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Child Abuse: Iowa Mandatory Reporter Training

2.00 Contact Hours
  • 0% complete
A score of 80% correct answers on a test is required to successfully complete any course and attain a certificate of completion.
Author:    Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)

Outcomes

The purpose of this course is to prepare professionals in Iowa, who come into frequent contact with children, to identify and respond to child abuse.

Objectives

After completing this course, the learner will be able to:

  1. Define Child Abuse
  2. Identify the physical and behavioral indicators of child abuse
  3. Correctly report child abuse
  4. Discuss the Code of Iowa and Iowa Administrative Code classifications of mandatory reporter, confidentiality provision, immunity provisions, and penalties for failure to report
  5. Describe the assessment protocol utilized by the Department of Human Services.

Introduction

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 confusion or misunderstanding about the laws and procedures and a lack of knowledge or awareness of warning signs. The study also found the professionals are often influenced by their professional beliefs values and past experiences (Research foundation, 2011).

Iowa’s child abuse reporting law, Iowa Code sections 232.67 through 232.75, was initially enacted in 1978 and has been amended several times since then. The intent of the law is to identify children who are victims of abuse. The law also provides for a professional assessment to determine if abuse has occurred. Accompanying the assessment are protective services designed to protect, treat, and prevent further maltreatment.

The purpose of the Iowa law is to provide the greatest possible protection to children by encouraging the reporting of suspected child abuse. The state respects the bond between parent and child. However, the state does assert the right to intervene for the general welfare of the child when there is a clear and present danger to the child’s health, welfare, and safety. The state does not intend to interfere with reasonable parental discipline and child-rearing practices that are not injurious to the child (IDOPH, 2016, pg. 3).

Meaning of Child Abuse

The definition of child abuse as defined in Iowa Code section 232.68(2) (IAC 641, 2014)

  1. "Child" means any person under the age of eighteen years.
  2. "Child abuse" or "abuse" means:
    1. Any nonaccidental physical injury, or injury which is at variance with the history given of it, suffered by a child as the result of the acts or omissions of a person responsible for the care of the child.
    2. Any mental injury to a child's intellectual or psychological capacity as evidenced by an observable and substantial impairment in the child's ability to function within the child's normal range of performance and behavior as the result of the acts or omissions of a person responsible for the care of the child, if the impairment is diagnosed and confirmed by a licensed physician or qualified mental health professional...
    3. The commission of a sexual offense with or to a child...as a result of the acts or omissions of the person responsible for the care of the child...the commission of a sexual offense under theparagraphincludes any sexual offense referred to in this paragraph with or to a person under the age of eighteen years.
    4. The failure on the part of a person responsible for the care of a child to provide for the adequate food, shelter, clothing, or other care necessary for the child's health and welfare when financially able to do so or when offered financial or other reasonable means to do so. A parent or guardian legitimately practicing religious beliefs who does not provide specified medical treatment for a child for that reason alone shall not be considered abusing the child, however this provision shall not preclude a court from ordering that medical service to be provided to the child where the child's health requires it.
    5. The acts or omissions of a person responsible for the care of a child which allow, permit, or encourage the child to engage in acts prohibited...
    6. An illegal drug is present in a child's body as a direct and foreseeable consequence of the acts or omissions of the person responsible for the care of the child.
    7. The person responsible for the care of a child has, in the presence of the child...or in the presence of the child possessed a product contracting ephedrine, its salts, optical isomers, salts of optical isomers, or pseudoephedrine, its salts, optical isomers, salts of optical isomers, with the intent to use the product as a precursor or an intermediary to a dangerous substance.
    8. The commission of bestiality in the presence of a minor...by a person who resides in a home with a child, as a result of the acts or omissions of a person responsible for the care of the child.
    9. Knowingly allowing a person custody or control of, or unsupervised access to a child or minor, after knowing the person is required to register or is on the sex offender registry.

Iowa Code section 232.68(2)(a)(11) defines “Child Sex Trafficking” as the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a child for the purpose of commercial sexual activity as defined in Iowa Code section 710A.1
“Commercial sexual activity” means any sex act or sexually explicit performance for which anything of value is given, promised to, or received by any person and includes, but is not limited to, prostitution, participation in the production of pornography, and performance in strip clubs.

NOTE: This category of child abuse that does not require caretaker status.

Iowa Code section 232.68(2)(a)(3) defines “Sexual Abuse” as the commission of a sexual offense with or to a child pursuant to Iowa Code chapter 709, section 726.2, or section 728.12(1), as a result of the acts or omissions of the person responsible for the care of the child or of a person who resides in a home with the child.

NOTE: This category of child abuse is expanded from caretaker status to also include any person who resides in a home with the child. 

Indicators of Child Abuse

Child abuse victims come into frequent contact with health professionals, but often only injuries are treated. Because there is a lack of training on what to look for and how to ask about abuse, health professionals often fail to identify victims. Opportunities for intervention are missed and victims continue to suffer the adverse health consequences of physical and emotional abuse

Healthcare professionals are often the first to observe abuse and neglect, and their observations are often crucial in substantiating that abuse has occurred. They can help by:

  • Reporting suspected cases of child abuse to Children’s Protective Services
  • Documenting abuse in the medical record
  • Safeguarding evidence
  • Providing medical advice, referrals, and safety planning
  • Showing empathy and compassion
  • Identifying the somatic signs and symptoms of abuse
  • Evaluating the plausibility of explanations given for common injuries and conditions
  • Providing expert testimony
  • Assessing cognitive status and health factors that affect it
  • Treating injuries or health problems that result from abuse
  • Performing abuse screenings
  • Encouraging clinics, hospitals, health maintenance organizations, or other medical providers to develop or adopt protocols for screening and responding to abuse
  • Provide referrals to legal and social services
  • Learning more about child abuse

Indicators of abuse warn the healthcare professional 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 healthcare professionals see a child only once, or very infrequently; others see them more often. In looking for a 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.

Physical Indicators

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):

  1. Unexplained bruises and welts
    1. On face, lips, mouth, torso, back, buttocks or thighs.

Handprint Injury

Handprint Injury
(AbuseWatch.net, 2012)

Bruising of torso, buttocks and thighs

(AbuseWatch.net, 2012)

  1. Bruising of torso, buttocks, and thighs
  2. Bruises in various stages of healing clustered bruises forming regular patterns that might reflect the shape of an article used to inflict the injury
  3. Bruises on several different areas
  4. Bruises regularly appear after absence, weekend, or vacation
  1. Unexplained fractures
    1. To nose, skull, or facial structure
    2. In various stages of healing
    3. Multiple or Spiral fractures

Spiral Fracture

Spiral Fracture
(AbuseWatch.net, 2012)

  1. Swollen or tender lambs
  1. Unexplained burns
    1. Cigar, cigarette burns especially on the soles of feet, palms, back and buttocks

Cigarette burn

Cigarette burn
(AbuseWatch.net, 2012)

  1. Immersion burns: sock like, glove like, doughnut shaped on buttocks or genitalia

Glove like burn

Glove like burn
(AbuseWatch.net, 2012)

Sock like burn

Sock like burn
AbuseWatch.net, 2012)

  1. Patterned like electric burner or iron

Steam Iron Injury
(AbuseWatch.net, 2012)

  1. Rope burns on arms, legs, neck, or torso

Steam Iron Injury

Looped cord injury (AbuseWatch.net, 2012)

  1. Unexplained lacerations or abrasions
    1. To mouth, lips, gums, or eyes
    2. To external genitalia
    3. On back of arms, legs, or torso
    4. Human bite marks
    5. Frequent injuries that are accidental or unexplained

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.

