The purpose of this course is to prepare healthcare professionals to identify child abuse and maltreatment/neglect and to comply with Pennsylvania 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 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.1
The US Department of Health & Human Services reports that there are nationally around 678,000 victims of child abuse and neglect. The victim rate is 9.2 victims per 1,000 children in the population.2
Victim demographics include:2
Child fatalities from abuse and neglect are estimated at 1,770, resulting in a rate of 2.39 per 100,000 children in the population.2
The youngest children are the most vulnerable to maltreatment, with 46.6 percent of child fatalities younger than one-year-old and died at a rate of 22.77 per 100,000 children in the population of the same age. Boys have a higher child fatality rate than girls; 2.87 per 100,000 boys in the population, compared with 2.19 per 100,000 girls in the population.2
The rate of African-American child fatalities (5.48 per 100,000 African-American children) is 2.8 times greater than the rate of White children (1.94 per 100,000 White children) and 3.4 times greater than the rate of Hispanic children (1.63 per 100,000 Hispanic children).2
Studies conclude that professionals that have contact with children report only half of the incidents that may be abuse.3 The reasons for this low report rate were:
The study also found the professionals are often influenced by their professional beliefs, values, and past experiences.3
Protecting Pennsylvania's children from abuse and neglect is a shared responsibility. It requires collaboration from the formal child protective services system, community partners, and our citizens to provide local safety nets for children and families that are facing challenges within our communities and neighborhoods.
Recently, 23 pieces of legislation were enacted, changing how Pennsylvania responds to child abuse. These changes significantly impact the reporting, investigation, assessment, prosecution, and judicial handling of child abuse and neglect cases.
This website, KeepKidsSafe.pa.gov, is designed to serve as the hub for information related to critical components impacting child protection including a link for mandated reporters to make reports of suspected child abuse electronically, training on child abuse recognition and reporting, information related to clearances and general information related to child protection.4
The Pennsylvania Child Protective Services Law (CPSL) was enacted in 1975 to protect children from abuse, allow the opportunity for healthy growth and development, and, whenever possible, preserve and stabilize the family.
The primary focus of Pennsylvania's Child Welfare System is the safety, permanency, and well-being of the children we serve. We operate from the assumption that children belong with their own families and should receive necessary services in the community rather than being placed outside of their homes. Although placement away from their families should be the last resort, if it is necessary, children should be placed in the most appropriate setting to meet their needs; preferably, a location that promotes reunification with the family where, and as soon as, possible.
The Child Welfare System (CWS) in Pennsylvania is state-supervised and county-administered.
The Department of Public Welfare is responsible for:
The county children and youth agency is responsible for:
Each county's children and youth social service (CYS) agency is responsible for administering a program of children and youth social services to children and their families. This agency includes services designed to:
Reports of child abuse will be made through ChildLine, but for your information, the following is the contact information for the regional state CWS agencies.
Office of Children, Youth, and Families
801 Market Street, 6th Floor
Philadelphia, PA 19107
(215) 560-2249 or (215) 560-2823
Counties Served: Bucks, Chester, Delaware, Montgomery, Philadelphia
Office of Children, Youth, and Families
11 Stanwix Street, Room 260
Pittsburgh, PA 15222
Counties Served: Allegheny, Armstrong, Beaver, Butler, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Venango, Warren, Washington, Westmoreland
Office of Children, Youth, and Families
Scranton State Office Building
100 Lackawanna Avenue, 3rd Floor
Scranton, PA 18503
Counties Served: Berks, Bradford, Carbon, Lackawanna, Lehigh, Luzerne, Monroe, Northampton, Pike, Schuylkill, Sullivan, Susquehanna, Tioga, Wayne, Wyoming
Office of Children, Youth, and Families
1401 North Seventh Street, Fourth Floor
Harrisburg, PA 17120
Counties Served: Adams, Bedford, Blair, Cambria, Centre, Clinton, Columbia, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Lycoming, Mifflin, Montour, Northumberland, Perry, Snyder, Somerset, Union, York
General Protective Services: Services and activities that are related to the safety of children, including, but not limited to, inadequate housing, clothing, and supervision.
Child Protective Services: Services and activities that are provided for concerns of child abuse. Ways to identify abuse and the reporting processes are discussed later in this course.
The following are legal definitions that are important to understand in order to identify child abuse.
Child: An individual under 18 years of age
The definition of perpetrator is used to determine if the case is child abuse. As a mandatory reporter, you should report any situation that is not clear to you. If the abuser does not meet the definition of perpetrator, the case will be referred to the appropriate agency or services by the CWS.
