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PENNSYLVANIA Psychology Continuing Education
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What’s Inside
CHILD ABUSE IDENTIFICATION AND REPORTING: THE PENNSYLVANIA REQUIREMENT 1 [3 CE hours] In 2020, there were 4,593 substantiated reports to child abuse in Pennsylvania. Healthcare professionals, regardless of their discipline or field, are in a unique position to assist in the identification, education, and prevention of child abuse and neglect. This course describes how victims of abuse can be accurately identified and provides the community resources available in the state of Pennsylvania for child abuse victims. Mandated reporter laws will also be outlined. THIS COURSE FULFILLS THE CHILD ABUSE RECOGNITION AND REPORTING REQUIREMENT 30 [6 CE hours] General ethical concepts applicable to all psychologists regardless of setting include competence, informed consent, privacy and confidentiality, and avoiding harm or exploitation. This course provides specific information regarding each of the areas and how they apply to psychologists in a variety of settings with a variety of professional relationships. Psychologists also must be able to understand and differentiate the complex relationships between the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, the ethics codes of various state psychological associations, regulations of state licensing boards, institutional policies and procedures, state and federal law, and community and local standards of practice. ETHICS FOR PSYCHOLOGISTS
Common ethical issues and complaint procedures are also reviewed. THIS COURSE FULFILLS THE ETHICS REQUIREMENT
SUICIDE ASSESSMENT AND PREVENTION 50 [6 CE hours] Suicide is a major preventable public health problem and cause of mortality. This course will review the major aspects of suicide assessment, management, and prevention, with a special focus on military veterans. Primary care contact may represent the last opportunity for intervention in the severely depressed suicidal patient, making the thorough comprehension of identification and treatment of depression and suicide risk imperative. THIS COURSE FULFILLS THE SUICIDE PREVENTION REQUIREMENT
FINAL EXAM ANSWER SHEET
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©2025: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
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PSYCHOLOGY CONTINUING EDUCATION
Frequently Asked Questions
What are the requirements for license renewal? Licenses Expire CE Credit Hours
Mandatory Subjects
30 (No more than 15 hours are allowed through home study)
2 hours - Child Abuse Recognition and Reporting 3 hours - Ethics 1 hour - Suicide Prevention
November 30th of odd years
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Child Abuse Identification and Reporting: The Pennsylvania Requirement
3
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Ethics for Psychologists
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Suicide Assessment and Prevention
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How do I complete this course and receive my certificate of completion? See the following page for step-by-step instructions on how to complete and receive your certificate. Are you a Pennsylvania board-approved provider? Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. Do I have to complete the new Child Abuse Recognition and Reporting course and why do I have to provide the last 4 digits of my Social Security number? The PA Department of State requires us to obtain this information in order to report your hours. We are required to report your child abuse training course to the Pennsylvania Department of State. What other mandatory courses am I required to take each renewal? Completion of at least 3 hours of continuing education in ethics and at least 1 hour of suicide prevention are required each renewal. Please note: The 1 hour of continuing education in suicide prevention may not be used towards satisfying the 3 hours of continuing education in ethics. Is my information secure? Yes! We use SSL encryption, and we never share your information with third parties. We are also rated A+ by the National Better Business Bureau.
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position to control content of the course activity. Sponsorship/commercial support and non-endorsement
It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Licensing board contact information: State Board of Psychology | Pennsylvania Department of State Mailing Address: P.O. Box 2649, Harrisburg, PA 17105-2649 Physical Address: Penn Center, 2601 N. 3rd Street, Harrisburg, PA 17110 Phone (717) 783-7155 I Fax (717) 787-7769 Website: https://www.dos.pa.gov/ProfessionalLicensing/ BoardsCommissions/Psychology/Pages/default.aspx
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PSYCHOLOGY CONTINUING EDUCATION
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Child Abuse Identification and Reporting: The Pennsylvania Requirement
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Ethics for Psychologists
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Suicide Assessment and Prevention
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PSYCHOLOGY CONTINUING EDUCATION
____________________________ Child Abuse Identification and Reporting: The Pennsylvania Requirement PYPA03CA — 3 CREDIT HOURS R elease D ate : 12/01/24 E xpiration D ate : 11/30/27
Child Abuse Identification and Reporting: The Pennsylvania Requirement This course is approved by the Pennsylvania Department of Human Services to fulfill the requirement for 3 hours of Child Abuse Recognition and Reporting (Act 31) training for healthcare professionals applying for licensure. Provider number CACE000020. This course is approved by the Pennsylvania Department of Human Services to fulfill the requirement for 2 hours of Child Abuse Recognition and Reporting (Act 31) training for healthcare professionals renewing their license. Provider number CACE000020.
