus or breast of the victim or the accused, or any part of the body of a child for the purpose of sexual gratification or arousal of the victim or the accused. Appendix B Procedures300 Allegation: Sexually Transmitted Diseases (1)

122 b) TAKING A REPORT REPORTS OF CHILD ABUSE AND NEGLECT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child has contracted a disease that has been transmitted sexually as the result of abuse may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the disease was contracted as the result of one of the following: A) The person from whom the child contracted the disease was a parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in the child contracting the disease. (ABUSE) C) The alleged perpetrator is unknown and the available information does not rule out one of the above persons. (ABUSE) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Verify that the child has a sexually transmitted disease as a result of sexual penetration or sexual contact with a parent/caretaker, as a result of the parents parent s failure to make reasonable efforts to stop the action of another person or the alleged perpetrator is unknown and the available information does not rule out one of the above persons. B) Identify and document possible/plausible etiology (cause) based on available information. Document parent/caretaker explanation as to how child contracted the disease. Use other professionals to help match disease with explanation. C) Acquire medical documentation that the parent or caretaker currently has or has recently been treated for the sexually transmitted disease. D) Document evidence related to the sexual act/abuse that lead to the transmission of the disease. Appendix B Procedures300 Allegation: Sexually Transmitted Diseases (2)

123 E) Secure evidence that alleged perpetrator meets the eligibility criteria as defined in Appendix B-P300. F) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. G) If multiple possible perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. H) The appropriate sexual abuse allegation (penetration and/or molestation) should also be indicated if the sexually transmitted disease allegation is indicated. 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of members of the family, and other subjects frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of the physical injury and completion of CERAP. Note: CPSW should not interview victim if case is victim sensitive interview (VSI) eligible per local protocol. A VSI should be arranged ASAP. If the victim is unsafe, per CERAP, every attempt must be made to arrange an emergency VSI. E) Interview physician who treated current injury if other than reporter/source. F) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with the child victim if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety. G) Interview alleged perpetrator either in person or by phone, if necessary for immediate safety planning. CPSW should consult with Law Enforcement prior to interview to avoid compromising the investigation. H) Interview DCFS or private agency caseworker if a service case is currently open. Appendix B Procedures300 Allegation: Sexually Transmitted Diseases (3)

124 I) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). J) Waiver of any of the above contacts must be given by the supervisor and documented on the SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a determination that the child victim has a sexually transmitted disease and there is reasonable cause to suspect the victim contracted the disease through sexual contact with an eligible perpetrator as defined by Procedures 300 (abuse) or the parent/caretaker failed to make reasonable efforts to protect the child from contracting the sexually transmitted disease from another person; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made and within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged perpetrator. C) In person, individual interview with all other adults and verbal child members of victim s household. Non-verbal children must be observed. D) Observation of environment where maltreatment occurred. E) Interview physician and /or other medical personnel (including paramedics/ambulance personnel, if child has been seen as a result of current situation. F) Interview law enforcement personnel involved in criminal investigation. G) Interview DCFS or private agency caseworker if a service case is currently closed but has been open in the past. Review all previous reports and case files. Appendix B Procedures300 Allegation: Sexually Transmitted Diseases (4)

125 H) Interview all identified witnesses who are reported to have knowledge of the incident. I) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. J) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. K) Interview primary care physician or physician who has seen child in past six months. L) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. M) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) Medical examination is required. B) Reports of attending physician regarding the type of sexually transmitted disease that afflicts the child. C) Medical records which documents the presence of the disease in the alleged perpetrator. D) Second opinion by physician if questions arise regarding the etiology of the transmission of the sexually transmitted disease. 6) Law Enforcement/State s Attorney Involvement or Notification A) Every effort should be made to coordinate investigative activities with local law enforcement officials, at a minimum local authorities must be notified. B) If available, use resources of Child Advocacy Centers. C) Notify the State s Attorney upon receipt of report. D) Notify the Illinois State Police at the time of report. 7) Assessment of Factors to Be Considered to Support Case Finding Not applicable to this allegation. Appendix B Procedures300 Allegation: Sexually Transmitted Diseases (5)

126 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Appendix B Procedures300 Allegation: Sexually Transmitted Diseases (6)

127 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT SEXUAL PENETRATON Allegation of Harm #19 Any contact, however slight, between the sex organ or anus of one person by an object, sex organ, mouth or anus of another person, or any intrusion, however slight, of any part of the body of one person or any animal or object into the sex organ or anus of another person. This includes acts commonly known as oral sex (cunnilingus, fellatio), anal penetration, coition, coitus and copulation. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child has been involved in sexual penetration as the result of abuse may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the sexual penetration resulted from one of the following: A) The person who had sexual penetration with the child was a parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in sexual penetration. (ABUSE) C) The alleged perpetrator is unknown and the available information does not rule out one of the above persons. (ABUSE) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Detailed victim statement alleging sexual penetration. If a Victim Sensitive Interview was conducted, the documentation should include copies of the notes taken at the interview, or a copy of the interview summary provided by the Advocacy Center. Note penetration definition, which only requires contact not actual insertion. Allegation: Sexual Penetration (1)

128 B) Secure evidence that the victim was sexually penetrated by an eligible perpetrator (abuse), the failure of a caretaker to stop the action of another person that results in penetration (abuse) C) Verify the typology of the incident documenting the type and extent of sexual conduct (digital manipulation, vaginal vs. anal penetration, oral sex). D) Document any physical injuries that were a result of the penetration by securing medical records. E) If physical evidence is unavailable, investigator should document a basic consistency between statements and outcries and supporting information (corroboration) regarding time(s), place, physical descriptions, and whereabouts of others living at address at time of occurrence. F) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. G) If multiple perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. H) Detailed documentation of perpetrator s statement. I) Scene observation and demonstration with anatomically correct dolls may provide valuable collaboration to statements provided by victim or alleged perpetrator. J) If behavioral/emotional problems are used as corroboration, statement from clinician regarding correlation. K) Every effort must be made to assess credibility of all subjects involved in the investigation. L) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. Allegation: Sexual Penetration (2)

129 C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of the physical injury and completion of CERAP. Note: CPSW should not interview victim if case is victim sensitive interview (VSI) eligible per local protocol. A VSI should be arranged ASAP. If the victim is unsafe, per CERAP, every attempt must be made to arrange an emergency VSI. E) Interview physician who treated current injury if other than reporter/source. F) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with the child victim if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation commenced. G) Interview alleged perpetrator either in person or by phone. If there is a need to contact alleged perpetrator for immediate safety planning, CPSW should advise and consult Law Enforcement prior to making this contact to avoid compromising the investigation. H) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). I) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a determination that the child victim alleges sexual penetration and there is reasonable cause to suspect that the victim was penetrated by an eligible perpetrator as defined by Procedures 300 (abuse) or the parent/caretaker failed to make reasonable efforts to stop the penetration by another person; and ii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. Allegation: Sexual Penetration (3)

130 C) The allegation cannot be unfounded at the initial investigation without medical consultation if the child has any injury related to the allegation. 4) Requirements for Formal Investigation A) In person, individual interview with child victim, if not interviewed during the initial investigation per the VSI protocol. B) In person, individual interview with parents/caretakers. C) In person, individual interview with alleged perpetrator. D) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. E) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. F) Observation of environment where maltreatment occurred. G) Interview any other outcry witnesses. H) Interview all those residing at the Address of Occurrence, at the time of incident(s) including observation of physical location. I) Interview any witnesses offered by alleged perpetrator that may provide an alibi. J) Interview physician who completed sexual abuse exam. K) Interview law enforcement Investigator involved in current criminal investigation. L) Interview all identified witnesses who are reported to have knowledge of the incident. M) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. N) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. O) Interview the therapist or any other professionals who have knowledge of the incident. P) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. Allegation: Sexual Penetration (4)

131 Q) Interview primary care physician or physician who has seen child in past six months. R) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. S) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Documentation and/or Consultations A) The worker must ensure that the child receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) Sexual abuse examination is required if child makes statement that any item was actually inserted in the vagina and/or rectum. C) Medical records of current treatment/diagnosis and relevant past treatment. D) Interview a DCFS registered nurse, if they had prior involvement. E) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding the likelihood of penetration as a result of abuse; or ii) iii) there are conflicting opinions among treating physicians; or The case has been staffed with a supervisor and, based on the totality of the information gathered; the CPSW is unable to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. F) Additional clinical consultation may be sought if the victim recants during the investigation, or if the victim s ability to make a statement is impaired due to emotional developmental, behavioral problems, etc. 6) Law Enforcement/State s Attorney Involvement or Notification A) Law enforcement and the State s Attorney shall be notified within 24 hours after receipt of the report. B) Where available, these investigations must be conducted under the auspices of the local Child Advocacy Centers. Allegation: Sexual Penetration (5)

132 C) DCFS and local law enforcement should cooperate in conducting investigations. 7) Assessment of Factors to Be Considered to Support Case Finding Not applicable to this allegation. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Sexual Penetration (6)

133 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT SEXUAL EXPLOITATION Allegation of Harm #20 Sexual use of a child for sexual arousal, gratification, advantage, or profit. This includes, but is not limited to: Indecent solicitation of a child/explicit verbal enticement; Child pornography; Exposing sexual organs to a child for the purpose of sexual arousal, or gratification; Forcing the child to watch sexual acts; or Self-masturbation in the child s presence. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child was sexually exploited as a result of abuse may be the reporter or source of the CA/N report. The reporter/source has reason to believe that the sexual exploitation resulted from one of the following: A) The person who sexually exploited the child was a parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caretaker, immediate family member, other person residing in the home, parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop another person from sexually exploiting the child. (ABUSE) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Victim statement alleging sexual exploitation. Note exploitation definition, which requires documentation that the sexual use of a child was for purposes of sexual arousal, gratification, advantage, or profit. Documentation of victim statement should include the copies of the Allegation: Sexual Exploitation (1)

134 notes taken during the Victim Sensitive Interview, or an interview summary provided by the Advocacy Center. B) Secure evidence that the victim was sexually exploited by an eligible perpetrator (abuse), or the parent/caretaker failed to stop the action of another person that resulted in exploitation (ABUSE). C) Document the typology of the incident stating the type and extent of sexual conduct (e.g. what was said and context, what was viewed, and circumstances, details of exposure, etc.). D) If physical evidence is unavailable, investigator should document a basic consistency between statements and outcries and supporting information (corroboration) regarding time(s), place, physical descriptions, and whereabouts of others living at the address at time of occurrence, etc. E) Detailed documentation of perpetrator s statement. F) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. G) If multiple perpetrators are identified, circumstantial evidence that identifies the most likely perpetrator. H) Scene observation and demonstration with anatomically correct dolls may provide valuable collaboration to statements provided by victim or alleged perpetrator. I) If behavioral/emotional problems are used as corroboration, statement from clinician regarding correlation. J) Every effort must be made to assess credibility of all subjects involved in the investigation. K) A waiver for any of the above must be given by the supervisor and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. Allegation: Sexual Exploitation (2)

135 C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of the physical injury and completion of CERAP. Note: CPSW should not interview Victim if case is Victim Sensitive Interview (VSI) eligible per local protocol. A VSI should be scheduled ASAP. If the victim is unsafe per CERAP, every effort should be made to arrange an emergency VSI. E) Interview physician involved if other than reporter/source. F) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with the child victim if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. G) In person or phone interview with law enforcement, if police have had contact on current report. This contact is to help establish the need to move to formal investigation phase. H) Interview alleged perpetrator either in person or by phone, if necessary for immediate safety planning. CPSW should consult with Law Enforcement prior to interview to avoid compromising the investigation. I) Notify Guardian ad Litem if alleged child victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). J) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a determination that the child victim alleges sexual exploitation, and/or there is reasonable cause to suspect that the victim was exploited by an eligible perpetrator, as defined by Procedure 300 (ABUSE) or the parent/caretaker failed to make reasonable efforts to stop the exploitation by another person; and iii) the alleged victim is under the age of 18. Allegation: Sexual Exploitation (3)

