California Child Abuse & Mandated Reporter

1. California Child Abuse & Mandated Reporter Adapted from the resources provided by prepared by Merced County Office of Education – Family Resource Council The Chadwick Center at Rady Children’s Hospital San Diego Merced County Human Services Agency

2. Agenda/ Objectives • Objectives • How the law defines child abuse and neglect • What is required of you as a mandated reporter • What protections the law provides for you as a mandated reporter • How to spot signs of child abuse • How to report child abuse • What happens after a report is filed

3. Introduction • California passed it’s first child abuse reporting law in 1963 • Stated that physicians must report physical abuse of children • CANRA was passed in 1974 in California • “Child Abuse Neglect and Reporting Act” • Has been amended over the years • Expanded list of who is mandated to report

4. Who are Mandated Reporters? • Complete list includes 40 categories, refer to penal code 11165.7 • Generally includes anyone who works or comes into contact with children in their job • Does not include volunteers • Can report, but not mandated • UNLESS: CASA volunteers (Court Appointed Special Advocates) = mandated reporters

5. What must be reported? • Under CANRA, suspicions of the following must be reported in California • Physical abuse • Sexual abuse • Emotional abuse/ damage • Neglect • When the victim is under the age of 18, and the perpetrator is any age • Remember that reporting child abuse does not mean physical intervention or snooping. • It simply means not ignoring the obvious.

6. What is Child Abuse and Neglect?Welfare & Institutions Code section 300, subdivisions (a) – (j) • Physical abuse • Neglect • Emotional damage • Sexual abuse • Severe physical abuse of children under five • Parent caused death of a sibling • Parent’s failure to support • Legal orphan • Cruelty • Other siblings neglected, child at risk

7. Definition of child abuse

8. Identifying Child Abuse • Requires first the understanding that child abuse can occur in any family, regardless of socio-economic status, religion, education, ethnic background, or other factors. • Cultural beliefs may affect our perception of this • Secondly, the professional must be aware of and alert to the signs of child abuse.

9. Culture A set of beliefs, attitudes, values, and behavior that is passed down from generation to generation Shaped by many factors including race, religion, and ethnicity Influences attitudes and ideas about acceptable child behavior and discipline Also affects perceptions of stress, trauma, abuse and reactions to all of those

10. Cultural Sensitivity • It is natural to see one’s own culture as the normal or correct culture • We must be aware of our own values, beliefs and biases, and how those influence our expectations of others so that we • are best able to understand differences in parenting • avoid unnecessary reports • meet the needs of all children in a sensitive manner

11. Definition What to Report Physical Abuse

12. What to Report - Physical Abuse • CANRA defines physical abuse as a physical injury inflicted by other than accidental means on a child • Also includes unlawful corporal punishment or injury, willfully inflicted, resulting in a traumatic condition • Spanking or corporal punishment is not necessarily illegal, it should be “reasonable and age-appropriate” PC 11165.6

13. Physical Abuse • A physical injury or action of harming a child • Bruises, bites, burns, fractures, abusive head trauma • Although the injury is not an accident, the parent or caretaker may not have intended to hurt the child • May result from excessive discipline or inappropriate physical punishment • The injury may be the result of a single episode or of repeated episodes and can range in severity from minor bruising to death

14. Physical Abuse • Type, location, and pattern of skin injuries may help distinguish accidental injuries from suspected physical abuse • However, any injury, even a small bruise in a very young infant is concerning • Young infants are not mobile • Completely dependent on their caregivers • Any injury in this age group should raise concern for the possibility of inflicted injury

15. Child Motor Development • Developmental abilities of a child should be considered when evaluating injuries • If a child is unable to roll over or crawl, they are unlikely to have sustained an injury on their own

16. Physical Abuse • Once children are toddlers, and capable of crawling or walking, bruises are very common • Location and pattern of the injury needs to be considered • Common locations for accidental bruises in toddlers and children include bony areas such as shins, elbows, knees, forehead, and chin, among others • Common locations of abusive injuries include the back, buttocks, ears, face (particularly the soft tissues of the cheek), neck, and genitalia

17. Location of Bruises ***This is not a complete list or a perfect rule, it is a guide

18. Physical Abuse Abusive bruises and burns may also be patterned, or have a distinct outline Accidental bruises usually do not leave a clear pattern or outline While an outline or pattern should raise concern, abusive injuries are not always patterned, and may look very similar to accidental bruises

19. Physical Abuse Other types of injuries that may signal child abuse include but are not limited to: • Broken bones • Lacerations • Burns (hot water scald, iron) • Abusive head trauma • Any injury with a delay in seeking treatment