Faculty Alice Yick Flanagan, PhD, MSW , received her Master’s in Social Work from Columbia University, School of Social Work. She has clinical experience in mental health in correc- tional settings, psychiatric hospitals, and community health centers. In 1997, she received her PhD from UCLA, School of Public Policy and Social Research. Dr. Yick Flanagan completed a year-long post-doctoral fellowship at Hunter College, School of Social Work in 1999. In that year she taught the course Research Methods and Violence Against Women to Masters degree students, as well as conducting qualitative research studies on death and dying in Chinese American families. Previously acting as a faculty member at Capella University and Northcentral University, Dr. Yick Flanagan is currently a contributing faculty member at Walden University, School of Social Work, and a dissertation chair at Grand Canyon Uni- versity, College of Doctoral Studies, working with Industrial Organizational Psychology doctoral students. She also serves as a consultant/subject matter expert for the New York City Board of Education and publishing companies for online cur- riculum development, developing practice MCAT questions in the area of psychology and sociology. Her research focus is on the area of culture and mental health in ethnic minority communities. Faculty Disclosure Contributing faculty, Alice Yick Flanagan, PhD, MSW, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned. Division Planner Margaret Donohue, PhD Senior Director of Development and Academic Affairs Sarah Campbell
Audience This introductory course is designed for all Pennsylvania psychologists required to complete child abuse education. Course Objective The purpose of this course is to enable healthcare professionals in all practice settings to define child abuse and identify the children who are affected by violence. This course describes how a victim can be accurately diagnosed and identifies the community resources available in the state of Pennsylvania for
child abuse victims. Learning Objectives Upon completion of this course, you should be able to:
1. Identify the basis for reporting suspected child abuse, including having “reasonable cause to suspect” a child is a victim of child abuse. 2. List the three key components of child abuse as defined by the PA CPSL. 3. Outline the action(s) a mandated reporter must imme- diately make if they have reasonable cause to suspect a child is a victim of child abuse, including identifica- tion of defining circumstances. 4. Relate the actions that are NOT required to take place in order for a mandated reporter to make a report of suspected child abuse. 5. Describe the concept of good faith and how it relates to a mandated reporter making a report of suspected child abuse. 6. Identify circumstances under which mandated report- ers are required to make a report if they have reason- able cause to suspect a child is a victim of child abuse.
Mention of commercial products does not indicate endorsement.
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Child Abuse Identification and Reporting: The Pennsylvania Requirement _____________________________
Division Planner/Director Disclosure The division planner and director have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned. Accreditations & Approvals
HOW TO RECEIVE CREDIT • Read the entire course online or in print. • Complete a mandatory test (a passing score of 75 percent is required). Test questions link content to learning objectives as a method to enhance individualized learning and material retention. Provide required personal information and payment information. • Complete the mandatory Course Evaluation.
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psycho-
logical Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibil- ity for the content of the programs. Designations of Credit NetCE designates this continuing education activity for 3 CE credits. Special Approvals This course is approved by the Pennsylvania Department of Human Services to fulfill the requirement for 3 hours of Child Abuse Recognition and Reporting (Act 31) training for healthcare professionals applying for licensure. Provider number CACE000020. This course is approved by the Pennsylvania Department of Human Services to fulfill the requirement for 2 hours of Child Abuse Recognition and Reporting (Act 31) training for healthcare professionals renewing their license. Provider number CACE000020. About the Sponsor The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare. Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice. Disclosure Statement It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distrib- uting or providing access to this activity to learners.
Sections marked with this symbol include evidence-based practice recommendations. The level of evidence and/or strength of recommendation, as provided by the evidence-based source, are also included
so you may determine the validity or relevance of the information. These sections may be used in conjunction with the course material for better application to your daily practice.