136 B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with child victim, if victim was not interviewed during the initial investigation per the VSI protocol. B) In person, individual interview with parents/caretakers. C) In person, individual interview with alleged perpetrator, after consultation with law enforcement. D) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. E) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. F) Interview any other outcry witnesses. G) Interview all those residing at the Address of Occurrence, at the time of incident(s) including observation of physical location. H) Interview any witness offered by alleged perpetrator who may offer an alibi. I) Interview physician who completed sexual abuse exam, if done. J) Interview the law enforcement investigator involved in the criminal investigation. K) Interview all identified witnesses who are reported to have knowledge of the incident. L) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. M) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. N) Interview therapist or any other professionals who have knowledge of the incident. O) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. Allegation: Sexual Exploitation (4)

137 P) Interview primary care physician or physician who has seen child in past six months. Q) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. R) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Documentation and/or Consultations A) The worker must ensure that the child receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) Sexual abuse exam is required if information obtained suggests other sexual abuse. C) Medical records of current treatment/diagnosis and relevant past treatment. D) Interview a DCFS registered nurse, if they had prior involvement. E) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding whether or not abuse occurred; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with a supervisor and, based on the totality of the information gathered, the CPSW is unable to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. F) Additional clinical consultation may be sought if the victim recants during the investigation, or if the victim s ability to make a statement is impaired due to emotional developmental, behavioral problems, etc. 6) Law Enforcement/State s Attorney Involvement or Notification A) Law enforcement and the State s Attorney shall be notified within 24 hours after receipt of the report. B) Where available, these investigations must be conducted under the auspices of the local Child Advocacy Centers. Allegation: Sexual Exploitation (5)

138 C) DCFS and local law enforcement should cooperate in conducting investigations. 7) Assessment of Factors to Be Considered to Support Case Finding Not Applicable 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Sexual Exploitation (6)

139 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT SEXUAL MOLESTATION Allegation: Sexual Molestation (1) Allegation of Harm #21 Sexual conduct with a child, when such contact, touching, or interaction is used for arousal, or gratification, of sexual needs or desires. Parts of the body as used in the examples below refer to the parts of the body described in the definition of sexual conduct found in the Illinois Criminal Sexual Assault Act as quoted in Allegation 18, Sexually Transmitted Diseases. Examples include, but are not limited to: Fondling The alleged perpetrator inappropriately touching or pinching of the child s body generally associated with sexual activity. Encouraging, forcing, or permitting the child to touch parts of the alleged perpetrator s body normally associated with sexual activity. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child was sexually molested as a result of abuse may be the reporter or source of the CA/N report. The reporter/source has reason to believe that the sexual molestation resulted from one of the following: A) The person who sexually molested the child was a parent, caretaker, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caretaker, immediate family member, other person residing in the home, parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop another person from sexually molesting the child. (ABUSE) c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Victim s statement alleging sexual molestation. Note molestation definition, which requires documentation that the molestation was for purposes of sexual arousal, or gratification. Documentation of victim

140 statement should include the copies of the notes taken during the VSI, or an interview summary provided by the Advocacy Center. B) Secure evidence that the victim was sexually molested by an eligible perpetrator (ABUSE), or the parent/caretaker failed to stop the action of another person, which resulted in molestation (ABUSE) C) Documentation the typology of the incident stating the type and extent of sexual conduct (who touched whom, where, if articles of clothing were removed, how long touching occurred, what if anything was said, etc.). D) If physical evidence is unavailable, investigator should document a basic consistency between statements and outcries and supporting information (corroboration) regarding time(s), place, physical descriptions, and whereabouts of others living at address at time of occurrence. E) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements and other information available to the police. The supervisor must review police report when it is received to ensure findings do not conflict with previously documented information received verbally. F) If multiple perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. G) Detailed documentation of perpetrator s statement. H) Scene observation and demonstration with anatomically correct dolls may provide valuable collaboration to statements provided by victim or alleged perpetrator. I) If behavioral/emotional problems are used as corroboration, statement from clinician regarding correlation. J) Every effort must be made to assess credibility of all subjects involved in the investigation. K) A waiver of the above requirements must be given by the supervisor and documented on a SACWIS Case Note. L) Medical findings that sexual abuse has more than likely occurred. (nonverbal children) Allegation: Sexual Molestation (2)

141 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Contact with reporter, source and OPWI identified in the current report or related information. D) Individual, in person interview with alleged child victim(s), assessment of the physical injury and completion of CERAP. Note: CPSW should not interview Victim if case is Victim Sensitive Interview (VSI) eligible per local protocol. A VSI should be scheduled ASAP. If the victim is unsafe per CERAP, every effort should be made to arrange an emergency VSI. E) Contact physician involved if other than reporter/source. F) Contact parents by phone or in person. Parents should be contacted on the same day as contact with the child victim if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety. G) Contact law enforcement. H) Contact alleged perpetrator either in person or by phone, if necessary for safety planning, or the case is being initially unfounded. If neither applies, CPSW should consult with Law Enforcement prior to making this contact. I) Notify Guardian ad Litem if alleged child victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). J) Waiver of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a determination that the child victim alleges sexual molestation, and there is reasonable cause to believe that the victim was molested by an eligible perpetrator, as defined by Procedure 300 (ABUSE) or the parent/caretaker failed to make Allegation: Sexual Molestation (3)

142 reasonable efforts to stop the molestation by another person; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Required Formal Investigation Interviews A) Victim, in person, if not interviewed during the initial investigation per VSI protocol. B) Parents/Caretakers (in person). C) Alleged Perpetrator (in person), after consultation with Law Enforcement. D) Law enforcement investigator. E) All other adults and verbal children of the victim s household, individually and in person. Non-verbal children must be observed. F) All other adults and verbal children of the perpetrator s household, individually and in person. Non-verbal children must be observed. G) Any other outcry witnesses. H) All those residing at the Address of Occurrence, at the time of incident(s) including observation of physical location. I) Alibi witness offered by alleged perpetrator. J) Physician who completed sexual abuse examination. K) All identified witnesses who are reported to have knowledge of the incident. L) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. M) DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. N) Therapist or any other professionals who have knowledge of the incident. Allegation: Sexual Molestation (4)

143 O) For children under the age of 12, school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. P) Primary care physician or physician who has seen child in past six months if past history of maltreatment is alleged. Q) Contact child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. R) Waiver of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Medical Documentation/Consultation Needed A) The worker must ensure that the child receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) A sexual abuse examination is required if the child makes a statement that any item was actually inserted in the vagina and/or rectum. C) Medical records of current treatment/diagnosis and relevant past treatment. D) Contact with a DCFS registered nurse, if they had prior involvement. E) A second opinion is required when: i) the treating physicians are unable or unwilling to offer an opinion regarding whether or not abuse occurred; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with a supervisor and, based on the totality of the information gathered, the CPSW is unable to make a well-supported finding. Note: The physician with the most relevant specialization and experience should be given the greatest regard. F) Additional clinical consultation may be sought if the victim recants during the investigation, or if the victim s ability to make a statement is impaired due to emotional developmental, behavioral problems, etc. Allegation: Sexual Molestation (5)

144 6) Law Enforcement/State s Attorney Involvement or Notification A) Law enforcement and the State s Attorney shall be notified within 24 hours after receipt of the report. B) Where available these investigations must be conducted under the auspices of the local Child Advocacy Centers. C) DCFS and local law enforcement should cooperate in conducting investigations. D) For indicated cases, notify the Guardian ad litem if the victim is a DCFS ward. 7) Assessment of Factors to Be Considered to Support Case Finding Not Applicable 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts who were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Sexual Molestation (6)

145 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT SUBSTANTIAL RISK OF SEXUAL INJURY Allegation of Harm #22 Substantial risk of sexual injury means that the parent, caregiver, immediate family member, other person residing in the home, or the parent s paramour has created a REAL AND SIGNIFICANT DANGER of sexual abuse, in that: Option A An indicated, registered, or convicted sex offender has significant access to children, and the extent/quality of supervision during contact is unknown, or suspected to be deficient. Option B There are siblings or other children in the same household as the alleged offender, or a current allegation of sexual abuse. Option C Persistent, highly sexualized behavior or knowledge in a very young child (e.g. under the age of 5 chronologically or developmentally) that is grossly age inappropriate and there is reasonable cause to believe that the most likely manner in which this was learned is in having been sexually abused. Note: When accepting a report based on behavioral indicators, SCR staff must inform the reporter that this report cannot be indicated unless the victim makes a statement regarding specific sexual abuse or a forensic evaluation or independent clinical consultation results in a clinical finding of sexual abuse. Reports of risk of sexual harm are not to be taken solely on the inappropriate or suggestive behavior of the alleged offender or because there is insufficient information for an allegation of specific sexual abuse, except as defined above. If, during the course of the investigation, a specific allegation of harm is identified, the appropriate allegation shall be added and a determination made on all of the allegations. If another allegation is determined to be more appropriate, that allegation should be utilized and the risk unfounded. Allegation: Substantial Risk of Sexual Injury (1)

146 b) TAKING A REPORT REPORTS OF CHILD ABUSE AND NEGLECT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child is at substantial risk of sexual abuse may be the Reporter/Source of a CA/N report. The Reporter/Source must have reason to believe that the incident/circumstances that create the risk of sexual abuse resulted from the following: A) A direct action of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare. (ABUSE) B) The failure of the parent, caregiver, immediate family member, other person residing in the home, the parent s paramour, or other person responsible for the child s welfare to make reasonable efforts to stop an action by another person which resulted in substantial risk of sexual abuse to the child. (ABUSE) 3) Factors to Be Considered Whether there is real and significant danger is determined by the following factors: A) the child s age; B) the child s medical condition, behavioral, mental or emotional problems, development disability, or physical handicap, particularly as it relates to his or her ability to protect himself or herself; C) the severity of the occurrence; D) the frequency of the occurrence; E) the alleged perpetrator s physical, mental and/or emotional abilities, particularly as it relates to his or her ability to control his or her actions; F) the dynamics of the relationship between the alleged perpetrator and the child; G) the alleged perpetrator s access to the child; H) the previous history of indicated abuse or neglect; I) the current stresses/crisis in the home; and Allegation: Substantial Risk of Sexual Injury (2)

147 J) the presence of other supporting persons in the home. 4) The narrative of the SACWIS Intake Report must document the real and significant danger, which has been identified to justify the taking of the report, a well as the factors that have a bearing on the decision. c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Verification that there was a past indication or conviction of sexual abuse by an eligible perpetrator, and that there has been insufficiently supervised contact with the victim. B) Option A Documentation of statements of any involved law enforcement officials, or clinicians regarding risk to the alleged victims based on history; or C) Option B Verification that the victim is residing in the same household as the victim, or perpetrator of a current allegation of specific sexual abuse, which is being indicated; or D) Option C Statements of witnesses to highly sexualized behavior and obtained an expert opinion, via forensic evaluation, or clinical consultation, that the child s sexualized behavior is diagnostic of past sexual abuse. Note: Without a statement of specific sexual abuse by the victim, this may only be indicated to an unknown perpetrator. E) Specific documentation of application of factors, as it relates to current substantial risk of sexual abuse. F) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review the police report when it is received to ensure findings do not conflict with previously documented information received verbally. G) If multiple perpetrators are identified, circumstantial evidence which identifies the most likely perpetrator. H) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. Allegation: Substantial Risk of Sexual Injury (3)

148 2) Requirements for Initial Investigation A) Data check, LEADS check, and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of the physical injury and completion of CERAP. E) Interview therapist, counselor, or other professionals engaged in child s treatment. F) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with the child victim if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. G) Interview alleged perpetrator either in person or by phone, if necessary for immediate safety planning. CPSW should consult with law enforcement prior to interview to avoid compromising the investigation. H) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). I) Waiver of any of the above contacts must be given by the supervisor and documented on the SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) The CERAP is marked unsafe; or ii) Option A There is verification of the indicated/registered status of the alleged perpetrator, and reasonable cause to suspect there is insufficiently supervised access to children; or iii) Option B There is a current, credible allegation of specific sexual abuse to a child, and reasonable cause to suspect the alleged perpetrator has access to the alleged victims (e.g. children in Allegation: Substantial Risk of Sexual Injury (4)