Bruising Areas
(AbuseWatch.net, 2012)

Suspicious areas of bruising
(AbuseWatch.net, 2012)

 

Clues to the mechanism of injury
(AbuseWatch.net, 2012)

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):

  1. the child is wary of adult contact,
  2. apprehensive when other children cry,
  3. demonstrates behavioral extremes,
  4. frightened of parents,
  5. afraid to go home,
  6. reports injury by parent,
  7. wears long sleeve or similar clothing to hide injuries,
  8. Seeks affection from adults.

Parent behavioral indicators of physical abuse may be (Research foundation, 2011, participant's guide pg. 6; NYOFS, 2016):

  1. seemed unconcerned about the child
  2. takes an usual amount of time to obtain medical care for the child
  3. offers inadequate or inappropriate explanations for the injury
  4. gives different explanations for the same injury
  5. misuses drugs or alcohol
  6. disciplines the child to harshly considering the child's age or what she has done wrong
  7. sees the child as bad or evil
  8. has a history of abuse as a child
  9. attempts to conceal the child's injury
  10. takes a child to a different hospital or doctor for each injury
  11. has poor impulse control

Maltreatment/Neglect

Child physical indicators of maltreatment/neglect may be (Research foundation, 2011, participant’s guide pg. 7; NYOFS, 2016):

  1. Consistent hunger, poor hygiene, inappropriate dress
  2. Consistent lack of supervision, especially in dangerous activities or for long periods
  3. Unattended physical problems or medical or dental needs
  4. Abandonment

Child behavioral indicators of maltreatment/neglect may be (Research foundation, 2011, participant’s guide pg. 7; NYOFS, 2016):

  1. Begging or stealing food
  2. Extended stays in school – arrives early, leaves late
  3. Attendance at school infrequent
  4. Consistent fatigue, falls asleep in class
  5. Alcohol and drug abuse
  6. States there is no caretaker

Parental behavior indicators of maltreatment/neglect may be (Research foundation, 2011, participant’s guide pg. 7; NYOFS, 2016):

  1. Misuses alcohol or other drugs
  2. Has disorganized, upsetting home life
  3. Is apathetic, feeling nothing will change
  4. Is isolated from friends, relatives, neighbors
  5. Has long term chronic illness
  6. Cannot be found
  7. Has history of neglect as a child
  8. Exposes child to unsafe living conditions
  9. Evidence limited intellectual capacity

Emotional Maltreatment

Child physical indicators of emotional maltreatment may be (Research foundation, 2011, participant’s guide pg. 7; NYOFS, 2016):

  1. Conduct disorders such as fighting in school, antisocial, or destructive.  
  2. Habit disorders such as rocking, fighting, or sucking fingers   
  3. Neurotic disorders such as speech disorders, sleep problems, or inhibition of play   
  4. Psychoneurotic reactions such as phobias, hysterical reactions, compulsions, or hypochondria   
  5. Lags in physical development
  6. Failure to thrive

failure to thrive

(AbuseWatch.net, 2012)

Child behavioral indicators of emotional maltreatment may be (Research foundation, 2011, participant’s guide pg. 7; NYOFS, 2016):

  1. Overly adaptive behavior such as inappropriately adult or inappropriately infantile
  2. Developmental delays, mental or emotional   
  3. Extremes of behavior such as compliant, passive, aggressive, or demanding   
  4. Suicide attempt or gestures or self-mutilation

Parent behavioral indicators of emotional maltreatment may be (Research foundation, 2011, participant’s guide pg. 7; NYOFS, 2016):

  1. Treats children in the family unequally   
  2. Doesn’t seem to care much about child’s problem
  3. Blames or belittles child   
  4. Is cold and rejecting   
  5. Inconsistent behavior toward child

Sexual Abuse

Child physical indicators of sexual abuse may be (Research foundation, 2011, participant’s guide pg. 8; NYOFS, 2016):

  1. Difficulty in walking or sitting
  2. Torn, sustained, or bloody underclothing,
  3. Pain or itching in genitalia.
  4. Pregnancy, especially in early adolescence
  5. Bruises or bleeding in external genitalia, vaginal or anal areas
  6. Sexually transmitted diseases especially in pre-adolescent age group, includes venereal oral infections

Child behavioral indicators of sexual abuse may be (Research foundation, 2011, participant’s guide pg. 8; NYOFS, 2016):

  1. Unwilling to change for or participate in physical education class
  2. Withdrawal, fantasy, or infantile behavior
  3. Bizarre, sophisticated, unusual sexual behavior or knowledge
  4. Self-injurious behaviors, suicide attempts
  5. Poor peer relationships
  6. Aggressive or disruptive behavior, delinquency, running away, or school truancy
  7. Reports sexual assault by caretakers
  8. Exaggerated fear of closeness or physical contact

Parent behavioral indicators of sexual abuse may be (Research foundation, 2011, participant’s guide pg. 8; NYOFS, 2016):

  1. Very protective or jealous of child
  2. Encourages child to engage in prostitution or sexual acts in the presence of caretaker
  3. Misuses alcohol or drugs
  4. Is geographically isolated and/or lacking in social and emotional contacts outside the family
  5. Has low self-esteem

Talking with Children

The role of the healthcare professional is to assess for reasonable cause to suspect maltreatment/neglect or abuse. The healthcare professional is not to investigate or interrogate. The healthcare professional identifies reasonable cause and leaves the investigation and interrogation to specially trained workers in child protective services or law enforcement.

When talking with children to establish reasonable cause to suspect abuse or maltreatment/neglect, 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.

What Is Reasonable Cause to Suspect Abuse or Maltreatment

Reasonable cause to be suspicious 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 (NYOFS, 2016).

Crimes committed against the child should be reported directly to law enforcement. 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 (NYOFS, 2016).

Case Studies

A. A female, age 15, has comes to the ER with the rash on her vaginal area. She discloses she has been engaging in sexual intercourse with her mother’s 38-year-old boyfriend for the past two months. The boyfriend has resided in the house with the child and her mother for the past five years and is responsible for the care of the child when the mother is at work (Research foundation, 2011, Participant Guide, Medical pg. 15).

  • What indicators are present?
  • Is there a reasonable cost to suspect abuse or maltreatment?
  • What are your next steps?

