Child Abuse: A Guide for Mandatory Reporters 1 Child Abuse Overview Child abuse is not a new phenomenon. The abuse and neglect of children has been documented for more than two thousand years. However, attempts to prevent child abuse are relatively new. The first documented legal response to child abuse in the United States occurred in 1874. The New York Society for the Prevention of Cruelty to Animals pleaded in court to have an eightyear-old child removed from her abusive and neglectful environment. Since there were no child abuse laws, the Society argued that the child was, in fact, an animal, and should be provided the same protection as other animals. During the last few decades of the 1800s, societies to protect children from cruelty were formed in many states. The next movement to protect children came as the result of several pediatricians publishing articles about children suffering multiple fractures and brain injuries at the hands of their caretakers. In 1961, Dr. C. Henry Kempe, then president of the American Academy of Pediatrics, held a conference on the “battered child syndrome,” in which he outlined a “duty” to the child to prevent “repetition of trauma.” The Battered Child Syndrome Conference resulted in many states passing laws to protect children from physical abuse. Child abuse is now recognized as a problem of epidemic proportions. Child abuse has serious consequences that may remain as indelible pain throughout the victim’s lifetime. The violence and negligence of parents and caretakers serve as a model for children as they grow up. The child victims of today, without protection and treatment, may become the child abusers of tomorrow. As with any social issue, child abuse is a problem for the entire community. Achieving the goals of protective services requires the coordination of many resources. Each professional group and agency involved with a family assumes responsibility for specific elements of the child protective service process. 2 Child Abuse: A Guide for Mandatory Reporters National Data Nationally, the 2008 “Child Maltreatment Report,” published by the U.S. Department of Health and Human Services Children’s Bureau, indicates that an estimated 3.3 million reports of child abuse involving 6 million children were made to child protection agencies that year, and that approximately 63% were accepted for investigation or assessment. One-fourth of the investigations and assessments (25%) confirmed child abuse. There were an estimated 794,000 victims of child abuse nationwide. The rate of victimization was 10.3 per 1,000 children. The highest victimization rates were for the birth to age 1 group (21.7 per 1,000 children). There was no prior history of victimization for 75% of all victims. National studies continue to indicate that only about one-third of maltreated children are reported to child protection agencies. Significant numbers of victims remain unidentified without protection and treatment. In 1985, the U.S. Surgeon General declared family violence to be a national epidemic. At that time, an estimated 3.3 million children were exposed to violence by a family member against a mother or female caretaker. The U.S. Advisory Board on Child Abuse and Neglect found domestic violence to be the single major precursor to child abuse and neglect fatalities in the United States. Child abuse is 15 times more likely to occur in homes where adult domestic violence is present. According to the Effective Intervention in Domestic Violence & Child Maltreatment Cases: Guide for Policy and Practice, published by the National Council of Juvenile and Family Court Judges in 1999, “domestic violence perpetrators do not victimize only adults. Recent reviews of more than two decades of studies have revealed that in families where women are abused, many of their children also are maltreated. According to the Iowa Attorney General’s Office, Crime Victim Assistance Division, from January 1995 through April 2010, 209 Iowans have been killed in domestic abuse homicides. During that period: ♦ ♦ ♦ ♦ ♦ 138 women were killed by their spouse, former spouse, boyfriend, or intimate partner; 24 men were killed by their partners; 46 bystanders were killed, including 25 children; 168 minor children survived the murder of their mother or father; and 67 children were present at the scene of a parent’s murder. Child Abuse: A Guide for Mandatory Reporters 3 Although many adults believe they have protected their child from exposure to domestic violence, 80% to 90% of children in those homes can give detailed descriptions of the violence experienced in their families. (Doyne, S. Bowermasyer, J. & Meloy, R. (1999). “Custody Disputes Involving Domestic Violence: Making Children’s Needs a Priority,” Juvenile & Family Court Journal, 50, (2)). The U.S. Advisory Board on Child Abuse suggests that domestic violence may be the single major precursor to child fatalities in this country. Varying by samples selected and types of data gathered, the majority of these studies have found that a substantial proportion, ranging from 30 to 60 percent, of battered mothers’ children also are maltreated. Children who are abused physically or sexually or witness violence tend to exhibit more developmental, cognitive, emotional, and social behavior problems, including depression and increased aggression, than other children.” Iowa Response 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. According to Iowa statute, the Department of Human Services (DHS) has the responsibility to assess reports of suspected child abuse. DHS is the agency designated by law to receive reports of suspected child abuse and neglect. In calendar year 2009, DHS accepted 25,814 reports for assessment. After completing the assessment of the allegations, DHS confirmed that abuse occurred in 8,867 (34%) of the assessed reports. There were 12,442 child victims named in the confirmed and founded reports. Some children suffered multiple types of abuse or repeat maltreatment. These results represent a rate of 15.6 per 1,000 Iowa children abused for 2009. 