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____________________________ Child Abuse Identification and Reporting: The Pennsylvania Requirement
each county agency for child abuse cases. Cases identified as CPS require an investigation because the alleged act or failure to act meets the definition of child abuse. The PA CPSL’s definition of child abuse recognizes 10 separate categories of child abuse. Examples of CPS cases include: • 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 • Causing or substantially contributing to serious mental injury to a child through any act or failure to act or a series 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 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 a specific recent “per se” act • Causing the death of the child through any act or failure to act • Engaging a child in a severe form of trafficking in per- sons or sex trafficking GENERAL PROTECTIVE SERVICES GPS is involved in non-abuse cases or acts that involve non- serious injury or neglect [38]. The primary purpose of GPS is to protect the rights and welfare of children, so they have an opportunity for healthy growth and development [38]. It includes services and activities provided by each county agency for cases requiring protective services, as defined by DHS in regulations. GPS cases require an assessment for services and supports. In these cases, the alleged act or failure to act may not meet the definition of child abuse but is still detrimental to a child. Examples of GPS cases: services are provided 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 their physical, mental, or emotional health, or morals • Has been placed for care or adoption in violation of law • Has been abandoned by their 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
CHILD WELFARE IN PENNSYLVANIA Pennsylvania was also the first state to take a noncriminal view of child abuse [22; 26]. In 1975, the Pennsylvania Child Protective Services Law (CPSL) (23 Pa.C.S. Chapter 63, Child Protective Services was enacted, which established a child abuse hotline and a statewide central registry in Pennsylvania in order to encourage the reporting of child abuse [26]. The purpose of the Law is to protect children from abuse, allow the opportunity for healthy growth and development, and preserve and stabilize the family whenever possible. It does not restrict the generally recognized existing rights of parents to use rea- sonable supervision and control when raising their children. The child welfare system in Pennsylvania is supervised by the state but administered by the different local counties [27]. This means that there are a total of 67 county agencies that administer the child welfare and juvenile justice services [27]. The State of Pennsylvania delineates two functions for the local agencies: child protective services (CPS) and general protective services (GPS). Recent amendments to the PA CPSL relevant to child abuse recognition and reporting include Act 115 of 2016 (relating to human trafficking), Act 54 of 2018 (relating to notification of substance affected infants by healthcare providers and plan of safe care), and Act 88 of 2019 (relating to penalties for failure to report or refer). In 2016, SB1311 (Act 115) was signed and went into effect. This Act provides for additional grounds for involuntary termi- nation of parental rights, provides for an additional grounds for aggravated circumstances, allows for the release of information in confidential reports to law enforcement when investigating cases of severe forms of trafficking in persons of sex trafficking, and adds a category of child abuse to include human trafficking. In 2017, Governor Tom Wolf approved Act 68 (also known as the Newborn Protection Act) to increase the number of loca- tions for parents to give up their newborn without criminal liability [6]. In 2018, Act 29 was signed and expanded the definition of child abuse in Pennsylvania to include leaving a child unsupervised with a sexual predator [5]. That same year, Act 54 was signed and required mandatory notification when a medical provider has determined that a child (younger than 1 year of age) was born affected by substance use or withdrawal symptoms resulting from prenatal drug or alcohol exposure. This Act also mandates the development of “interagency pro- tocols” to support local multidisciplinary teams to identify, assess, and develop a plan of safe care for infants born affected by substance use or withdrawal symptoms. In 2019, Act 88, relating to penalties for failure to report or refer, was enacted. CHILD PROTECTIVE SERVICES The Pennsylvania child welfare system is state-supervised and county-administered. County children-and-youth agencies (CCYAs) have two main functions: Child Protective Services (CPS) and General Protective Services (GPS). The first is CPS, which consists of services and activities provided by DHS and
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Child Abuse Identification and Reporting: The Pennsylvania Requirement _____________________________