B. Seven-year-old Chris came to the doctor’s office for a physical. He has a bruise on the right side of his face with scrapes along his right arm. The child claimed he fell off his bike. The child lives with his mother, a single parent. She says Chris is a very active child and at times can present challenging behaviors at school (Research foundation, 2011, Participant Guide, Medical pg. 16).

  • What indicators are present?
  • Is there a reasonable cost to suspect abuse or maltreatment?
  • What are your next steps?

C. A mother delivers a baby that has neonatal drug withdrawal. When talking to the mother, you learned she has not prepared for baby to come home (Research foundation, 2011, Participant Guide, Medical pg. 17). 

  • What indicators are present?
  • Is there a reasonable cost to suspect abuse or maltreatment?
  • What are your next steps?

D. Eight-year-old Jason comes to the ER with a broken arm. His mother says he fell off the bed. When Jason Jason’s arm is x-rayed there’s a spiral fracture to his humorous (Research foundation, 2011, Participant Guide, Medical pg. 18).

  • What indicators are present?
  • Is there a reasonable cost to suspect abuse or maltreatment?
  • What are your next steps?

Case Study Answers

Case Study A

  • What indicators are present? Sexual abuse and verbal disclosure
  • Is there reasonable cause to suspect abuse or maltreatment? Yes
  • What are your next steps? Report abuse, maltreatment, or neglect

Case Study B

  • What indicators are present? Bruises, scrapes
  • Is there reasonable cause to suspect abuse or maltreatment? No, the story is consistent with a bike injury. Injuries sustained in an accidental fall would be along one side of the child’s body.
  • What are your next steps? Treat child’s injury.

Case Study C

  • What indicators are present? Neonatal drug withdrawal and no plan for the baby
  • Is there reasonable cause to suspect abuse or maltreatment? Yes
  • What are your next steps? Report abuse, maltreatment, or neglect

Case Study D

  • What indicators are present? Spiral fracture, explanation is not plausible
  • Is there reasonable cause to suspect abuse or maltreatment? Yes
  • What are your next steps? Report abuse, maltreatment, or neglect

Safe Haven for Newborns

Iowa has joined 30 other states in creating safe havens for infants. The Newborn Safe Haven Act (Iowa Code Chapter 233) is a law that allows parents (or another person who has the parent’s authorization) to leave an infant up to 14 days old at a hospital or health care facility without fear of prosecution for abandonment.

A “safe haven” is an institutional health facility, which is defined according to the Act to be:

    A “hospital” as defined in Iowa Code section 135B.1, including a facility providing medical or health services that is open 24 hours per day, 7 days per week and is a hospital emergency room; or

    A “health care facility” as defined in Iowa Code section 135C.1, including a residential care facility, a nursing facility, an intermediate care facility for persons with mental illness, or an intermediate care facility for persons with mental retardation.

The Act provides immunity from prosecution for abandonment for a parent (or a person acting with the parent’s authorization) who leaves an infant at a hospital or health care facility.

The Act provides immunity from civil or criminal liability for hospitals, health care facilities, and persons employed by those facilities that perform reasonable acts necessary to protect the physical health and safety of the infant.

Additional resources are available on the Department’s website, and Reading the Safe Haven Act, Iowa Code Chapter 233. The Code of Iowa is available at public libraries or online.

Reporting Procedures

How do I report Chikd Abuse? (IDPH, 2011, pg. 10)

(Call 1-800-362-2178. According to Iowa Code section 232.70, if you are a mandatory reporter of child abuse and you suspect a child has been abused, you need to report it to the Department of Human Services. The law requires you to report suspected child abuse to DHS orally within 24 hours of becoming aware of the situation. You must also make a report in writing within 48 hours after your oral report. The employer or supervisor of a person who is a mandatory or permissive reporter shall not apply a policy, work rule, or other requirement that interferes with the person making a report of child abuse. As a mandatory reporter, you are also required to make an oral report to law enforcement if you have reason to believe that immediate protection of the child is necessary. The law requires the reporting of suspected child abuse. It is not the reporter’s role to validate the abuse. The law does not require you to have proof that the abuse occurred before reporting. The law clearly specifies that reports of child abuse must be made when the person reporting “reasonably believes a child has suffered abuse.”

Making a report of child abuse may be difficult. You may have doubts about whether the circumstances merit a report, how the parents will react, what the outcome will be, and whether or not the report will put the child at greater risk. The best way to minimize the difficulty of reporting is to:

  • Be knowledgeable about the reporting requirements, and
  • Be aware of the Department’s intake criteria and the response that is initiated by making a report.

Within 24 hours of receiving your report, you will be orally notified whether or not the report has been accepted or rejected. Within five working days, you will also be sent form 470-3789, Notice of Intake Decision, indicating whether the report of child abuse was accepted or rejected.

If you see a child that is in imminent danger, immediately contact law enforcement, to provide immediate assistance to the child. Law enforcement is the only profession that can take a child into custody in that situation. After you have notified law enforcement, then call DHS. To report a suspected case of child abuse:

  • Call 1-800-362-2178.
  • Then, follow up by making a written report within 24 hours.

Oral and written reports should contain the following information, if it is known:

  • The names and home address of the child and the child’s parents or other persons believed to be responsible for the child’s care.
  • The child’s present whereabouts.
  • The child’s age.
  • The nature and extent of the child’s injuries, including any evidence of previous injuries.
  • The name, age, and condition of other children in the same household.
  • Any other information that you believe may be helpful in establishing the cause of the abuse or neglect to the child.
  • The identity of the person or persons responsible for the abuse or neglect to the child.
  • Your name and address.

The following is a sample copy of form 470-0665, Report of Suspected Child Abuse and is available on the DHS website. This specific form is not required, but you may use it as a guide in making a report of child abuse.

Iowa Report of Suspected Child Abuse

If you suspect sexual abuse of a child under the age of 12 by a non-caretaker, you are required by law to make a report of child abuse to DHS. If the child is aged 12 or older, you may report the sexual abuse by a non-caretaker but you are not required by law to do so. DHS must report all sexual abuse allegations to law enforcement within 72 hours.

