Pennsylvania Child Abuse Recognition and Reporting
Munaza Batool Rizvi et al.
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Healthcare providers in Pennsylvania are mandated reporters of child abuse; if a mandated child abuse reporter has reasonable cause to suspect a child was or is a victim of abuse they must report it immediately, in accordance with CPSL. This not only requires an understanding of the categories and common indicators of child abuse but the roles and responsibilities for reporting suspected child abuse.
Child Abuse/Neglect In The State Of Pennsylvania
In the U.S. over 3 million children per year are abused or neglected. In Pennsylvania, over 40,000 are the subjects of reports ad approximately 1 in 1000 children are abused or neglected.
Healthcare providers in Pennsylvania are mandated to report suspected child abuse in accordance with the CPSL. The Pennsylvania child welfare system is state-supervised and county-administered. The two main services of the county children-and-youth agencies are Child Protective Services (CPS) and General Protective Services (GPS).
Child Protective Services Versus General Protective Services
When a call/referral is made to ChildLine, the trained professionals categorize it as a CPS or GPS referral.
Cases identified as CPS require an investigation because the alleged act or failure to act has been identified as one of the 10 categories of abuse outlined in the CPLS.
Cases identified as GPS require an assessment for services and support. In these cases, the act or failure to act is detrimental to a child but does not fall under one of the 10 categories of abuse outlined in the CPLS. These services can assist parents in being able to recognize and address or correct conditions that are harmful to their children.
The key distinction between CPS and GPS is that CPS are services and activities for child abuse cases whereas GPS are services for cases requiring protective services.
Examples of 10 Categories of CPSL Cases
Causing bodily injury to a child through any recent act or failure to act
Fabricating, feigning, or intentionally exaggerating or inducing medical symptoms or disease which results in potentially harmful medical evaluation or treatment to the child through any recent act
Causing or substantially contributing to serious mental injury to a child through any act or failure to act or a serious of such acts or failures to act
Causing sexual abuse or exploitation of a child through any act or failure to act
Creating a reasonable likelihood of bodily injury t o a child through act recent act or failure to act
Creating a likelihood of sexual abuse or exploitation of a child through any recent act or failure to act
Causing serious neglect of a child
Engaging in specific recent acts ("per se acts" )
Causing the death of the child through any act or failure to act
Engaging a child in a severe form of trafficking in persons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000
Examples of GPS Cases —Services to prevent the potential for harm to a child who meets one of the following conditions:
Is without proper parental care or control, subsistence, education as required by law, or other care or control necessary for his physical, mental, or emotional health, or morals.
Has been placed for care or adoption in violation of law.
Has been abandoned by his parents, guardian or other custodian.
Is without a parent, guardian or legal custodian.
Is habitually and without justification truant from school while subject to compulsory school attendance.
Has committed a specific act of habitual disobedience of the reasonable and lawful commands of his parent, guardian or other custodian and who is ungovernable and found to be in need of care, treatment or supervision.
Is under 10 years of age and has committed a delinquent act.
Has been formerly adjudicated dependent under section 6341 of the Juvenile Act (relating to adjudication), and is under the jurisdiction of the court, subject to its conditions or placements and who commits an act which is defined as ungovernable in subparagraph (vi).
Has been referred under section 6323 of the Juvenile Act (relating to informal adjustment), and who commits its an act that is defined as ungovernable.
Case Scenario #1
A 4-year-old child is admitted to the hospital for a third episode of hypoglycemia and lethargy. Prior workup has been unable to determine an organic cause. The child is observed in the hospital for 3-days and no underlying pathologic process is discovered. The mother stays with the child, is extremely protective, and engaged in making sure "all stones are overturned" to find the cause of the child's condition. The child is set for discharge in the morning and at 4 am. While making rounds, the nurse finds the mother wide awake standing at the bedside. During her examination, the child has a seizure. A bedside rapid blood sugar tests reveal a dangerously low level. Glucagon is administered and the child recovers quickly. The nurse is suspicious of Munchausen syndrome by proxy. What should the nurse do?