• Has committed a specific act of habitual disobedience of the reasonable and lawful commands of their parent, guardian, or other custodian and who is ungovernable and found to be in need of care, treatment, or supervi- sion • Is younger than 10 years of age and has committed a delinquent act • Has been formerly adjudicated dependent under sec- tion 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 that is defined as ungovernable • Has been referred under section 6323 of the Juvenile Act (relating to informal adjustment) and who commits an act that is defined as ungovernable DEFINITIONS OF CHILD ABUSE In Pennsylvania, the child abuse law takes a very comprehensive approach to defining of child abuse [26]. According to Penn- sylvania law, child abuse shall mean intentionally, knowingly, or recklessly doing any of the following [13]: • 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 that results in a 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 series 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 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 specific recent “per se” 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 younger than 1 year of age – Forcefully slapping or otherwise striking a child younger than 1 year of age
– Interfering with the breathing of a child – Causing a child to be present at a location while a violation of 18 Pa.C.S. § 7508.2 relating to the operation of methamphetamine laboratory is occurring, provided 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 a) is required to register as a Tier II or Tier III sex- ual offender (under 42 Pa.C.S. Ch. 97 Subch. H relating to registration of sexual offenders), where the victim of the sexual offense was younger than 18 years of age when the crime was committed; b) 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); or d) has been determined to be a sexually violent c) predator (under 42 Pa.C.S. § 9799.58, relating to assessments) or has to register for life (under 42 Pa.C.S. § 9799.55(b) relating to registration) • Causing the death of the child through any act or failure to act • Engaging a child in a severe form of trafficking in per- sons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000 KEY COMPONENTS OF CHILD ABUSE • Child: An individual younger than 18 years of age • Act or failure to act; Recent act; Recent act or failure to act; or A series of acts or failures to act – Act: Something that is done to harm or cause potential harm to a child – Failure to act: Something that is NOT done to prevent harm or potential harm to a child – Recent act: Any act committed within two (2) years of the date of the report to DHS or county agency – Recent act or failure to act: Any act or failure to act committed within two (2) years of the date of the report to DHS or county agency • Intentionally, knowingly, or recklessly – Intentionally: Done with the direct purpose of causing the type of harm that resulted – Knowingly: Awareness that harm is practically certain to result – Recklessly: Conscious disregard of substantial and unjustifiable risk
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____________________________ Child Abuse Identification and Reporting: The Pennsylvania Requirement
EXCLUSIONS In addition, the CPSL explicitly excludes specific acts and injuries from the definition of child abuse: • Restatement of culpability: Conduct that causes injury or harm to a child or creates a risk of injury or harm to a child shall not be considered child abuse if there is no evidence that the person acted intentionally, knowingly, or recklessly when causing the injury or harm to the child or creating a risk of injury or harm to the child. • Child abuse exclusions: The term child abuse does not include any conduct for which an exclusion is provided in § 6304 of the PA CPSL (relating to exclusions from child abuse). Exclusions to the definition of child abuse (23 Pa.C.S. § 6304): • Environmental factors: No child shall be deemed to be physically or mentally abused based on injuries that result solely from environmental factors, such as inadequate housing, furnishings, income, clothing, and medical care, that are beyond the control of the parent or person responsible for the child’s welfare with whom the child resides. This shall not apply to any child-care service as defined under section 6303(a) of the PA CPSL (excluding an adoptive parent). • Practice of religious beliefs: If, upon investigation, the county agency determines that a child has not been provided needed medical or surgical care because of sincerely held religious beliefs of the child’s parents or relative within the third degree of consanguinity and with whom the child resides, which beliefs are consis- tent with those of a bona fide religion, the child shall not be deemed to be physically or mentally abused. In such cases the following shall apply: – The county agency shall closely monitor the child and the child’s family and shall seek court-ordered medical intervention when the lack of medical or surgical care threatens the child’s life or long-term health. – All correspondence with a subject of the report and the records of the department and the county agency shall not reference child abuse and shall acknowledge the religious basis for the child’s condition. – The family shall be referred for general protective services, if appropriate. – This exclusion shall not apply if the failure to provide needed medical or surgical care causes the death of the child. – This exclusion shall not apply to any childcare service as defined under section 6303(a) of the PA CPSL (excluding an adoptive parent).
