LEARNING OBJECTIVES

Upon completion of this course, you will be able to:

• Define maltreatment, abuse, and neglect according to the New York State Family Court Act and Social Services Law.
• Identify physical and behavioral indicators of child maltreatment.
• State the risk factors contributing to child abuse.
• List situations in which mandated reporters must report suspected cases of maltreatment.
• Summarize the actions that reporters may take to protect a child beyond filing a child abuse report.
• Outline procedures for placing a child into protective custody.
• Describe the legal protections afforded reporters as well as the consequences for failing to report.

Today, like every other day, hundreds of children in New York State will be terrorized, battered, bruised, left unfed, ignored, sexually violated or even killed by the very people they instinctively trust and turn to for love and nursing. In an average month, at least ten children in New York State are killed by abuse or neglect. Typically, half of those children who die are under a year old. These are the realities of child abuse and neglect in New York.
—NEW YORK LAW ENFORCEMENT, 2003

CHILD MALTREATMENT

Child maltreatment (child abuse and neglect) is, at a minimum, any recent act or failure to act on the part of a parent or caregiver that results in death, serious physical or emotional harm, or sexual abuse or exploitation; or an act or failure to act that presents an imminent risk of serious harm (Child Welfare Information Gateway, 2005).

The federal Child Abuse Prevention and Treatment Act identifies four major types of maltreatment: physical abuse, child neglect, sexual abuse, and emotional abuse. Although definitions of child maltreatment vary from state to state, operational definitions include the following:

• Physical abuse is any nonaccidental physical injury to the child and can include striking, kicking, biting, burning, shaking, or any action that results in a physical impairment of the child.
• Child neglect is failure to provide for a child's basic needs, and the neglect can be physical, educational, or emotional. Neglect includes withholding of medically indicated treatment.
• Sexual abuse is fondling a child's genitals, intercourse, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials.
• Emotional abuse (psychological/verbal abuse, mental injury) is acts or failures to act on the part of parents or other caregivers that have caused or could cause injury to the psychological capacity or emotional stability of the child, resulting in serious behavioral, cognitive, emotional, or mental disorders.

Child abuse/maltreatment is a hidden crime that inflicts permanent damage on victims and families of every culture and every socioeconomic level. According to the Centers for Disease Control and Prevention (2007), in 2005 nearly a million cases of child abuse were confirmed by child protective services agencies. Experts believe these statistics are conservative because many cases of child abuse go unreported. Slightly more than half of child maltreatment victims are female, except in cases of child sexual abuse, which is 4 times higher among females than males.

The most common type of abuse is neglect, affecting nearly two-thirds of maltreated children. One in five children suffers physical abuse, 1 in 10 are sexually abused, and 1 in 20 are emotionally or psychologically abused.

Physical neglect is the failure to provide a child with adequate food, shelter, clothing, education, hygiene, medical care, and/or supervision needed for normal growth and development.

Emotional neglect includes parent or other caretaker behaviors that cause or could cause serious cognitive, affective, or other mental health problems. Such behaviors include but are not limited to torture or close confinement or continuing use of verbally abusive language to harshly criticize and denigrate a child.

Many children suffer multiple types of abuse, which increases their risk of serious health consequences as adults. These risks include smoking, alcoholism, drug abuse, physical inactivity, severe obesity, depression, suicide, sexual promiscuity, and certain chronic diseases (Felitti et al., 1998; Runyan et al., 2002). Abuse and neglect also increase the risk that children will grow up to be arrested for a violent crime.

Children in families where intimate partner violence (IPV) occurs are at high risk for maltreatment. Living with intense anger and unpredictable behaviors creates a chronic and corrosive anxiety state.

Children who have been abused or neglected are at increased risk for experiencing intimate partner violence (IPV) as adults. Males face a threefold increase in risk; females a twofold increase (Tjaden & Thoennes, 2000). Moreover, child victims of violence, particularly males, often grow up to become batterers themselves.

Children with disabilities are at higher risk for sexual violence than those without disabilities. According to the CDC, rates of sexual violence among adolescent boys with disabilities range from 4% to 6%; reported rates for adolescent girls with disabilities are about 24%.

Children under the age of 4 years are at greatest risk of severe injury or death from maltreatment. In 2003 infants younger than 1 year accounted for nearly half of all deaths from abuse (DHHS, 2005).

Child abuse has lasting effects on the whole family. As one grandmother remembers:

My grandson Darren* was an absolutely perfect 4-month-old baby boy with velvet-smooth olive skin and the beginnings of silky ringlets. He voiced his needs, as all babies that age do, by crying. His father silenced Darren's voice forever by shaking him to death. If that had never happened, Darren would be finishing first grade about now, having learned to read, write, and tie his shoes, maybe even had a visit from the tooth fairy.
[*not his real name]

Today, Darren's father is in prison. Darren's mother, grandmother, and sister have had extensive therapy to help them deal with the loss. Darren's sister, who was 3 years old at the time of his death, still fears hospitals because her baby brother went there and never came home.