In this case, it is reasonable to suspect child abuse, specifically "fabricating, feigning, or intentionally exaggerating or inducing medical symptoms or disease which results in potentially harmful medical evaluation or treatment to a child through any recent act" or "Munchausen by Proxy." As a mandated reporter, the nurse is required to make a referral/report of suspected child abuse to Childline via phone at 1-800-932-0313 (24 hours a day, 7 days a week) or electronically via the Child Welfare Portal at www.compass.state.pa.us/cwis. A mandated reporter is not required to identify or categorize the referral as GPS or CPS; a trained professional at ChildLine is responsible for determining the most appropriate course of action upon receiving the referral/report. Given the gravity of the situation, in this hospital setting, clinicians and social workers should also be contacted.
Case Scenario #2
A 16-year-old child presents to the emergency department due to acting out at school. Shortly after arrival, the child asks for a sandwich. The school could not reach the biological mother, and the biological father is deceased. The child indicates his mother is on a honeymoon on a boat somewhere in the Cayman Islands. He is currently being taken care of by his grandmother, who is at work as a dietician, but she will be home shortly. The mother left him with $200 ten days ago and told him to buy local fast food for both of them for dinner. He admits he was told not to spend more than $20 daily and avoid dessert due to his grandmother's diabetes. He says he is out of money because he bought dessert daily and spent $30 instead of $20. He says he is "starving." There is no food in the house besides the fruits, vegetables, and frozen meals his mother provided. Which of the following would be an appropriate response of the emergency department health providers?
The child should be given food, and the grandmother should be contacted. Additionally, while there may not be reasonable cause to suspect child abuse, a call/referral can still be made to ChildLine for further assessment via phone at 1-800-932-0313 (24/7) or electronically via the Child Welfare Portal at www.compass.state.pa.us/cwis.
Definitions
The 3 forms of child abuse include the following:
A child: An individual under 18 years old.
An act of failure to act. An act is something done to harm or cause potential harm to a child. The failure to act is something that is NOT done to prevent harm or potential harm to a child. A recent or failure to act is defined as action or inaction being committed within two years of the date of the report to the department or county agency.
A perpetrator: A person who has committed child abuse. The term includes only the following:
Parent of the child
Spouse or former spouse of the child's parent
Person 14 years or older and responsible for the child's welfare or having direct contact with the child as an employee of a childcare service, school or school program, activity, or service.
Individual 14 years or older who live in the same house as the child
Individual 18 years or older who does not live in the same home as the child but is related within the third degree of consanguinity or affinity by birth or adoption to the child
Individual 18 years or older who engages a child in severe forms of trafficking in persons or sex trafficking as defined in section 103 of the Victims Protection Act of 2000
Inclusion of School Employees
The CPSL allows school employees to be considered perpetrators under the definition provided for a “person responsible for the child’s welfare” or a person “having direct contact with children.” § 6303. Definitions:
A school employee is an individual who is employed by a school or who provides a program, activity, or service sponsored by a school. The term does not apply to administrative or other support personnel unless the administrative or other support personnel have direct contact with the children.
Person responsible for the child’s welfare is a person who provides permanent or temporary care, supervision, mental health diagnosis or treatment, training, or control of a child instead of parental care, supervision, and control.
Direct contact is the care, supervision, guidance, or control of children OR routine interaction with children.