• Use of force for supervision, control, and safety pur- poses: Subject to subsection (d) (relating to the rights of parents), the use of reasonable force on or against a child by the child’s own parent or person responsible for the child’s welfare shall not be considered child abuse if any of the following conditions apply: – The use of reasonable force constitutes incidental, minor, or reasonable physical contact with the child or other actions that are designed to main- tain order and control. – The use of reasonable force is necessary to quell a disturbance or remove the child from the scene of a disturbance that threatens physical injury to per- sons or damage to property; to prevent the child from self-inflicted physical harm; for self-defense or the defense of another individual; or to obtain possession of weapons or other dangerous objects or controlled substances or paraphernalia that are on the child or within the control of the child. • Rights of parents: Nothing in this chapter shall be con- strued to restrict the generally recognized existing rights of parents to use reasonable force on or against their children for the purposes of supervision, control, and discipline of their children. Such reasonable force shall not constitute child abuse. • Participation in events that involve physical contact with child: An individual participating in a practice or competition in an interscholastic sport, physical educa- tion, recreational activity, or extracurricular activity that involves physical contact with a child does not, in itself, constitute contact that is subject to the reporting requirements of the PA CPSL. • Defensive force: Reasonable force for self-defense or the defense of another individual shall not be considered child abuse. – Reasonable force for self-defense or the defense of another individual (consistent with the provisions of 18 Pa.C.S. § 505, relating to use of force in self-protection, and § 506 (relating to use of force for the protection of other persons) shall not be considered child abuse. • Child-on-child contact: – Harm or injury to a child that results from the act of another child shall not constitute child abuse unless the child who caused the harm or injury is a perpetrator. – Notwithstanding paragraph (1) above, the follow- ing shall apply: Acts constituting any of the following crimes against a child shall be subject to the reporting requirements of the PA CPSL:
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– Rape (as defined in 18 Pa.C.S. § 3121, relating to rape) – 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) – Aggravated indecent assault (as defined in 18 Pa.C.S. § 3125, relating to aggravated indecent assault) – Indecent assault (as defined in 18 Pa.C.S. § 3126, relating to indecent assault), and indecent exposure (as defined in 18 Pa.C.S. § 3127, relating to indecent expo- sure) No child shall be deemed to be a perpetrator of child abuse based solely on physical or mental injuries caused to another child in the course of a dispute, fight, or scuffle entered into by mutual consent. A law enforcement official who receives a report of suspected child abuse is not required to make a report to the department if the person allegedly responsible for the child abuse is a nonperpetrator child. Nothing in the CPSL requires a person who has reasonable cause to suspect a child is a victim of child abuse to consider the exclusions from child abuse before making a report of suspected child abuse; the exclusions from child abuse are considered/determined by DHS or the investigating agency after receipt of a referral/report. PERPETRATOR For the purposes of this course, a perpetrator is defined as an individual who has committed child abuse as defined under section 6303(b.1) of the Child Protective Services Law. The term includes only [2; 13]: • A parent of the child • A spouse or former spouse of the child’s parent • A paramour or former paramour of the child’s parent • A person 14 years of age or older responsible for the child’s welfare or having direct contact with children as an employee of childcare services, a school, or through a program, activity, or service • An individual 14 years of age or older who resides in the same home as the child • An individual 18 years of age or older who does not reside 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
• An individual 18 years of age or older who engages a child in severe forms of trafficking in persons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000 In a significant revision to the definition of perpetrator, school personnel and other childcare providers are consid- ered “individuals responsible for the child’s welfare” and may be perpetrators of child abuse; there is no longer a separate definition for student abuse [2]. As such, a perpetrator may be any such person who has direct or regular contact with a child through any program, activity, or services sponsored by a school, for-profit organization, or religious or other not-for- profit organization. In addition, only the following may be considered a perpetrator for failing to act [2; 13]: • A parent of the child • A spouse or former spouse of the child’s parent • A paramour or former paramour of the child’s parent • A person 18 years of age or older and responsible for the child’s welfare or who resides