The purpose of this course is to prepare healthcare professionals to identify child abuse and maltreatment/neglect and to comply with New York mandatory reporting requirements.
After completing this course the learner will be able to:
Violence is an important public health issue. The World Health Organization (WHO) estimates that nearly 53,000 children are murdered each year and that the prevalence of forced sexual intercourse and other forms of sexual violence involving touch, among boys and girls under 18, is 73 million and 150 million respectively (WHO, 2016).
For 2014, there were a nationally estimated 702,000 victims of abuse and neglect, resulting in a rate of 9.4 victims per 1,000 children in the population. The youngest children are the most vulnerable to maltreatment. In FFY 2014, 52 states reported that more than one-quarter (27.4%) of victims were younger than 3 years. (DHHS, 2014, pg. 21.
The percentages (not shown) of child victims were similar for both boys (48.9) and girls (50.7). African-American children had the highest rate of victimization at 15.3 per 1,000 children in the population of the same race or ethnicity and American Indian or Alaska Native children had the second highest rate at 13.4 per 1,000 children. Hispanic and White children had lower rates of victimization at 8.8 and 8.4 per 1,000 children in the population of the same race or ethnicity (DHHS, 2014, pg. 23).
For FFY 2014, a nationally estimated 1,580 children died from abuse and neglect at a rate of 2.13 per 100,000 children in the population (DHHS, 2014, pg. 51).Studies conclude that professionals that have contact with children report only half of the incidents that may be abuse or maltreatment/neglect (Research foundation, 2011). The reason for this low report rate was due to confusion or misunderstanding about the laws and procedures and a lack of knowledge or awareness of warning signs. The study also found that professionals are often influenced by their professional beliefs values and past experiences (Research foundation, 2011). This prompted the state of New York to require mandated reporter training.
In 1973, New York State passed the child protective services act. This created the New York State Central Register (SCR) of Child Abuse and Maltreatment. This is a 24 hours seven day a week central registry known in New York as SCR. New York State Office of Children and Family Services operates SCR. Local Child Protective Services (CPS) receive and investigate registers reports. Local CPS offices have human service professionals specially trained to investigate allegations of child abuse and maltreatment.
CPS is a system that operates as a preventive-protective continuum of care. CPS works to support families in crisis and stress. They work with the families to improve their life and break the cycle of abuse and maltreatment/neglect (Research foundation, 2011). Don’t think of a report to the SCR as punitive. Sometimes intervention can provide exactly the kind of help a family needs to prevent the abuse or maltreatment/neglect from causing irreversible harm. Sometimes a report is a wake-up call for parents or as a mean of getting assistance in areas of their life that has become unmanageable (Research foundation, 2011).
The majority of reports are made by mandated reporters. This is due to their professional training and mandated reporter training (NYOFS, 2016).
Anyone may report suspected abuse or maltreatment/neglect at any time and are encouraged to do so. However, Section § 413 of the social services law requires designated professionals to report to the SCR when (NYOFS, 2016):
Social services workers are held to a higher standard. They are required to report whenever they have reasonable cause to suspect if any person speaks directly to the staff concerning possible abuse; even if that person is not the parent, child, or other legally responsible person (Research foundation, 2011).
Reports must be made to the SCR immediately upon development of reasonable cause to suspect child abuse and maltreatment/neglect. Reports should be made by the person with knowledge of the reasonable cause. No employer can establish any conditions, prior approval, or prior notification before making a report; however, there may be need to discuss your findings with others to determine if there is reasonable cause. The supervisory staff should be notified of the report immediately after making the report to SCR. No more than one report from any institution, school, or agency is required, but the report should include names and contact information of everyone who has knowledge of the situation.
Mandated reporters are only required to report when acting in their professional capacity. When a professional is off-duty and witness possible abuse or maltreatment/neglect, the professional is not required to report; but, is encouraged to report as a concerned citizen (Research foundation, 2011).
No retaliatory personnel action for making a report is allowed.
Required Mandated Reporters may change as legislature is passed. The most recent list can be found in the social services law section 413 at www.senate.state.NY.us. or at http://ocfs.ny.gov/main/cps/faqs_mandatedreporter.asp. The following persons or officials are mandated reporters in accordance with social services law § 413 as of 5/26/16 is (NYOFS, 2016):
The legal framework that applies to mandated reporters is immunity from liability, confidentiality, and penalties for failure to report.