149 the same household as the alleged victim or perpetrator of the specific sexual abuse); or iv) Option C There is reasonable cause to suspect the alleged victim s sexualized behavior/knowledge may be a result of past sexual abuse; and v) The alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days of the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged perpetrator. C) In person, individual interview with all other adults and verbal children residing in the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children residing in the alleged perpetrator s household. Non-verbal children must be observed. E) Observation of environment where maltreatment occurred. F) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. G) Interview primary care physician or physician who has seen child in past six months. H) Interview child protective services in other states in which the family members have resided in the previous five years. If a history of maltreatment is found, attempts must be made to abuse/neglect history for an additional five years. I) Additional Contacts i) Option A Law enforcement Probation officer Allegation: Substantial Risk of Sexual Injury (5)

150 Past or current treatment providers of alleged perpetrator Provider for any sex offenders evaluation Any alibi witnesses offered by the alleged offender ii) Option B See requirements for specific sex abuse allegation iii) Option C A substantial sample of witnesses to sexualized behavior/knowledge, including those in different settings Current counselor or therapist Physician (if sex abuse examination has been completed) Forensic evaluator (if available, and used) Any person named as a possible offender J) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) Records of sex abuse examination, if completed. B) Records of any psychological evaluations, etc. C) Forensic or expert clinical consultation for option C. D) Records of sex offender evaluation for option A. 6) Law Enforcement/State s Attorney Involvement or Notification A) None required, however, if evidence of specific sexual abuse is obtained, see requirements for allegation added. B) Notify State s Attorney if report constitutes second, or more, indicated report of abuse. 7) Assessment of Factors to Be Considered to Support Case Finding A) Option A i) Frequency/severity of original offense(s). ii) Length of time since original conviction/indication. Allegation: Substantial Risk of Sexual Injury (6)

151 iii) iv) If conviction, adult or child victim, and if child, age of victim in relation to offender. Age of the original victim as it relates to current alleged victim. v) Relationship of original victim to offender. vi) vii) viii) ix) Length of time with current alleged victims. Any treatment received by alleged perpetrator. Age/emotional/developmental issues of current alleged victims, as it relates to their ability to disclose self-protective information. Current legal status of offender (outside protection). x) Other protective adults in home/access of offender. B) Option C i) Is the behavior/knowledge substantially outside of developmental norms? Use consultation if needed in order to make an informed determination. ii) iii) iv) Is there sexual activity between the victim and children who are not peers/regular playmates? Is there preoccupation with sex/sexual behavior to the exclusion of other regular childhood activities? Is the sexual behavior/knowledge evidenced in public or does the child appear to be unable to stop (behavior appears compulsive) despite clear requests to stop/punishment? v) Is the knowledge/behavior increasing in frequency, intensity, etc.? 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of the investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Substantial Risk of Sexual Injury (7)

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153 DEPARTMENT OF CHILDREN AND FAMILY SERVICES DATE: August 27, 2013 POLICY GUIDE ALLEGATION OF HARM #40/90 HUMAN TRAFFICKING OF CHILDREN Distribution: X and Z TO: FROM: EFFECTIVE: Rules and Procedures Bookholders and Child Protection Staff Richard H. Calica, Director Immediately I. PURPOSE The purpose of this Policy Guide is to amend instructions for investigation and intake requirements involving allegation #40/90, Human Trafficking of Children. Procedures 300 Appendix B, The Allegation System is being revised and will be issued in the near future. II. Definition Federal law defines severe forms of trafficking in persons (Human Trafficking) as: sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage or slavery. [U.S.C. 7102(8)] For the purpose of a child abuse/neglect investigation, force, fraud, or coercion need not be present. Incidents of Maltreatment Labor exploitation (ABUSE). Commercial sexual exploitation (i.e., prostitution, the production of pornography or sexually explicit performance) (ABUSE). Blatant disregard of a caregiver s responsibilities that resulted in a child being trafficked. (NEGLECT).

154 b) Taking a Report 1) Acceptable Reporter/Source/Other Person with Information (OPWI) 2) Usage Any person who has reason to believe that a child is a victim of human trafficking may be the reporter/source/opwi of a CA/N report. Note: A person under the age of 18 suspected of or charged with a prostitution offense shall be immune from prosecution for a prostitution offense and shall be subject to the temporary protective custody provisions of Sections 2-5 and 2-6 of the Juvenile Court Act of Pursuant to the provisions of Section 2-6 of the Juvenile Court Act of 1987, a law enforcement officer who takes a person under 18 years of age into custody under this section shall immediately report an allegation of a violation of Section 10-9 of this Code to the Illinois Department of Children and Family Services State Central Register, which shall commence an initial investigation into child abuse or child neglect within 24 hours pursuant to Section 7.4 of the Abused and Neglected Child Reporting Act. The reporter/source/opwi must have reason to believe that human trafficking resulted from one or both of the following: A) A direct action of a parent, caregiver, immediate family member, other person residing in the home, a parent s paramour, or other person responsible for the child s welfare resulted in the child being recruited, abducted, transported, harbored, or provided for the purpose(s) of labor exploitation and/or commercial sex exploitation. B) The blatant disregard of a parent, caregiver, immediate family member, parent s paramour, other person residing in the home, or other person responsible for the child s welfare, to make reasonable efforts to stop another person from trafficking a child. 3) Factors to be considered All factors need not be present to justify taking the report. One factor alone may justify taking a report. The child s age and cognitive development. The child s inability to attend school on a regular basis due to the actions of a perpetrator. The child is a runaway. The child makes references to frequent travel to other cities.

155 The child makes reference to being coerced into performing illegal activities. The child is employed or performs work inappropriate for their age. The child is not compensated for work performed. The child has been isolated from family, friends, religious institutions or other sources of support and protection. The child and/or child s family has been threatened with physical harm, deportation or being reported to law enforcement. The child is not compensated for work performed. The child shows signs of moderate to severe physical harm. The child appears withdrawn, depressed or fearful. The child lacks control over his or her schedule. The child lacks control over his or her identification documents. The child is often hungry or appears malnourished. The child is inappropriately dressed for the weather or other physical conditions. The child refers to or shows signs of drug addiction and/or exposure to drug manufacture or trafficking. Additional factors that may indicate sex-related trafficking include the following. The child has a sudden change in attire, behavior, or material possessions (e.g., has expensive items, dresses provocatively or has unaccounted for money). The child makes reference to having a pimp. The child makes reference to sexual situations that are beyond age-specific norms. The child uses or makes reference to the terminology of the commercial sex trade. The child has a boyfriend or girlfriend who is significantly older. The child engages in sexually provocative behaviors, is promiscuous and/or has unprotected sex with multiple partners. c) Investigating a Report 1) Required Documentation/Evidence to Support Finding: A) Secure evidence that the victim was trafficked by an eligible perpetrator (ABUSE), or that the blatant disregard of a harmful situation resulted in trafficking (NEGLECT). B) If previous investigations are used to support current finding, the files must be read to ensure evidentiary value. C) If law enforcement has conducted an investigation their report and final finding must be obtained and documented. If the police report is not

156 available, a SACWIS contact note must be included in the file that documents that the report was requested as well as documentation of verbal statements made by law enforcement. The supervisor must review law enforcement reports and/or findings in order to ensure consistency with previous law enforcement documentation of the pending investigation. Note: In addition to requesting a copy of a law enforcement report, the Investigation Specialist must also request a copy of all other police reports involving the same subject or subjects of the pending investigation. Use a SACWIS contact note to document this activity. D) Apply and document the application of the Factors to be Considered. Each factor should be assessed as to the relevance of the specific case and the assessment should be documented on a SACWIS contact note. E) Ensure there has been a detailed analysis of all inculpatory and exculpatory evidence and whether any inconsistencies in the evidence have been resolved. F) A waiver of any of the above requirements must be approved by the Investigation Supervisor. Details of the request and the supervisor s decision must be documented on a SACWIS contact note. 2) Requirements for Initial Investigation Where available, these investigations should be conducted under the auspices of the local Child Advocacy Centers. A) Complete a SACWIS and LEADS check of members of the family and other subjects frequenting or living in the home/environment. B) Thoroughly read and review prior indicated and existing unfounded investigations. Note: A pending report involving the same subjects of an unfounded report shall not be indicated solely on the basis of the prior unfounded report. If new details provide information that could impact a previously unfounded investigation, this information must be reported to the SCR to determine if a new investigation of the unfounded allegation is warranted. C) Interview the reporter, source, and OPWI(s) identified in the current report and related information reports.

157 D) Interview each alleged child victim(s) individually and in-person and complete the CERAP. Ask the child if there is an extended family member, another adult or caregiver that he or she feels safe with, important, or special to. Persons identified by the child victim shall be interviewed. Note: The Investigation Specialist should not interview the victim if the case is Forensic Interview eligible, per local protocol. If a VSI interview is necessary, the Investigation Specialist shall coordinate with the VSI interviewer to ensure the child is asked if there is an extended family member, another adult or caretaker that he or she feels safe with, important or special to. Persons identified by the child victim shall be interviewed. E) If police have conducted an investigation, interview the police officer/investigator in person or by telephone. This contact will help establish the need to move to formal investigation phase. Investigation Specialists must also inquire about and document efforts to obtain existing law enforcement reports on the persons under investigation. F) Interview the caseworker if the family has an open service case. G) Interview the parents/caregivers in person and individually. The parents should be contacted on the same day contact is made with the child victim(s), if possible. If the CERAP is marked unsafe, parents must be interviewed immediately to ensure child safety and the formal investigation must be commenced. If the CERAP is marked safe, the Investigation Specialist must secure corroboration of the parent/caregiver s statements for the purpose of strengthening the safe determination. Efforts to corroborate the statements must occur as soon as possible. If information obtained from collateral sources conflicts with the statements of the parent/caregiver, the Investigation Specialist shall immediately notify his or her supervisor or Area Administrator for guidance regarding the need to complete a subsequent CERAP and additional investigation activities. H) Interview the alleged perpetrator in person, if necessary, for immediate safety planning. The Investigation Specialist should consult with law enforcement prior to interview to avoid compromising the investigation Note: If the allegation is human trafficking by neglect, an effort must be made to identify who trafficked the child. I) Verbally notify the DCFS Guardian and interview the guardian ad litem if the alleged child victim is a DCFS ward or a ward of the court (i.e., a child in the home with a parent/caregiver under an order of protection).

158 J) A waiver of any of the above requirements must be approved by the supervisor. The request for a waiver, including the reasons for the request, and the supervisor s decision must be documented on a SACWIS contact note. K) Complete all relevant assessment screens for household members (e.g., Adult Substance Abuse Screen, CFS 440-5). 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe ; ii) there is a determination that the child victim alleges labor exploitation or commercial sexual exploitation, and/or there is reasonable cause to suspect that the victim was trafficked by an eligible perpetrator (ABUSE) or by the blatant disregard (NEGLECT) of an eligible perpetrator; iii) the alleged victim is under the age of 18. B) Apply Factors to be Considered to determine if sufficient and reasonable cause exists to move to a formal investigation. C) The decision to proceed to a formal investigation must be made within 14 days from the date of the report and documented on a SACWIS contact note. Note: Because the nature of a DCFS investigation is intrusive to families, careful consideration should be given regarding the necessity to move to a formal investigation. 4) Requirements for Formal Investigation: All interviews of subjects of an investigation should be in person and individually. Interviews of collateral contacts may be in person or by phone. A) Interview the parents/caregivers. B) Interview the alleged perpetrator. C) Interview all other adults and verbal children in the victim s and/or perpetrator s household. Non-verbal children must be observed, and if possible, observed interacting with others in their surroundings.