Abuse

[Material in this section on abuse, including maltreatment and neglect, is taken from the revised curriculum (2006) developed at the request of, and funded by, the New York State Office of Children and Family Services Bureau of Training and published by the Center for the Development of Human Services/ Research Foundation, State University of New York/Buffalo State College.]

The legal definition of an abused child means a child less than 18 years of age who is defined as abused by the New York State Family Court Act.

Section 1012(e) of the Family Court Act further defines an abused child, less than 18 years of age, whose parent or other person legally responsible for his or her care:

• Inflicts or allows to be inflicted upon such child an injury*
  OR
• Creates or allows to be created a substantial risk of physical injury* to that child
  OR
• Commits, or allows to be committed, a sexual crime against that child, as defined in sections 230.25, 230.30, or 263 of the penal law

*In this context, the term injury means serious or protracted disfigurement, or protracted impairment of physical, mental or emotional health, or protracted loss or impairment of the function of any bodily organ, or death

Section 412.8 of the Social Services Law also states that "an abused child can be a child residing in a group residential care facility." The definition of an abused child in these settings is virtually identical to the above definition of abuse occurring in a family setting.

Section 412.1(c) also stipulates that an abused child can be a child with a handicapping condition, who is 18 years of age or older, who is defined as an abused child in residential care, and who is in residential care provided in one of the following:

• The New York State School for the Blind or the New York State School for the Deaf
• A private residential school which has been approved by the Commissioner of Education for special education services or programs
• A special act school district
• State-supported institutions for the instruction of the deaf and blind that have a residential component

Maltreatment and Neglect

Social Services Law, Section 412, defines a maltreated child as a child less than 18 years of age: (a) defined as a neglected child by the Family Court Act; or (b) who has had serious physical injury inflicted upon him or her by other than accidental means.

Section 1012(f) of the Family Court Act defines a neglected child as a child less than 18 years of age:

• Whose physical, mental or emotional condition has been impaired or is in imminent danger of becoming impaired
  OR
• The subject (his or her parent or other person legally responsible for his or her care) failed to exercise a minimum degree of care:
  • In supplying adequate food, clothing, shelter
  • In supplying adequate education
  • In supplying medical or dental care, though financially able to do so
    OR
  • Offered financial or other reasonable means to do so
  • In providing proper supervision or guardianship
  • By inflicting excessive corporal punishment
  • By misuse of drugs or alcohol
    AND
  • There is a causal connection between the child's condition and the subject's failure to exercise a minimum degree of care
    OR
• The parent has abandoned the child by demonstrating an intent to forgo his or her parental rights
• The legal guardian creates a substantial risk of physical injury to a child.

ABANDONMENT

Abandonment of newborn infants in unsafe places is an example of extreme neglect. Under New York law, it is considered a Class E felony and a Class A misdemeanor, and must be reported as such by mandated reporters. The Abandoned Infant Protection Act (AIPA) enacted in 2000 offers an affirmative defense to these criminal charges if the following criteria are met:

1. The abandoned infant can be no more than 5 days old.
2. The person abandoning the infant must have intended the child be safe and well cared for. He or she cannot have intended the child any harm.
3. The infant must be left in an appropriate or suitable location. Should the infant be left in a suitable location, an appropriate person must be notified immediately of the child's location so the child can be taken into custody and cared for.

Although the law does not define "suitable location" or "appropriate person," district attorneys have stated that hospitals, police stations, and fire stations could be suitable if they are open and staff is present.

Any mandated reporter who learns of abandonment is obligated to fulfill mandated reporter responsibilities. Even if you are unsure of the name of the person abandoning the child, you must make a report, simply listing the unknown person as "Unknown." For more information, call the AIPA Informational Hotline at 1-866-505-SAFE.

EMOTIONAL NEGLECT

Emotional neglect, that is, impairment of mental or emotional condition, is defined as follows:

"Impairment of emotional health" and "impairment of mental or emotional condition" include a state of substantially diminished psychological or intellectual functioning in relation to, but not limited to, such factors as failure to thrive, control of aggression or self-destructive impulses, ability to think and reason, or acting out and misbehavior, including incorrigibility, ungovernability or habitual truancy; provided, however, that such impairment must be clearly attributable to the unwillingness or inability of the respondent [ie, parent or other person legally responsible for the child] to exercise a minimum degree of care toward the child. (Family Court Act, Section 1012(h))

Leaving a young child or children without supervision by a responsible person is a type of neglect. Infants and toddlers should never be left alone, even briefly. Each child develops and matures at his or her own rate so parents need to make careful decisions about who can be safely left at home alone. Some older preteens are responsible and independent enough to be left alone while some older teenagers are too irresponsible or have special needs that limit their ability to be safe if left alone.