20. Intimate Partner Violence • California is one of the few states that mandates reports of intimate partner abuse between adolescents / teenagers • “Intimate relationship” not dependent on age • Can be reported to either local child welfare services or law enforcement agency • Unfortunately, responses to reports of intimate partner violence affecting minors vary enormously from jurisdiction to jurisdiction

21. Red Flags – Parent Behaviors • Parental depression or other mental illness • Parent tells you of use of objects to discipline the child • belts, whips, clothes hanger • Parent has unrealistic expectation of child • toilet-training a 6-month-old • Parent is unduly harsh and rigid about childrearing • Parent singles out one child as "bad," "evil," or "beyond control" • Parent berates, humiliates, or belittles child • Parent misinterprets child's normal behavior • a parent interprets an infant's crying as evidence that child hates the parent • Parent is indifferent to child

22. Red Flags – Child Behaviors • Hostile, aggressive, or verbally abusive toward others • Fearful or withdrawn behavior • Self-destructive • self-mutilates, bangs head, etc. • Destructive • breaks windows, sets fires, etc. • Frightened of going home, frightened of parents/caretakers • Attempts to hide injuries • Frequent absence from school • Clingy, forms indiscriminate attachments

23. What is NOT Physical Abuse A "mutual fight between minors" "Reasonable and necessary force" used by a peace officer "Reasonable and necessary force" used by a person employed in a public school to suppress a disturbance threatening physical injury to person or damage to property, for purposes of self-defense, or to obtain possession of weapons or other dangerous objects within the control of the pupil Spanking that is reasonable and age-appropriate and does not expose the child to risk of serious injury

24. Practice Question You are an employee at a school. A 7 year old child comes to school with linear red bruises on his cheeks. He was absent the day prior. When you ask him what happened to his cheek, he replies that he fell while riding his bike. Do you report this injury? No, because falling off a bike is an accidental injury Yes, because he missed school the day prior No, it is a very minor injury Yes, because the injury is concerning for a slap mark

25. Practice Question In the course of your work, you observe a mother spanking a 2 year old child twice on the buttocks with her hand for eating food off the ground. What should you do as a mandated reporter? • Confront the mother • Nothing, the spanking seems reasonable and age-appropriate • Report this as physical abuse for excessive discipline • Any of the above

26. Vignette 1 12-year-old Colin, a student in your class, has recently begun exhibiting a variety of concerning behaviors. He has engaged in recurrent fights with other students resulting in chronic probationary status. He uses verbally abusive language, is frequently truant, and has been suspended once for drinking at school. Over the past year, his grades have declined significantly and he has withdrawn from all sports. Colin has been absent for a few days, and when he returns to school, you notice that he has a bruise on his cheek. When you ask about his injury, he tells you that his father hit him when he came home late from a friend’s house. Confront the mother Do you make a report? Why?

27. Definition What to Report Sexual Abuse

28. What to Report - Sexual Abuse PC 11165.1 • Per CANRA, child sexual abuse includes both sexual assault and sexual exploitation • Sexual assault includes • Sex acts with children • Child molestation • Intentional masturbation in the presence of a child • Sexual exploitation includes • Preparing, selling, or distributing pornographic materials involving children • Performances involving obscene sexual conduct • Child prostitution

29. Sexual Assault CANRA cites following sections of CA penal code: 261, section d of 261.5, 264.1, 285, 286, 288, 288a, 289, 647.6 • Includes • Forcible Rape • Statutory rape (section 261.5) • Incest • Sodomy • Lewd or lascivious (indecent, or of a sexual nature) acts upon a child • Oral sex • Sexual penetration • Child molestation • Intentional touching or fondling of the genitals or intimate parts (including the breasts, genital area, groin, inner thighs, and buttocks) or the clothing covering them, for purposes of sexual arousal or gratification • Masturbating in the presence of a child

30. Sexual Abuse

31. Reporting Consensual Sexual Intercourse M = mandated, must be reported based on age difference CJ = Clinical Judgment, the report is not mandated solely by age, but other factors may warrant reporting From “Understanding Confidentiality and Minor Consent in California” http://www.californiateenhealth.org/download/toolkit-rri-Web.pdf

32. Sexual Abuse • The following situations do not require reporting: • Unforced sexual activity between minors under 14 years who are "of like age" • Unforced sexual activity between minors aged 14-17 and partners aged 14-20 • Note: There is no law that requires health providers or other professionals who work with adolescents to ask the age of a patient's sexual partner(s)