Classification of Mandatory Reporters (IDPH, 2011, pg. 8)

Iowa law defines classes of people who must make a report of child abuse within 24 hours when they reasonably believe a child has suffered abuse. These “mandatory reporters” are professionals who have frequent contact with children, generally in one of six disciplines:

  1. Health
  2. Education
  3. Child care
  4. Mental health
  5. Law enforcement
  6. Social work
  • All licensed physicians and surgeons.
  • Physician assistants.
  • Dentists.
  • Licensed dental hygienists.
  • Optometrists.
  • Podiatrists.
  • Chiropractors.
  • Residents or interns in any of the professions listed above.
  • Registered nurses.
  • Licensed practical nurse.
  • Basic and advanced emergency medical care providers.
  • Any of the following persons who, in the scope of professional practice or in their employment responsibilities, examines, attends, counsels, or treats a child:
    • A social worker.
    • An employee or operator of a public or private health care facility as defined in Iowa Code section 135C.1.
    • A certified psychologist.
    • A licensed school employee, certified paraeducator, or holder of a coaching authorization issued under Iowa Code section 272.31, or an instructor employed by a community college.
  • An employee or operator of a licensed child care center, registered child development home, Head Start program, Family Development and Self-Sufficiency Grant program under Iowa Code section 216A.107, or Healthy Opportunities for Parents to Experience Success – Healthy Families Iowa program under Iowa Code section 135.106.
  • An employee or operator of a licensed substance abuse program or facility licensed under Iowa Code Chapter 125.
  • An employee of an institution operated by DHS listed in Iowa Code section 218.1.
  • An employee or operator of a juvenile detention or juvenile shelter care facility approved under Iowa Code section 232.142.
  • An employee or operator of a foster care facility licensed or approved under Iowa Code Chapter 237.
  • An employee or operator of a mental health center.
  • A peace officer.
  • A counselor or mental health professional.
  • An employee or operator of a provider of services to children funded under a federally approved medical assistance home- and community-based services waiver. 

The employer or supervisor of a person who is a mandatory reporter shall not apply a policy, work rule, or other requirement that interferes with the person making a report of child abuse. Clergy members are not considered to be mandatory reporters unless they are functioning as social workers, counselors, or another role described as a mandatory reporter. If a member of clergy provides counseling services to a child, and the child discloses an abuse allegation, then the clergy member is mandated to report as a counselor. (The counseling is provided to a child during the scope of the reporter’s profession as a counselor, not clergy.)

Waiver of Confidentiality (IDPH, 2011, pg. 14)

The issues of confidentiality and privileged communication are often areas of concern for mental health and health service professionals. Rules around confidentiality and privileged communication are waived during the child abuse assessment process (once a report of child abuse becomes a case). Iowa Code section 232.71B indicates that the Department may request information from any person believed to have knowledge of a child abuse case. County attorneys, law enforcement officers, social services agencies, and all mandatory reporters (whether or not they made the report of suspected abuse) are obligated to cooperate and assist with the child abuse assessment upon the request of the Department.

Physician privilege is waived in cases of suspected child abuse. Physicians are allowed to share whatever information is necessary with the Department of Human Services to facilitate a thorough assessment. It is a good idea to let your clients know your status as a child abuse reporter at the onset of treatment. This will help establish an open relationship and minimize the client’s feelings of betrayal if a report needs to be made. Making a child abuse referral does not necessarily mean that your relationship with the child and family will end, especially when you are able to support the family during the assessment process. When possible, discuss the need to make a child abuse report with the family. However, be aware that there are certain situations where if the family is warned about the assessment process, the child may be at risk for further abuse, or the family may leave with the child.

In situations where you are not required to make a child abuse report, ethically you need to address these concerns in a therapeutic setting. Refer to your Professional Code of Ethics for further clarification on issues surrounding child abuse.

Immunity from Liability (IDPH, 2011, pg. 15)

Iowa Code section 232.73 provides immunity from any civil or criminal liability which might otherwise be incurred when a person participates in good faith in:

  • Making a report, photographs, or x-rays,
  • Performing a medically relevant test, or
  • Assisting in an assessment of a child abuse report.

A person has the same immunity with respect to participation in good faith in any judicial proceeding resulting from the report or relating to the subject matter of the report. As used in this section and section 232.77, “medically relevant test” means a test that produces reliable results of exposure to cocaine, heroin, amphetamine, methamphetamine, or other illegal drugs, or their combinations or derivatives, including a drug urine screen test. 

Sanctions for Failure to Report Child Abuse (IDPH, 2011, pg. 15)

Iowa Code section 232.75 provides for civil and criminal sanctions for failing to report child abuse. Any person, official, agency, or institution required by this chapter to report a suspected case of child abuse who knowingly and willfully fails to do so is guilty of a simple misdemeanor. Any person, official, agency, or institution required by Iowa Code section 232.69 to report a suspected case of child abuse who knowingly fails to do so, or who knowingly interferes with the making of such a report in violation of section 232.70, is civilly liable for the damages proximately caused by such failure or interference. 

Sanctions for Reporting False Information (IDPH, 2011, pg. 16)

The act of reporting false information regarding an alleged act of child abuse to DHS or causing false information to be reported, knowing that the information is false or that the act did not occur, is classified as simple misdemeanor under Iowa Code section 232.75, subsection 3. If DHS receives a fourth report which identifies the same child as a victim of child abuse and the same person as the alleged abuser or which is from the same person, and DHS determined that the three earlier reports were entirely false or without merit, DHS may:

  • Determine that the report is again false or without merit due to the report’s spurious or frivolous nature.
  • Terminate its assessment of the report.
  • Provide information concerning the reports to the county attorney for consideration of criminal charges. 

Assessment Protocol

How Does DHS Respond? (IDPH, 2011, pg. 27)

A DHS child abuse assessment consists of the following processes:

  • Intake
  • Case assignment
  • Evaluation of the alleged abuse
  • Determining if abuse occurred
  • Placing a report on the Child Abuse Registry
  • Assessment of family strengths and needs
  • Preparing forms and reports

Intake

The purpose of intake is to obtain information to ensure that reports of child abuse meeting the criteria for assessment are accepted and reports that do not meet the legal requirements are appropriately rejected. DHS policy is to accept a report when there is insufficient information to reject it. The first step in this process is to initiate safeguards for children who are at risk or have been abused. DHS staff will ask questions of the reporter, record necessary information, and discern between significant and extraneous information.

Information gathered at intake includes:

  • The allegation of child abuse
  • The identity and location of the child, parents or caretakers
  • The safety of and risk to the child
  • The identity and location of the person allegedly responsible for the abuse
  • That person’s access to children
  • Information regarding the mandatory reporter

While it is helpful to be familiar with child abuse definitions to make a report, knowing the definitions and terminology is not essential. DHS will determine the type of abuse being alleged. It may be possible to make reasonable inferences that would cause a report to be accepted for assessment based upon the description of what occurred, so detail and accurate information is essential. You may be contacted when:

  • Your initial report is made through a written report of child abuse.
  • Any of the information in your initial report is unclear or incomplete.
  • Information in your initial report is called into question once the assessment is initiated.
  • The written report you submit contains new or different information from that provided in your oral report of child abuse.

When more than one mandatory reporter reasonably suspects abuse involving the same incident, the mandatory reporters, may jointly make a written report to DHS. When more than one reporter separately makes a report of suspected child abuse on the same incident, and the first report is currently being assessed, DHS will advise the subsequent reporters that the report of child abuse they are making has already been accepted as a case.  