159 D) Interview all identified witnesses who are reported to have knowledge of the incident. E) The previous DCFS caseworker should be interviewed if the family had a service case closed within the past two years. F) If there are children 12 years of age and younger, interview the school teachers and/or care providers who would have knowledge of the children and the level of care provided to them. G) Interview the child s primary care physician or the physician that examined the victim within the past six months, if a past history of maltreatment is alleged. H) Interview the physician who completed the sex abuse exam, if performed. I) Interview the law enforcement investigator involved in the criminal investigation. J) Interview other community professionals who would have firsthand knowledge of the incident or circumstances concerning the incident. K) Contact the Child Protection Service in other states where family members have resided during the previous five years. If a history of maltreatment is uncovered, the Investigation Specialist shall request documentation of the family s abuse/neglect history. L) A waiver of any of the above contacts must be approved by the Area Administrator. The request for a waiver and the Area Administrator s decision must be documented in a SACWIS contact note. 5) Required Medical Information and/or Consultations Whether or not the child s medical needs are related to the alleged incident, Investigation Specialists must take the following actions when it is suspected that the child is in need of urgent medical care. A) Ensure that the parent/caregiver seeks immediate medical care for the child. Contact the child s physician within 24 hours of him/her seeing the child to confirm that medical care was provided. B) If the parent/caregiver refuses or fails to obtain medical assistance for the child, the Investigation Specialist must immediately consult with his or her supervisor or Area Administrator to determine if the child should be taken into temporary protective custody.

160 C) Call law enforcement for assistance as needed. D) If appropriate, add Medical Neglect allegation #79 or Medical Neglect of Disabled Infants #85 to the report. E) Obtain medical records of the child s current treatment/diagnosis and relevant past treatment. 6) Law Enforcement/State s Attorney Notification and Involvement A) The State s Attorney and law enforcement shall be notified within 24 hours of taking a report. B) The State s Attorney shall be notified if the current report is to be indicated and if there are indicated priors reports within the same family unit. C) DCFS and law enforcement should cooperate in conducting these investigations. D) Report the suspected incident of trafficking to the FBI Violent Crimes Against Children Task Force at E) If a DCFS ward is being investigated for allegedly committing crimes, other than being a victim of human trafficking, then contact the DCFS Guardian s Office at to obtain legal representation for the ward. 7) Assessment to Support Case Finding The Investigation Supervisor shall have a formal supervisory conference with the Investigation Specialist to assess all inculpatory and exculpatory evidence obtained during the course of the investigation. Use a SACWIS contact note to document the supervisory conference and the evidence used to reach a finding. Evidence used to support an investigative finding must include documentation that a child under 18 years of age has been recruited, abducted, transported, harbored, or provided for the purpose of labor exploitation and/or commercial sexual exploitation. Note: While force, fraud, or coercion need not be present for the purposes of investigating child abuse/neglect, they may be present. Examples of force, fraud or coercion may include any of the following: Threats of serious harm to the child and/or child s family; Physical restraint or threats of restraint to the child; Exposure to violent or intimidating acts towards other children;

161 Promoting and coercing drug and/or alcohol dependency; False promises to the victim (e.g., reunification with family; citizenship, or eventual independence); Withholding of basic needs, such as food and shelter; Threats of deportation or other legal processes; Destruction, confiscation or concealment of any identification document belonging to the child (e.g., passport, immigration document, or any other government issued identification); Extortion or financial control of the child and/or child s family by the threat or act of causing monetary harm. 8) Assessment of Factors to be Considered to Support Case Finding A) What are the ages of the involved children? B) Does the child have a medical condition, behavioral, mental or emotional problem, or other disability or handicap that would impact his or her potential for being trafficked? C) Is there a pattern of similar instances of human trafficking with this child or other children for whom the parent/caregiver is or has been responsible? D) Was an instrument or weapon used on the victim or was the victim threatened with an instrument or weapon? E) Is there a history of abuse and/or neglect that is verifiable in official records or has substantial corroboration from other credible sources. F) What are the relationship dynamics between the victim and the parent/caregiver? Does the child express fear or mistrust of the parent/caregiver? Does the parent/caregiver appear to be appropriately concerned about the child s welfare and protection? G) Is there any support system in place for the victim and the parent/caregiver? H) Identify any issue of substance abuse or the manufacture/distribution of illegal drugs, that involves the child, parent/caregiver, other household members, or others who are frequently in the home. 9) Notification of Findings Required notifications and supervisory consultations concerning the recommended finding shall be documented on a SACWIS contact note prior to submitting the investigation for supervisory approval. Notification of the

162 recommended finding must occur after the supervisor and/or Area Administrator have discussed the recommended finding with the Investigation Specialist and approved the finding. A) Verbally notify the family of the recommended finding. B) Verbally notify and discuss the recommended finding with the mandated reporter. If the mandated reporter disagrees with the recommended finding, the Investigation Specialist shall immediately notify his or her supervisor of the concerns raised by the reporter. The Investigation Supervisor shall contact the reporter to resolve identified issues and/or to determine if there are additional investigation activities that need to be completed. When a resolution cannot be reached, the supervisor shall inform the reporter of his or her right to appeal the investigation finding. The supervisor and Investigation Specialist shall document all attempts to resolve issues raised by mandated reporters in a SACWIS contact note. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Verbally notify and discuss the recommended finding with the guardian ad litem if the victim is a DCFS ward or a ward of the court (e.g.., a child home with a parent under an order of protection). If the guardian ad litem disagrees with the recommended finding, the Investigation Specialist shall immediately notify his or her supervisor of the concerns raised by the guardian ad litem. The Investigation Supervisor shall contact the guardian ad litem to resolve identified issues and determine if there are additional investigation activities that need to be completed. When a resolution cannot be reached, the supervisor shall inform the guardian ad litem of his or her right to appeal the investigation finding. The supervisor and Investigation Specialist shall document all attempts to resolve issues raised by the guardian ad litem in a SACWIS contact note. III. IV. QUESTIONS Questions concerning these revisions may be directed to the Office of Child and Family Policy at 217/ or through Outlook at OCFP-Mailbox or for non-outlook users at [email protected] FILING INSTRUCTIONS Place remove Policy Guide from behind Procedures 300 Appendix B, Allegation 22, Substantial Risk of Sexual Injury and replace with this Policy Guide

163 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT INADEQUATE SUPERVISION Allegation of Harm #74 The child has been placed in a situation or circumstances which are likely to require judgment or actions greater than the child s level of maturity, physical condition, and/or mental abilities would reasonably dictate. Examples include, but are not limited to: leaving children alone when they are too young to care for themselves; leaving children who have a condition that requires close supervision alone. Such conditions may include medical conditions, behavioral, mental, or emotional problems, developmental disabilities or physical disabilities; being present but unable to supervise because of the caregiver s condition (This includes (1) the parent or caregiver who repeatedly uses drugs or alcohol to the extent that it has the effect of producing a substantial state of stupor, unconsciousness, intoxication or irrationality; and (2) the parent or caregiver who cannot adequately supervise the child because of his or her medical condition, behavioral, mental, or emotional problems, developmental disability or physical disability.); leaving children unattended in a place which is unsafe for them when their maturity, physical condition, and mental abilities are considered; or leaving children in the care of an inadequate or inappropriate caregiver, as indicated by the caregiver factors. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child has been/is being inadequately supervised may be the reporter or source of the CA/N report. The reporter/source has reason to believe that the child has been/is being inadequately supervised due to the disregard of his or her responsibilities by the parent or other person responsible for the child s welfare. (NEGLECT) 3) Factors to be Considered The following factors should be considered when determining whether a child is inadequately supervised. Allegation: Inadequate Supervision (1)

164 A) Child Factors i) Child s age and developmental stage, particularly as it relates to the ability to make sound judgments in the event of an emergency. ii) iii) Child s physical condition, particularly as it relates to the child s ability to care for or protect him or herself. Is the child physically or mentally handicapped, or otherwise in need of ongoing prescribed medical treatment such as periodic doses of insulin or other medications? Child s mental abilities, particularly as it relates to the ability to comprehend the situation. B) Caretaker Factors i) Presence or Accessibility of Caregiver How long does it take the caregiver to reach the child? Can the caregiver see and hear the child? Is the caregiver accessible by telephone? Has the child been given phone numbers to call in the event of an emergency? ii) Caregiver s Capability Is the caregiver mature enough to assume responsibility for the situation? Does the caregiver depend on extraordinary assistance to care for self or child? iii) Caregiver s Physical Condition Is the caregiver physically able to care for the child? Does the caregiver s health impede his or her ability to care for the child? iv) Caregiver s Cognitive and Emotional Condition Is the caregiver able to make appropriate judgments on the child s behalf? Does the caregiver show signs of confusion or memory loss? Allegation: Inadequate Supervision (2)

165 C) Incident Factors i) Frequency of occurrence. ii) iii) iv) Duration of the occurrence (as related to the child factors above). Time of the day or night when the incident occurs. Child s location (the condition and location of the place where the minor was left without supervision). v) Weather conditions, including whether the minor was left in a location with adequate protection from the natural elements such as adequate heat or light? vi) vii) viii) Other supporting persons who are overseeing the child (Was the child given a phone number of a person or location to call in the event of an emergency and whether the child was capable of making an emergency call?) Whether food and other provisions were left for the child. Other factors that may endanger the health and safety of the child. c) INVESTIGATING A REPORT Note: This harm is always NEGLECT. 1) Documentation/Evidence Needed to Indicate A) Documented observations that demonstrate that a child has been inadequately supervised or placed in circumstances that are likely to require judgment or actions greater than the child s level of maturity, physical condition, or mental abilities. B) Specific and thorough identification and documentation of supervision issues which pose harm or significant risk of harm to the child as well as documentation of the parent disregard and/or failure to correct the situation. C) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the condition have been obtained. D) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must Allegation: Inadequate Supervision (3)

166 review police report when it is received to ensure findings do not conflict with previously documented information received verbally. E) All other required contacts made, or documentation as to why they were not. F) Apply and document the application of the Factors to Be Considered. Each factor should be assessed as to relevance to the specific case and that assessment should be documented on a SACWIS Case Note or other form designed for this purpose. G) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. Review prior investigation. B) Interview reporter, source and OPWI identified in the current report or related information. C) In person, individual interview with alleged child victim(s), assessment of physical condition, and completion of CERAP. D) In person or phone interview with law enforcement, if police have had contact on report. This contact is to help establish the need to move to the formal investigation phase. E) Interview DCFS or private agency caseworker if a service case is currently open. F) In person, individual parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. G) Interview alleged perpetrator either in person or by phone. H) Observation of the environment where the lack of supervision occurred. I) Notify Guardian ad Litem if alleged child victim is DCFS ward or ward of the court (e.g., a child home with a parent under an order of protection). J) In cases with non-verbal children and an anonymous reporter, an interview must be conducted with an individual (collateral) who has Allegation: Inadequate Supervision (4)

167 (or would likely have) knowledge of the family situation and/or reported incident. K) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is reasonable cause to suspect that the child victim was inadequately supervised as a result of the caretaker s disregard of their responsibilities, and/or the allegation is on a non-verbal child and a suitable collateral cannot be identified; and iii) the alleged victim is under the age of 18. B) Apply Factors to Be Considered to determine if there is reasonable cause to believe the child was inadequately supervised as a result of neglect. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety. B) In person, individual interview with alleged offender. C) In person, individual all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview all identified witnesses who are reported to have knowledge of the incident. F) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. G) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. H) Interview other community professionals who have first hand knowledge of the incident. Allegation: Inadequate Supervision (5)