NEGLECTED CHILD IN RESIDENTIAL CARE

Section 412.9 of the Social Services Law provides a separate definition of "a neglected child in residential care." This definition pertains to children residing in group residential facilities under the jurisdiction of the State Department of Social Services, Division for Youth, Office of Mental Health, Office of Mental Retardation and Developmental Disabilities, or State Education Department. Section 412.6 defines a custodian as a director, operator, employee or volunteer of a residential care facility of program.

• A neglected child in residential care means a child whose custodian impairs, or places in imminent danger of becoming impaired, the child's physical, mental or emotional condition:
  • By intentionally administering to the child any prescription drug other than in accordance with a physician's or physician assistant's prescription
  • By failing to adhere to standards and regulations for the care, services or supervision of children in such a way that inflicts or allows to be inflicted physical or serious emotional injury, or a substantial risk thereof.
• Section 412.2(c) also specifies that a maltreated child can include a child with a handicapping condition, who may be up to 21 years of age, who is defined as a neglected child in residential care, and who is in residential care (as defined earlier).

Abuse or maltreatment can result from the acts of the parent or person legally responsible for a child's care, and suspected incidents should be reported accordingly. In accordance with Section 1012(g) of the Family Court Act:

Person legally responsible includes the child's custodian, guardian, or any other person responsible for the child's care at the relevant time. Custodian may include any person continually or at regular intervals found in the same household as the child when the conduct of such persons causes or contributes to the abuse or neglect of the child.

REPORTING CHILD MALTREATMENT/ABUSE

Anyone may report suspected child abuse at any time and is encouraged to do so. All reports are confidential and may be made anonymously by members of the public. However, physicians, nurses and other healthcare professionals are legally required to report suspected cases of child abuse, maltreatment, and neglect. New York State Law also specifies other professionals and persons who are classified as mandated reporters.

Mandated reporters are required to report instances of suspected child abuse or maltreatment "whenever they have reasonable cause to suspect that a child has been abused or maltreated where any person comes before them in their professional or official capacity and states from personal knowledge the facts, conditions, or circumstances which, if correct, would mean that a child has been abused or maltreated" (New York State Office of Children & Family Services (OCFS) Administrative Directive, 2007).

The law requires that mandated reports must "personally make a report to the Statewide Central Register of Child Abuse and Maltreatment (SCR)" and "immediately notify the person in charge of the institution, school, facility, or agency where they work or the designated agent of the person in charge that a report has been made" (New York State Office of Children and Family Services (OCFS), Information Letter, January 18, 2008).

Mandated reporters can be held liable by both the civil and criminal legal systems for intentionally failing to make a report of suspected abuse encountered while acting in their professional capacity.

RISK FACTORS CONTRIBUTING TO CHILD ABUSE

Health professionals need to be alert for individual, relational, community and societal factors that increase the risk of child maltreatment. The CDC (2007) cites the following risk factors as contributing to child abuse:

• Disabilities or mental retardation in children that may increase caregiver burden
• Social isolation of families
• Parent's lack of understanding of children's needs and child development
• Parent's history of domestic abuse
• Poverty, unemployment, homelessness
• Family disorganization, dissolution, and violence, including IPV
• Lack of family cohesion
• Substance abuse in family
• Young, single nonbiological parents
• Poor parent-child relationships and negative interactions
• Parental thoughts and emotions supporting maltreatment behaviors
• Parental stress and distress, including depression or other mental health conditions
• Community violence

Presence of these factors signals the need for the professional to examine the situation more closely, carefully, and methodically. These factors seldom appear in isolation but rather in clusters.

INDICATORS OF PHYSICAL ABUSE

Healthcare professionals need to be alert for physical injuries that are unexplained or inconsistent with the parent or other caretaker's explanation and/or the developmental state of the child.

Emergency department physicians and nurses have a key role in identifying and reporting suspected child abuse. Because of the likelihood of multiple injuries, the patient should be completely undressed for examination. Infants should be examined without a diaper, which otherwise might conceal evidence of injury.

Re-examination is essential because bruising may not be apparent on initial examination. Note any suspicious patterns of bruising. Frequent reassessment is also important because the child's condition can deteriorate rapidly, particularly when internal injuries lead to hemorrhage (Koschel, 2003).