Time Frame for Deciding Whether to Accept a Report for Assessment

The DHS decision on whether to accept or reject a report of child abuse is to be made within a 1-hour or 12-hour time frame from receipt of the report, depending on the information which is provided and the level of risk to the child:

  • When a report indicates that the child has suffered a “high-risk” injury or there is an immediate threat to the child, the Department acts immediately to address the child’s safety. The decision to accept the report of child abuse is made within one hour from receipt of the report
  • When the report does not meet the criteria to be accepted, such as the person alleged responsible is not a caretaker, but the report alleges the child is at high risk, DHS still acts immediately to address the child’s safety (by calling law enforcement, for example). A supervisor reviews and approves the decision to reject the report of child abuse within one hour from receipt of the report.
  • When a report indicates that the child has been abused, but it is not considered a “high risk” injury or there is no immediate threat to the child, DHS still acts promptly. The decision to accept the report of child abuse and supervisory approval on that decision are made within 12 hours from receipt of the report.

When the report does not meet the criteria to be accepted, such as the person alleged responsible is not a caretaker, and the report alleges the child is not considered to be at “high risk,” a supervisor reviews and approves the decision to reject the report of child abuse within 12 hours from receipt of the report.

Accepted Intakes

When your report meets the criteria for assessment, DHS will inform you that the report of child abuse has been accepted as a case within 24 hours of receiving the report. DHS may provide this oral notification at the time that the report is made if the report is accepted immediately. If your report is not accepted immediately because further consultation is required with a supervisor, you will be informed that further consultation is needed before a decision can be made, and someone will be calling you back with the decision.

Rejected Intakes

DHS must obtain sufficient information to be able to determine if a report meets the intake criteria. A supervisor reviews the report and makes the final determination about rejecting the report for assessment. If your report is rejected, DHS will:

  • Contact law enforcement if a child’s safety appears to be in jeopardy.
  • Orally notify you that the report has been rejected within 24 hours of receipt.
  • Send you a written notice indicating the decision to reject the report within five working days of its receipt, using form 470-3789, Notice of Intake Decision, which includes instructions on what to do if you disagree with the decision.
  • Provide a copy of intake information to the county attorney within five working days of its receipt.

You will be advised that:

  • The report is being rejected for one or more of the following reasons:
    • The reported victim is not a child.
    • The person alleged to have abused the child is not a caretaker.
    • The reported abuse does not fall within the definition of child abuse.

The report will be screened for a possible “child in need of assistance” assessment to determine if juvenile court action is necessary. The family may apply for services through DHS if there is a founded child abuse report or a juvenile court order. 

You may inform the family of services available in the community.

If you become aware of circumstances where you believe that the child is imminently likely to be abused or neglected, report this to DHS. These may include, but are not limited to, a child born into a family in which:

The court has previously adjudicated another child to be a child in need of assistance due to abuse;
The court has terminated parental rights to a child; or
The parent has relinquished rights with respect to a child due to child abuse.

DHS may seek an ex parte removal order if it appears that the newborn’s immediate removal is necessary to avoid imminent danger to the child’s life or health. When intake information does not meet the legal definition of child abuse, but a criminal act to a child is alleged, DHS refers the report to the appropriate law enforcement agency. If the intake information alleges sexual abuse of a child by a person who is not a “caretaker,” DHS refers the report to law enforcement verbally and also submits the referral information in writing within 72 hours of receiving the report.

The DHS Intake Unit keeps a copy of intake information for rejected reports of child abuse for three years, then destroys it. Rejected intake information is not considered “child abuse information.” It is governed by the same provisions of confidentiality as DHS service case records. If a subject of a report requests information about a rejected intake involving the subject, DHS will provide a copy of the rejected intake to the subject, if it is available, after removing the name of the reporter.

If you become aware of new information after your report has been rejected, make a new report to DHS.

Case Assignment (IDPH, 2011, pg. 31)

When a report indicates that the child has suffered a “high risk” injury or there is an immediate threat to the child, DHS must act immediately to address the child’s safety. The case must be assigned immediately. When a report indicates that the child has been abused but it is not considered a “high risk” injury or there is no immediate threat to the child, DHS must still act promptly. The case must be assigned within 12 hours from receipt of the report. The primary purpose of the assessment is to take action to protect and safeguard the child by evaluating the safety of and risk to the child named in the report and any other children in the same home as the parents or other person responsible for their care. If DHS staff believe at any time during the assessment that there is an immediate threat because of abuse, they will immediately contact the proper authorities and communicate these concerns. This may include any or all of the following:

  • Law enforcement
  • Juvenile court
  • Physicians

DHS staff have contact with the family in all assessments. Other assessment activities vary, depending upon the evaluation of the child’s safety and the family’s strengths and needs.

Evaluation of the Alleged Abuse

During the evaluation process, DHS gathers information about the allegations of child abuse, as well as the strengths and needs of the family, through:

  • Observing the alleged child victim
  • Interviewing subjects of the report and other sources
  • Gathering documentation
  • Evaluating the safety of and risk to the child 

Observation of the Alleged Child Victim

The purpose of observation of the alleged victim is to address the safety of the child and determine if the child has visible symptoms of abuse. Careful and timely observation of the child is most relevant to physical abuse allegations. Observation may also be relevant in assessments involving allegations of denial of critical care, particularly failure to provide adequate food, shelter, or clothing. Requirements for observations depend on the level of risk to the child posed by the allegation, as follows:

1 hour when the report involves an immediate threat or high risk to the child’s safety.

24 hours when the report doesn’t involve immediate threat or high risk to the child but the person alleged responsible has access to the child.

96 hours when the report doesn’t involve an immediate threat or high risk to the child and the person alleged responsible clearly does not have access to the child.

Whenever possible, the child protection worker attempts to observe and interview the child named in the report when interviewing the parents. When the worker must observe and interview a child named in the report away from the parental home, attempts are made to obtain parental consent. 

Interviews with Subjects of the Report and Other Sources

DHS staff interview the child to gather information not only regarding the abuse allegations, but also about the child’s immediate safety, the risk of abuse, the parents, the person allegedly responsible for the abuse, and the family. Other siblings may be interviewed to determine if they have experienced abuse, to evaluate their vulnerability, to gather corroborating information regarding the alleged child victim, and to gather information to assist in the risk assessment. During an assessment, DHS may interview parents who are not alleged to have abused the child to find out what they know about the alleged abuse, gather information related to the risk of abuse; and determine their capacity to protect the child. Iowa law requires that the person allegedly responsible for abuse be offered an opportunity (when the person’s whereabouts are known) to be interviewed and respond to the allegations, but the person may decline the interview. The information is used to determine if abuse occurred, as well as to measure the risk this person may present to the alleged victim, other children, or others residing in the household. DHS may contact and interview other people who may have relevant information to share regarding the report of the alleged abuse and the assessment of the safety of and risk to the child. During an assessment, physicians are asked to contact DHS immediately when:

  • The parents or caretakers fail to take the child to the scheduled appointment.
  • There is any confirmation or evidence of physical abuse.
  • The child has other medical conditions that require immediate medical attention.