168 I) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. K) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered for this time period, attempts must be made to gather abuse/neglect history for the previous five-year period. L) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations The worker must ensure that the child receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. 6) Law Enforcement/State s Attorney Involvement or Notification Notification of law enforcement and the State s Attorney is mandatory if protective custody is taken. 7) Assessment of Factors to be Considered to Support Case Finding A) What age is the reported child(ren)? B) Does the child have a medical condition; behavioral, mental or emotional problem; or disability that impacts on their ability to protect themselves or significantly increases a caretakers stress level? C) Is there a pattern of similar instances with this child or other children for whom the caretaker has been responsible? D) What is the severity of the condition? (Identify specifics including caretaker too intoxicated to supervise child, caretaker s age or physical condition prevents them from caring for the child.) E) Is there a previous history of abuse and/or neglect? (More weight should be given to a documented history and DCFS files used as a basis for identifying history should be reviewed prior to being considered a factor. History described by subjects or collateral s should be viewed in the spirit and light it is presented.) F) What dynamics are present between the child and the parent? (Identify the child s level of fear of the caretaker. Does the caretaker appear to be concerned about child s welfare and protection? Is there an appropriate parent-child relationship?) Allegation: Inadequate Supervision (6)

169 G) What is the level of stress/crisis in the home? (Is there a positive home environment or is the environment chaotic?) H) Is an appropriate support system in place for the child and the caretakers? Are there supportive people in the home? 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Inadequate Supervision (7)

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171 a) DEFINITION Abandonment REPORTS OF CHILD ABUSE AND NEGLECT ABANDONMENT/DESERTION Allegation of Harm #75 Abandonment is parental conduct that demonstrates the purpose of relinquishing all parental rights and claims to the child. Abandonment is also defined as any parental or caregiver conduct which evinces a settled purpose to forego all parental duties and relinquish all parental claims to the child. Desertion Desertion is any conduct on the part of a parent, which indicates that they have no intention, now or in the future, to maintain any degree of interest, concern or responsibility for the child. Desertion includes leaving a child with no apparent intention to return, unless the child has been left in the care of a relative. Examples of abandonment/desertion include, but are not limited, to parents who: leave a baby on the doorstep; leave a baby in the garbage can; leave a child with no apparent intention to return; or leave a child with an appropriate caregiver but fail to resume care of the child, as agreed, and the caregiver cannot or will not continue to care for the child. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child was abandoned or deserted may be the reporter or source of the CA/N report. The reporter/source has reason to believe that the child has been abandoned/deserted due to the parent, caregiver, or responsible person s disregard of his or her responsibilities. (NEGLECT) Allegation: Abandonment/Desertion (1)

172 c) INVESTIGATING A REPORT REPORTS OF CHILD ABUSE AND NEGLECT 1) Documentation/Evidence Needed to Indicate A) Documented evidence that a child has been abandoned/deserted. B) Detailed explanatory statements of the victim, perpetrator, witnesses, any other person with knowledge of the situation has been obtained. C) If police have conducted an investigation; the final police report must be obtained and documented. (If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review Police report when it is received to ensure findings do not conflict with previously documented information received verbally. D) All other required contacts made, or documentation as to why they were not. E) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of physical condition, and completion of CERAP. E) In person or phone interview with law enforcement, if police have had contact on report. This contact is to help establish the need to move to the formal investigation phase. F) Contact DCFS or private agency caseworker if a service case is currently open. G) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. H) Interview alleged perpetrator either in person or by phone. Allegation: Abandonment/Desertion (2)

173 I) Notify Guardian ad Litem if alleged child victim is DCFS ward or ward of the court (e.g., a child home with a parent under an order of protection). J) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is reasonable cause to suspect that the child victim has been abandoned or deserted due to caretaker s disregard of their responsibilities; and iii) the alleged victim is under the age of 18. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety. B) In person, individual interview with alleged offender. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview all identified witnesses who are reported to have knowledge of the incident. F) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. G) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. H) Interview other community professionals who have first hand knowledge of the incident. I) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. Allegation: Abandonment/Desertion (3)

174 J) Interview primary care physician or physician who has seen child in past 6 months if past history of maltreatment is alleged. K) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. L) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the child receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and relevant past treatment. 6) Law Enforcement/State s Attorney Involvement or Notification A) Notification of law enforcement and the State s Attorney is mandatory if protective custody is taken. 7) Assessment of Factors to Be Considered to Support Case Finding Not Applicable 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts who were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Abandonment/Desertion (4)

175 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT INADEQUATE FOOD Allegation of Harm #76 Lack of food adequate to sustain normal functioning. It is not as severe as Malnutrition or Failure to Thrive, both of which require a medical diagnosis. Examples include: the child who frequently and repeatedly misses meals or who is frequently and repeatedly fed insufficient amounts of food; the child who frequently and repeatedly asks neighbors for food and other information substantiates that the child is not being fed; and the child who is frequently and repeatedly fed unwholesome foods when his age, developmental stage, and physical condition are considered. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child has received/is receiving inadequate food may be the reporter or source of the CA/N report. The reporter/source has reason to believe that the child has not received/is not receiving adequate food due to the parent s, caregiver s or other responsible person s disregard of his or her responsibilities. If friends or neighbors are feeding the child but the child would not be receiving adequate food otherwise, this also constitutes a valid report of child neglect. (NEGLECT) 3) Factors to be Considered A) Child Factors i) The child s age and developmental stage. ii) iii) The child s physical condition, particularly as it relates to the need for a special diet. The child s mental abilities, particularly as it relates to his or her ability to obtain and prepare his own food. Allegation: Inadequate Food (1)

176 B) Incident Factors i) Frequency of the occurrence. ii) iii) iv) Duration of the occurrence. Chronicity or pattern of occurrence. Previous history of occurrences. v) Availability of adequate food. c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Documented information that demonstrates that a child is receiving insufficient or inadequate food to sustain normal functioning. B) Specific and thorough identification and documentation of issues which pose harm or significant risk of harm to the child as well as documentation of the parent disregard and/or failure to correct the situation. C) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the condition have been obtained. D) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review Police report when it is received to ensure findings do not conflict with previously documented information received verbally. E) Apply and document the application of the Factors to Be Considered. Each factor should be assessed as to relevance to the specific case and that assessment should be documented on a SACWIS Case Note or other form designed for this purpose. F) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. Allegation: Inadequate Food (2)

177 C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of physical condition, and completion of CERAP. E) Observation of the environment in which the child resides. F) In person or phone interview with law enforcement, if information suggests police have had contact on report. This contact is to help establish the need to move to the formal investigation phase. G) Interview DCFS or private agency caseworker if a service case is currently open. H) In person, individual interview with parents. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. I) Interview alleged perpetrator either in person or by phone. J) Notify Guardian ad litem if alleged child victim is DCFS ward. K) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is reasonable cause to suspect that the child victim is receiving inadequate food; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety. B) In person, individual interview with alleged perpetrator. Allegation: Inadequate Food (3)

178 C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview all identified witnesses who are reported to have knowledge of the incident. F) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. G) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. H) Interview other community professionals who have first hand knowledge of the incident. I) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. J) If child has received medical attention based on current condition, interview primary care physician or physician who has seen child in past six months. K) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. L) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) The worker must ensure that the child receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and relevant past treatment. 6) Law Enforcement/State s Attorney Involvement or Notification Notification of law enforcement and the State s Attorney s is mandatory if protective custody is taken. Allegation: Inadequate Food (4)

179 7) Assessment of Factors to Be Considered to Support Case Finding A) What age is the reported child(ren)? B) Does the child have a medical condition; behavioral, mental or emotional problem; or disability or handicap that impacts on their ability to protect themselves or significantly increases a caretakers stress level? C) Is there a history of similar instances with this child or other children for whom the caretaker has been responsible? D) What is the severity of the condition? E) Is there a previous history of abuse and/or neglect? (More weight should be given to a documented history and DCFS files used as a basis for identifying history should be reviewed prior to being considered a factor. History described by subjects or collateral s should be viewed in the spirit and light it is presented.) F) What dynamics are present between the child and the parent? (Identify the child s level of fear of the caretaker. Does the caretaker appear to be concerned about child s welfare and protection? Is there an appropriate parent-child relationship?) G) What is the level of stress/crisis in the home? (Is there a positive home environment or is the environment chaotic?) H) Is an appropriate support system in place for the child and the caretakers? Are there supportive people in the home? 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Inadequate Food (5)

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181 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT INADEQUATE SHELTER Allegation of Harm #77 Lack of shelter which is safe and which protects the child(ren) from the elements. Examples of inadequate shelter include, but are not limited to: no housing or shelter; condemned housing; exposed, frayed wiring; housing with structural defects which endanger the health or safety of the child; housing with indoor temperatures consistently below 50 degrees F; housing with broken windows in sub-zero weather; housing which is a fire hazard obvious to the reasonable person; and housing with an unsafe heat source that poses a fire hazard or threat of asphyxiation. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child is being inadequately sheltered may be the reporter or source of the CA/N report. The reporter/source has reason to believe that the child is being inadequately sheltered due to the parent s, caregiver s, or other responsible person s disregard of his or her responsibilities. (NEGLECT) 3) Factors to be Considered The following factors should be considered when determining whether a child has inadequate shelter. A) Child Factors i) The child s age and developmental stage. Allegation: Inadequate Shelter (1)

182 ii) iii) The child s physical condition, particularly when the inadequate shelter may aggravate it. The child s mental abilities, particularly as it relates to the child s ability to comprehend the dangers posed by the inadequate shelter. B) Shelter Factors i) Seriousness of the problem. ii) iii) iv) Frequency of the problem. Duration of the problem. Pattern or chronicity of the problem. c) INVESTIGATING A REPORT v) Previous history of shelter-related problems. 1) Documentation/Evidence Needed to Indicate A) Documented observations that demonstrate that a child s living conditions are inadequate to the point the child s health may be impaired. B) Specific and thorough identification and documentation of shelter issues which pose harm or significant risk of harm to the child as well as documentation of the parent disregard and/or failure to correct the situation. C) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the condition have been obtained. D) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review police report when it is received to ensure findings do not conflict with previously documented information received verbally. E) Apply and document the application of the Factors to Be Considered. Each factor should be assessed as to relevance to the specific case and that assessment should be documented on a SACWIS Case Note or other form designed for this purpose. F) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. Allegation: Inadequate Shelter (2)

183 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of physical condition, and completion of CERAP. E) Observation of the environment. F) Interview DCFS or private agency caseworker if a service case is currently open. G) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. H) Interview alleged perpetrator either in person or by phone. I) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). J) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is reasonable cause to suspect that the child victim has been inadequately sheltered as a result of the caretaker s disregard of their responsibilities; and iii) The alleged victim is under the age of 18. B) Apply Factors to Be Considered to determine if there is reasonable cause to believe the child was inadequately sheltered as a result of neglect. C) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. Allegation: Inadequate Shelter (3)

184 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety. B) In person, individual interview with alleged offender. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview all identified witnesses who are reported to have knowledge of the incident. F) If the family or the subjects identify two or more possible witnesses, at least two must be interviewed either by phone or in person. G) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. H) Interview other community professionals who have first hand knowledge of the incident. I) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. J) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. K) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations A) the worker must ensure that the child receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and relevant past treatment. 6) Law Enforcement/State s Attorney Involvement or Notification Notification of law enforcement and the State s Attorney is mandatory if protective custody is taken or if the alleged perpetrator is a paramour. Allegation: Inadequate Shelter (4)

185 7) Assessment of Factors to Be Considered to Support Case Finding A) What age is the reported child(ren)? B) Does the child have a medical condition; behavioral, mental or emotional problem; or disability or handicap which impacts on their ability to protect themselves or significantly increases a caretakers stress level? C) Is there a pattern of similar instances with this child or other children for whom the caretaker has been responsible? D) What is the severity of the condition? (Identify specifics including condemned housing, exposed, frayed wiring, structural defects, unsafe heat source or broken windows in sub-zero weather. E) Is there a previous history of abuse and/or neglect? (More weight should be given to a documented history and DCFS files used as a basis for identifying history should be reviewed prior to being considered a factor. History described by subjects or collateral s should be viewed in the spirit and light it is presented.) F) What dynamics are present between the child and the parent? (Identify the child s level of fear of the caretaker. Does the caretaker appear to be concerned about the child s welfare and protection? Is there an appropriate parent-child relationship?) G) What is the level of stress/crisis in the home? (Is there a positive home environment or is the environment chaotic?) H) Is an appropriate support system in place for the child and the caretakers? Are there supportive people in the home? 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of the investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Inadequate Shelter (5)