It is important to know both normal and suspicious bruising patterns when assessing children's injuries. (Research Foundation, 2006)

Although x-rays may detect skull fractures and other skeletal injuries, research indicates x-rays may fail to detect one-fourth of head injuries in abused children. Researchers suggest that CT or MRI scans also be used when head injury is suspected (Rubin et al., 2003). CT scans may also be needed to detect abdominal injury, which can damage the liver, duodenum, pancreas, and mesentery. Although injury to the abdomen and chest is less common than other injuries in child abuse, 40% to 60% of abdominal and chest injuries are fatal (Zenel & Goldstein, 2002).

Physical Indicators

Physical indicators of possible physical abuse include:

1. Unexplained bruises and welts
   • On the face, lips, mouth, neck, wrists, or ankles
     
     

     This pattern signals the blow of a hand to the face of a child (New York Mandated Reporter, 2006).

   • On the torso, back, buttocks, and thighs
   • On both eyes or cheeks (these lesions are always suspicious because an accident usually injures only one side of the face)
   • Clusters of lesions or those that form a regular pattern, reflecting the shape of the article used to inflict the injury (electric cord, belt buckle)
     
     

     Regular patterns reveal that a looped cord was used to inflict injury on this child (New York Mandated Reporter, 2006).

   • On several different surface areas
   • Injuries in various stages of healing
   • Injuries that regularly appear after absence from school or daycare (eg, after a weekend or a vacation)
2. Unexplained lacerations or abrasions:
   • To mouth, lips, gums, eyes
   • To external genitalia
   • On backs of arms, legs, or torso
   • Human bite marks (these compress the flesh, in contrast to animal bites, which tear the flesh and leave narrower teeth imprints)
3. Unexplained burns:
   • Cigar or cigarette burns, especially on soles, palms, back, or buttocks
   • Immersion burns by scalding water (sock-like, glove-like, doughnut-shaped on buttocks or genitalia–"dunking syndrome")
   • Patterned like an electric burner or iron
     
     

     A steam iron was used to inflict injury on this child (New York Mandated Reporter, 2006).

   • Rope burns on arms, legs, neck, or torso
4. Unexplained fractures:
   • Of skull, nose, facial structure
   • Skeletal trauma with other injuries, such as dislocations
   • Multiple or spiral fractures
   • In various stages of healing
   • Swollen or tender limbs
5. Head injuries:
   • Absence of hair and/or hemorrhaging beneath the scalp due to vigorous hair pulling
   • Subdural hematoma (a hemorrhage beneath the outer covering of the brain, due to severe hitting or shaking)
   • Retinal hemorrhage or detachment, due to shaking
   • Whiplash shaken-baby syndrome (see box below, "Symptoms of Shaken Baby Syndrome")
   • Eye injury
   • Jaw and nasal fractures
   • Tooth or frenulum (of the tongue or lips) injury
6. Symptoms suggestive of parent-induced or fabricated illnesses:
   • Known as Munchausen Syndrome by Proxy (MSP). For example, repeatedly forcing a child to ingest quantities of laxatives sufficient to cause diarrhea, dehydration, and hospitalization

Child's Behavioral Indicators

Careful assessment of a child's behavior may also indicate physical abuse, even in the absence of obvious physical injury. Behavioral indicators of physical abuse include the following:

1. Shows fear of going home, fear of parents
2. Apprehensive when other children cry
3. Exhibits aggressive, destructive, or disruptive behavior
4. Exhibits passive, withdrawn or emotionless behavior
5. Reports injury by parents
6. Habit disorders
   • Self-injurious behaviors (for example, cutting)
   • Psychoneurotic reactions (obsessions, phobias, compulsiveness, hypochondria)
7. Wears long sleeves or other concealing clothing, even in hot weather, to hide physical injuries
8. Seeks affection from any adult

Parent's Behavioral Indicators

Presence of the following parent/guardian behaviors may indicate an abusive relationship:

1. Seems unconcerned about the child
2. Takes an unusual amount of time to obtain medical care for the child
3. Offers inadequate or inappropriate explanation for the child's injury
4. Offers conflicting explanations for the same injury
5. Misuses alcohol or other drugs
6. Disciplines the child too harshly considering the child's age or what he or she did wrong
7. Sees the child as bad, evil, etc.
8. Has a history of abuse as a child
9. Attempts to conceal the child's injury
10. Takes the child to a different doctor or hospital for each injury
11. Shows poor impulse control

INDICATORS OF NEGLECT

Child neglect is the most common type of child maltreatment. Failure to provide for a child's basic physical, educational, or emotional needs results in both physical and behavioral changes.