4 Child Abuse: A Guide for Mandatory Reporters Iowa Confirmed Child Abuse in Calendar Year 2006 - 2009 Percentage of Total Confirmed or Founded Abuse Type of Abuse 2006 2007 2008 2009 Denial of critical care 77.2% 78.87% 79.4% 81.0% Physical abuse 10.0% 9.35% 10.8% 9.0% Presence of illegal drugs 7.2% 6.63% 3.86% 3.6% Sexual abuse 4.1% 3.81% 3.86% 3.8% Cohabitation with registered sex offender* 0.7% 0.84% 1.11% 0.6% 0.5% 0.34% 0.67% 0.45% Mental injury 0.1% 0.12% 0.20% 0.1% Child prostitution 0.0% 0.0% 0.0% 0.0% Bestiality in the presence of a minor 0.0% 0.0% 0.0% 0.0% Manufacturing or possession of dangerous substance with intent to manufacture * This type of abuse was revised by legislative action effective July 1, 2009, to allow access by a registered sex offender. Source: DHS Division of Results-Based Accountability reports of child abuse allegations that were confirmed or founded in calendar years 2006, 2007, 2008, and 2009. (Note: A victim may have suffered more than one type of abuse.) DHS works closely with physicians, nurses, educators, mental health practitioners, law enforcement agencies, and the judiciary. These parties are involved in the identification, reporting, assessment, and treatment of cases of child maltreatment. Ultimately, children can be kept safer from abuse and neglect through increased community ownership, responsibility, and involvement. One entity (whether legislators, DHS, physicians, educators, or local law enforcement) alone cannot eliminate “child abuse.” The safety of children depends upon how well communities support families, organize basic systems, and make inclusive decisions about available resources. Partnerships that involve parents, neighbors, and grassroots community groups, in addition to public agencies and non-profit organizations, create community ownership, responsibility, and involvement. The vision of partnerships has evolved with the realization that “one size does not fit all.” Through partnerships, its citizens define a community’s needs, and services can be tailored to the particular needs and strengths of individual communities. Child Abuse: A Guide for Mandatory Reporters 5 The child abuse reporting law is only one type of Iowa statute designed to deal with child abuse. Juvenile justice laws authorize the court to provide protection for children through supervision in their own homes or in substitute care. Criminal laws are separate from the child abuse reporting and juvenile justice laws. Criminal laws provide for prosecution of alleged perpetrators in cases where a criminal act has been committed. Am I a Mandatory Reporter of Child Abuse? 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: Health Mental health ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ Education Law enforcement Child care 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. 6 Child Abuse: A Guide for Mandatory Reporters ♦ 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.) Health Health service professionals play many roles in the recognition and treatment of child abuse, including the recognition of the abuse, reporting the suspected abuse, crisis intervention, and long-term treatment. Health services personnel are often the first line of defense in the early detection of child abuse. Most health professionals who treat children are required to be mandatory reporters of child abuse. Health care professionals are often called upon to work collaboratively with many other disciplines, including social work, education, law enforcement, and the courts to ensure a multi-disciplinary approach to the recognition and treatment of child abuse. Child Abuse: A Guide for Mandatory Reporters 7 A health care practitioner may, if medically indicated, take or cause to be taken, a radiological examination, physical examination, or other medical test of the child or take photographs, which would provide medical indications for the child abuse assessment. A physician has the authority to keep a child in custody without a court order and without the consent of a parent, guardian, or custodian, provided that the child is in a circumstance or condition that presents an imminent danger to the child’s life or health. However, the physician must orally notify the court within 24 hours. The ability to take or keep a child in custody is unique to physicians and peace officers. Education Educators may spend more hours per day with children than their families. That’s why the role of educators is vital in the mandatory reporting process. All licensed school employees, teachers, coaches and paraeducators are mandatory reporters. The involvement of educators in the reporting of child abuse is mandated or supported by federal standards and regulations and state laws, policies and procedures. Each of these government levels provides authority for, encourages, or mandates educator involvement in the reporting process by stating what is required of the educator and how that obligation is to be fulfilled. The primary authority at the federal level is the Federal Family Education Rights and Privacy Act (FERPA) of 1974. FERPA, which governs the release of information from school records, does not bar the reporting of suspected child abuse by