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187 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT INADEQUATE CLOTHING Lack of appropriate clothing to protect the child from the elements. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Allegation of Harm #78 Any person who has reason to believe that a child is inadequately clothed may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the child is/has been inadequately clothed due to the parent s, caregiver s or other responsible person s disregard of his or her responsibilities. (NEGLECT) 3) Factors to Be Considered A) Child Factors i) The child s age and developmental stage, particularly as it relates to the ability to make judgments regarding appropriate clothing. ii) iii) The child s physical condition, particularly as it relates to conditions which may be aggravated by exposure to the elements. The child s mental abilities, particularly as it relates to his or her ability to obtain appropriate clothing. B) Incident Factors i) Frequency of the incident. ii) iii) iv) Duration of the incident. Chronicity or pattern of occurrence. Weather conditions such as extreme heat or extreme cold. Allegation: Inadequate Clothing (1)

188 c) INVESTIGATING A REPORT REPORTS OF CHILD ABUSE AND NEGLECT 1) Documentation/Evidence Needed to Indicate A) Documented observations and/or photographs that demonstrate that a child s clothing is inadequate to the point the child s health may be impaired. B) Specific and thorough identification and documentation of clothing issues which pose harm or significant risk of harm to the child as well as documentation of parent disregard and/or failure to correct the situation. C) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the condition have been obtained. D) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review Police report when it is received to ensure findings do not conflict with previously documented information received verbally. E) Apply and document the application of the Factors to Be Considered. Each factor should be assessed as to relevance to the specific case and that assessment should be documented on a SACWIS Case Note or other form designed for this purpose. F) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual contact with alleged child victim(s), assessment of appropriate clothing, and completion of CERAP. E) Interview DCFS or private agency caseworker if a service case is currently open. F) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if Allegation: Inadequate Clothing (2)

189 at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. G) Interview alleged perpetrator either in person or by phone. H) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). I) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is reasonable cause to suspect that the child victim has been inadequately clothed as a result of the caretaker s disregard of their responsibilities; and iii) the alleged victim is under the age of 18. B) Apply Factors to Be Considered to determine if there is reasonable cause to suspect the child was inadequately clothed as a result of neglect. C) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety. B) In person, individual interview with alleged perpetrator. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) Interview all identified witnesses who are reported to have knowledge of the incident. E) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. Allegation: Inadequate Clothing (3)

190 F) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. G) For children under the age of 12, school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. H) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Information and/or Consultations The worker must ensure that the child receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. 6) Law Enforcement/State s Attorney Involvement or Notification Notification of law enforcement and the State s Attorney is mandatory if protective custody is taken. 7) Assessment of Factors to Be Considered to Support Case Finding A) Is there a history of similar instances with this child or other children for whom the caretaker has been responsible? B) What is the severity of the condition? (Identify specifics including frostbite, hypothermia, extreme heat, and extreme cold.) C) What is the level of stress/crisis in the home? (Is there a positive home environment or is the environment chaotic?) 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Inadequate Clothing (4)

191 a) DEFINITION Medical or Dental Treatment REPORTS OF CHILD ABUSE AND NEGLECT MEDICAL NEGLECT Allegation of Harm #79 Lack of medical or dental treatment for a health problem or condition which, if untreated, could become severe enough to constitute a serious or long-term harm to the child; lack of follow-through on a prescribed treatment plan for a condition which could become serious enough to constitute serious or long-term harm to the child if the plan goes unimplemented. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child has been/is being medically neglected may be the Reporter or Source of a CA/N report. The Reporter/Source has reason to believe that the child has not/is not receiving proper and necessary medical care (defined in Section I) due to the parent s, caregiver s, or other responsible person s disregard of his or her responsibilities. (NEGLECT) 3) Factors to Be Considered A) Child s age, particularly as it relates to the ability to obtain treatment. B) Seriousness of the current health problem. C) Child s physical condition. D) Child s developmental stage. E) Probable outcome if the current health problem is not treated and the seriousness of that outcome. F) Generally accepted medical benefits of the prescribed treatment. G) Generally recognized side effects/harms associated with the prescribed treatment. Allegation: Medical Neglect (1)

192 c) INVESTIGATING A REPORT REPORTS OF CHILD ABUSE AND NEGLECT 1) Information to Support a Final Finding A) Verifiable information that a child has been denied reasonable medical treatment (including an unimplemented prescribed treatment plan) through an action of a parent or other eligible caretaker. B) Sufficient information from medical providers to assess and apply Factors to Be Considered. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Contact with reporter, source and OPWI identified in the current report or related information. D) In person contact with alleged child victim(s), assessment of physical injury including photographs or body chart and completion of CERAP. E) Contact physician who is treating current condition if other than reporter/source. F) Contact DCFS or private agency caseworker if a service case is currently open. G) Contact parents by phone or in person. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety. H) Contact alleged perpetrator either in person or by phone. I) Waiver of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a determination that the child victim is not or has not received necessary medical care and there is reasonable cause to believe that the situation is the result of a parent or caretakers disregard of his or her responsibilities; and Allegation: Medical Neglect (2)

193 iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Required Formal Investigation Interviews A) Parents/Caretakers (in person). B) Alleged offender in person. C) All other adults and verbal children of the victim s household, individually and in person. Non-verbal children must be observed. D) All other adults and verbal children of the perpetrator s household, individually and in person. Non-verbal children must be observed. E) Regular physician or physician who has seen child in previous 6 months. F) All physicians with knowledge of reported condition. G) All identified witnesses who are reported to have knowledge of the incident. H) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. I) DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. J) Other community professionals who have first hand knowledge. K) For children under the age of 12, school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. L) Primary care physician or physician who has seen child in past 6 months if past history of maltreatment is alleged. M) Contact child protective services in other states in which the family members have resided in the previous three years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional three years. N) Waiver of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. Allegation: Medical Neglect (3)

194 5) Required Medical Documentation and/or Consultations A) The worker must ensure that the child receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and relevant past treatment. C) Copies of medical records regarding the child s medical condition including diagnosis, hospitalization reports, feeding record, and other care records. D) Expert opinion stating the medical outcome if the current problem is not treated. E) Expert opinion concerning the benefits and potential side effects/harms of the prescribed course of treatment. F) A second medical opinion must be obtained when: i) the treating physician(s) is/are unable or unwilling to offer an opinion regarding the likelihood that this medical condition caused by abuse/neglect; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with the supervisor and, based on the totality of information gathered, the CPSW is not yet able to make a well-supported finding. Note: The physician with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney involvement or notification A) It is mandatory that law enforcement and the State s Attorney be notified if protective custody is taken. B) Notification is mandatory if this is the second indicated report. C) For indicated cases, notify the Guardian ad litem if the victim is a DCFS ward. 7) Assessment of Factors to Be Considered to support case finding A) Child s medical condition. B) Seriousness of the current health problem. Allegation: Medical Neglect (4)

195 C) Probable medical outcome if the current health problem is not treated and the seriousness of that outcome. D) Generally accepted medical benefits of the prescribed treatment. E) Generally recognized side effects/harms associated with the prescribed treatment. F) The judgment of the treating physician regarding whether treatment is medically indicated and whether there is credible evidence of medical neglect. G) The parent s knowledge and understanding of the treatment and the probable medical outcome. 8) Documentation/Evidence Needed to Indicate A) Verifiable information that a child has been denied reasonable medical treatment (including an unimplemented prescribed treatment plan) through an action of a parent or other eligible caretaker. B) Sufficient information from medical providers to assess and apply Factors to Be Considered. C) Detailed explanatory statements of the victim, perpetrator, witnesses or any other person with knowledge of the condition have been obtained. D) All other required contacts made or documentation as to why they were not. E) Consultations have been obtained as required. F) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review Police report when it is received to ensure findings do not conflict with previously documented information received verbally. G) Waiver of the above must be given by the supervisor and documented on a SACWIS Case Note. 9) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. Allegation: Medical Neglect (5)

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197 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT FAILURE TO THRIVE (NON-ORGANIC) Allegation of Harm #81 A serious medical condition most often seen in children under one year of age. The child s weight, height and motor development fall significantly short of the average growth rates of normal children (i.e., below the fifth percentile). In about 10% of these cases there is an organic cause such as a serious kidney, heart, or intestinal disease, a genetic error of metabolism or brain damage. All other cases are a result of a disturbed parent-child relationship manifested in severe physical and emotional neglect of the child. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any medical person who has reason to believe that a child suffers from nonorganic failure to thrive may be the Reporter or Source of a CA/N report. The Reporter/Source has reason to believe that the child has failure to thrive syndrome as a result of the parent s, caregiver s or other responsible person s neglect (non-organic failure to thrive). (NEGLECT) 3) Factors to be Considered In determining that the child has non-organic failure to thrive, the following factors should be considered: A) The child s weight is below the fifth percentile of the normal range for a child of that age, but substantial weight gain occurs when the child is properly nurtured, such as when hospitalized. B) The child exhibits developmental retardation which decreases when there is adequate feeding and appropriate stimulation. C) Medical investigation provides no evidence that disease or medical abnormality is causing the symptoms. D) The child exhibits clinical signs of deprivation which decrease in a more nurturing environment. Allegation: Failure to Thrive (1)

198 E) There appears to be a significant environmental or psychosocial disruption in the child s family. c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Medical diagnosis that the child is suffering from non-organic failure to thrive. B) Verify that child s weight is below the fifth percentile of the normal range for a child of that age, but substantial weight gain occurs when the child is properly nurtured. C) Document that child exhibits developmental retardation which decreases when there is adequate feeding and appropriate stimulation. D) Medical rule out of disease or medical abnormality which could cause symptoms. E) All medical reports that support or refute diagnosis should be included in the file. F) Identify possible etiology (cause) for failure to thrive (e.g. disturbed parent-child relationship). G) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the condition have been obtained. H) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review Police report when it is received to ensure findings do not conflict with previously documented information received verbally. I) All other required contacts made or documentation as to why they were not. J) Consultations have been obtained as required. K) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. Allegation: Failure to Thrive (2)

199 C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of physical condition including photographs, and completion of CERAP. E) Interview treating physician if other than reporter/source. F) In person or phone interview with law enforcement, if police have had contact on current report. This contact is to help establish the need to move to formal investigation phase. G) Interview DCFS or private agency caseworker if a service case is currently open. H) In person, individual interview with parents. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. I) Observation of the environment where maltreatment occurred. J) Interview alleged perpetrator either in person or by phone. K) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). L) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is reasonable cause to suspect that the child victim is diagnosed with the condition of failure to thrive and there is reasonable cause to believe that the condition is the result of a disturbed parent-child relationship manifested in severe physical and emotional neglect of the child by an eligible caretaker and; iii) the alleged victim is under the age of 18. Allegation: Failure to Thrive (3)

200 B) The decision to proceed to a formal investigation must be made within 14 days of receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged perpetrator in person. C) All other adults and verbal children of the victim s household, individually and in person. Non-verbal children must be observed. D) All other adults and verbal children of the perpetrator s household, individually and in person. Non-verbal children must be observed. E) Interview all physicians with knowledge of reported condition. F) All identified witnesses who are reported to have knowledge of the environment or condition that led to the diagnosis of failure to thrive. G) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. H) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. I) Interview public health department s high-risk pregnancy/birth unit. J) Interview other community professionals who have first hand knowledge. K) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. L) Interview primary care physician or physician who has seen child in past six months. M) Interview child protective services in other states in which family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. N) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. Allegation: Failure to Thrive (4)