Categories of Child Abuse
The definition of child abuse, per the CPSL, shall mean intentionally, knowingly, or recklessly doing any of the following:
Causing bodily injury to a child through any recent act or failure to act
Fabricating, feigning, or intentionally exaggerating or inducing a medical symptom or disease which results in a potentially harmful medical evaluation or treatment to the child through any recent act (This is also known as Munchausen By Proxy)
Causing or substantially contributing to serious mental injury through any act or failure to act
Causing sexual abuse or exploitation of a child through any act or failure to act
Creating a reasonable likelihood of bodily injury to a child through any recent act or failure to act
Creating a likelihood of sexual abuse or exploitation of a child through any recent act or failure to act
Causing serious physical neglect of a child
Engaging in any of the following recent acts
Kicking, biting, throwing, burning, stabbing, or cutting a child in a manner that endangers the child
Unreasonably restraining or confining a child, based on consideration of the method, location, or duration of the restraint or confinement
Forcefully shaking a child under one year of age
Forcefully slapping or otherwise striking a child under one year of age
Interfering with the breathing of a child
Causing a child to be present in a location while a violation of 18 Pa. C.S. §7508.2 (relating to operation of methamphetamine laboratory) is occurring, providing that the violation is being investigated by law enforcement
Leaving a child unsupervised with an individual, other than the child’s parent, who the actor knows or reasonably should have known:
Is required to register as a Tier II or Tier III sexual offender under 42 Pa. C.S. Ch. 97 Subch. H (relating to registration of sexual offenders), where the victim of the sexual offense was under 18 years of age when the crime was committed
Has been determined to be a sexually violent predator under 42 Pa. C.S. §9799.24 (relating to assessments) or any of its predecessors
Has been determined to be a sexually violent delinquent child as defined in 42 Pa. C.S. §9799.12 (relating to definitions)
Causing the death of the child through any act or failure to act
Engaging a child in a severe form of trafficking in persons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000
Bodily Injury: Impairment of physical condition of substantial pain
The law considers two parameters: impairment and pain.
Impairment - If, due to the injury, the child’s ability to function is reduced in any way; either temporarily or permanently
Pain - If the child experiences what a reasonable person believes to be substantial pain
Serious Mental Injury: A psychological condition, as diagnosed by a physician or licensed psychologist, including the refusal of appropriate treatment that:
Renders a child chronically and severely anxious, agitated, depressed, socially withdrawn, psychotic, or in reasonable fear that the child’s life or safety is threatened or;
Seriously interferes with a child’s ability to accomplish age-appropriate developmental and social tasks
Serious Physical Neglect: Any of the following when committed by a perpetrator that endangers a child’s life or health, threatens a child’s well-being, causes bodily injury or impairs a child’s health, development or functioning:
A repeated, prolonged or egregious failure to supervise a child in a manner that is appropriate considering the child’s developmental age and abilities
The failure to provide a child with adequate essentials of life, including food, shelter, or medical care
Sexual Abuse and Exploitation: Any of the following:
The employment, use, persuasion, inducement, enticement, or coercion of a child to engage in or assist another individual engaging in sexually explicit conduct, which includes but is not limited to:
Looking at sexual or other intimate parts of a child or another individual to arouse or gratify sexual desire in any individual
Participating in sexually explicit conversation either in person, by telephone, by computer, or by computer-aided device for the purpose of sexual stimulation or gratification of any individual
Actual or simulated sexual activity or nudity for the purpose of sexual stimulation or gratification of any individual
The employment, use, persuasion, inducement, enticement, or coercion of a child to engage in or assist other individuals to engage in sexually explicit conduct, which includes but is not limited to: Actual or simulated sexual activity for the purpose of producing visual depiction, including photographing, videotaping, computer depicting or filming
*This paragraph does NOT include consensual activities between a child who is 14 years or older and another person 14 years or older and whose age is within four years of the child’s age
Any of the following offenses committed against a child:
Rape as defined in 18 Pa. C.S. §3121 (relating to rape)
Statutory sexual assault as defined in 18 Pa.C.S. §3122.1 (relating to statutory sexual assault)
Involuntary deviate sexual intercourse as defined in 18 Pa. C.S. §3123 (relating to involuntary deviate sexual intercourse)
Sexual assault as defined in 18 Pa. C.S. §3124.1 (relating to sexual assault)
Institutional sexual assault as defined in 18 Pa. C.S. §3124.2 (relat