Physical Indicators

Physical indicators of neglect include:

• Consistent hunger, poor hygiene (skin, teeth, ears, etc.), inappropriate dress for the season
• Failure to thrive (physically or emotionally)
• Positive indication of toxic exposure, especially in newborns, such as drug withdrawal symptoms, tremors, etc.
• Delayed physical development
• Speech disorders
• Consistent lack of supervision, especially in dangerous activities or for long periods of time
• Unattended physical problems or medical or dental needs
• Chronic truancy
• Abandonment

Child's Behavioral Indicators

Behavioral indicators of neglect include:

• Begging or stealing food
• Extended stays at school (early arrival or late departure)
• Constant fatigue, listlessness, or falling asleep in class
• Alcohol or other substance abuse
• Delinquency, such as thefts
• Reports there is no caretaker at home
• Runaway behavior
• Habit disorders (sucking, nail biting, rocking, etc.)
• Conduct disorders (antisocial or destructive behaviors)
• Neurotic traits (sleep disorders, inhibition of play)
• Psychoneurotic reactions (hysteria, obsessive-compulsive behaviors, phobias, hypochondria)
• Extreme behavior:
  • Compliant, passive
  • Aggressive, demanding
• Overly adaptive behavior:
  • Inappropriately adult
  • Inappropriately infantile
• Delays in mental and/or emotional development
• Suicide attempt

Parent's Behavioral Indicators

A parent or guardian exhibiting the following behavioral indicators may be emotionally maltreating/neglecting the child:

• Treats children in the family unequally
• Seems not to care much about the child's problems
• Blames or belittles the child
• Is cold and rejecting
• Behaves inconsistently toward the child

INDICATORS OF SEXUAL ABUSE

Child sexual abuse involves the coercion of a dependent, developmentally immature person to commit a sexual act with someone older. For example, an adult may sexually abuse a child or adolescent, or an older child or adolescent may abuse a younger child.

Detecting child sexual abuse can be very difficult. Physical evidence is not apparent in most cases, and victims fear the consequences of reporting their "secret." Most perpetrators of child sexual abuse are known to the victim. In more than half of cases of repeated abuse, the perpetrator is a member of the family. Anyone, even a mother, can be a perpetrator, but most are male.

Such betrayal by a family member or friend further increases the child's reluctance to disclose the abuse, as does shame and guilt plus the fear of not being believed. The child may fear being hurt or even killed for telling the truth and may keep the secret rather than risk the consequences of disclosure. Very young children may not have sufficient language skills or vocabulary to describe what happened.

Child sexual abuse is found in every race, culture, and class throughout society. Girls are sexually abused more often than boys; however, this may be due to boys'—and later, men's—tendency not to report their victimization. There is no particular profile of a child molester or of the typical victim. Even someone highly respected in the community—the parish priest, a teacher or coach—may be guilty of child sexual abuse.

Negative effects of sexual abuse vary from person to person and range from mild to severe in both the short and long term. According to the American Psychological Association (2001), effects that persist into adulthood include depression, high-level anxiety, alcoholism or drug abuse, and insomnia. Many victims also have problems in adult relationships and sexual functioning.

Child's Physical Indicators

Physical evidence of sexual abuse may be present in about one-third of cases. These physical indicators include:

• Symptoms of sexually transmitted diseases, including oral infections, especially in preteens
• Difficulty in walking or sitting
• Torn, stained, or bloody underwear
• Pain, itching, bruising, or bleeding in the genital or anal area
• Bruises to the hard or soft palate
• Pregnancy, especially in early adolescence
• Painful discharge of urine and/or repeated urinary infections
• Foreign bodies in the vagina or rectum

Child's Behavioral Indicators

Behavioral indicators of child sexual abuse include:

• Unwillingness to change clothes for or participate in physical education activities
• Withdrawal, fantasy, or regressive behavior, such as returning to bedwetting or thumb-sucking
• Bizarre, suggestive, or promiscuous sexual behavior or knowledge
• Reports sexual assault by caretaker
• Prostitution
• Forcing sexual acts on other children
• Extreme fear of closeness or physical examination
• Suicide attempts or other self-injurious behaviors

Parent's Behavioral Indicators

Sexually abusive parents/guardians may exhibit the following behaviors:

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

RECOGNIZING VICTIM'S DISCLOSURES

[Material in this section is from Prevent Child Abuse New York, 2003, adapted from information provided by Orange-Ulster BOCES in New York and the Rhode Island Chapter of NCPCA.]

Victims of child abuse often feel helpless and hopeless, and think that no one can do anything to help them. They may also attempt to protect an abusive parent or be reluctant to report any abuse for fear of the consequences. Therefore, abuse may continue for months and even years, particularly if the abuser is someone close to the child.

Victimized children may cry out in a variety of nonverbal or indirect ways, for example, a drawing left behind for the teacher, the counselor, or a trusted relative to see. Some children report vague somatic symptoms to the school nurse, hoping the nurse will guess what happened. To the child, this indirect approach is not betrayal of the abuser and therefore not grounds for punishment.