Many mandated reporters feel there is a conflict between their legal obligation to report to SCR and their legal obligation to maintain client or patient confidentiality. Section 419 of the social services law provides immunity from liability for mandated reporters. Mandated reporters are immune from any criminal or civil liability if the report was made in good faith. Good faith for a mandated reporter is presumed. This means if someone accuses you of making a false report they have to prove you acted with gross negligence or willful misconduct (NYOFS, 2016).
New York State Social Security law number 422(4)(A) provides confidentiality to those who make a report. The employees of the office of children and family services and the local CPS are not permitted to release any data that would identify the source of the report to the subject of the report unless reporter has given written permission. Information about the report source may be shared by the Office of Children and Family Services or the local CPS and with certain individuals such as court, police, or district attorneys; but, only as provided by law (NYOFS, 2016).
A mandated reporter who fails report can be found guilty of a class A misdemeanor. A class A misdemeanor can result in a penalty of up to one year in jail, and a fine of up to $5000, or both. Failing to report may also result in a lawsuit in civil court for monetary damages for any harm that was caused by the mandated reporter’s failure to make a report to SCR, including wrongful death (NYOFS, 2016).
Mandated reporters of suspected child abuse or maltreatment/neglect must comply with the records requested by CPS. Written consent from the people involved is not required. However, the mandated reporter makes a determination of what information is essential. If the CPS should ask for additional records, an attempt to come to agreement must be made. If an agreement cannot be reached, CPS can request the court order. Disclosure of substance abuse treatment records are pursuant to the standards and procedures for the disclosure of such records as delineated by federal law (NYOFS, 2016).
Children are defined as individuals from birth up to 18 years of age; therefore, prenatal harm does not fall into the mandated reporter responsibility. However, if a child is born with a positive toxicology, that can be reported. Individuals no more than 21 years of age that have a handicapping condition and are in residential care in certain New York schools for the blind or deaf or private residential schools for special education services may also be reported to SCR (NYOFS, 2016).
In identifying reasonable cause, for reporting to SCR, consider (NYOFS, 2016):
Maltreatment involves the quality of care the child receives. Abuse reflects the seriousness of the injury. There has to be a connection between harm to the child, or substantial likelihood of harm, and the actions or inactions of the person responsible for the child. Do not worry about classifying the incident as abuse or maltreatment; that is the job for SCR and will be decided during the investigation (NYOFS, 2016).
Elements of abuse are defined in the Family Court Act 1012 (Research foundation, 2011, Trainer’s Presentation Guide, pg. 16-17).
A. Subject inflicts or allows to be inflicted on a child serious physical injury by other than accidental means?
B. Such action causes or creates a substantial risk of death or serious or protracted disfigurement, impairment of physical or emotional health or impairment of the function of any bodily organ
C. Subject creates or allows to be created a substantial risk of physical injury to the child by other than accidental means
D Such action causes or creates a substantial risk of death or serious or protracted disfigurement, impairment of physical or emotional health, or impairment of the function of any bodily organ
E. Subject commits or allows to be committed a sex offense as described in section 130 of the penal law
F. Subject commits or encourages the child to engage in any act defined in section 230.25, 230.30, or 230.32 of the penal law (promoting prostitution)
G. Subject commits any acts described in section 255.25 of the penal law (incest)
H. Subject allows child to engage in acts described in article 263 of the penal law:
The terms maltreatment and neglect are often used interchangeably. Maltreatment is defined as (Research foundation, 2011, Trainer’s Presentation Guide, pg. 18):
A. A child whose physical, mental, or emotional condition has been impaired or is at imminent danger of becoming impaired
B. The subject failed to exercise a minimum degree of care
C. There is a causal connection between the child’s conditions in the subject’s failure to exercise the minimum degree of care
D. The parent has abandoned the child by demonstrating intent to forgo his or her parental rights and obligations by failing to visit the child to communicate with the child though able to do so.
Even if a child is abandoned under the Abandoned Infant Protection Act, the case must be reported to SCR.
The terms minimum degree of care and excessive corporal punishment are vague and open to interpretation. Decisions are made by CPS based on case-by-case determination. They consider the form of punishment, its ability to cause serious injury, the purpose of the punishment, and what the child did to receive the punishment. The following questions might help focus the mandated reporters thought process (Research foundation, 2011, Trainer’s Presentation Guide, pg. 18; NYOFS, 2016):
A mother slaps her 16-year-old daughter for being disrespectful. The child did not sustain any bruises. This type of discipline would not be considered excessive.
A mother slaps her 12-year-old daughter for being disrespectful. As a result of this level of physical discipline, the child sustained an upper lip laceration on the right side of her face. This type of discipline should be reported to SCR.
