Abuse/Neglect of a Child

Revised 3/08; Reviewed 10/09,10/10,10/11, 6/13

ECHO Community Health Care, Inc. Policy and Procedure Abuse/Neglect of a Child

PURPOSE: This document is intended to inform employees of ECHO Community Health Care, Inc. (ECHC) of the indicators of neglect and abuse of a child, their responsibilities of handling indications, and where to report victims.

POLICY: It is the policy of ECHC to report suspected or alleged abuse/neglect or exploitation of a ‘Child In Need of Services’ (CHINS) in compliance with the laws of Indiana. The Federal Child Abuse prevention and treatment Act (CAPTA), (42 U.S.C.A.), as amended provides the following definitions:

Child – is a person who has not attained the lesser of: - The age of eighteen (18); or - Except in the case of sexual abuse, the age specified by the child protection law of the State in which the child resides.

Child abuse and neglect – is, at a minimum: - Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or - An act or failure to act which presents an imminent risk of serious harm.

Sexual abuse is: - The employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or - The rape, in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children.

Indiana Definitions:

Child – means any person under the age of eighteen (18) years.

Child in need of Services (CHINS) – Introduction: The Indiana Juvenile Code refers to the Child In Need of Services (CHINS), which is a name for a child who is neglected, abused and dependent. IC-31-6-4-3 (a) (1) through IC-31-6-4-3-(a)(5) constitutes that portion of the CHINS definition that defines the abused/neglected child.

1 Section 4-8 Revised 3/08; Reviewed 10/09,10/10,10/11, 6/13

A child in need of services (CHINS), if before the child’s eighteenth birthday: 1. The child’s physical or mental condition is seriously impaired or seriously endangered as a result of the inability, refusal or neglect of the child’s parent, guardian or custodian to supply the child with necessary food, clothing, shelter or medical care, education or supervision. 2. The child’s physical or mental health is seriously endangered due to injury by the act of omission of the child’s parent, guardian or custodian. 3. The child is a victim of a sex offense under IC 35-42-4-1 (Rape); IC 35-42-4-2 (Criminal Deviate Conduct); IC 35-42-4-3- (Child Molestation); IC 35-42-4-4 (Child Exploitation); IC 35-42-4-7 (Child Seduction); IC 35-42-4-1 (Public Indecency/Indecent Exposure); IC 35-45-4-2 (Prostitution); or IC 35-46-1-3 (Incest). A. The age of legal consent for consensual sex in Indiana is 16 years old.

B. Reportable offenses occur when someone under 16 years old has sex with someone 18 years or over. IC 35-42-4-9 In this case age of the partner is important, but if unknown, then CPS will investigate.

C. Any sex with a child 13yrs of age or younger must also be reported.

D. If in doubt about a situation, then we report and CPS will screen.

E. Obligation to report is relieved if a report has already been made to the best of our belief. IC 31-33-5-3

F. Reports made in good faith are immune from civil or criminal liability. IC 31-33-6-1 & IC 31-33-6-3

G. Failure to report may result in a class B misdemeanor. IC 31-33-22-1

4. The child’s parent, guardian or custodian allows the child to participate in obscene performance defined by IC 34-49-2-2 (Matter of Performance Harmful to Minors) or IC 35-49-3-2 (Obscene Performance) 5. The child’s parent, guardian or custodian allows the child to commit a sex offense prohibited by IC 35-45-4 6. The child is born with fetal alcohol syndrome or an addiction to a controlled substance or a legend drug,; or the child has an injury, has abnormal physical or psychological development, or is substantially aggravated because the child’s mother was addicted to alcohol, a controlled substance, or a legend drug during pregnancy and needs care, treatment or rehabilitation that the child is not receiving, or that is unlikely to be provided or accepted without the coercive intervention of the court. As added by P.L. 294-1987, Sec 3. 7. Parents may not refuse indicated medical treatment on behalf of their minor children. Failure to give consent for indicated medical treatment is child abuse according to Indiana statute. In such case, court appointment of a guardian for the child must be sought.

Indiana’s Child Protective Services (CPS)- protects Indiana’s children from further abuse or neglect and prevents, remedies, and assists in solving problems that may result in abuse, neglect, exploitation, or delinquency of children. The child’s safety is the primary factor in all CPS investigations.

Indiana State Statute (PL 98-457) requires the reporting of the suspected “medical neglect of a handicapped infant”, as CHINS. The Physician, providers and Social Workers of ECHC are the official liaisons to the Department of Family and Children Services for such cases reported. A person who in good faith makes a report required to be made under Indiana State Statute, or testifies at Administrative or judicial proceedings on matters arising from the report is immune from any civil or criminal liability.