Professional consultation may be sought, including the use of multidisciplinary teams, or child protection assistance teams or child protection centers when a determination is needed which is outside the Department’s professional scope. For example, a worker may be able to identify a child who is underweight, but “failure to thrive” is a diagnosis that only a physician can make. Multidisciplinary teams consist of professionals practicing in medicine, public health, mental health, social work, child development, education, law, juvenile probation, law enforcement, nursing, domestic violence and substance abuse counseling. These teams function as an advisory and consultation group to aid child protection workers in resolving issues related to a case during the assessment phase. They may also assist in identifying treatment plans. Counties or multi-county areas with 50 or more reports of child abuse annually are required to develop multidisciplinary teams. Child protection assistance teams are convened by the county attorney and involve DHS, law enforcement and the county attorney to consult on cases involving a forcible felony against a child younger than age 14 by a person responsible for the care of the child and child sexual abuse. The team may consult with other professionals in specified disciplines. The county attorney is to establish a team for each county unless two or more county attorneys agree to establish a single team for a multicounty area. The team may consult with or include juvenile court officers, medical and mental health professions, physicians or other hospital-based health professions, court appointed special advocates, guardian ad litem and members of a multidisciplinary team created by DHS for child abuse assessments. DHS has established agreements with multiple child protection centers across the state of Iowa. These centers assist child protection workers in the assessment of reports of child abuse. In most cases, these centers provide medical evaluations and psychosocial assessments of the victim when there are allegations of sexual abuse or serious physical abuse. Other evaluative information is sometimes obtained through textbooks, scholarly journals, or other publications. 

Gathering Documentation

Documentation gathered during the assessment process is used to assist in determining if the information contained in the report of child abuse is accurate, to complete the assessment of family strengths, and developing a plan of action.

Attorney, any law enforcement agency, and any social service agency in the state shall cooperate and assist in the assessment upon the request of the DHS. In addition to information gathered through interviews, the child protective worker may take photographs or secure photographs taken by others to show injuries to the child or to document conditions in the household. Common sources for photographic documentation are police departments and hospitals. DHS by law may request the criminal history of a person alleged to be responsible for abuse. Information suggesting that a record check is advisable may include allegations of sexual abuse, domestic violence, or abuse of alcohol or other drugs. DHS may use medical reports and records that are relevant to the report of child abuse, including X-rays, findings of physical or sexual abuse examinations, reports from interviews and examinations at a child protection center and medically relevant tests related to the presence of illegal drugs within a child’s body. DHS may use audiotapes, videotapes, and other electronic recording media to document observations or conversations. 

Evaluation of the Safety of and Risk to the Child

The evaluation of a child’s safety is an ongoing activity that continues during the entire assessment process. A safety analysis focuses on the current situation. A child is considered “safe” when the evaluation of all available information leads to the conclusion that the child will not be abused in the current living arrangement. If a child is determined not to be safe, DHS takes action to address safety concerns. This may include (but is not limited to) any of the following active steps:

  • Provision of safety services.
  • Provision of family safety, risk, and permanency services.
  • Removal of a child from the home.
  • Placement of a child with relatives.
  • Removal of the person allegedly responsible for the abuse from the home.

 

The assessment of the risk of abuse to the child is based on the following factors:

  • The severity of the incident or condition.
  • Chronicity of the incident or condition.
  • The child’s age, medical condition, mental and physical maturity, and functioning.
  • The attitude of the person allegedly responsible for the abuse regarding its occurrence.
  • Current resources, services, and supports available to the family that can meet the family’s needs and increase protection for the child.
  • Special events, situations, or circumstances that may have created immediate stress, tension, or anxiety in the family or household.
  • Access of the person allegedly responsible for the abuse of the child.
  • Willingness and ability of the parent, or caretaker not responsible for the abuse, to protect the child from further abuse.

Determination if Abuse Occurred

After gathering necessary information from observations, interviews and documentation, and after assessing the credibility of subjects of the report, collateral contacts and information, DHS must determine whether or not abuse occurred. Each category or subcategory of child abuse requires that specific criteria be met in order to conclude that abuse occurred. This determination is based on a “preponderance” of credible evidence, defined as greater than 50% of the credible evidence gathered. The child protective worker must make one of the following conclusions regarding a report of child abuse:

  • Not confirmed: Based on the credible evidence gathered, DHS determines that there is not a preponderance of available credible evidence that abuse did occur.
  • Confirmed (but not placed on the Child Abuse Registry): Based on a preponderance of all of the credible evidence available to DHS, the allegation of abuse is confirmed; however, the abuse will not be placed on the Child Abuse Registry.
  • Founded: Based on a preponderance of credible evidence available to DHS, the allegation of abuse is confirmed and it is the type of abuse that requires placement on the Child Abuse Registry.

Determination if Report Is Placed on the Child Abuse Registry

After a decision is made that a report of child abuse is confirmed, DHS makes a determination about whether the report must be placed on the Child Abuse Registry. When a report of child abuse is placed on the Child Abuse Registry, the child’s name, the names of the child’s parents, and the name of the perpetrator of the abuse are all entered into the Registry. Placing the name of a person responsible for the abuse of a child on the Registry may affect employment, registration, and licensure opportunities for that person. Unconfirmed cannot be placed on the Registry. A report of child abuse that is confirmed must be placed on the Registry as a founded report under any of the following circumstances:

  • Physical abuse, when one or more of the following criteria are met:
    • The injury was not minor.
    • The injury was not isolated.
    • The injury is likely to reoccur.
  • Denial of critical care by:
    • Failure to provide adequate food and nutrition.
    • Failure to provide adequate shelter.
    • Failure to provide adequate health care.
    • Failure to provide adequate mental health care.
    • Gross failure to meet emotional needs.
    • Failure to respond to an infant’s life-threatening condition.
  • Failure to provide proper supervision, when one or more of the following criteria are met:
    • The risk of injury was not minor.
    • The risk of injury was not isolated.
    • The risk of injury is likely to reoccur.
  • Failure to provide adequate clothing, when one or more of the following criteria are met:
    • The risk of injury was not minor.
    • The risk of injury was not isolated.
    • The risk of injury is likely to reoccur.
  • Mental injury.
  • The presence of illegal drugs.
  • Child prostitution.
  • Sexual abuse committed by a person age 14 or older at the time of the abuse.
  • Manufacturing or possession of dangerous substances with the intent to use the product as a precursor or intermediary.
  • Bestiality in the presence of a minor.
  • Allows access by a registered sex offender.
  • Allows access to obscene material.