Indicators of abuse warn the mandated reporter to pay more attention to a particular situation. Sometimes there are no indicators even though the child is being abused. There are three types of indicators of abuse or maltreatment/neglect; 1) physical indicators, 2) child behavioral indicators, and 3) parent behavioral indicators.
Indicators should not be viewed in isolation they must be considered in relationship to the child’s condition. Indicators should be considered in the overall context of the child’s physical appearance and behavior. Sometimes a single indicator is self-evident or points to abuse or maltreatment/neglect. Often several indicators must be pulled together or clusters of indicators used to develop reasonable cause (Research foundation, 2011).
Some mandated reporters see a child only once are very infrequently others see them more often. In looking for reasonable cause you need to consider what you know about the child’s normal behavior. No two children will respond the same way to the same situation.
Common physical indicators are severe unexplained or suspicious bruises and welts, fractures, burns, lacerations, or abrasions. Specific physical indicators are (Research foundation, 2011, participant's guide pg. 6; NYOFS, 2016):
Glove like burn
Sock like burn
Steam Iron Injury
Looped cord injury (AbuseWatch.net, 2012)
Accidental injuries usually involve injury on a bony prominence of the body such as elbows and knees and shins. Suspicious injuries usually occur in areas not susceptible to accidental age-appropriate areas. The following pictures indicate areas where children would normally bruises, and suspicious bruising areas, as well as other suspicious areas of injury.
Suspicious areas of bruising
Clues to the mechanism of injury
Consider the size and shape of the injury, as well as the location of injury (Research foundation, 2011). Consider the relationship of the mechanism of injury (explanation of how injury occurred) to the child's developmental stage. For example toddlers fall when they learn to walk and young children scrape their knees when learning to ride a bicycle. Consider if the story that was given as an explanation for an injury would produce the physical indicators that are present. For instance a toddler falls to the floor while walking, not striking anything when he fell. That toddler has bruises on the back of his legs. One would expect that from a fall, while walking, the toddler would have bruises and scrapes on his hands, knees, and shins; not bruises on the back of his legs.
Child behavioral indicators of physical abuse may be (Research foundation, 2011, participant's guide pg. 6; NYOFS, 2016):
Parent behavioral indicators of physical abuse may be (Research foundation, 2011, participant's guide pg. 6; NYOFS, 2016):
Child physical indicators of maltreatment/neglect may be (Research foundation, 2011, participant's guide pg. 6; NYOFS, 2016):
Child behavioral indicators of maltreatment/neglect may be (Research foundation, 2011, participant's guide pg. 6; NYOFS, 2016):
Parental behavior indicators of maltreatment/neglect may be (Research foundation, 2011, participant's guide pg. 6; NYOFS, 2016):
Child physical indicators of emotional maltreatment may be (Research foundation, 2011, participant's guide pg. 7; NYOFS, 2016):
FIG. 6-3. Photograph of patient with marked failure to thrive (case 6-7).
Child behavioral indicators of emotional maltreatment may be (Research foundation, 2011, participant's guide pg. 7; NYOFS, 2016):
Parent behavioral indicators of emotional maltreatment may be (Research foundation, 2011, participant's guide pg. 7; NYOFS, 2016):
Child physical indicators of sexual abuse may be (Research foundation, 2011, participant's guide pg. 8; NYOFS, 2016):
Child behavioral indicators of sexual abuse may be (Research foundation, 2011, participant's guide pg. 8; NYOFS, 2016):
Parent behavioral indicators of sexual abuse may be (Research foundation, 2011, participant's guide pg. 8; NYOFS, 2016):
The role of the mandated reporter is to assess for reasonable cause to suspect maltreatment/neglect or abuse. The mandated reporter is not to investigate or interrogate. The mandated reporter identifies reasonable cause and leaves the investigation and interrogation to specially trained workers in SCR and CPS.
When talking with children to establish reasonable cause, find a private place and remain calm. Be honest, open, and up front with the child. Be supportive. Listen to the child and stress that it’s not the child’s fault. Do not overreact, make judgments, make promises, nor interrogate or investigate.
There is no legal requirement to inform the parent or other persons legally responsible for the child’s care that you are making a report to SCR. In fact, informing the parents of the report may place the child for the risk of harm. Do not assume that the parent will support the child. If you have questions about whether to inform the parents, contact your local CPS.
In the case of suspected sexual abuse, avoid talking in detail with the child about the incident. There are special guidelines that apply to the case of suspected sexual abuse. Usually, CPS and law enforcement work together to interview the child same time using specially trained professionals.