in the same home as the child Nothing under Pennsylvania law requires a person who has reasonable cause to suspect a child is a victim of child abuse to identify the person responsible for the child abuse in order to make a report of suspected child abuse. FORMS OF CHILD ABUSE There are several acts that may be considered abusive, and knowledge of what constitutes abuse is vital for healthcare providers and other mandated reporters. In this section, specific behaviors that fall under the category of abuse and neglect will be reviewed. Bodily Injury Bodily injury can range from minor bruises and lacerations to severe neurologic trauma and death. Bodily injury is one of the most easily identifiable forms of abuse and the type most commonly seen by healthcare professionals [34]. Definitions (23 Pa.C.S. § 6303) The following words and phrases, when used in the PA CPSL, shall have the meanings given to them in this section unless the context clearly indicates otherwise: • Bodily injury: Impairment of physical condition or substantial pain – Impairment: If, due to the injury, the child’s ability to function is reduced temporarily or permanently in any way – Substantial pain: If the child experiences what a reasonable person believes to be substantial pain
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Sexual Abuse/Exploitation Definitions (23 Pa.C.S. § 6303) Sexual abuse or exploitation includes any of the following [45]: • The employment, use, persuasion, inducement, enticement, or coercion of a child to engage in or assist another individual to engage in sexually explicit conduct, which includes, but is not limited to, the fol- lowing: – Looking at the sexual or other intimate parts of a child or another individual for the purpose of arousing or gratifying sexual desire in any indi- vidual – Participating in sexually explicit conversation either in person, by telephone, by computer, or by a 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 – Actual or simulated sexual activity for the purpose of producing visual depiction, including photo- graphing, videotaping, computer depicting, or filming The above does not include consensual activities between a child who is 14 years of age or older and another person who is 14 years of age or older and whose age is within 4 years of the child’s age. • Any of the following when 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 devi- ate 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, relating to institutional sexual assault) – Aggravated indecent assault (as defined in 18 Pa.C.S. § 3125, relating to aggravated indecent assault) – Indecent assault (as defined in 18 Pa.C.S. § 3126, relating to indecent assault)
Indicators of bodily injury include: • Fear of going home • Fear of parent or caregiver
• Extreme apprehensiveness/vigilance • Pronounced aggression or passivity • Flinches easily or avoids being touched • Play includes abusive talk or behavior • Unexplained injuries
• Unbelievable or inconsistent explanations of injuries • Injuries inconsistent with a child’s age/developmental level • Unable to recall how injuries occurred or account of injuries is inconsistent with the nature of the injuries • Multiple bruises in various stages of healing • Bruises located on face, ears, neck, buttocks, back, chest, thighs, back of legs, and genitalia • Bruises that resemble objects such as a hand, fist, belt buckle, or rope • Burns Fractures that result from abuse might be found on the child’s skull, ribs, nose, or any facial structure. These may be multiple or spiral fractures at various stages of healing. When examining patients, note bruises on the abdominal wall, any intestinal perforation, ruptured liver or spleen, and blood vessel, kidney, bladder, or pancreatic injury, especially if accounts for the cause do not make sense. Look for signs of abrasions on the child’s wrists, ankles, neck, or torso. Lacerations might also appear on the child’s lips, ears, eyes, mouth, or genitalia. If violent shaking or trauma occurred, the child might experience a subdural hematoma [9; 34].
According to the American College of Radiology, fractures highly suggestive of physical abuse include rib fractures, classic metaphyseal lesions, those unsuspected or inconsistent with the history or age of the child, multiple fractures involving more
than one skeletal area, and fractures of differing ages. (https://acsearch.acr.org/docs/69443/Narrative. Last accessed December 9, 2024.) Level of Evidence : Expert Opinion/Consensus Statement
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Child Abuse Identification and Reporting: The Pennsylvania Requirement _____________________________
– Indecent exposure (as defined in 18 Pa.C.S. § 3127, relating to indecent exposure) – Incest (as defined in 18 Pa.C.S. § 4302, relating to incest) – Prostitution (as defined in 18 Pa.C.S. § 5902, relat- ing to prostitution and related offenses) – Sexual abuse (as defined in 18 Pa.C.S. § 6312, relating to sexual abuse of children) – Unlawful contact with a minor (as defined in 18 Pa.C.S. § 6318, relating to unlawful contact with minor) – Sexual exploitation (as defined in 18 Pa.C.S. § 6320, relating to sexual exploitation of children) Indicators of sexual abuse or exploitation include: • Sexually promiscuous behavior • Developmental age-inappropriate sexual play and/or drawings • Cruelty to others • Cruelty to animals • Fire setting • Anxious • Withdrawn • Sleep disturbances • Bedwetting • Pain or irritation in genital/anal area • Difficulty walking or sitting • Difficulty urinating • Pregnancy • Positive testing for sexually transmitted infection(s) (e.g., HIV) • Excessive or injurious masturbation