Some children may come to a trusted teacher or other professional and talk directly and specifically about their situation, if that person has established a safe, nurturing environment and a sense of trust. More commonly, however, abused children use other, less direct approaches, such as:

• Indirect hints: "My brother wouldn't let me sleep last night." "My babysitter keeps bothering me."
  
  Appropriate responses would be invitations to tell you more, such as "Is it something you are happy about?" and open-ended questions such as "Can you tell me more?" or "What do you mean?" Gently encourage the child to be more specific. Let the child use his or her own language, and don't suggest other words to the child.
• Disguised disclosure: "What would happen if a girl told someone her mother beat her?" "I know someone who is being touched in a bad way."
  
  Appropriate response would be to encourage the child to tell you what he or she knows about the "other child." It is probable that the child will eventually tell you who the abused child really is.
• Disclosure with strings attached: "I have a problem, but if I tell you about it, you have to promise not to tell anyone else." Most children know that negative consequences can result if they break the silence about abuse.
  
  Appropriate responses would include letting the child know you want to help him or her and telling the child, from the beginning, that there are times when you too may need to get some other special people involved.

Guidelines for talking with children who may be abused are summarized below.

MANDATED REPORTING IN NEW YORK STATE

New York law requires mandated reporters to report suspected child abuse or maltreatment in the following three situations:

1. When a mandated reporter has reasonable cause to suspect that a child whom the reporter sees in his or her professional or official capacity is abused or maltreated; or
2. When a mandated reporter has reasonable cause to suspect that a child is abused or maltreated where the parent or person legally responsible for such child comes before them in his or her professional or official capacity and states from personal knowledge facts, conditions, or circumstances which, if correct, would render the child abused or maltreated;
3. Whenever a mandated reporter suspects child abuse or maltreatment while acting in his or her professional capacity as a staff member of a medical or other public or private institution, school, facility, or agency, he or she shall immediately notify the person in charge of that school, facility, institution or his or her designated agent, who will then (also) become responsible for reporting or causing a child abuse report to be made to the county Child Protective Services CPS) agency.

It should be noted that Section 413.1 of the Social Services Law does not require more than one report from the institution, school, facility, or agency on any one incident of suspected abuse or maltreatment. However, the mandated reporter's obligation is not discharged unless the report is made.

A situation could occur in which the staff member is mistaken about the standard of abuse or maltreatment, or about whom the subject of a report may be; the person in charge, or his or her designated agent, could determine that a report need not be made in this situation. Nevertheless, the person in charge—or his or her designated agent—may not prevent the staff member from making a report

Reasonable Cause

There can be "reasonable cause" to suspect that a child is abused or maltreated if, considering the physical evidence observed or told about, and based on the reporter's own training and experience, it is possible that the injury or condition was caused by neglect or by nonaccidental means.

Certainty is not required. The reporter need not be certain that the injury or condition was caused by neglect or by nonaccidental means. The reporter should only be able to entertain the possibility that it could have been neglect or nonaccidental in order to possess the necessary "reasonable cause." It is enough for the mandated reporter to distrust or doubt what is personally observed or told about the injury or condition.

In child abuse cases, many factors can and should be considered in the formation of that doubt or distrust. Physical and behavioral indicators may also help form a reasonable basis of suspicion. Although these indicators are not diagnostic criteria of child abuse, neglect, or maltreatment, they illustrate important patterns that may be recorded in the written report when relevant (New York State OCFS, 2006).

When to Report

Mandated reporters are required to report suspected child abuse, maltreatment, or neglect immediately, by telephone, at any time of day, seven days a week. In addition, a written report must be filed within 48 hours of the oral report.

Recipient of the Report

Oral telephone reports should be made to the New York State Central Register of Child Abuse and Maltreatment (SCR) by calling the statewide, toll-free telephone number:

800-635-1522 (hotline for mandated reporters)

A written report on Form LDSS-221A, signed by the reporter, must be filed within 48 hours of the oral report with the local department of social services (LDSS) assigned the investigation. Mandated reporters can request the mailing address of the local agency when making the oral report to the hotline. (A written report involving a child cared for away from the home [e.g., foster care, residential care] should be submitted to the New York State Child Abuse and Maltreatment Register, P.O. Box 4480, Albany, NY 12204-0480.)

Reporters may wish to maintain careful notes for their own personal records, noting dates, times, places, names of individuals involved in any reporting incident, and any other pertinent comments.

For purposes of reporting suspected cases of child abuse and maltreatment to the Statewide Central Register of Child Abuse and Maltreatment (SCR) and Child Protective Services, it is important to understand the definition of who can be the "subject of the report" as defined by Section 412.4 of the Social Services Law.