Also, the report shall be founded when:

  • The case was referred for juvenile or criminal court action. DHS may recommend court action for an adjudication, removal, or redisposition in an existing court case.
  • Within 12 months of the report, the county attorney or juvenile court initiated court action that resulted in an adjudication or criminal conviction. (This could result in change in determination of placement on the Registry for a report not previously placed on the Registry). The same person has been confirmed responsible for abuse in the last 18 months. If there is any prior report, the current assessment will be placed on the Registry if abuse is confirmed, because the abuse occurrence was not isolated.
  • The person responsible for the abuse continues to pose a danger to the child named or another child. This is determined by assessing if the abuse was minor, isolated, and unlikely to reoccur. If the incident does not meet these three criteria, then the person may continue to pose a danger to the child named or to another child and the incident will be placed on the Registry.
  • In summary, all confirmed reports of abuse will be placed on the Registry as founded reports except for:
  • Denial of critical care through failure to provide proper supervision, when the endangerment of the child was minor, isolated and unlikely to reoccur.
  • Denial of critical care through failure to provide adequate clothing, when the endangerment of the child was minor, isolated and unlikely to reoccur.
  • Physical abuse, when the injury to the child was minor, isolated and unlikely to reoccur. 

Assessment of Family’s Strengths and Needs

The assessment process requires an evaluation of the family’s functioning, strengths, and needs. The family’s participation is essential. Information is gathered from family members to identify strengths, possible rehabilitation needs of the child and family, and develop the plan of action. The process usually includes a visit to the home. As part of the evaluation of the family functioning, the Department gathers information on:

  • Home environment
  • Parent or caretaker characteristics
  • Child characteristics
  • Domestic violence and substance abuse
  • Social and environmental characteristics

Preparation of Reports and Forms

There are several reports and forms which are generated as a result of an assessment being initiated providing notification and other relevant information to reporters, subjects of the report, the county attorney and juvenile court.

Notice of Intake Decision

The Notice of Intake Decision provides written notification to all mandatory and permissive reporters about whether or not a report of child abuse was accepted or rejected for assessment. This form is completed and mailed to the reporter within five working days of the receipt of a report.

Parental Notification

The Parental Notification form provides written notice to the parents of a child who is the subject of a child abuse assessment within five working days of commencing an assessment. Both custodial and noncustodial parents are notified if their whereabouts are known. DHS is required by law to issue this notification. Only the court may waive issuance of the notice. 

Child Protective Assessment Summary

The Child Protective Services Assessment Summary provides documentation of efforts to assess the abuse allegations and to assess the child and family functioning. The Child Protective Services Assessment Summary is available to the mandatory reporter who made the report, upon request. The custodial and noncustodial parents are provided a copy of the summary at the completion of the assessment. The safety and risk assessment can be released only with the permission of the subjects.

The Summary includes a report and disposition information divided into several sections.

  • Abuse reported. This section includes the allegations reported, including the name of the child subject, the person alleged to be responsible, and the type of abuse reported; and any additional allegations received while the assessment is being conducted.
  • Assessment of child safety. This section includes an assessment of the immediate safety of the child, actions taken to address safety issues, and an assessment of future risk to the child.
  • Summary of contacts. This section includes family and child identification, with a list of household members by name, and relationship to one another. It describes the date and time the child subject was observed; the rationale for using confidential access, if applicable; and the physical evidence pertaining to the abuse allegations. It identifies those interviewed (by name, date, and time), including collateral contacts and a summary of their remarks.

Notice of Child Abuse Assessment

The Notice of Child Abuse Assessment is issued to the parents, guardians, custodians of the child, noncustodial parent, child, person alleged to be responsible for the abuse, as well as the mandatory reporter, when applicable, a facility administrator and other child protection workers who assisted in completing the assessment, if any. The Notice:

  • Indicates that the assessment process is concluded and whether the allegations of abuse were founded, confirmed or not confirmed.
  • Lists the recommendation for services and juvenile or criminal court.
  • Provides information regarding confidentiality provisions related to child abuse assessment information and how to request an appeal hearing.
  • Provides information on how to obtain copies of the Child Protective Assessment Services Summary. Mandatory reporters may use the notice form to request a copy of the written summary of the assessment of their allegations of abuse.

What Happens After the Assessment?

By the close of the child protective assessment process, the child protection worker will determine the family’s eligibility and the need for services. The eligibility for services is based on the age of the child, the risk of abuse or reabuse, and the finding of child abuse assessment. DHS provides protective services to abused and neglected children and their families without regard to income when there is a founded child abuse report or with a court order. Community resources provide rehabilitative services for the prevention and treatment of child abuse to children and families.

Service Recommendations and Referrals

During or at the conclusion of a child abuse assessment, the department may recommend information, information and referral, community care referral, or services provided by the department. If it is believed that treatment services are necessary for the protection of the abused child or other children in the home, juvenile court intervention shall be sought.

  • Information or information and referral. Families with children of any age that have confirmed or not confirmed abuse and low risk of abuse shall be provided either information and referral or information when:
    • No service needs are identified, and the worker recommends no service; or
    • Service needs are identified, and the worker recommends new or continuing services to the family to be provided through informal supports; or
    • Service needs are identified, and the worker recommends new or continuing services to the family to be provided through community agencies.
  • Referral to community care. With the exception of families of children with an open department service case, court action pending, or abuse in an out-of-home setting, a referral to community care shall be offered to:
    • Families with children whose abuse is not confirmed that have moderate to high risk of abuse when service needs are identified and the worker recommends community care.
    • Families with children that have confirmed but not founded abuse and moderate or high risk of abuse when service needs are identified and the worker recommends community care.
    • Families with children with founded abuse, a victim child six years of age or older, and a low risk of repeat abuse when service needs are identified and the worker recommends community care.

Note: “Community care” means child and family-focused services and supports provided to families referred from the department. Services shall be geared toward keeping the children in the family safe from abuse and neglect; keeping the family intact; preventing the need for further intervention by the department, including removal of the child from the home; and building ongoing linkages to community-based resources that improve the safety, health, stability, and well-being of families served.

Referral for department services. Families with children that have founded abuse and moderate to high risk of abuse and families with victim children under age six that have founded abuse and low risk of abuse shall be offered department services on a voluntary basis.

  • The worker shall recommend new or continuing treatment services to the family to be provided by the department, either directly or through contracted agencies.
  • Families refusing voluntary services shall be referred to a child in need of assistance action through juvenile court.

DHS services such as homemaker services, parenting classes, respite child care, foster care, financial assistance, psychological and psychiatric services, and sexual abuse treatment may be provided and may be provided without court involvement if the parent consents to services. Other interventions can be ordered by a court. Juvenile court intervention may be sought in order to intervene on an emergency basis to place the child in protective custody by removing the child from the home or by seeking adjudication of the child to place the child under the protective supervision of the juvenile court with the child remaining in the care and custody of the parent. The child protective assessment worker continuously evaluates the safety and risk to the child while conducting the assessment of allegations of abuse. The assessment worker may consider alternatives to the removal of a child if the child would be provided adequate protection. Options may include:

  • Bringing protective relatives to the child’s home while the parents leave the home.
  • Initiating public health nurse or visiting nurse services.
  • Initiating homemaker services or family safety, risk, and permanency services.
  • Implementing intensive services, such as family preservation.
  • Placing the child in voluntary foster or shelter care.
  • Placing the child voluntarily with relatives or friends.
  • Obtaining a court order requiring that the person responsible for the abuse leave the home, when other family members are willing and able to adequately protect the child.