Indicators of serious physical neglect include: • Not registered in school • Inadequate or inappropriate supervision • Poor impulse control • Frequently fatigued • Parentified behaviors • Lack of adequate medical and dental care
• Often hungry • Lack of shelter • Weight is significantly lower than normal for their age and gender • Developmental delays • Persistent (untreated) conditions (e.g., head lice, diaper rash) • Exposure to hazards (e.g., illegal drugs, rodent/insect infestation, mold) • Clothing that is dirty, inappropriate for the weather, too small, or too large
Serious Mental Injury Definitions (23 Pa.C.S. § 6303)
Serious mental injury is a psychological condition, as diagnosed by a physician or licensed psychologist, including the refusal of appropriate treatment, that [1]: • Renders a child chronically and severely anxious, agitated, depressed, socially withdrawn, psychotic, or in reasonable fear that the child’s life or safety is threat- ened; or • Seriously interferes with a child’s ability to accomplish age-appropriate developmental and social tasks Indicators of serious mental injury include: • Expressing feelings of inadequacy • Fearful of trying new things • Overly compliant • Poor peer relationships • Excessive dependence on adults • Habit disorders (e.g., sucking, rocking) • Eating disorders • Frequent psychosomatic complaints (e.g., nausea, stom- achache, headache) • Bed-wetting • Self-harm • Speech disorders
Serious Physical Neglect Definitions (23 Pa.C.S. § 6303)
Pennsylvania law defines serious physical neglect of a child as 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
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____________________________ Child Abuse Identification and Reporting: The Pennsylvania Requirement
Severe Forms of Trafficking in Persons Severe forms of trafficking in persons: • Sex trafficking in which a commercial sex act is induced by force, fraud, or coercion or in which the person induced to perform such act has not attained 18 years of age; or – Sex trafficking: the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a com- mercial sex act Commercial sex act: Any sex act on account of which anything of value is given to or received by any person • The recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion, for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. Examples include: – Peonage: Paying off debt through work – Debt bondage: Debt slavery, bonded labor, or services for a debt or other obligation – Slavery: A condition compared to that of a slave in respect of exhausting labor or restricted freedom Labor trafficking is labor obtained by use of threat of serious harm, physical restraint, or abuse of legal process. Examples include: • Being forced to work for little or no pay (frequently in factories and farms) • Domestic servitude, defined as providing services within a household for 10 to 16 hours per day, such as, but not limited to, childcare, cooking, cleaning, yard work, and gardening Victim Identification/Warning Signs (Human Trafficking [Act 115 of 2016]) Warning signs specifically associated with victims of child traf- ficking and/or exploitation include (but are not limited to): • A youth that has been verified to be younger than 18 years of age and is in any way involved in the com- mercial sex industry or has a record of prior arrest for prostitution or related charges • An explicitly sexual online profile • Excessive frequenting of Internet chat rooms or classi- fied sites • Depicting elements of sexual exploitation in drawing, poetry, or other modes of creative expression • Frequent or multiple sexually transmitted infections or pregnancies • Is found in a hotel, street track, truck stop, or strip club
• Lies about or has no identification or knowledge of personal data, such as but not limited to: age, name, and/or date of birth • Wearing clothing that is dirty, sexually inappropriate, inappropriate for the weather, or too large or too small (often dresses or skirts that are provocative in nature) • Wearing new clothes of any style, getting hair and/or nails done with no financial means • Having multiple cell phones or very expensive items that they have no way of purchasing on their own • Having unaddressed medical issues or goes to the ER or clinic alone or with an unrelated adult
• Being secretive about whereabouts • Having late nights or unusual hours