Knowing who harmed the child is important information in determining how to proceed. The SCR only registers reports against the parent, guardian, or other person 18 years of age or older who is legally responsible for the child. According to the Family Court act, persons legally responsible include any person continually or at regular intervals found in the same household as the child when the conduct of the person causes or contributes to the abuse or maltreatment/neglect at the child. This definition includes parent, guardian, custodian, day care providers, and residential care staff (NYOFS, 2016). Teachers do not qualify as subjects of a SCR report when they are acting as teachers. A teacher who assaults a child may be subject to a criminal act report through the law enforcement system.
Reasonable cause to suspect things that based on what you have observed or been told, combined with your training and experience, you feel harm or imminent danger of harm to the child could be the result of an act or omission by the person legally responsible for the child. If there is reasonable cause to suspect the child is being abused or maltreated you must call SCR immediately (Research foundation, 2011, Trainer’s Presentation Guide, pg. 26).
Crimes committed against the child should be reported directly to law enforcement. If you’re uncertain if the incidence is criminal, you can contact the SCR anyway. If the child is in imminent danger, contact law enforcement immediately. Imminent danger is when the child is placed at immediate risk or a substantial risk of harm. In other words, how direct is the threat to the child? The danger must be immediate or nearly immediate (Research foundation, 2011).
Case Study A
Case Study B
Case Study C
Case Study D
The SCR mandated reporter express line number is 800-635-1522. The Public hotline number is 800-342-3720. For abuse by institutional staff call 855-373-2122
A report call to the local CPS does not fulfill your obligation as a mandated reporter. Reports must be called to SCR. The exception is one county with a localized hotline that may be used instead of SCR
Onondaga County (315)422-9701
Be prepared to articulate your concerns in a clear and concise manner when you call SCR. One way to prepare for the call is to fill out form LPSS-2221A. Since this form needs to be filled out anyway this will not be a waste of time. A copy of the reporting form is available below:
When you call SCR, be sure to ask for a verification number that is going to be assigned the report and the full name of the CPS specialist you are speaking with. You can request a summary of the findings. This is a brief document that will be provided to you following the completion of the local CPS evaluation. Just because you are a mandated reporter does not mean that SCR will automatically register a report. The SCR specialist will make a determination when you call whether or not to register the report. If you’re not satisfied with your interview with the CPS specialist you can ask for a supervisor. Supervisors are on duty around the clock at SCR.
Some situations are just not appropriate for CPS intervention. They may be more appropriate for referral to preventive services. If this is the case, you might contact your local CPS directly to get the family to help they need.
After completing the call to SCR, immediately notify the person in charge of the facility. Once the call is reported to the supervisor the supervisor becomes responsible for subsequent administration concerning the report including preparation and submission of the form LDSS 2221-A. This form should be sent to the local CPS office within 48 hours of making the report. Additional copies of the form are available on the OCFS website, www.OCFS.state.NY.us.
If SCR registers a report, it's been immediately transmitted to the local CPS agency for investigation, which must be started within 24 hours. After the investigation, the determination will be made that the report was indicated or unfounded. If it's unfounded the report is legally sealed. Unfounded reports are expunged 10 years after receipt of the report. If indicated, a determination is made whether to provide services. If services are needed a plan is developed and continued monitoring of the needed services is provided. When the services are no longer needed the case is closed.
AbuseWatch.net (2012). Prevention Resources for the Community and Professionals. Retrieved May 5, 2013.
New York Office of Children and Family Services. (2016). Mandated Reporter Training Online. Retrieved 5/26/16 (Visit Source).
New York Office of Children and Family Services. (2016). Frequently Asked Questions for Mandated Reporters. Retrieved 5/26/16 (Visit Source).
Research foundation for SUNY (2011). Mandated reporter trainer's resource guide; identifying and reporting child abuse and maltreatment/neglect. Buffalo State College, Center for development of human services, 2011.
U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, (2014). Child Maltreatment 2014, retrieved 5/26/16 (Visit Source).
World Health Organization (2016). Prevention of Child Maltreatment, retrieved 5/26/16 (Visit Source).
This course is applicable for the following professions:
Advanced Registered Nurse Practitioner (ARNP), Certified Nursing Assistant (CNA), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Dental Hygienist, Dentist, Dietetic Technicians, Registered (DTR), Dietitian/Nutritionalist (RDN), Home Health Aid (HHA), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Registered Nurse (RN), Respiratory Therapist (RT)
CPD: Preserve Safety, Legal & Regulatory, Pediatrics