Perpetrator of Child Abuse:
Perpetrator of child abuse for failure to act:
School Employee: An individual who is employed by a school or who provides a program, activity, or service sponsored by a school. The term excludes an individual who has no direct contact with children.
If the alleged perpetrator is a school employee or childcare service employee, the administrator or employer will receive notice of a pending allegation and the final status of the report following the investigation as to whether the report is indicated, founded or unfounded. If the perpetrator is a school employee, the notice of the final status of the report shall be sent to the Department of Education within 10 days of the completion of the investigation.
Act or failure to act: A perpetrator can cause the abuse (act) or can allow the abuse through negligence.
Child abuse means intentionally, knowingly, or recklessly doing any of the following:
Recent act or failure to act: Any act or failure to act committed within two years of the date of the report to the Department or county agency.
Serious bodily injury: Bodily injury, which creates a substantial risk of death or which causes serious permanent disfigurement or protracted loss or impairment of the function of any bodily member or organ.
Serious mental injury: A psychological condition, as diagnosed by a physician or licensed psychologist, including the refusal of appropriate treatment, that:
Serious physical neglect: Any of the following when committed by a perpetrator that endangers a child's life or health, threatens a child's well-being, causes bodily injury or impairs a child's health, development or functioning:
Sexual abuse or exploitation: Any of the following:
This paragraph does not include consensual activities between a child who is 14 years of age or older and another person who is 14 years of age or older and whose age is within four years of the child's age.
Environmental factors: No child shall be deemed to be physically or mentally abused based on injuries that result solely from environmental factors, such as inadequate housing, furnishings, income, clothing and medical care, that are beyond the control of the parent or person responsible for the child's welfare with whom the child resides. This subsection shall not apply to any childcare service, as defined in this chapter, excluding an adoptive parent.
Practice of religious beliefs: If, upon investigation, the county agency determines that a child has not been provided needed medical or surgical care because of sincerely held religious beliefs of the child's parents or relative within the third degree of consanguinity and with whom the child resides, which beliefs are consistent with those of a bona fide religion, the child shall not be deemed to be physically or mentally abused.
Use of force for supervision, control and safety purposes: The use of reasonable force on or against a child by the child's own parent or person responsible for the child's welfare shall not be considered child abuse if any of the following conditions apply:
Rights of parents: Nothing in this chapter shall be construed to restrict the generally recognized existing rights of parents to use reasonable force on or against their children for the purposes of supervision, control, and discipline of their children. Such reasonable force shall not constitute child abuse.
Participation in events that involve physical contact with the child: An individual participating in a practice or competition in an interscholastic sport, physical education, a recreational activity or an extracurricular activity that involves physical contact with a child does not, in itself, constitute contact that is subject to the reporting requirements of this chapter.
Child-on-child contact: Harm or injury to a child that results from the act of another child shall not constitute child abuse unless the child who caused the harm or injury is a perpetrator.
No child shall be deemed to be a perpetrator of child abuse based solely on physical or mental injuries caused to another child in the course of a dispute, fight or scuffle entered into by mutual consent.
A law enforcement official who receives a report of suspected child abuse is not required to make a report to the Department under section 6334(a) (relating to disposition of complaints received) if the person allegedly responsible for the child abuse is a non-perpetrator child.
Defensive force: Reasonable force for self-defense or the defense of another individual, shall not be considered child abuse.
Exclusions are used when evaluating a case in order to substantiate the report. However, a mandatory reporter's responsibility is to report suspected abuse. If the mandatory reporter is unsure, a report should be filed. The CWS will investigate and determine that child abuse did not occur if the case meets the exclusion criteria.
The Pennsylvania Consolidated Statutes provides for additional grounds for involuntary termination of parental rights; providing for an additional grounds for aggravated circumstances; allowing for the release of information in confidential reports to law enforcement when investigating cases of severe forms of trafficking in persons or sex trafficking; adding a category of child abuse to include: engaging a child in a severe form of trafficking in persons or sex trafficking.
Anyone (permissive reporter) may report suspected abuse at any time and are encouraged to do so.6
The following adults are mandated to report suspensions of child abuse:
If a child is in immediate danger, call 911.
The mandated reporter is required to report even if their knowledge is incomplete. The role of the mandated reporter is to assess for reasonable cause to suspect abuse. The mandated reporter identifies reasonable cause and leaves the investigation to specially trained workers in the CWS.