201 5) Required Medical Documentation and/or Consultations A) The worker must ensure that the child receives an immediate medical examination and treatment if child is not currently under a physicians care. B) Medical records of current treatment/diagnosis and relevant past treatment. C) Copies of medical records regarding the failure to thrive including diagnosis, hospitalization reports, feeding record, and other care records. D) Expert opinion stating that the child is failure to thrive and there are no known /observable organic causes. E) A second medical opinion must be obtained when: i) the treating physician(s) is/are unable or unwilling to offer an opinion regarding the likelihood that child s condition was the result of abuse/neglect; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with the supervisor and, based on the totality of information gathered, the CPSW is not yet able to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. 6) Law enforcement/state s Attorney involvement or notification A) Notification of law enforcement and the State s Attorney is mandatory if protective custody is taken or if the alleged perpetrator is a paramour. B) Notification to State s Attorney is mandatory if this is the second indicated report. 7) Assessment of Factors to Be Considered To Support Case Finding Not applicable to this allegation. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. Allegation: Failure to Thrive (5)

202 D) Notify the Guardian ad Litem of the investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Failure to Thrive (6)

203 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT ENVIRONMENTAL NEGLECT Allegation of Harm #82 The child s person, clothing or living conditions are unsanitary to the point the child s health may be impaired. This may include infestations of rodents, spiders, insects, snakes, etc., human or animal feces, rotten or spoiled food or rotten or spoiled garbage that the child can reach. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a child is living in conditions as defined in section (a) above and that the conditions may be a threat to the child s health may be the Reporter or Source of a CA/N report. The Reporter/Source has reason to believe that the child is living in the conditions defined in section (a) as the result of disregard of duty or negligence on the part of the child s parent, caregiver, or other person responsible for the child s welfare. (NEGLECT) 3) Factors to Be Considered A) Child Factors i) Child s age. ii) iii) iv) Child s developmental stage. Child s physical condition. Child s mental abilities. B) Incident Factors i) Severity of conditions. ii) iii) iv) Frequency of the conditions. Duration of the conditions. Chronicity or pattern of similar conditions. Allegation: Environmental Neglect (1)

204 c) INVESTIGATING A REPORT REPORTS OF CHILD ABUSE AND NEGLECT 1) Documentation/Evidence Needed to Indicate A) Documented observations and/or photographs that demonstrate that a child s person, clothing or living conditions are unsanitary to the point that the child s health may be impaired. B) Specific and thorough identification and documentation of environmental issues which pose harm or significant risk of harm to the child as well as documentation of the parent s disregard and/or failure to correct the situation. C) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the condition have been obtained. D) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review Police report when it is received to ensure findings do not conflict with previously documented information received verbally. E) Apply and document the application of the factor to be considered. Each factor should be assessed as to relevance to the specific case and that assessment should be documented on a SACWIS Case Note or other form designed for this purpose. F) Waiver of any of the above must be given by the supervisor and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of physical condition, and completion of CERAP. E) Observation of the environment that poses a risk to the child. F) Interview DCFS or private agency caseworker if a service case is currently open. Allegation: Environmental Neglect (2)

205 G) Contact parents, by phone or in person. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. H) Contact alleged perpetrator either in person or by phone. I) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). J) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is reasonable cause to suspect that the child victim is exposed to an environment that is unsanitary and/or unhealthy due the parent/caretaker s disregard or negligence; and iii) the alleged victim is under the age of 18. B) Apply Factors to Be Considered to determine if there is reasonable cause to suspect the environment is unsafe. C) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Required Formal Investigation Interviews A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged offender. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview all identified witnesses who are reported to have knowledge of the condition of the environment. Allegation: Environmental Neglect (3)

206 F) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. G) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. H) Interview other community professionals who have first hand knowledge of the conditions leading to the report. I) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. J) Interview primary care physician or physician who has seen child in past six months. K) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. L) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 5) Required Medical Documentation and/or Consultations The worker must ensure that the child receives an immediate medical examination if evidence exists that the child is in need of urgent medical care. 6) Law Enforcement/State s Attorney Involvement or Notification Notification of law enforcement and the State s Attorney is mandatory if protective custody is taken, or if the alleged perpetrator is a paramour. 7) Assessment of Factors to Be Considered to Support Case Finding A) What age is the reported child(ren)? B) Does the child have a medical condition; behavioral, mental or emotional problem; or disability or handicap which impacts on their ability to seek help or significantly increases a caretakers stress level? C) Is there a history of similar instances with this child or other children for whom the caretaker has been responsible? D) What is the severity of the condition? (Identify specifics including infestation of rodents or insects, presence of human or animal feces, and/or presence of rotten or spoiled food and garbage.) Allegation: Environmental Neglect (4)

207 E) Is there a previous history of abuse and/or neglect? (More weight should be given to a documented history and DCFS files used as a basis for identifying history should be reviewed prior to being considered a factor. History described by subjects or collaterals should be viewed in the spirit and light it is presented.) F) What dynamics are present between the child and the parent? (Identify the child s level of fear of the caretaker. Does the caretaker appear to be concerned about child s welfare and protective? Is there an appropriate parent-child relationship?) G) What is the level of stress/crisis in the home? (Is there a positive home environment or is the environment chaotic?) H) Is there an appropriate support system in place for the child and the caretakers? Are there supportive people in the home? 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of the investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Environmental Neglect (5)

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209 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT MALNUTRITION (NON-ORGANIC) Allegation of Harm #83 Lack of necessary or proper food substances in the body caused by inadequate food, lack of food, or insufficient amounts of vitamins or minerals. (Also known as marasmus or kwashiorkor.) The child with malnutrition is not simplistically a diminutive version of a well-nourished child. The various physical signs of malnutrition are: a decrease in lean body mass or fat; very prominent ribs; the child may often be referred to as skin and bones; hair is often sparse, thin, dry, and is easily pulled out or falls out spontaneously; the child is often pale and suffers from anemia; excessive perspiration, especially about the head; the face appears lined and aged, often with a pinched and sharp appearance; the skin has an old, wrinkled look with poor turgor (skin folds hang loose on the inner thigh and buttock); the abdomen is often protuberant; and there are abnormal pulses, blood pressure, stool patterns, intercurrent infections, abnormal sleep patterns and a decreased level of physical and mental activity. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any medical person who has reason to believe that a child was malnourished as a result of neglect may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the child was malnourished due to the parent s, caregiver s, or other responsible person s disregard of his or her responsibilities. The malnourishment must be non-organic in nature. (NEGLECT) Allegation: Malnutrition (1)

210 c) INVESTIGATING A REPORT REPORTS OF CHILD ABUSE AND NEGLECT 1) Documentation/Evidence Needed to Indicate A) Medical diagnosis that the child is suffering from malnutrition. B) Medical rule out of disease or medical abnormality that could cause symptoms. C) All medical reports that support or refute diagnosis should be included in the file. D) Identify possible etiology (cause) for malnutrition (e.g. parent fails to provide adequate food either quantity or nutritionally). E) Documentation of physical exam that demonstrates that child is suffering from several of the following signs of malnutrition: i) a decrease in lean body mass or fat; very prominent ribs; the child may often be referred to as skin and bones; ii) iii) iv) hair is thin, sparse, and dry and is easily pulled out or falls out spontaneously; the child is pale and suffers from anemia; excessive perspiration, especially about the head; v) the face appears lined and aged, often with a pinched and sharp appearance; vi) vii) viii) the abdomen is often protuberant; the pulse, blood pressure, sleep patterns and stool patterns are abnormal. Child has decreased level of physical and mental activity and suffers from intercurrent infections; the skin has an old, wrinkled look with poor turgor. F) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the condition have been obtained. G) All other required contacts made, or documentation as to why they were not. H) Consultations have been obtained as required. I) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must Allegation: Malnutrition (2)

211 review Police report when it is received to ensure findings do not conflict with previously documented information received verbally. J) Waiver of any of the above must be given by the Child Protection Manager and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter, source and OPWI identified in the current report or related information. D) In person, individual contact with alleged child victim(s), assessment of physical condition, and completion of CERAP. E) Interview physician who treated current condition if other than reporter/source. F) In person or phone interview with Law Enforcement, if police have had contact on current report. This contact is to help establish the need to move to formal investigation phase. G) Interview DCFS or private agency caseworker if a service case is currently open. H) In person, individual interview with parents/caretakers. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. I) Interview alleged perpetrator either in person or by phone. J) Notify Guardian ad Litem if alleged child victim is DCFS ward or ward of the court (e.g., a child home with a parent under an order of protection). K) Waiver of any of the above contacts must be given by the Child Protection Investigator and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a determination that the child victim is diagnosed with the condition of malnutrition and there is reasonable cause to Allegation: Malnutrition (3)

212 suspect that the condition is the result of a parent s disregard of his or her responsibilities; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged offender. C) In person, individual interview all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview all physicians with knowledge of reported condition. F) Interview all identified witnesses who are reported to have knowledge of the situation that let to the current condition. G) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. H) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. I) Interview other community professionals who have first hand knowledge of the conditions leading to the report. J) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. K) Interview primary care physician or physician who has seen child in past six months. L) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. M) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. Allegation: Malnutrition (4)

213 5) Required Medical Documentation and/or Consultations A) Medical examination is required. B) Medical records of current treatment/diagnosis and relevant past treatment. C) Copies of medical records regarding the malnutrition including diagnosis, hospitalization reports, feeding record, and other care records. D) Expert opinion stating that the child is malnourished. and there are no known /observable organic causes. E) A second medical opinion must be obtained when: i) the treating physician(s) is/are unable or unwilling to offer an opinion regarding the likelihood that condition was caused by abuse/neglect; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with the supervisor and, based on the totality of information gathered, the CPSW is not yet able to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney Involvement or Notification A) Notification of law enforcement and the State s Attorney is mandatory if protective custody is taken, or if the alleged perpetrator is a paramour. B) Notification mandatory if this is the second indicated report. 7) Assessment of Factors to Be Considered to Support Case Finding Not applicable to this allegation. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. Allegation: Malnutrition (5)

214 D) Notify the Guardian ad Litem of the investigative findings if the victim is a DCFS ward or ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Malnutrition (6)

215 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT LOCK-OUT Allegation of Harm #84 The parent or caregiver has denied the child access to the home and has refused or failed to make provisions for another living arrangement for the child. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that the child has been locked out of his home may be the Reporter or Source of the CA/N report. The Reporter/Source has reason to believe that the child has been denied access to his home and that his parent, caregiver, or other responsible person has refused or failed to provide living arrangements for the child. (NEGLECT) c) INVESTIGATING A REPORT 1) Documentation/Evidence Required to Indicate A) Parent/caregiver statement refusing to allow the alleged victim access to the home and refusing to make an alternative living arrangement. B) Alleged victim statement that they are willing to return home or remain at home. C) Documentation that rules out parental inability to provide for the alleged victim in the home setting due to the alleged victim s serious mental illness, violent, threatening behavior, sexual abuse of a sibling or criminal activities which place family members at serious risk. D) Documentation of application of all relevant factors to be considered. E) Documentation of any clinical staffing or consultation. F) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review Police report when it is received to ensure findings do not conflict with previously documented information received verbally. Allegation: Lock-Out (1)

216 2) Requirements for Initial Investigation A) Data check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter/source and OPWI identified in the current report or related information. D) In person, individual contact with alleged child victim(s), assessment of physical condition and completion of CERAP. E) Interview DCFS or private agency caseworker if a service case is open. F) In person or phone contact with parents/caretakers on the same day as contact with the victim, if possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety and the formal investigation must be commenced. G) In person or phone interview with youth services provider. H) Notify Guardian ad Litem if alleged child victim is a DCFS ward or ward of the court (e.g., a child home with a parent under an order of protection). I) Verification that the alleged perpetrator and victim are eligible as defined in Procedures 300. J) Waiver of any of the above contacts must be given by the supervisor and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or ii) there is a reasonable cause to suspect that the child victim has been denied access to his home by his parent, caregiver or other person responsible for the child s welfare; and iii) the alleged victim is under the age of 18. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. Allegation: Lock-Out (2)