HISTORY/ASSESSMENT/DOCUMENTATION

Child: 1. Observe for injuries that are not explained by the history provided. 2. Observe for injuries located on multiple body sites and/or in different stages of healing. 3. Note inconsistencies in the history of the injury (by parents, relatives, neighbors, caretakers, etc.) 4. Assess the possibility of the history being provided in light of any pre-existing medical conditions. 5. Observe for extremes in behavior and inappropriateness of behavior according to the developmental stage. 6. Remain supportive, objective and professional toward child and caretakers. Maintain a non-judgmental approach toward the child and family members at all times. A judgmental attitude may hamper the level of cooperation. The family should be kept informed of what is happening to the child at all times. 7. Document assessment on the patient’s chart noting physical and emotional findings. Photographs are encouraged and to be taken when ever possible, a consent is to be signed prior to photographs. Photographs are limited to the body area of concern and the person’s face is not to be included. If the face is involved in the affected areas then limit the photo to only the area of the face involved. 8. Sit near the child, at the child’s eye level, not across from a desk or table. 9. When questioning the child, attempt to establish a trusting relationship by using the child’s own words and terms in discussing the situation whenever possible. Attempt to explain things to them in the language appropriate to their developmental level.

Parent/Caregiver

1. Interview parent/caretaker/guardian in an objective and professional manner. A judgmental attitude may hamper the level of cooperation. 2. Note any findings of other violence in the home. 3. Note if there is any known substance/alcohol abuse in the home by parents or caregivers. 4. Observe lack of necessary maturity to care for the child. 5. Note if the child’s caretaker is socially isolated (i.e., has no external support system) 6. Observe for parental expectations that are inconsistent with the child’s developmental abilities. 7. Observe for families that are experiencing high levels of stress from events such as loss of a job, increased financial burdens, serious illness, death of the family, divorce or separation. 8. Note parental behavior toward the child such as inappropriate concern about the injury, delay in seeking necessary treatment, and/or inability to locate parent or guardian.

INDICATIONS OF ABUSE/NEGLECT:

A. Physical: 1. Bruises and welts forming regular patterns often resembling the shape of the article used to inflict the injury (e.g., hand, teeth, belt buckle, electrical cord, etc.) 2. Burns such as from cigars, cigarettes, especially on the soles, palms, back or buttocks, immersion burns (stocking or glove-like without splash burns on extremities, doughnut-shaped on buttocks or genitals). 3. Lacerations or abrasions such as rope burns, particularly on wrists, ankles, neck or torso, palate, gums, lips, eyes, ears, external genitalia. 4. Fractures. 5. Under nutrition 6. Poor hygiene such as being extremely dirty or having extraordinarily severe diaper rash. 7. Developmental delay 8. Untreated medical conditions 9. Rampant dental carries 10. Lack of proper immunizations for age.

B. Behavioral Findings 1. Depression 2. Anxiety 3. Enuresis 4. Sleep disturbances 5. Excessive masturbation 6. Impaired interpersonal relationships 7. Discipline problems, aggressive behavior 8. Poor school performance

9. “Role reversal” in which the child assumes the caretaker role. 10.Excessive household responsibilities, including childcare.

REPORTING Indiana Child Protective Service, Toll-free hotline (1-800-800-5556) All reporting is done with the Statewide hotline number

PROCEDURE:

A. Treat any physical source of pain, use non-pharmacological measures, if possible, such as positioning for comfort and ice. B. Document findings using the patient’s and caretaker’s own words. Photographs are encouraged and to be taken when ever possible, consent is to be signed prior to photographs. Photographs are limited to the body area of concern and the person’s face is not to be included. If the face is involved in the affected areas then limit the photo to only the area of the face involved. The Polaroid photos are placed in the medical record with the visit note. See Attachment, ‘ Photo Release’. C. If the patient acknowledges abuse, neglect or exploitation or you highly suspect the patient has been abused neglected or exploited; a. Notify the Social Worker b. The Social Worker completes assessment of the situation and includes the following information in narrative form or by completing the attached form (IC 12-10-3-10): A. The name, age, and address of the child. B. The names and addresses of family members or other persons financially responsible for the child’s care or other individuals who may be able to provide relevant information. C. The apparent nature and extent of the alleged neglect, battery, or exploitation and the child’s physical and mental condition. D. The name, address, and telephone number of the reporter and the basis of the reporter’s knowledge. E. The name and address of the alleged offender. F. Any other relevant information regarding the circumstances of the child. c. The Social Worker will notify proper authorities. d. Locate a safe environment for the patient, if questionable consult with the social service coordinator or appointed designee. e. Arrange for transportation for the patient to that safe environment if necessary. a. Provide emotional support

b. ECHC is not obligated to tell a parent/adult of a reported concern to the authorities. If ECHC staff is questioned if we were the reportee, the staff member is to state, “I’m not at liberty to give that information.”

REFERENCES:

Indiana Codes Indiana Child Protective Services

6 Section 4-8