• Having a tattoo that s/he is reluctant to explain • Being in a controlling or dominating relationship • Lack of insurance or control of own finances • Exhibiting hypervigilance or paranoid behaviors • Expressing interest in or being in relationships with adults or much older men or women • Avoiding answering questions and letting someone else speak for them • Having significant change in behavior, including increased social media and new associates or friends at school • Having unexplained injuries and/or unbelievable or inconsistent explanations of injuries • Having multiple bruises or cuts in various stages of healing • Using specific terms, such as “trick,” “the life,” or “the game” With this in mind, it is important not to stigmatize children based on their gender expression and clothing choices. At-Risk Youth Populations (Human Trafficking [Act 115 of 2016]) At-risk youth populations include, but are not limited to, youth [7]: • In the foster care system • Who identify as LGBTQIA+ • Who are homeless or runaway • With disabilities • With mental health or substance abuse disorders • With a history of sexual abuse • With a history of being involved in the welfare system • Who identify as native or aboriginal • With family dysfunction
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Child Abuse Identification and Reporting: The Pennsylvania Requirement _____________________________
Some of the types of behaviors and symptoms discussed in the definitions of physical, sexual, and serious mental injury are also warning signs. For example, any of the injuries that may result from bodily injury, such as a child presenting with bruises in the shape of electric cords or belt buckles, should be considered risk factors for abuse. CONSEQUENCES OF CHILD ABUSE The consequences of child abuse and neglect vary from child to child, and these differences continue as victims grow older. Several factors will mediate the outcomes, including the [17]: • Severity, intensity, frequency, duration, and nature of the abuse and/or neglect • Age or developmental stage of the child when the abuse occurred • Relationship between the victim and the perpetrator • Support from family members and friends • Level of acknowledgment of the abuse by the perpetra- tor • Quality of family functioning In examining some of the effects of bodily injury, it is helpful to frame the consequences along a lifespan perspective [3]. During infancy, bodily injury can cause neurologic impairments. Most cases of infant head trauma are the result of child abuse [19]. Neurologic damage may also affect future cognitive, behavioral, and developmental outcomes. Some studies have noted that, in early childhood, physically abused children show less secure attachments to their caretakers compared to their non-abused counterparts [20]. By middle to late childhood, the consequences are more nota- ble. Studies have shown significant intellectual and linguistic deficits in physically abused children [3]. Other environmental conditions, such as poverty, may also compound this effect. In addition, a number of affective and behavioral problems have been reported among child abuse victims, including anxiety, depression, low self-esteem, excessive aggressive behaviors, conduct disorders, delinquency, hyperactivity, and social detachment [3]. Surprisingly, there has been little research on the effects of childhood bodily injury on adolescents [3]. However, differ- ences have been noted in parents who abuse their children during adolescence rather than preadolescence. It appears that lower socioeconomic status plays a lesser role in adoles- cent abuse as compared with abuse during preadolescence [21]. In addition, parents who abuse their children during adolescence are less likely to have been abused as children themselves compared with those parents who abused their children during preadolescence [21]. It is believed that the psychosocial effects of bodily injury manifest similarly in late childhood and adolescence.
RECOGNIZING WARNING SIGNS It is crucial that practitioners become familiar with the indica- tions of child abuse and neglect. These factors do not necessar- ily conclusively indicate the presence of abuse or neglect; rather, they are clues that require further interpretation and clinical investigation. Some parental risk indicators include [16]: • Recounting of events that do not conform either with the physical findings or the child’s physical and/or developmental capabilities • Inappropriate delay in bringing the child to a health facility • Unwillingness to provide information or the informa- tion provided is vague • History of family violence in the home • Parental misuse of substances and/or alcohol • Minimal knowledge or concern about the child’s devel- opment and care • Environmental stressors, such as poverty, single parent- hood, unemployment, or chronic illness in the family • Unwanted pregnancy • Early adolescent parent • Expression that the parent(s) wanted a baby in order to feel loved • Unrealistic expectations of the child • Use of excessive physical punishment • Healthcare service “shopping” • History of parent “losing control” or “hitting too hard” Child risk indicators include [16]: • Multiple school absences • Learning or developmental disabilities • History of multiple, unexplained illnesses, hospitaliza- tions, or accidents • Poor general appearance (e.g., fearful, poor hygiene, malnourished appearance, inappropriate clothing for weather conditions) • Stress-related symptoms, such as headaches or stomach- aches • Frozen watchfulness • Mental illness or symptoms, such as psychosis, depres- sion, anxiety, eating disorders, or panic attacks • Regression to wetting and soiling • Sexually explicit play • Excessive or out-of-the-ordinary clinging behavior • Difficulties with concentration • Disruptions in sleep patterns and/or nightmares
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