Law & Ethics Week 3- Child Abuse Reporting
Regarding the child abuse report, what steps would you take to maintain objectivity and clarity in this case?
- Assess the situation carefully - Consult with more experienced peers - Check my emotional reactivity with own therapist - Know the laws and ethics regarding this issue
Child Abuse Management
- Clinical purposes - Am I going to tell? - Is there an increased risk of danger and harm to the child, parent, th, or others? - It's always clinical decision. - Give resources? What resources can I give to the clients? (As part of clinical intervention) - Explain the process. (There may not be evidence in children's court, but there may not be evidence for criminal court) - Need to balance between therapeutic relationship
QRMOTH: Mental Status Exam What is it?
- Cognitive and emotional functioning assessment -Best practice guidelines to do MSE during first session. MSE is your observation about the client's: 1. Appearance 2. Behavior (how does patient behave? congruent/incongruent?) 3. Speech (describe quality of talking. rapid, slow, deliberate, disjointed etc) 4. Emotion/affect (Is emotions depressed, euthymic, dythymaic, manic,? Is affect labile, flat, expansive?) 5. Though processes (delusional? obsessive, compulsive?) 6. Orientation (is patient oriented to person/place/time?) 7. Memory: patient memory intact for recent/intermediate/remote? 7. General intellectual abilities **What they are wearing, their grooming, their affect
Child Abuse Reporting (ages 0-17 year old)
- Report reasonable suspicion - Report sexual, physical and neglect and optional for emotional maltreatment (hard to prove) - Reports to Child Protective Services - Call immediately or soon as practically possible (over within couple of hours of finding out) but no later than 24 hours - After the calls, must submit written report within 36 hours - Verbal reports carries for weight than written reports. - Document: who you talked to, who you report to, what supervisor said - Need to know your agency's policy in keeping a copy (If supervisor doesn't think that you didn't report, when in fact you have gut feeling to have reasonable suspicion, you can let the supervisor know that you are uncomfortable and will at least consult.) (Is it safe for the child to leave the office? If it's significantly serious, you keep the child and cancel next session.)
Neglect
- Required a mandated report. - Child is the victim of neglect if the person responsible for their welfare fails to provide adequate food, clothing, shelter, medical care or supervision - Reportable even if it takes place by accident Important: Child need not have suffered actual harm before a report of neglect can be made.
How is Mental Status Exam used?
- Used to determine if client is appropriate for psychotherapy. - Initial assessment of cognitive and emotional functioning can establish baseline and useful for future comparison to determine improvement or worsening of clients mental/emotional state
What information is needed to make a Child abuse report?
1-Child's name. 2- address. 3-statement from them, along with the perpetrator's name.
Abuse that occurred out of state
Abuse that occurred out of state is reportable and should be reported to CPS.
When two or more mandated reporters are involved in a case, who is primarily responsible for reporting?
Both of them equally
What is the legal requirements for reporting a reasonable suspicion of child abuse?
Call "Child Protective Services" immediately. Write written report within 36 hours of the call.
What do I do if I am not sure whether I should report something?
Consult with Child Protective Services and ask about appropriateness of a referral.
Reporting child abuse when victim is now an adult
Do not report when adult client reveals they were abused as child. Victim can still be encouraged to report abuse on their own to law enforcement
Treatment by Spiritual Means
Failure to receive medical treatment for religious reasons -Not a reportable issue
QRMOTH: History
History: - Ask about involvement with CPS in the past? (Previous involvement) - Find out how the parents were disciplined - history of substance abuse?
Reporting when the abuser has moved away or no longer has access to children
Mandated Report. Abuser cannot escape responsibility by moving away Abuse may gain access to children in the future
Sexting
Mandated report when reporter has reasonable suspicion that someone knowingly download, streams or accesses any images or video that involve minors engaging in an 'act of obscene sexual conduct' Both sender and recipients of sext can be considered to have committed a crime.
Reporting child abuse when abuser/victim has died
Mandated report when the victim has died and there are no exception for reporting and abuser died. Report as there may be other victims and abusers involved
When sexual intercourse coerced or not voluntary
Must report any intercourse that was coerced or in nay other way not voluntary, irrespective of the age of the partners, even if both partners are the same age
Do I have to ascertain the age of a minor's sexual partner for the purpose of child abuse reporting?
No but case law states that providers should ask questions as in the ordinary course of providing care according to standard prevailing in the medical profession.
Consensual sexual intercourse involving client under 13 with another client under age 13
No- Report
QRMOTH: Observe
Observe: -Interaction with therapist - Their play (are they playing with toys? Does that house always blow up? Are the dolls engaging in sexual activity beyond the age that the child will be aware of? - How they interact with their parents? Observe eye contact, - how they are groomed, do they look malnourished? **Pay attention to your gut- and your feelings towards it
Emotional Suffering (emotional damage characterized by severe anxiety, depression, withdraw, aggressive behavior to self and others etc)
Permitted reportable situation. Not a mandated report. Emotional Abuse standard requires that there be a some behavioral evidence of the emotional harm the child is suffering or at risk of suffering (severe anxiety, depression, withdraw, aggression toward self or others)
What does QRMOTH stand for?
Question Release Mental Status Exam Observe Testing History -Once you assess, ask "do I have reasonable suspicion for abuse?" -It's important to ask your assessment questions before moving on to management. -You only want to share what you need to share in the report. - Do not share information that is not relevant to the report, as you still have to maintain confidentiality - **If you are working as a team, and one person is report, make sure to get/give copy of the report. *Sometimes be careful when client minimizing *Even without bruising, a client's narrative is enough to have reasonable suspicion Consider if there is a minor child with the perpetuator.
QRMOTH: Question
Question: Ask open-ended questions like "where did you get the bruise?" -Don't panic, just be curious. Examples: 'Wow, you have a big bruise. What happened? " "What happens when you get in trouble?" "Does anyone ever touch you in an area you feel uncomfortable or icky about?" "So tell me about bath time at home?" "When someone tucks you in at night, what happens? " "What are some things you like to do at home?" "What did you have for breakfast?" "What kind of backpacks do you have?"
What is Red Flag Assessment?
Red Flag Assessment is way to partially determining need to report. - Follow QRMOTH steps of red flag assessment
QRMOTH: Release of Information
Release of Information/ Authorization -May need authorization to talk to the school teacher, doctor, daycare provider -How they are doing at school and at home etc
Unlawful Corporal Punishment
Required a MANDATED report
QRMOTH: Test
Testing: - Should go through the process every time you work with a new client - Medical Testing (child behavior assessment),
Reporting Consensual Sexual Activity
Under 14with other under 14- No report 14-15 with under 14- Yes Report
Mental Suffering
Willful harm causing suffering, unjustifiable physical pain or mental suffering REPORTABLE condition
Consensual sexual intercourse involving 15 year and 21 year old or above
Yes. Mandated Report
Consensual sexual intercourse involving client 14 yr old with 13 year and/or younger
Yes. Mandated Report
Reporting child abuse involving adults abused as child
if client over 18 yrs of age, there is no mandate to report If alleged perpetrator is still in contact with children, MFT is mandated to report to CPS
What does "reasonable suspicion" mean?
objectively reasonable for a person to entertain a suspicion, based on facts to suspect abuse/neglect. - Does not require certainty that abuse/neglect occurred