"Subject of the report" means any parent, guardian, custodian, or other person 18 years of age or older who is legally responsible (as defined in Section 1012 [g] of the Family Court Act) for a child reported to the Central Register of Child Abuse and Maltreatment and who is allegedly responsible for causing—or allowing the infliction of—injury, abuse, or maltreatment to such child.

"Subject of the report" also means an operator of, or employee or volunteer in a home operated or supervised by an authorized agency, the Division for Youth, or an office of the Department of Mental Hygiene, or a family daycare home, daycare center, group family daycare home, or a day-services program who is allegedly responsible for causing—or allowing the infliction of—injury, abuse, or maltreatment to a child who is reported to the Central Register.

Abuse and maltreatment may be caused by individuals other than a parent or person legally responsible for the child's care, such as teachers, coaches, neighbors or strangers. Such individuals might not fit the legal definition of the "subject of the report" (as defined in Section 412.4 of the Social Services Law).

If a call is received by the State Central Register, and the person allegedly responsible for the abuse or maltreatment cannot be the subject of a report, and the SCR believes that the alleged acts or circumstances described by the caller may constitute a crime or an immediate threat to the child's health or safety, the SCR is required by law to transmit the information contained in the call to the appropriate law enforcement agency, district attorney, or other public official empowered to provide necessary aid or assistance (Social Services Law, Section 422.2(c).

Content of the Report

At the time of the oral telephone report, the Child Protective Services (CPS) specialist will request the following information:

• The effect on the child
• Names and addresses of the child and parents or other person responsible for care
• Location of the child at the time of the report
• Child's age, gender, and race
• Nature and extent of the child's injuries, abuse, or maltreatment, including any evidence of prior injuries, abuse, or maltreatment to the child or its siblings
• Name of the person or persons you suspect is responsible for causing the injury, abuse, or maltreatment
• Family composition
• Any special needs or medications
• Whether an interpreter is needed
• Source of the report
• Person making the report and where reachable
• Actions taken by the reporting source, including taking of photographs or x-rays, removal or keeping of the child, or notifying the medical examiner or coroner
• Any personal issues for CPS workers (eg, weapons, dogs)
• Additional information that may be helpful

Be sure to ask the CPS specialist for the "Call ID" assigned to the telephone report you have made.

Note: A reporter is not required to know all of the above information in making a report; therefore, lack of complete information does not prohibit a person from reporting. However, information necessary to locate a child is crucial.

For a written report, use LDSS-2221-A (Report of Suspected Child Abuse or Maltreatment). The form can be obtained from local Child Protective Services (CPS) or at http://www.ocfs.state.ny.us. Information should be written as clearly and objectively as possible. Written reports are admissible as evidence in any judicial proceedings; accurate completion is vital.

After the Phone Call to the State Central Register

Sections 411.2(a) and 422.11 of the Social Services Law establish the procedures to be followed by the Department of Social Services after the phone call is received. When any allegations contained in the phone call could reasonably constitute a report of child abuse or maltreatment, including reports involving children who reside in residential facilities or programs, such allegations must be immediately transmitted by the Department of Social Services to the appropriate agency or local CPS for investigation.

The CPS unit of the local department of social services is required to begin an investigation of each report within 24 hours. The investigation should include an evaluation of the safety of the child named in the report, and any other children in the home, and a determination of risk to the children if they continue to remain in the home.

Flow chart illustrating the response to a call for investigation of possible child abuse or neglect in New York State (New York State OCFS, 2006).

If the Department records indicate a previous report concerning a "subject of the report," other persons named in the report, or other pertinent information, the appropriate agency or local CPS must be immediately notified of this fact.

Reporting Implications of HIPAA

The Health Insurance Portability and Accountability Act of 1996 contains privacy provisions that have caused confusion regarding the obligation of a mandated reporter to provide copies of written records that underlie the report. However, these HIPAA provisions do not affect the responsibilities of mandated reporters as they are defined in New York Social Services Law.

As part of the Governor's Permanency Bill of 2005, SSL 415 was amended to clarify that the obligation of a mandated reporter who makes a report that initiates an investigation of suspected child abuse or maltreatment also extends to providing CPS with the written records essential for a full investigation of the report.

The amendment specifies that this includes "all records relating to diagnosis, prognosis, or treatment, and clinical records, of any patient or client that are essential for a full investigation of allegations of child abuse or maltreatment, provided that disclosure of substance abuse treatment records shall be made pursuant to the standards and procedures for disclosure of such records delineated in federal law."

If the mandated reporter is employed by an institution, that institution is required to provide all of the records of the institution that pertain to the report, regardless of who actually made the report. In addition, the records that CPS requests should be limited only to information that directly pertains to the report itself.

The mandated reporter makes the initial determination of what information is essential for a full investigation. However, if CPS believes that the mandated reporter has additional essential information pertaining to the report, CPS should request additional records and attempt to come to agreement regarding any additional records. If CPS and the mandated reporter cannot reach agreement, CPS may seek a court order directing the mandated reporter to produce the essential information.