217 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person interview with all other adults and verbal children residing in the home of the alleged victim. Non-verbal children must be observed. C) If the alleged victim is currently hospitalized psychiatrically or recently discharged from a psychiatric facility, interview attending psychiatrist and all present or past mental health providers. D) If the alleged victim is the subject of a pending delinquency petition, interview probation officer and/or other court personnel. E) Interview DCFS or POS worker if the case is open or has been closed within the last year. F) Interview any other social service personnel involved with the family. G) Interview all identified witnesses who are reported to have knowledge of the incident. H) If the family or subjects identify two or more possible collateral contacts, at least two must be interviewed by telephone or in person. I) Interview anyone who has provided an alternative living arrangement for the alleged victim in the past. J) For children under the age of 12, interview school teacher or child care provider who has knowledge of the child and/or the level of care provided to the child. K) Interview primary care physician or physician who has seen child in past six months. L) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered attempts must be made to gather abuse/neglect history for an additional five years. 5) Factors Which Must Be Considered Alleged adolescent victims of this allegation often are exhibiting violent, threatening behavior, dangerous criminal activity or serious mental illness which may be the primary problem. The lock-out may reflect parental inability to independently access the necessary correctional, therapeutic or structured setting services (e.g. MRAI, ICG, IEP, etc.). The following factors should be considered in determining whether the available evidence substantiates a finding of neglect. Allegation: Lock-Out (3)

218 A) Age of the alleged victim. B) Is the alleged victim currently hospitalized or recently discharged from a psychiatric facility? (See required consultations.) C) Does the alleged victim have a history of serious psychiatric problems? If so, can the parents produce documentation of numerous attempts to secure services (e.g. past hospitalizations, treatment, counseling, etc.)? D) Was the alleged victim cooperative with past services? E) Is there a documented history of serious, violent behavior toward family members? F) Is the alleged victim a juvenile sex offender with siblings in the home? G) Is the allege victim currently the subject of a police investigation or a delinquency petition? H) Have the parents already tried informal placements (alternative living arrangements) which have failed due to the alleged victim s behavior? I) Has the alleged victim previously been referred as an MRAI? J) Does the alleged victim express a willingness to return to the home (or remain) and participate in recommended services? K) Has a professional suggested to the parents that the alleged victim needs residential placement services that can be provided by DCFS? Note: If factors indicate that the evidence suggests that neglect has not occurred and the living arrangement for the youth remains unresolved, the CPSW must assist in linking the family with the appropriate service system (e.g. MRAI, mental health/sass, etc.). A no fault dependency should be considered if the situation is unresolved and the CPSW has obtained a clinical consultation. 6) Required Medical Information and/or Consultations A) The worker must ensure that the child receives an immediate medical exam if evidence exists the child is in need of urgent medical care. B) Medical records of current treatment/diagnosis and relevant past treatment. C) Staffing with DCFS Clinical Services is required when the alleged victim is hospitalized in a psychiatric facility and psychiatric records must be obtained. Allegation: Lock-Out (4)

219 D) Clinical consultation is strongly suggested if the alleged victim has a significant mental health issue, even if not hospitalized, or if the alleged victim is a juvenile offender with siblings. E) DCFS legal staff must be consulted if the alleged victim is an adjudicated delinquent or there is a pending delinquency petition. 7) Law Enforcement/State s Attorney Involvement or Notification A) None required. Investigative staff should attempt to initiate crisis intervention services if the reporter is not the youth service agency or SCR has been unsuccessful in an attempt to get the reporter to initiate crisis intervention services. B) Notification of law enforcement and the State s Attorney is mandatory if protective custody is taken or if the alleged perpetrator is a paramour. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of the investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Lock-Out (5)

220 This page intentionally left blank. Allegation: Lock-Out (6)

221 a) DEFINITION REPORTS OF CHILD ABUSE AND NEGLECT MEDICAL NEGLECT OF DISABLED INFANTS Allegation of Harm #85 The withholding of appropriate nutrition, hydration, medication or other medically indicated treatment from a disabled infant with a life-threatening condition. Medically indicated treatment includes medical care which is most likely to relieve or correct all life-threatening conditions and evaluations or consultations necessary to assure that sufficient information has been gathered to make informed medical decisions. Nutrition, hydration, and medication, as appropriate for the infant s needs, are medically indicated for all disabled infants. Other types of treatment are not medically indicated when: the infant is chronically and irreversibly comatose, the provision of the treatment would be futile and would merely prolong dying, or the provision of the treatment would be virtually futile and the treatment itself would be inhumane under the circumstances. In determining whether treatment will be medically indicated, reasonable medical judgments such as those made by a prudent physician knowledgeable about the case and its treatment possibilities will be respected. However, opinions about the infant s future quality of life are not to bear on whether a treatment is judged to be medically indicated. Note: Whenever a hospital has an Infant Care Review Committee, Department investigative staff or the Perinatal Coordinator will consult with the Committee and will document in writing any disagreements with the Committee s recommendations and the reasons for them. b) TAKING A REPORT 1) Acceptable Reporter/Source 2) Usage Any person who has reason to believe that a disabled infant with a life threatening condition has been/is being medically neglected. The Reporter/Source has reason to believe that the disabled infant has not/is not receiving medically indicated treatment (includes appropriate nutrition, hydration, and medication and independent evaluations and consultations) Allegation: Medical Neglect of Disabled Infants (1)

222 due to the parent s, caregiver s or other responsible person s disregard of his or her responsibilities. 3) Factors to Be Considered A) The infant s physical condition. B) The seriousness of the current health problem. C) The probable medical outcome if the current health problem is not treated and the seriousness of that outcome. D) Generally accepted medical benefits of the prescribed treatment. E) Generally recognized side effects/harms associated with the prescribed treatment. F) Opinions of the Infant Care Review Committee (ICRC), (if the hospital has an ICRC). G) The judgment of the DCFS nurse regarding whether treatment is medically indicated and whether there is credible evidence of medical neglect. H) The parent s knowledge and understanding of the treatment and the probable medical outcome. c) INVESTIGATING A REPORT 1) Documentation/Evidence Needed to Indicate A) Verifiable information that a disabled infant has been denied reasonable medical treatment (including appropriate nutrition, hydration, or medication) through an action of a parent or other eligible caregiver. B) Sufficient information from medical providers to assess and apply Factors to Be Considered. C) All medical reports that support or refute diagnosis should be included in the file. D) Detailed explanatory statements of the victim, perpetrator, witnesses, and any other person with knowledge of the condition have been obtained. E) All other required contacts made or documentation as to why they were not. Allegation: Medical Neglect of Disabled Infants (2)

223 F) If police have conducted an investigation, the final finding must be obtained and documented. If the police report is not available, a case note must be included indicating the report has been requested along with documentation of the verbal statements. The supervisor must review police report when it is received to ensure findings do not conflict with previously documented information received verbally. G) Consultations have been obtained as required. H) Waiver of any of the above must be given by the Child Protection Manager and documented on a SACWIS Case Note. 2) Requirements for Initial Investigation A) Data check, LEADS check and Soundex of members of the family and other subjects regularly frequenting or living in the home. B) Thoroughly read and review prior investigations. C) Interview reporter/source and OPWI identified in the current report or related information. D) In person, individual interview with alleged child victim(s), assessment of physical condition and completion of CERAP. E) Interview physician who is treating current condition if other than reporter/source. F) Interview DCFS or private agency caseworker if a service case is currently open. G) In person, individual interview with parents. Parents should be contacted on the same day as contact with child victim(s) if at all possible. If CERAP is marked unsafe, parents must be interviewed immediately to ensure the child s safety, and the formal investigation must be commenced. H) Interview alleged perpetrator either in person or by phone. I) Notify Guardian ad Litem if alleged child victim is DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). J) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 3) Requirements for Proceeding to Formal Investigation A) A formal investigation must be commenced if: i) the CERAP is marked unsafe; or Allegation: Medical Neglect of Disabled Infants (3)

224 ii) there is a determination that the child victim is disabled infant who is not receiving necessary medical care and there is reasonable cause to suspect that the situation is the result of a parents or caretakers disregard of his or her responsibilities. B) The decision to proceed to a formal investigation must be made within 14 days from the receipt of the report and documented on a SACWIS Case Note. 4) Requirements for Formal Investigation A) In person, individual interview with parents/caretakers. B) In person, individual interview with alleged offender. C) In person, individual interview with all other adults and verbal children of the victim s household. Non-verbal children must be observed. D) In person, individual interview with all other adults and verbal children of the perpetrator s household. Non-verbal children must be observed. E) Interview regular physician or physician who has seen child in previous six months. F) Interview all physicians with knowledge of reported condition. G) Interview Hospital Infant Care Review Committee if available. H) Interview DCFS nurse. I) Interview all identified witnesses who are reported to have knowledge of the incident. J) If the family or the subjects identify two or more possible collateral contacts, at least two must be interviewed either by phone or in person. K) Interview DCFS or private agency caseworker if service case is currently closed but has been open within the past two years. L) Interview other community professionals who have first hand knowledge of the circumstances that led to the condition. M) Interview primary care physician or physician who has seen child in past six months. N) Interview child protective services in other states in which the family members have resided in the previous five years. If history of maltreatment is uncovered, attempts must be made to gather abuse/neglect history for an additional five years. Allegation: Medical Neglect of Disabled Infants (4)

225 O) Waiver of any of the above contacts must be given by the Child Protection Manager and documented on a SACWIS Case Note. 5) Required Medical Documentation and/or Consultation A) Worker must ensure child receives an immediate medical exam if evidence exists the child is not in a hospital or medical facility. B) Medical records of current treatment/diagnosis and relevant past treatment. C) Copies of medical records regarding the infant s medical condition including diagnosis, hospitalization reports, feeding record, and other care records. D) Expert opinion stating that the child is a disabled infant and the medical outcome if the current problem is not treated. E) Expert opinion concerning the benefits and potential side effects/harms of the prescribed course of treatment. F) A second medical opinion must be obtained when: i) the treating physician(s) is/are unable or unwilling to offer an opinion regarding the likelihood that condition was caused by neglect; or ii) iii) there are conflicting opinions among treating physicians; or the case has been staffed with the supervisor and Perinatal Coordinator and, based on the totality of information gathered, the CPSW is not yet able to make a well-supported finding. Note: The opinion of the physician with the most relevant specialization and experience should be given the greatest regard. 6) Law Enforcement/State s Attorney Involvement or Notification A) Notification of law enforcement and the State s Attorney is mandatory if protective custody is taken, or if the alleged perpetrator is a paramour. B) Notification mandatory if this is the second indicated report. 7) Assessment of Factors to Be Considered to Support Case Finding A) Infant s medical condition. B) Seriousness of the current health problem. Allegation: Medical Neglect of Disabled Infants (5)

226 C) Probable medical outcome if the current health problem is not treated and the seriousness of that outcome. D) Generally accepted medical benefits of the prescribed treatment. E) Generally recognized side effects/harms associated with the prescribed treatment. F) The opinions of the hospital Infant Care Review Committee (ICRC) if available. G) The judgment of the DCFS nurse regarding whether treatment is medically indicated and whether there is credible evidence of medical neglect. H) The parent s knowledge and understanding of the treatment and the probable medical outcome. 8) Notification of Findings A) Verbally notify the family of the recommended finding. B) Verbally notify the mandated reporter of the recommended finding. C) With parental consent, notify collateral contacts that were interviewed if the case is unfounded. D) Notify the Guardian ad Litem of the investigative findings if the victim is a DCFS ward or a ward of the court (e.g., a child home with a parent under an order of protection). Allegation: Medical Neglect of Disabled Infants (6)