When the juvenile court orders the person alleged responsible for the abuse to vacate the child’s residence, a child in need of assistance petition must be filed within three days. If there are concerns about the person having contact with the child following the person’s removal from the home, a “no contact” order through the county attorney may be requested.

Removal of a Child

Iowa laws provide for a child to be placed in protective custody in various situations. DHS does not have a statutory authority to simply “remove” a child from a parent or other caretaker. The procedures for a child to be placed in protective custody are outlined in Iowa Code sections 272.78 through 232.79A. Assessment workers do not have the legal authority to remove children from their home without a court order or parental consent. Only a peace officer or a physician treating a child may remove a child without a court order if the child’s immediate removal is necessary to avoid imminent danger to the child’s life or health. There are four legal procedures for the emergency temporary removal of a child:

♦ Emergency removal by an ex parte court order

♦ Emergency removal of the child by a peace officer

♦ Emergency removal of the child by a physician

♦ With parent’s consent

Removal by Ex Parte Court Order

A child may be taken into custody following the issuance of an ex parte court order pursuant to Iowa Code section 232.78, which states:

  1. The juvenile court may enter an ex parte order directing a peace officer or a juvenile court officer to take custody of a child before or after the filing of a petition under Chapter 232 provided all of the following apply:
    1. The person responsible for the care of the child is absent, or though present, was asked and refused to consent to the removal of the child and was informed of an intent to apply for an order under this section, or there is reasonable cause to believe that a request for consent would further endanger the child, or there is reasonable cause to believe that a request for consent will cause the parent, guardian, or legal custodian to take flight with the child.
    2. It appears that the child’s immediate removal is necessary to avoid imminent danger to the child’s life or health. The circumstances or conditions indicating the presence of such imminent danger shall include but are not limited to any of the following:
      1. The refusal or failure of the person responsible for the care of the child to comply with the request of a peace officer, juvenile court officer, or child protection worker for such person to obtain and provide to the requester the results of a physical or mental examination of the child. The request for a physical examination of the child may specify the performance of a medically relevant test.
    3. There is not enough time to file a petition and hold a hearing under [Iowa Code] section 232.95.
    4. The application for the order includes a statement of the facts to support the findings specified in paragraphs a, b, and c.
  2. The person making the application for an order shall assert facts showing there is reasonable cause to believe that the child cannot either be returned to the place where the child was residing or placed with the parent who does not have physical care of the child.
  3. Except for good cause shown or unless the child is sooner returned to the place where the child was residing or permitted to return to the child care facility, a petition shall be filed under this chapter within three days or the issuance of the order.
  4. The juvenile court may enter an order authorizing a physician or hospital to provide emergency medical or surgical procedures before the filing of a petition under Chapter 232 provided:
    1. Such procedures are necessary to safeguard the life and health of the child; and b. There is not enough time to file a petition under this chapter and hold a hearing as provided in section 232.95.
  5. The juvenile court, before or after the filing of a petition under Chapter 232, may enter an ex parte order authorizing a physician or hospital to conduct an outpatient physical examination of a child, or authorizing a physician…, a psychologist…, or a community mental health center… to conduct an outpatient mental examination of a child, if necessary to identify the nature, extent, and cause of injuries to the child, provided all the following apply:
    1. The parent, guardian, or legal custodian is absent, or though present, was asked and refused to provide written consent to the examination.
    2. The juvenile court has entered an ex parte order directing the removal of the child from the child’s home or a child care facility under this section.
    3. There is not enough time to file a petition and to hold a hearing as provided in section 232.98.
  6. Any person who may file a petition under Chapter 232 may apply for an order for temporary removal, or the court on its own motion may issue such an order. An appropriate person designated by the court shall confer with a person seeking the removal order, shall make every reasonable effort to inform the parent or other person legally responsible for the child’s care of the application, and shall make such inquiries as will aid the court in disposing of such application.

How Is Child Abuse Information Treated? (IDPH, 2011, pg. 50)

Iowa Code section 235A.15 provides that confidentiality of child abuse information shall be maintained, except as specifically authorized. Under Iowa law, “child abuse information” includes any or all of the following data maintained by DHS in a manual or automated data storage system and individually identified:

  • Report data, including information pertaining to an assessment of an allegation of child abuse in which DHS has determined the alleged abuse meets the definition of child abuse.
  • Assessment data, including information pertaining to the DHS evaluation of a family.
  • Disposition data, including information pertaining to an opinion or decision as the occurrence of child abuse.

Note: Iowa Code section 232.71B, subsection 2, directs that DHS shall not reveal the identity of the reporter of child abuse in the written notification to parents or otherwise. The Department shall withhold the name of the person who made the report of suspected child abuse. Only the court may allow the release of that person’s name.

Protective Disclosure

Iowa Code allows for DHS to disclose that an individual is listed on the child abuse registry, the dependent adult abuse registry or is required to register for the sexual offender registry when it is necessary for the protection of a child. The disclosure can only be made to persons who are subjects of a child abuse assessment.

Disposition of Reports

Iowa law limits access to child abuse information to specific individuals and entities depending on placement of the Child Abuse Registry. All subjects of the report and their attorneys have access to:

Information contained within the Child Protective Services Assessment Summary.
Correspondence or written information that pertains to Child Protective Services Assessment Summary.

A copy of the entire Child Protective Services Assessment Summary is automatically provided to subjects, including but not limited to the custodial and noncustodial parents.

References

AbuseWatch.net (2012) Prevention Resources for the Community and Professionals Retrieved May 5, 2013 (Visit Source).

Child Welfare Information Gateway (2016). Retrieved on 5/26/16 (Visit Source).

Iowa Administrative Code, Public Health (2014). 641—93.5(135) Standards for approval of curricula. 2/15/14.

Iowa Code 232.68 DEFINITIONS

Iowa Department of Public Health. (2011), Child Abuse: A Guide for Mandatory Reporters. Retrieved 6/26/16 from (Visit Source).

New York Office of Children and Family Services. (2016). Mandated Reporter Training Online. Retrieved 5/26/16 from (Visit Source).

New York Office of Children and Family Services. (2016). Frequently Asked Questions for Mandated Reporters. Retrieved 5/26/16 from (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 from (Visit Source).

World Health Organization, 2016. Prevention of Child Maltreatment, retrieved 5/26/16 from (Visit Source).


This course is applicable for the following professions:

Advanced Registered Nurse Practitioner (ARNP), Athletic Trainer (AT/AL), Certified Nursing Assistant (CNA), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Dietetic Technicians, Registered (DTR), Dietitian/Nutritionalist (RDN), Home Health Aid (HHA), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Obstetrics and Gynecology (OB/GYN), Pedorthist (PED), Physical Therapist (PT), Podiatric Physician (PO), Registered Nurse (RN), Respiratory Therapist (RT)

Topics:

CPD: Preserve Safety, Iowa Requirements, Medical Surgical, Pediatrics


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