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Overview
As previously stated, mandated reporters
fail to report child abuse and maltreatment because they feel
they cannot identify abuse correctly and they feel they do
not know the correct procedure for reporting. Additionally,
people sometimes fear that reporting child abuse or maltreatment
will destroy a family. The truth, however, is that reporting
should lead to getting help for the family by protecting the
child from further suffering and harm and by assisting the
family in facing and overcoming its problems. Professionals
can all help end child abuse by their efforts to become more
aware of the signs of child abuse and maltreatment and reporting
suspected cases (PCA-NY, n.d.; NYCACS, 2008).
As mentioned previously, more than one-half
(56.3%) of all reports made to Child Protective Services agencies
came from professionals who came in contact with the child
as part of their professional responsibilities. In 2006, the
three most common sources of reports were from professionals-teachers
(16.5%), lawyers or police officers (15.8%), and social services
staff (10.0%) (USDHHS-ACF, 2008). Many people in these professions
are required by law to report suspected abuse or neglect.
Non-professionals submitted almost 44% of
reports. These reports were made by parents, relatives, friends
and neighbors, alleged victims, alleged perpetrators, anonymous
callers, and "other" sources (which may include clergy members,
sports coaches, camp counselors, bystanders, volunteers, and
foster siblings). The three largest groups of nonprofessional
reporters were anonymous (8.2%), "other" (8.0%) and other
relatives (7.8%) (USDHHS-ACF, 2008). It is important for everyone
to know the signs that may indicate maltreatment and how to
report it. We all share a responsibility to help keep children
safe as we take steps to prevent abuse from occurring in the
first place (CWIG, 2006a).
Case #1: Corey
Does the emergency department
physician have reasonable cause to suspect that Corey
has been abused? Should a report be made?
The emergency department physician
was given conflicting information about how Corey was
injured (the EMS personnel reported that Corey had been
hit with a softball during practice; Corey reports he
was "beat up"). However, Corey also has multiple bilateral
bruises in various stages of healing. These differing
accounts of Corey's injuries are noted by the physician.
Corey seems so distressed by his father's presence and
the father is very angry at Corey and humiliates him,
despite the boy's injury and pain. Corey's father seems
to have particular anger towards what he perceives as
Corey's shortcomings. As the emergency department physician
you report Corey to the Child Abuse hotline.
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Case #2: Juanita
As the family nurse practitioner,
who knows this family well, you decide to ask mother
and daughter about what happened that upset them both
so much. Mom does not respond, but Juanita blurts out
that she stole some nail polish and lipstick from the
drug store and her mother found out once they got home.
Mom uses corporal punishment in dealing with Juanita
and she slapped the girl across the face as well as
grabbed her arm rather roughly. She ordered Juanita
to take the items back to the store and to apologize
to the clerk at the store. Juanita, although initially
minimizing her actions, began to feel guilt and remorse
for her actions. She was still recovering from the incident
that had occurred earlier today.
After Juanita confessed her crime
to the nurse practitioner, Mom confirmed the story and
talked about how upset she was that her daughter had
stolen from the store. She was angry because she is
a religious woman who lives by a strict moral code and
feels betrayed by her daughter for not also living by
the values she thought she had instilled in her daughter.
As the nurse practitioner, you believe the explanation
that the mother and daughter provide you and you encourage
them to continue to talk about the incident with each
other. You decide this is not a case of potential abuse
and you do not report this to the Child Abuse Hotline.
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Case #3: Sam
As the teacher, you recognize
that Sam's clothing, wearing a short-sleeved t-shirt
and jeans despite the 30 degree temperature, is inappropriate
attire for the season. His family has neglected to seek
medical attention for Sam, despite his ongoing difficulty
walking, despite your request to have him receive medical
attention. Although an adequate student, Sam has poor
social skills with his peers; he is even bullied by
them. His behavior, including poor eye contact, nervousness
and significant startle reflex leads you to think that
Sam is likely experiencing, at the very least, neglect
from his parents, and possibly also physical abuse.
You call the Child Abuse Hotline.
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Case #4 Alicia and
Martin
As the visiting nurse you recognize
the obvious signs of neglect in the Alicia and the signs
of abuse and neglect in Martin. You call the Child Abuse
Hotline and discuss the immediacy of the need for safety
and services (ie. This is the first time you have been
in the house in 6 weeks; there is a history of cocaine
use; Alicia has lost a significant amount of weight
and there is no formula or food in the house; Martin
has been abused multiple times and is fearful of adults).
You request that immediate action be taken; it is your
belief that the children are not safe in the home at
this time. You also call law enforcement to take the
children into protective custody.
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Case #5: Tisha
As the family nurse practitioner
in the primary care practice, you must report Tisha
to the Child Abuse Hotline. In a child as young as Tisha,
only 5 years old, a positive lab test for syphyllis
is a strong indication that the child is being sexually
abused. You report the positive result to Tisha's mother,
who becomes tearful and angry and agrees to cooperate
with the report, because she fears that Tisha has been
sexually abused and is very upset that she has not been
able to keep her daughter safe. She wants to find out
how this could have happened.
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Case #6: Marcus, Amber
and Isaiah
The school nurse meets with
the teachers of the Shaw children, requesting their
perspectives on whether or not the Shaw children are
neglected. She learns that they rarely miss school.
Amber and Isaiah are average students, but Marcus is
in gifted classes. There has never been any suspicion
on the part of the teachers that there may be any abuse
in the family. Given what the Shaw children have told
the nurse, as well as the teachers' reports, the nurse
decides to refer the Shaw children for the school breakfast
and lunch programs, seeing this as a financial issue,
not a case of denial of care. The nurse does not report
the Shaw children to the Child Abuse Hotline, but refers
them and their family to the social service office for
other potential entitlements.
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Case #7: Tim
As the nurse for this residential
treatment center and a mandatory reporter, Jean knows
that she has a legal obligation report her suspicions
of child abuse. This legal requirement overrides any
loyalty she may feel towards her employer. She also
recognizes that reporting may put her job in jeopardy,
since the employer has "investigated" and does not believe
the allegations of abuse. Given what Tim has told her,
the bloody underwear, and her own discomfort/suspicions
when observing staff/client interactions, Jean knows
that she has a legal responsibility to report. Ethically
and professionally, she also recognizes that she must
report, despite whatever ramifications there may be
from her employer.
Despite the internal investigation
that was conducted by the employer, Jean still has a
legal responsibility to report her suspicion of sexual
abuse to the Child Abuse Hotline.
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Continue to Reporting Child
Abuse and Maltreatment, Con't.
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