The mandated reporter does not:
When talking with children to establish reasonable cause, find a private place, and remain calm. Be honest, open, and upfront 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 childcare that you are making a report to ChildLine. 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.
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, CWS and law enforcement work together to interview the child at the same time using specially trained professionals
Reasonable cause to suspect things that based on what you have observed or been told, combined with your training and experience, you feel that 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 ChildLine immediately.3
Mandated reporters are required to make a report of suspected child abuse if they have reasonable cause to suspect that a child is a victim of child abuse under any of the following circumstances:
It is not required that the child comes before the mandated reporter in order to make a report of suspected child abuse.
Crimes committed against the child should be reported directly to law enforcement. If you're uncertain if the incidence criminal, you can contact the CWS 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.3
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.
Reports of child abuse may be reported to ChildLine electronically at www.compass.state.pa.us/cwis if the situation does not require an emergency response.
You should call the Child Abuse Hotline, ChildLine at 1-800-932-0313 for the following situations:
If an oral report is made to ChildLine, a report of suspected child abuse, form CY-47, must also be completed and forwarded to the county children and youth agency within 48 hours after making the report. This form can be obtained at www.KeepKidsSafe.pa.gov under the forms tab or from the children and youth agency. If a report is made electronically, no form CY-47 is required to be completed.
Be prepared to articulate your concerns in a clear and concise manner when you call ChildLine. The following is a list of information the mandated reporter is asked to provide if known:3
The law requires that mandated reporters identify themselves and where they can be reached. This information is helpful if the caseworker needs additional information. However, the identity of the person making the report is kept confidential, with the exception of being released to law enforcement officials or the district attorney's office.
Mandatory reporting and postmortem investigation of deaths.6
A person or official required to report cases of suspected child abuse, including employees of a county agency, who has reasonable cause to suspect that a child died as a result of child abuse shall report that suspicion to the appropriate coroner or medical examiner. The coroner or medical examiner shall accept the report for investigation and shall report his findings to the police, the district attorney, the appropriate county agency, and, if the report is made by a hospital, the hospital.7
ChildLine forwards the report of suspected child abuse to the local county children and youth agency, which investigates the report to determine if the allegations can be substantiated as child abuse/neglect and also arranges for or provides the services that are needed to prevent the further maltreatment of the child and to preserve the family unit.7 Services that are available include:
The county children and youth agency must begin an investigation within 24 hours. A thorough inquiry is conducted to determine if the child was abused and what services are appropriate for the child and family. This must be completed within 30 days unless the agency provides justification as to why the investigation cannot be completed, including attempts being made to obtain medical records or interview subjects of the report.7
If the alleged perpetrator report does not meet the definition of perpetrator but does suggest the need for an investigation, ChildLine will forward the information to the district attorney's office in the respective county.7
Mandated reporters are immune from any criminal or civil liability if the report was made in good faith. Good faith for the mandated reporter is presumed. This means if someone accuses you of making a false report that they have to prove to you acted with gross negligence or willful misconduct.3
A mandated reporter who willfully fails report can be found guilty of a misdemeanor of the second degree up to a felony of the first degree or higher. 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 ChildLine, including wrongful death.3
Mandated reporters will receive information from the Department regarding the final status of the report, whether it was unfounded, indicated or founded, and the services planned or provided to protect the child.7
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:
Indicators should not be viewed in isolation; they must be considered in relation 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.3
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 of abuse, maltreatment, or neglect are:3
Glove like burn8
Sock like burn8
Steam Iron Injury8
Looped cord injury (AbuseWatch.net, 2012)8
Accidental injuries usually involve injury on a bony prominence of the body, such as elbows, 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 bruising8
Clues to the mechanism of injury8
Consider the size and shape of the injury, as well as the location of injury.3 Consider the relationship of the mechanism of injury (explanation of how the 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, and 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, maltreatment, or neglect may be:3
Parent behavioral indicators of physical abuse, maltreatment, or neglect may be:3
Child physical indicators of emotional abuse, maltreatment, or neglect may be:3
Child behavioral indicators of emotional abuse, maltreatment, or neglect may be:3
Parent behavioral indicators of emotional abuse, maltreatment, or neglect may be:3
Child physical indicators of sexual abuse may be:3
Child behavioral indicators of sexual abuse may be:3
Parent behavioral indicators of sexual abuse may be:3
Case Study A:
Case Study B:
Case Study C:
Case Study D:
Case Study A:
Case Study B:
Case Study C:
Case Study D: