HealthStream Regulatory Script
Identifying and Assessing Victims of Child Abuse and Neglect
Release Date: August 2008
HLC Version: 602
Lesson 1:
Lesson 2:
Lesson 3:
Lesson 4:
Lesson 5:
Introduction
Definitions and Consequences
Identifying Victims
Assessment and Referral
Reporting Requirements
Lesson 1: Introduction
1001
Introduction
Welcome to the introductory lesson on identifying and assessing
victims of child abuse and neglect.
IMAGE: 1001.JPG
As your partner, HealthStream strives to provide its customers with excellence in
regulatory learning solutions. As new guidelines are continually issued by regulatory
agencies, we work to update courses, as needed, in a timely manner. Since
responsibility for complying with new guidelines remains with your organization,
HealthStream encourages you to routinely check all relevant regulatory agencies
directly for the latest updates for clinical/organizational guidelines.
If you have concerns about any aspect of the safety or quality of patient care in your
organization, be aware that you may report these concerns directly to The Joint
Commission.
Point 1 of 4
2
1002
Course Rationale
The 2008 Joint Commission Comprehensive Accreditation Manual
for Hospitals (CAMH) includes a standard for victims of abuse or
neglect (Standard PC.3.10).
IMAGE: 1002.JPG
The rationale for the standard explains the importance of
identifying victims. See the text image to the right for the major
points of this rationale.
This course focuses on child abuse and neglect. You will learn how
to identify, assess, refer, and report victims.
This will help you:
• Improve public health and your facility’s quality of patient
care.
• Comply with The Joint Commission Standard PC.3.10.
Note: For more details about The Joint Commission Standard
PC.3.10, and an overview of all types of abuse and neglect, see
the course: Identifying and Assessing Victims of Abuse and
Neglect.
Point 2 of 4
1003
Course Goals
After completing this course, you should be able to:
• Recognize forms of child maltreatment
• List the effects of child abuse and neglect
• Recognize methods for identifying victims
• List steps in the process of assessing a victim
• Recognize the importance of laws about reporting child
abuse
NO IMAGE
Point 3 of 4
1004
Course Outline
This introductory lesson gave the course rationale and goals.
FLASH ANIMATION
Lesson 2 presents background information on child abuse and
neglect. This will help you understand what abuse and neglect
mean. You also will learn about the harmful effects of abuse and
neglect.
Lesson 1: Introduction
Lesson 2: Definitions and Effects
• Prevelance
• Forms of child abuse
• How child abuse affects victims and
society
Lesson 3: Identifying victims
• Risk factors
• Signs and symptoms
Lesson 4: Assessment and Referral
• Physical health assessment
• Interviews with child and caretakers
• Documentation of evidence of abuse
• Referral
Lesson 5: Reporting Requirements
• What to report
• How to report
• Implications of reporting/not reporting
Lesson 3 provides information on identifying victims of child abuse
and neglect.
Lesson 4 presents information on assessing and referring victims.
Finally, lesson 5 talks about reporting child maltreatment.
Point 4 of 4
Lesson 2: Definitions and Consequences
2001
Introduction & Objectives
Welcome to the lesson on definitions and consequences.
FLASH ANIMATION
After completing this lesson, you should be able to:
• List important features and examples of physical abuse,
sexual abuse, emotional abuse, and neglect
• List important effects of child maltreatment
Lesson 2: Definitions and Effects
• Prevelance
• Forms of child abuse
• How child abuse affects victims and
society
Point 1 of 15
2002
Child Abuse Statistics
Child maltreatment [glossary] is a significant problem in the United
States.
IMAGE: 1001.JPG
For example, in 2005:
• Child Protective Services had reports of suspected abuse
involving a total of 3.6 million children.
• Nearly 900,000 of those children were found to be victims
of abuse or neglect.
• 1,460 children died as a result of child abuse or neglect.
Most of these children were under the age of four.
Source: National Clearinghouse on Child Abuse and Neglect Information, Child
Maltreatment 2005: Summary of Key Findings.
Point 2 of 15
2003
Forms of Child Maltreatment
Child maltreatment may be:
• Physical abuse
• Sexual abuse
• Emotional abuse
• Neglect
IMAGE: 2003.jpg
Let’s take a closer look at each.
Point 3 of 15
2004
Child Maltreatment: Physical Abuse
Physical abuse:
• Tends to be the most visible form of child abuse
• Occurs when a caretaker injures a child on purpose
IMAGE: 2004.JPG
Examples of physical abuse include:
• Severe and unreasonable physical punishment
• Punching
• Beating
• Kicking
• Biting
• Burning
• Shaking
• Throwing
If this form of abuse is not stopped promptly, it is likely that:
• The abuse will become more and more severe.
• The abuser will find it harder and harder to stop abusing
the child.
Point 4 of 15
2005
Child Maltreatment: Sexual Abuse
Sexual abuse happens when an adult or older child involves a
child in any sexual activity.
IMAGE: 2005.JPG
Sexually abusive acts include:
• Fondling a child’s genitals
• Oral, anal, or vaginal sex with a child
• Exposing genitalia in front of a child
• Child prostitution
• Child pornography
• Forcing or persuading a child to perform sexual acts with
other children
Point 5 of 15
2006
Child Maltreatment: Emotional Abuse
In 2005, 7% of abused children were emotionally abused.
CLICK TO REVEAL
This type of abuse happens when a caretaker treats a child in any
of the following ways on a regular basis:
• Rejecting
• Degrading
• Terrorizing
• Ignoring
• Isolating
• Corrupting
Rejecting behaviors may include:
• Avoiding a child
• Telling a child that he or she is useless or inferior
• Treating a child’s thoughts, feelings, or needs as if
they are not important
Click on each type of emotional abuse for examples.
Degrading behaviors may include:
• Insulting or ridiculing a child
• Calling a child names
• Teasing a child about a disability
• Publicly humiliating a child
Terrorizing behaviors may include:
• Threatening a child with severe punishment
• Placing a child in a dangerous environment
• Punishing a child for not meeting unrealistic goals
or expectations
• Causing a child to feel intense fear in any other
way
Ignoring behaviors may include:
• Not responding to a child
• Refusing to interact with a child
Isolating behaviors can include:
• Physically confining a child
• Limiting a child’s contact with others
• Preventing a child from having normal friendships
Corrupting Corruption teaches a child to behave in
antisocial or abnormal ways.
Point 6 of 15
2007
Child Maltreatment: Neglect
Child neglect occurs when a caretaker does not meet a child’s
basic needs.
IMAGE: 2007.JPG
These needs may be physical, developmental, or psychological.
For example, all children need:
• Food
• Clothing
• Shelter
• Emotional support
• Love and nurturing
• Education
• Safety and supervision
• Medical and dental care
Point 7 of 15
2008
Consequences of Child Abuse/Neglect
Child abuse has far-reaching effects.
IMAGE: 2008.JPG
These effects include:
• Physical health consequences for the child
• Psychological consequences for the child
• Behavioral consequences for the child
• Costs to society
Let’s take a closer look at each.
Point 8 of 15
2009
Consequences: Physical
The immediate physical health effects of abuse range from minor
to severe. Examples of minor injuries include cuts and bruises.
Examples of severe effects include broken bones, massive
bleeding, and even death.
The long-term physical effects of abuse can include:
• Damage to the nervous system caused by shaken
baby/shaken impact syndrome
• Problems with brain development caused by long-term
abuse
• Long-term physical health problems
Click on each effect to learn more.
CLICK TO REVEAL
Damage to the nervous system caused by shaken baby/shaken
impact syndrome [glossary]
Long-term neurological [glossary] effects of shaken baby syndrome can
include:
•
Blindness, hearing loss, seizures
•
Learning disabilities
•
Mental retardation
•
Cerebral palsy
•
Paralysis
Problems with brain development caused by long-term abuse
Child abuse and neglect can cause certain areas of the brain to form
incorrectly. This can cause:
•
Problems with physical development
•
Problems with mental development
•
Problems with emotional development
Long-term abuse also can cause a stress response. This stress can
cause certain areas of the brain to become abnormally sensitive to input
from the outside world. This can lead to:
•
Hyperactivity, including attention deficit/hyperactivity disorder
(ADHD)
•
Sleep disorders
•
Anxiety
•
Post-traumatic stress disorder (PTSD)
•
Behavioral problems
•
Learning and memory problems
Long-term physical health problems
Victims of childhood abuse or neglect may be at high risk for health
problems as adults. These health problems can include:
•
Sexually transmitted diseases
•
Heart disease
•
Cancer
•
Lung disease
•
Bone fractures
•
Liver disease
Point 9 of 15
2010
Consequences: Psychological
The immediate psychological effects of child abuse or neglect
include:
• Isolation
• Fear
• Inability to trust
IMAGE: 2010.JPG
These problems can lead to lifelong troubles.
Victims of childhood abuse often have psychological problems
later in life. These problems can include:
• Depression
• Anxiety
• Difficulty forming relationships with others
• Eating disorders
• Suicide attempts
Source: U.S. Department of Health and Human Services, Administration for
Children & Families, Long-Term Consequences of Child Abuse and Neglect.
Point 10 of 15
2011
Consequences: Behavioral
Victims of childhood abuse or neglect are at high risk for
behavioral problems during their teenage years. These problems
can include
• Crime
• Teen pregnancy
• Poor grades in school
• Drug use
IMAGE: 2011.JPG
Victims of childhood abuse or neglect also are at high risk for:
• Crime as adults
• Cigarette use
• Alcohol abuse
• Other drug abuse
Finally, victims of childhood abuse or neglect are more likely to
become abusive parents.
Point 11 of 15
2012
Consequences: Societal
Child abuse and neglect have costs for all of us.
IMAGE: 2012.JPG
Direct costs come from:
• Investigating abuse
• Treating abused children and their families
Indirect costs come from the effects discussed earlier in the
lesson. For example, society pays a price for victims of childhood
abuse or neglect who:
• Need a lot of healthcare
• Need special education
• Have mental illnesses
• Abuse drugs or alcohol
• Go on to abuse their own children
• Are unemployed or underemployed
• Commit crimes
Point 12 of 15
2013
Review
The most common form of child maltreatment is:
a. Neglect
b. Sexual abuse
c. Physical abuse
d. Emotional abuse
MULTIPLE CHOICE INTERACTION
Correct answer: A
Feedback for A: Correct. According to 2005 statistics, 63%
of cases of child maltreatment involved neglect. Seventeen
percent of cases involved physical abuse, 9% involved
sexual abuse, and 7% involved emotional abuse.
Feedback for B: Incorrect. The correct answer is A.
According to 2005 statistics, 63% of cases of child
maltreatment involved neglect. Seventeen percent of cases
involved physical abuse, 9% involved sexual abuse, and
7% involved emotional abuse.
Feedback for C: Incorrect. The correct answer is A.
According to 2005 statistics, 63% of cases of child
maltreatment involved neglect. Seventeen percent of cases
involved physical abuse, 9% involved sexual abuse, and
7% involved emotional abuse.
Feedback for D: Incorrect. The correct answer is A.
According to 2005 statistics, 63% of cases of child
maltreatment involved neglect. Seventeen percent of cases
involved physical abuse, 9% involved sexual abuse, and
7% involved emotional abuse.
Point 13 of 15
2014
Review
Survivors of childhood abuse or neglect are at high risk for:
a. Substance abuse and crime
b. Heart disease, cancer, and lung disease
c. Depression, anxiety, and eating disorders
d. All of these
e. None of these
MULTIPLE CHOICE INTERACTION
Correct answer: D
Feedback for A: Not quite. The correct answer is D.
Survivors of childhood abuse or neglect are at high risk for
all of these problems.
Feedback for B: Not quite. The correct answer is D.
Survivors of childhood abuse or neglect are at high risk for
all of these problems.
Feedback for C: Not quite. The correct answer is D.
Survivors of childhood abuse or neglect are at high risk for
all of these problems.
Feedback for D: Correct. Survivors of childhood abuse or
neglect are at high risk for all of these problems.
Feedback for E: Incorrect. The correct answer is D.
Survivors of childhood abuse or neglect are at high risk for
all of these problems.
Point 14 of 15
2015
Summary
You have completed the lesson on definitions and effects.
NO IMAGE
Remember:
• Physical abuse happens when a caretaker injures a child
on purpose.
• Sexual abuse happens when an adult or older child
involves a child in any sexual activity.
• Emotional abuse happens when a caretaker rejects,
degrades, terrorizes, ignores, isolates, or corrupts a child
on a regular basis.
• Child neglect happens when a caretaker does not meet a
child’s basic needs.
• Child abuse and neglect have both immediate and longterm consequences for the child. These include harm to
the child’s physical, psychological, and behavioral health.
• Abuse and neglect also have costs to society.
Point 15 of 15
Lesson 3: Identifying Victims
3001
Introduction & Objectives
Welcome to the lesson on identifying victims of child
abuse/neglect.
After completing this lesson, you should be able to:
• List risk factors for child abuse and neglect
• Recognize signs and symptoms of child abuse and neglect
FLASH ANIMATION
Lesson 3: Identifying victims
• Risk factors
• Signs and symptoms
Point 1 of 18
3002
Challenges to Identifying Victims
Identifying victims of child abuse and neglect can be difficult for
healthcare providers. There are two main reasons for this:
IMAGE: 3002.JPG
1. Children usually do not tell anyone about the abuse or neglect.
They often think that:
• The abuse is their own fault.
• Adults will not believe them if they tell about the abuse.
2. Because they see the child every day, the child’s parents should
notice signs and symptoms of abuse. However, parents usually do
not give healthcare providers good information about signs and
symptoms. There are two reasons for this:
• In most cases of child abuse, a parent is the abuser.
• When parents are not the abusers, they may ignore signs
and symptoms. This is because they do not want to think
that their child may be a victim.
Point 2 of 18
3003
Overcoming Challenges and Identifying Victims
In short, victims and their parents rarely give healthcare providers
useful information.
IMAGE: 3003.jpg
In this case, how can healthcare providers identify victims?
Healthcare staff must be alert to the possibility of abuse.
They must be aware of:
• Risk factors for child maltreatment
• Signs of abuse and neglect
Let’s take a closer look at each.
Point 3 of 18
3004
Risk Factors
There are three types of risk factors for child abuse and neglect:
• Child-related factors
• Family-related factors
• Social and environmental factors
IMAGE: 3004.JPG
We will review each type of factor on the following screens. Keep
in mind:
• Many factors may put a child at risk. Some of these factors
may not be listed in this lesson.
• The factors listed show a strong correlation with child
abuse. Correlation means that child abuse is most often
seen when at least one of these factors is present.
Correlation does not mean that any of these factors
causes child abuse.
• Any child may be abused or neglected. Risk factors do not
have to be present.
Point 4 of 18
3005
Risk Factors: Child-Related
A child is more likely to be a victim if he or she:
• Came from an unwanted pregnancy
• Had problems at birth (for example, premature birth or low
birth weight)
• Has physical, mental, or emotional problems
• Has behavioral problems or problems with attention span
• Has antisocial friends
• Has suffered trauma [glossary]
• Is slow to warm up to other people
• Is aggressive
• Is between the ages of zero and three years
• Is a girl
IMAGE: 3005.GIF
Important note: A child with risk factors should never be blamed for
abuse. Child abuse is NEVER the child’s fault.
Point 5 of 18
3006
Risk Factors: Family-Related
A child is at increased risk for abuse or neglect if a parent:
• Is a single parent
• Is a teenager
• Is unemployed or homeless
• Does not have enough social support
• Has many children living in the household
• Has been separated or divorced, especially if the divorce
was difficult
• Was abused as a child
• Abuses alcohol or other drugs
• Abuses an intimate partner
• Tends to act impulsively
• Does not trust others
• Feels insecure, especially in the relationship with his or her
own parents
• Has depression, anxiety, stress, or other mental health
problems
• Is easily frustrated
• Has an external locus of control [glossary]
• Has poor parenting or communication skills
• Does not interact effectively with the child
• Has negative attitudes about the child’s behavior
• Has unrealistic expectations for the child’s development
IMAGE: 3006.GIF
Point 6 of 18
3007
Risk Factors: Social and Environmental
Social and environmental factors that can put a child at risk for
abuse include:
• Poverty
• Stressful life events (for example, money problems or a
death in the family)
• Not having medical care, health insurance, childcare, or
social services
• Racism or other discrimination
• Poor schools
• Community violence or other crime
IMAGE: 3007.JPG
Point 7 of 18
3008
Signs of Abuse
Let’s now consider signs and symptoms of abuse and neglect.
IMAGE: 3009.jpg
These include:
• Physical abuse: physical signs
• Sexual abuse: physical signs, behavioral signs
• Emotional abuse: behavioral signs
• Neglect: historical and physical signs, behavioral signs
We will review these signs and symptoms on the following pages.
Keep in mind:
• The signs listed do not prove abuse. When you suspect
abuse, you must think about how all of the evidence fits
together. Use your best clinical judgment to make a
diagnosis.
• An abused child may not have physical signs or
symptoms. This is often the case for sexual and emotional
abuse. Be sure to look for behavioral signs and symptoms.
Point 8 of 18
3009
Physical Abuse: Physical Signs (1)
CLICK TO REVEAL
Click on each of the following to learn more about specific types of
injuries that may be signs of physical abuse:
• Bruises and welts
• Burns
• Cuts and scrapes
• Broken bones
• Abdominal injuries
• Brain injuries
Bruises and welts may be a sign of abuse if they form patterns. These patterns
often look like the item that was used:
•
Hand
•
Teeth
•
Belt buckle
•
Electrical cord
Burns may be a sign of abuse. Look for:
•
Cigar or cigarette burns. This type of burn is highly suspicious on the
soles of the feet, palms of the hands, back, or buttocks.
•
Immersion burns. On the feet and legs, these burns look like stockings.
On the hands and arms, they look like gloves. On the genitals, they are
donut-shaped.
•
Patterned burns. These burns look like an iron, burner, grill, or other
appliance that was used to cause the burn.
Cuts and scrapes can be signs of abuse. Look for:
•
Rope burns on the wrists, ankles, neck, or torso
•
Cuts or scrapes on the palate, mouth, gum, lips, eyes, or ears
•
Cuts or scrapes on the external genitalia
Abuse can cause broken bones. Look for fractures in the:
•
Skull
•
Ribs
•
Long bones
•
Growth plates of the long bones
Abdominal injuries can be a sign of abuse. Look for:
•
Bruising of the abdominal wall
•
Bruising of the small intestine
•
Intestinal perforation [glossary]
•
Liver or spleen rupture
•
Blood vessel rupture
•
Injury to the kidneys or bladder
•
Pancreatic injury [glossary]
Brain injuries may be a sign of abuse. Look for:
•
Bleeding on the surface of the brain (often due to violent shaking or blunt
trauma)
•
Brain damage due to swelling of the brain
•
Bleeding in the retina of the eye
Point 9 of 18
3010
Physical Abuse: Physical Signs (2)
Remember: The physical injuries listed on the previous screen do
not prove abuse.
IMAGE: 3011.JPG
Many childhood injuries are accidents. Accidents can happen
when active children explore and play.
How can you tell the difference between accidental injuries and
abuse?
The following types of injuries are probably not accidental. They
are more likely to be a sign of abuse:
• Injuries on both sides of the body (bilateral) [glossary]
• Injuries on many areas of the body at one time
• Injuries in different stages of healing
• Injuries in a late stage of healing (showing that the parent
did not take the child for medical care immediately)
• Injuries that do not match the parent’s explanation
• A pattern of frequent, unexplained injuries
Point 10 of 18
3011
Signs of Sexual Abuse
Physical signs of sexual abuse may include:
• Cuts or scrapes on the genitalia or inner thighs
• Pain or bleeding in the rectum or genitalia
• Change in the size or shape of the hymen
• Abnormally relaxed or tensed muscles of the anus and
rectum
• Pregnancy
• Sexually transmitted diseases (STDs)
IMAGE: 3012.JPG
STDs are very suspicious in children before puberty, if the STD did
not come from the mother at or around the time of birth. See the
table at the right for more information.
Important notes:
• Sexually abused children often have no physical signs.
This does not mean the child has not been abused.
• If you suspect sexual abuse, do not routinely screen for
STDs. Screen only after considering the child’s symptoms
and history, the epidemiology [glossary] of STD’s in the
area, and any state-specific policies or requirements.
Point 11 of 18
3012
Behavioral Signs of Sexual Abuse
A child with sexual behavior that is unusually mature or advanced
for his or her age may be a victim of abuse.
IMAGE: 3013.JPG
Other behavioral signs of sexual abuse tend to be nonspecific.
This means that they may be signs of abuse, but also might be
caused by other problems
These signs include:
• Non-sexual behavior that is mature for the child’s age
• Behavior that is immature for the child’s age, such as
bedwetting
• Compulsive behavior
• Poor peer relationships
• Poor grades in school
• Hyperactivity
• Withdrawal
• Low self-esteem
• Shame or guilt
• Distorted body image
• Eating disorders
• Fears, especially of adults
• Attempts to run away from home
• Suicide attempts
• Behavior that invites a sexual response
• Having many sexual partners
• Sexual abuse of a sibling, friend, or young child
• Pregnancy
Point 12 of 18
3013
Behavioral Signs of Emotional Abuse
Behavioral indicators of emotional abuse may include:
• Depression
• Withdrawal
• Low self-esteem
• Severe anxiety
• Fearfulness
• Failure to thrive (in infants)
• Aggressive behavior
• Emotional instability
• Sleep disturbances
• Age-inappropriate behavior
• Overly passive or compliant behavior
• Suicide attempts
• Extreme dependence
• Underachievement
• Inability to trust
• Stealing or other forms of acting out
IMAGE: 3014.JPG
Point 13 of 18
3014
Historical and Physical Signs of Neglect
Historical signs of neglect can include:
• Lack of immunizations and other well-child medical care
• Lack of medical care for chronic illness
• Lack of eyeglasses, hearing aides, or other necessary
health aides
IMAGE: 3015.JPG
Physical signs of neglect can include:
• Poor nutrition
• Poor hygiene
• Developmental delays
• Untreated medical conditions
• Tooth decay
Point 14 of 18
3015
Behavioral Signs of Neglect
Behavioral signs of neglect can include:
• Depression
• Anxiety
• Bedwetting
• Sleep problems
• Excessive masturbation
• Lack of cuddliness
• Avoiding eye contact
• Preferring inanimate objects to people
• Discipline problems
• Aggressive behavior
• Role reversal (the child takes care of the parent)
• Too much responsibility at home
IMAGE: 3016.JPG
Point 15 of 18
3016
Review
Poverty and community violence _______ child abuse and neglect.
a. Cause
b. Are unrelated to
c. Are not risk factors for
d. Show a correlation with
MULTIPLE CHOICE INTERACTION
Correct answer: D
Feedback for A: Incorrect. Poverty and community violence
are not known to cause child abuse and neglect. However,
they are risk factors. The best answer is D. Poverty and
community violence show a positive correlation with child
abuse and neglect.
Feedback for B: Incorrect. Poverty and community violence
are not known to cause child abuse and neglect. However,
they are risk factors. The best answer is D. Poverty and
community violence show a positive correlation with child
abuse and neglect.
Feedback for C: Incorrect. Poverty and community violence
are not known to cause child abuse and neglect. However,
they are risk factors. The best answer is D. Poverty and
community violence show a positive correlation with child
abuse and neglect.
Feedback for D: Correct. Poverty and community violence
are not known to cause child abuse and neglect. However,
they are risk factors. The best answer is D. Poverty and
community violence show a positive correlation with child
abuse and neglect.
Point 16 of 18
3017
Review
FLASH INTERACTION: 3017.SWF
Children often have accidents.
Did you recall some or all of the following?
How can you tell the difference between an accidental injury and
abuse?
The following types of injuries are probably not accidental.
They are more likely to be a sign of abuse:
• Injuries on both sides of the body (bilateral)
• Injuries on many areas of the body at one time
• Injuries in different stages of healing
• Injuries in a late stage of healing (showing that the
parent did not take the child for medical care
immediately)
• Injuries that do not match the parent’s explanation
• A pattern of frequent, unexplained injuries
Type your thoughts in the box below. Then click Submit to
compare your answer to ours.
Point 17 of 18
3018
Summary
You have completed the lesson on identifying victims of child
maltreatment.
NO IMAGE
Remember:
• Certain factors increase the risk of child abuse and
neglect.
• Victims of abuse and neglect often have signs and
symptoms.
• Knowing the risk factors, signs, and symptoms can help
you identify victims.
Point 18 of 18
Lesson 4: Assessment and Referral
4001
Introduction & Objectives
Welcome to the lesson on assessment and referral.
FLASH ANIMATION
After completing this lesson, you should be able to:
• Identify the components of a child abuse assessment
• Specify when and how the physical health component of
a child abuse assessment should be performed
• List guidelines for interviewing suspected victims and
their caretakers
• Recognize procedures for collecting and documenting
evidence of child abuse or neglect
Lesson 4: Assessment and Referral
• Physical health assessment
• Interviews with child and caretakers
• Documentation of evidence of abuse
• Referral
Point 1 of 20
4002
Components of the Assessment
A child abuse or neglect assessment has two basic parts:
• A physical health check of the suspected victim
• Interviews with the suspected victim and his or her
caretakers
IMAGE: 4002.JPG
Let’s take a closer look at each part.
Point 2 of 20
Components: Physical Health Assessment
The first part of a child abuse assessment is a full physical health
check.
IMAGE: 4003.JPG
This health check should include:
• Taking a full medical history
• Performing a full pediatric physical exam
• Assessing the child’s developmental status
• Ordering any necessary lab or medical imaging tests
The goals of the health check are to:
• Look carefully at any current injuries
• Find signs of any previous injuries
• Look for any other physical problems that need medical
care
• Rule out a medical cause for the physical exam findings
(e.g. genetic bleeding disorder)
• Record evidence of abuse or neglect (as discussed in
greater detail later in the lesson)
Point 3 of 20
4004
Physical Health Assessment: When
When should the physical health check be performed?
IMAGE: 4004.JPG
In cases of sexual abuse, it may be necessary to collect forensic
evidence. If so, the physical health check should be performed
right away.
In most cases of child abuse and neglect, however, forensic
evidence is not an issue. In these cases, the full physical health
check may be scheduled for a follow-up visit.
If the child seems unusually upset, check with a mental health
professional before conducting the physical exam.
Point 4 of 20
4005
Physical Health Assessment: How
When physically examining a suspected victim of abuse:
• Explain each step of what you are doing
• Ask for the child’s permission before each step.
• Never use restraint or force
• Go slowly. Make sure the child feels okay with the pace
of the examination
• Be gentle and sensitive
IMAGE: 4005.JPG
Point 5 of 20
4006
Physical Health Assessment: Suspected Sexual Abuse (1)
When physically examining a suspected victim of sexual abuse:
• Make sure another adult is present. This adult should not
be the suspected abuser. This adult should be someone
the child trusts.
• Examine the child’s genitals as part of a full physical exam.
Do not examine the genitals as an isolated procedure.