Following Up on the Report

Section 422.4 of the Social Services Law provides that a mandated reporter can receive, upon request, the findings of an investigation made pursuant to his or her report. This request can be made to the SCR at the time of making the report or to the appropriate local CPS at any time thereafter. However, no information can be released unless the reporter's identity is confirmed.

If the request for information is made prior to the completion of an investigation of a report, the released information shall be limited to whether the report is "indicated" (ie, substantiated), "unfounded," or "under investigation," whichever the case may be.

If the request for information is made after the completion of an investigation of a report, the released information shall be limited to whether a report is "indicated" or, if the report has been expunged, that there is "no record of such report," whichever the case may be.

Note: Reports are expunged for lack of credible evidence of alleged abuse or maltreatment after an investigation, or 10 years after the eighteenth birthday of the youngest child named in the report.

Photographs and X-rays

Any mandated reporter may take, or order to be taken, at public expense, color photographs of the area of trauma visible on a child. A reporter may ask the local CPS to take photographs when appropriate.

Photographs and x-rays provide objective visual evidence to substantiate a report of suspected child abuse and are, along with other imaging studies, legally admissible evidence in court proceedings. Suggested guidelines for the photography of trauma are provided below.

PROTECTIVE CUSTODY

Mandated reporters may also place an alleged abused or neglected child in protective custody, under certain circumstances. A child may be taken into protective custody (without court order or parental consent):

1. If the child is in such circumstances or condition that continuing to stay in his or her residence or in the care and custody of the parent or other legally authorized caretaker, presents an imminent danger to the child's life or health; and
2. If there is not enough time to apply to the family court for an order of temporary removal.

However, protective custody should not be confused with the status of the child admitted voluntarily to the hospital by parent(s).

Other persons legally authorized to place the child into physical protective custody include:

• A peace officer (acting pursuant to his or her special duties),
• A police officer,
• A law enforcement official,
• An agent of a duly incorporated society for the prevention of cruelty to children,
• A designated employee of a city or county department of social services, or
• A person in charge of a hospital or similar institution.

When a child is placed in protective custody, the authorized person must take the following actions:

• He or she must bring the child immediately to a place designated by the rules of the family court for this purpose, unless the person is a physician treating the child and the child is or soon will be admitted to a hospital.
• He or she must make every reasonable effort to inform the parent or other person legally responsible for the child's care about which facility the child is in.
• He or she must provide the parent or other person legally responsible for the child's care with written notice, coincident with removal of the child from their care. (Family Court Act 1024(b)(iii))
• He or she must inform the court and make a report of suspected child abuse or maltreatment pursuant to Title 6 of the Social Services Law, as soon as possible (FCA, Section 1024(b)).
• He or she must immediately notify the appropriate local child protective service, which shall begin a child protective proceeding in the Family Court at the next regular weekday session of the appropriate Family Court or recommend that the child be returned to his or her parents or guardian. In neglect cases, pursuant to Section 1026 of the Family Court Act, the authorized person or entity (usually CPS) may return a child prior to a child protective proceeding if it concludes there is no imminent risk to the child's health.

IMMUNITY FROM LEGAL LIABILITY

To encourage prompt and complete reporting of suspected child abuse and maltreatment, the Social Services Law, Section 419, affords the reporter certain legal protections from liability. Any persons, officials, or institutions who in good faith make a report, take photographs, and/or take protective custody of a child or children, have immunity from any liability, civil or criminal, that might result from such actions.

All persons, officials, or institutions who are required to report suspected child abuse or maltreatment are presumed to have done so in good faith as long as they were active in the discharge of their official duties and within the scope of their employment and so long as their actions did not result from willful misconduct or gross negligence (New York State Syllabus, 2001).

CONFIDENTIALITY

The Commissioner of Social Services and the local department of social services are not permitted to release to the subject of a report any data which identify the person who made the report unless that person has given written permission for the SCR to do so. The person who made the report may also grant the local CPS permission to release his or her identity to the subject of the report (if a reporter needs reassurance, he or she should feel free to emphasize the need for confidentiality if the situation warrants) (Research Foundation, 2006).

CONSEQUENCES FOR FAILING TO REPORT

Legal Repercussions

Any person, official, or institution required to report a case of suspected child abuse or maltreatment who willfully fails to do so:

• Can be charged with a Class A misdemeanor and subject to criminal penalties;
• Can be sued in a civil court for monetary damages for any harm caused by such failure to report to the SCR.

Societal Repercussions

CPS cannot act until child abuse is identified and reported, ie, services cannot be offered to the family nor can the child be protected from further suffering (Research Foundation, 2006).

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