33. Sexual Exploitation Depicting a minor engaged in obscene acts Preparing, selling, or distributing obscene matter that depicts minors Employment of minor to perform obscene acts Any person who knowingly promotes, assists, employs, uses, persuades, induces, or coerces a child to engage in prostitution or a live performance involving obscene sexual conduct, or to either pose or model in child pornographic material Any person who depicts a child in, or who knowingly develops, duplicates, prints, or exchanges, any film, photograph, video tape, negative, or slide involving child pornography PC 11165.1 (c)

34. Sexual Abuse – Risk Factors • Identified risk factors include: • Being female • Living in a single parent household • Having a mother who is unavailable • Perceiving family life as unhappy • Having psychological or mental delays • Sexual abuse often occurs in the absence of any risk factors and without any obvious signs

35. Red Flags – Child Behaviors Inappropriate sexual knowledge for age Demonstrating sexual acts on other children or toys Molesting other children Post-traumatic stress disorder Emotional and behavioral problems Sexually transmitted infections

36. Sexual Abuse - Disclosure • Most victims of sexual abuse report the crime(s) months or even years after they have occurred • Many victims never report at all • It is very common for children to recant a disclosure of sexual abuse • They disclose the abuse and then change their story, denying that it ever happened • This happens for a variety of reasons including fear, guilt, shame, embarrassment, or even a desire not to hurt the perpetrator or family unit

37. Vignette 3 You become concerned because 8-year-old Sara, a student in your class, is caught exposing herself to other children on the playground and telling them to touch her. You talk with her about this behavior, and she informs you that her 14-year-old brother always wants to see her “pee pee” and likes to touch it. What should you do? Call Sara’s parents to tell them what she said and to find out more about her brother. Nothing, Sara does not seem upset and you do not want to over-react. Make a child abuse report for possible sexual abuse. Tell the principal of your concerns and hope that s/he will take the appropriate action.

38. Definition What to Report Neglect

39. Neglect • Under CANRA neglect of a child, whether "severe" or "general," must be reported if the perpetrator is a person responsible for the child's welfare • Includes: • Acts (i.e. locking a toddler in a hot car) • Omissions (i.e. not providing food) • The neglect may cause harm to the child or just threaten to harm the child's health or welfare • Must still report even if no injury PC 11165.2

40. Neglect • General neglect • Failure of a caregiver to provide adequate food, clothing, shelter, medical care, or supervision, where no physical injury to the child has occurred • Severe neglect • The intentional failure of a caregiver to provide adequate food, clothing, shelter, or medical care • Or caregiver willfully causes or permits the child to be placed in a situation such that his or her person or health is endangered PC 11165.2

41. Neglect • Can be further divided into different types - the following examples do not constitute a complete list • General or physical neglect - not providing adequate food, clothing, or a safe home environment • Medical neglect - not providing appropriate medical care, dental care, or immunizations • Emotional neglect - not interacting with an infant or child • Educational neglect - not enrolling a child in school or providing proper home-schooling • Note: It is very important to distinguish between neglect and failure to provide necessities of life because of poverty or cultural norms

42. Drug-exposed Infants • A positive toxicology screen at the time of the delivery of an infant is alone not a sufficient reason for reporting child abuse or neglect • However, any indication of maternal substance abuse shall lead to an assessment of the needs of the mother and child • If other factors are present that indicate risk to a child, then a report shall be made • A report based on the parent's inability to provide care because of substance abuse shall be made only to county welfare departments and not to a law enforcement agency

43. Neglect- Religious Considerations Refusing medical care for religious reasons is a hotly debated topic when children are involved Per CANRA, a child receiving treatment by spiritual means or not receiving specified medical treatment for religious reasons, shall not for that reason alone be considered a neglected child An informed and appropriate medical decision made by a caregiver after consultation with a physician does not constitute neglect PC 11165.2 [b]

44. Red Flags – Child Behaviors Dirty clothes, poor hygiene Failure to thrive, or a malnourished child Severe dental cavities Developmental delay Self-abusive behaviors Socially withdrawn Behavioral problems such as anxiety or aggression

45. Is this Neglect?

46. Neglect

47. Neglect

48. Neglect

49. Neglect? What Is This? First discovery or notation of head lice is not neglect. Each school has a policy on how to deal with head lice. You may want to know what your district’s policy is. Merced County Office of Education’s head lice policy is on their web site.

50. Red Flags – Parent Behaviors Depression Domestic violence Unemployment Poverty Lack of social support Mental illness or mood disturbances History of abuse as a child Substance abuse