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Reasonable Cause/When to Report
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"). 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 SCR.
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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 SCR.
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Case #3: Sam
As Sam's teacher and
a mandated reporter, do you have reason to suspect that
Sam may be the victim of both neglect and abuse in his
home?
Sam is often not dressed appropriately
for the weather. He is teased by his classmates, largely
for his nervousness, anxiety and poor eye contact. His
injured ankle has not been treated even though you sent
a note home almost two weeks ago.
You decide that you do indeed
suspect neglect and possible abuse. You talk to your
principal about making a report for neglect and request
that the family be evaluated for possible abuse as well.
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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 SCR 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. |
Case #5: Tisha
As the family nurse practitioner in the primary care
practice, you must report Tisha to the SCR. 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: Leah and Tisha
Does the clinical social worker have a legal obligation
to report what the patient, Leah, has told her? The
clinical social worker hasn't been treating Tisha, rather
it is Leah who is her patient. Is the social worker
required to make a report to the State Central Register?
Yes. As stated previously, mandated reporter must report
when s/he has reasonable cause to suspect that a child
is abused or maltreated where the parent or personal
legally responsible for the child comes before them
in her/his professional or official capacity and states
from personal knowledge facts, conditions or circumstances
which, if correct, would render the child abused or
maltreated. The therapist is in contact with Leah because
Leah has sought out the professional's services. Leah
lives in the home with her husband and with Tisha. If
what Leah saw was true, then it is reasonable to suspect
that abuse may be occurring.
The clinical social worker may
want to work with Leah, to assist her to make the report,
but this does not take the place of the requirement
for the clinical social worker, as a mandated reporter
to report her suspicions of sexual abuse.
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Case #7: 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 neglect.
The nurse does not report the Shaw children to the SCR,
but refers them and their family to the social service
office for other potential entitlements.
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Case #8: Tim
As the nurse for this residential treatment center and
a mandated 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. Additionally, the 2007 changes to the child abuse
reporting laws also protect the mandated reporter from
retaliation for reporting from the employing agency.
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