Child Abuse Identification and Reporting: The Pennsylvania Requirement _____________________________
CASE 3 A young girl, 2 years of age, is brought to the emergency depart- ment by her mother and stepfather for a scalp laceration. The girl is very quiet and appears listless and out of sorts. Her mother reports that she was injured when she fell onto a rock outside, but that the injury occurred when the girl was being watched by the stepfather. The girl undergoes assessment for traumatic brain injury, including assessment of function using the modified Glasgow Coma Score. The toddler is found to have mild impairment (a score of 13), and the follow-up test two hours later indicates normal functioning. The nurse notices that the toddler appears to be afraid of the stepfather, leaning away and crying when he is near her. The stepfather also appears to be easily frustrated with the child, saying that he does not know why she cries so much. Is there reasonable cause to suspect this child is a victim of child abuse? What, if any, indicators of child abuse exist in this case? Aside from the physical injury, which could be consistent with the reported accident, this patient has some signs of bodily injury (e.g., flinches easily or avoids being touched) that may give a provider reasonable cause to suspect abuse. If the pro- vider caring for this patient has reasonable cause to suspect that the child is a victim of child abuse, they are required to make a report to ChildLine, which would initiate an investigation. CASE 4 A boy, 13 years of age, is undergoing a routine physical exam with his family physician. The physician asks the boy if he is excited to start school in the next few weeks and how his baseball team is doing. The boy becomes quiet and states that he is nervous about an upcoming trip with his baseball team but does not give additional information. When asked directly, the boy says that he is uncomfortable with the new assistant coach, who watches pornography with them during out-of-town tournaments and supplies them with pornographic magazines. However, the boy states that he doesn’t think it’s a big deal and that “all of the other kids seem to really like it.” Is there reasonable cause to suspect this child is a victim of child abuse? What, if any, indicators of child abuse exist in this case? What is the reporting procedure in this case? In this case, the physician is required to make a report to ChildLine, because indicators are that the situation is consis- tent with sexual abuse or exploitation. CASE 5 A girl, 6 years of age, visits the school nurse complaining of a stomachache. She is disheveled in appearance, with torn, dirty clothing and unbrushed hair. She reports being hungry, as she did not have dinner the night before or breakfast this morning. She also reports that she has been sleeping on a relative’s couch with her mother since they moved out of their apartment last month.
Is there reasonable cause to suspect this child is a victim of child abuse? What, if any, indicators of child abuse exist in this case? The signs in the case indicate poverty, not abuse. Because there is no reasonable cause to suspect child abuse, the nurse is not required to make a report to ChildLine. Instead, the patient and her family should be connected with available services and resources to assist in meeting their immediate needs. The nurse could make a report to ChildLine or the county Children and Youth Agency if the nurse is unable or unsuccessful in connecting the family with needed services. KEY TAKEAWAYS This course has explored the scope of child abuse and neglect in Pennsylvania as well as the appropriate response to suspected or known cases of child abuse. The following is a summary of key points: • The basis for reporting suspected child abuse is having “reasonable cause to suspect” a child is a victim of child abuse. • Nothing in the PA CPSL requires a person who has reasonable cause to suspect a child is a victim of child abuse to identify the type of abuse they are reporting when making a report of suspected child abuse. • The PA CPSL recognizes three key components of child abuse: – Child – Act or failure to act; recent act; recent act or failure to act; or a series of acts or failures to act – Intentionally, knowingly, or recklessly • A mandated reporter enumerated under section 6311(a) of the PA CPSL must immediately make a report suspected child abuse to ChildLine, Pennsylva- nia’s 24/7 Child Abuse Hotline and Registry, by calling 1-800-932-0313 or electronically through the Child Welfare Portal, if they have reasonable cause to suspect a child is a victim of child abuse under any of the fol- lowing circumstances: – The mandated reporter comes into contact with the child in the course of employment, occupation, and practice of a profession or through a regularly scheduled program, activity, or service. – The mandated reporter is directly responsible for the care, supervision, guidance, or training of the child, or is affiliated with an agency, institution, organization, school, regularly established church or religious organization, or other entity that is directly responsible for the care, supervision, guid- ance, or training of the child. – A person makes a specific disclosure to the man- dated reporter that an identifiable child is the victim of child abuse.
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