As mandated reporters, in our clinical role we are required to report any reasonable suspicion we have of child abuse. One does not have to be physically present or witness the abuse to identify suspected cases of abuse, or even have definite proof that a child may be subject to child abuse or neglect. Under the law, it is reasonable for a person to entertain a suspicion of child abuse or neglect, based upon facts that could cause a reasonable person, in a like position, drawing, when appropriate, on his or her training and experience, to suspect child abuse or neglect.
Reporting suspected abuse can be challenging in certain circumstances. It is helpful to remember that by reporting we are not issuing a judgment or sentence or punishment, but instead providing the affected family access to services and support that will further determine the degree of abuse, if any, and provide services as necessary.
Child Protective Services is the major system of intervention of child abuse and neglect in California. Their goal is to keep the child in his/her own home when it is safe, and when the child is at risk, to develop an alternate plan as quickly as possible.
When a referral is received, the social service staff obtains facts from the person making the referral to determine if the referral alleges abuse, neglect, or exploitation. The Emergency Response staff determines if an in-person response is indicated. Whenever a report indicates the need for protection, Child Protective Services will a) accept the case, b) intervene in the crisis, if
required, c) apply Family Preservation and Support Services for some families, d) assess or identify problems, gather facts and clarify the problems, e) plan and provide services, set goals, identify resources and timeframes, f) document the case, and g) terminate the case or transfer it to another program.
Approximately 12 months of services are provided to children who can remain safely in the home while the family receives services. If it is determined that a child cannot remain in the home, even with family preservation and support services, then foster placement is arranged in the most family-like setting, that is located close to the parent’s home, consistent with the best interests of the child.
Up to 18 months of services are provided to children and their families when a child has been removed from the home and the family is making progress toward reunification. When a child cannot be returned to a safe home after services have been delivered, the child must be provided with a family-like living arrangement as soon as possible.
California law defines child abuse as any of the following:
- A child is physically injured by other than accidental
- A child is subjected to willful cruelty or unjustifiable
- A child is abused or exploited
- A child is neglected by a parent or caretaker who fails to provide adequate food, clothing, shelter, medical care or supervision.
Importantly, emotional abuse, which is often present with other types of abuse, is voluntary and not mandated to report. In the California penal code, emotional abuse is defined as when a person causes or permits a child to suffer unjustifiable or significant mental suffering. Behavior qualifying as emotional abuse — such as belittling, blaming, sarcasm, rejection, humiliation, threatening, name-calling, isolation, withholding, exposure to domestic violence — is often indicative of deep problems under the surface and reporting should be strongly considered.
Warning Signs of Abuse:
Neglect (most common):
- Clothes are ill-fitting, filthy, or inappropriate for the
- Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor).
- Untreated illnesses and physical
- Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments (can include instances where child witnesses domestic violence or intimate partner violence)
- Is frequently late or missing from
- Trouble walking or
- Displays knowledge or interest in sexual acts inappropriate to his or her age, or even seductive behavior.
- Makes strong efforts to avoid a specific person, without an obvious
- Doesn’t want to change clothes in front of others or participate in physical
- Has a sexually transmitted disease (STD) or pregnancy, especially under the age of
- Runs away from
- Frequent injuries or unexplained bruises, welts, or
- Is always watchful and “on alert” as if waiting for something bad to
- Injuries appear to have a pattern such as marks from a hand or
- Shies away from touch, flinches at sudden movements, or seems afraid to go
- Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot
- Excessively withdrawn, fearful, or anxious about doing something
- Shows extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive).
- Doesn’t seem to be attached to the parent or
- Acts either inappropriately adult-like (taking care of other children) or inappropriately infantile (rocking, thumb-sucking, throwing tantrums).
How to Report:
- Talk over with team (attending, SW) and discuss
- Collect as much detail as possible regarding the specific event, or pattern of
- Ascertain what other children are in the home, if any, and what other adults are
- Collect the addresses, names, and dates of birth of all involved to the greatest degree
- Ascertain if the alleged abuse is non-emergent (child is not in immediate danger), or emergent
- For non-emergent reports, submit a report online at https://mandreptla.org
- For emergent reports, first call the CPS hotline for the area where the abuse
Within LA County, the hotline number is: 800-540-4000. For all other counties, look up the corresponding hotline on:
- Document the name of the staff member you speak with and the 19 digit referral number
- After filing the verbal emergent report, connect to https://mandreptla.org and submit your follow-up suspected child abuse report (required).
- Print a copy of the report to be uploaded to the patient’s medical
For Further Consultation:
- While on inpatient or ABC, discuss with SW and consider consulting the NPH Suspected Child and Adult Abuse and Neglect Team (SCAAN)
- While in the ER/CL, speak with SW during the day, or page the RRMC SCAAN team at night at p96672