educators. In the majority of cases, educators will be relying not on school records, but on their own personal knowledge and observations when reporting child abuse. Because no school records are involved in these cases, FERPA does not apply. In a small number of cases, it may be necessary to consult school records to determine whether a report of child abuse should be made. Ordinarily parental consent is required before information contained in school records can be released. However, there are exceptions that can apply in cases of child abuse. Some local school systems and boards of education have enacted school policies and procedures regarding child abuse reporting. The policies and procedures support state law with regard to reporting and often provide internal mechanisms to be followed when a report of child abuse is made. Local school policy may specify that parents be notified when the school makes a report of child abuse. If so, notify DHS of that local policy when making the report of child abuse. Sometimes local procedure may require that administrative staff be notified when a report of child abuse is made and a copy of the written report be filed. 8 Child Abuse: A Guide for Mandatory Reporters Child Care Child care providers play a critical role in keeping children safe. It is very important for them to report when they suspect child abuse. Child care providers include child care staff, foster parents, and residential care personnel. All of these people are mandatory reporters. A child care provider who suspects that a child has been abused should report that to DHS and to the licensing worker. Mental Health Mental health professionals are often trusted with intimate information about children and families. This makes their role critical when reporting child abuse. All counseling providers, even those who are self-employed, are mandatory reporters of child abuse in regard to the child they counsel. Law Enforcement Law enforcement officers play a very important role in protecting our children from child abuse. Law enforcement officers are seen as a symbol of public safety. They are in an excellent position to raise community awareness about child abuse. Law enforcement officers often encounter situations that involve child abuse. For example, on domestic calls or during drug arrests the officer may learn of information that constitutes an allegation of child abuse. Children residing in homes where methamphetamine is being manufactured or where precursors are present constitutes an allegation of child abuse as well as possible criminal charges. Law enforcement is mandated to report to DHS. Law enforcement officers who suspect child abuse in the line of duty are required to report that abuse to the Department of Human Services as soon as they suspect it. Law enforcement officers need to follow the same procedures as all mandatory reporters in reporting child abuse. Law enforcement and child protective services may need to work together. Sometimes child protective service workers must visit isolated, dangerous locations and deal with unstable, violent, or substance abusing individuals. Generally, child protective service workers do not have on-site communications (radio, car phone, etc.), weapons, or special training in self-protection. It is often necessary for law enforcement personnel to accompany child protective workers to conduct their assessment. Failure to have proper backup may have unfortunate consequences to both the child protection worker and the child that may have been abused. Child Abuse: A Guide for Mandatory Reporters 9 Law enforcement has the power to arrest and to enforce any standing orders of the court. When it is necessary to remove a child from the child’s home, law enforcement officers are often called upon for assistance. Law enforcement has the general authority to take custody of children. Law enforcement is often able to react to emergency situations faster than child protective service. Law enforcement is also available 24 hours a day, while the child protection worker after hour response is limited in some communities. Others Required to Report Some employers may have specific policies that require certain training and reporting procedures regarding child abuse for their staff, even when they are not by law considered mandatory reporters. Reporters who by law are not considered mandatory reporters will be considered permissive reporters regardless of the employer’s requirements. Iowa Administrative Code 441--175.23(2) mandates certified adoption investigators and DHS income maintenance workers to report suspected abuse. Income maintenance workers and certified adoption investigators are “mandated,” not mandatory reporters. As such, they are not required to make a written report, although they may do so if they wish. They receive the same information and notices as permissive reporters. They are not entitled to written notification that the assessment has been completed nor to a copy of information placed on the Registry. However, they may receive a copy of the report if they have another role with the child that allows access to the summary. How Do I Report Child Abuse? 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.” 10 Child Abuse: A Guide for Mandatory Reporters Reports are made in terms of the child’s possible condition, not in terms of an accusation against parents. A report of child abuse is not an accusation, but a request to determine whether child abuse exists and begin the helping process. 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. Reporting Procedures 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.