• Consider screening for STDs. The decision to screen
should be based on the child’s symptoms and history, the
epidemiology of STDs in the area, and any legal
requirements in your state.
IMAGE: 4006.JPG
Point 6 of 20
4007
Physical Health Assessment: Suspected Sexual Abuse (2)
Examining a victim of sexual abuse can be upsetting.
IMAGE: 4007.JPG
Do not start a sexual abuse assessment unless you are prepared
to:
• Accept that sexual abuse of children does happen
• Take everything the child says seriously
• Respond sensitively to everything the child says
• Collect forensic evidence
• Stop the exam to get help from an expert, if needed
Point 7 of 20
4008
Components: Interviewing the Child and the Caretakers
The second part of the child abuse assessment is the interview
process.
IMAGE: 4008.JPG
If at all possible, there should be two separate interviews:
• The child should be interviewed in private, without the
caretakers.
• The caretakers should be interviewed in private, without
the child.
Point 8 of 20
4009
Interviewing: Before the Interview
Before interviewing the child or caretakers, it is a good idea to get
some background information from a reliable source.
Useful background information includes:
• Specific details of the abuse
• A complete social history
Click on each item for details.
CLICK TO REVEAL
Specific details of the abuse
Ask your source exactly what happened to cause the
child’s injuries. Ask about:
• The date, time, and place of the abusive incident
• The sequence of events
• Any witnesses
• How long the caretakers waited before getting
medical care for the child
A complete social history
Ask your source:
• Where the child lives
• How long he or she has lived there
• Who lives with the child
• What types of support systems the family has
• Who takes care of the child (parent, babysitter,
nanny, daycare center)
Point 9 of 20
4010
Interviewing: The Child
A child older than age 3 years may be able to tell a sensitive and skillful interviewer that a particular adult
hurt him or her.
When interviewing the child:
•
•
•
•
•
•
•
•
•
DO
Meet in private, without the
caretaker.
Sit near the child, at the child’s eye
level.
Establish trust.
Explain the reason for the interview
in words the child can understand.
Ask the child to explain any of his
or her words or terms that are
unclear to you. Then use the child’s
words and terms whenever
possible.
Use aids such as anatomic dolls
only if you are trained in their use.
Encourage the child to ask
questions. Answer all questions
sensitively and truthfully.
Let the child know that you
understand how difficult the
situation is.
Make sure the child knows that he
or she is not at fault in any way.
•
•
•
•
•
•
Do NOT
Offer answers or rewards.
Press for answers.
Criticize or correct the child’s choice
of words.
Say anything that might cause the
child to feel guilt or blame.
Leave the child alone.
Act shocked or horrified at what the
child tells you.
Point 10 of 20
4011
Interviewing: The Caretakers
When interviewing the caretaker(s) of a suspected victim of child abuse:
•
•
•
•
•
DO
Stay objective.
Explain the reason for the
interview.
Explain that the law requires you to
report suspected abuse.
Describe what will be done to
protect the child.
Answer any questions that do not
compromise the child’s safety or
the evidence in the case.
•
•
•
•
Do NOT
Judge or blame before knowing all
the facts.
Try to prove that the child has been
abused or neglected.
Act angry, horrified, or
disapproving.
Talk about the explanation the
parents have given for the child’s
injuries (this could help the parents
change an unlikely explanation).
Point 11 of 20
4012
Documentation and Collection of Evidence
Careful documentation of the child abuse assessment is critical.
IMAGE: 4012.JPG
Documentation can provide evidence for:
• Legal action to protect the child
• Legal action to prosecute the abuser
In some cases, the medical record may provide the only hard
evidence of abuse.
Point 12 of 20
4013
Documentation: Written Record
The following should be documented in the medical record:
• Results of the pediatric health check, including the
patient’s medical and social history
• Results of pertinent lab tests or other diagnostic tests
• Any statements made by the victim and caretaker(s),
including any taped interviews
• Observed appearance and behavior of the victim
• Name of the abuser and his or her relationship to the
victim (if known)
• Date, time, location, and description of the abusive
event(s) (if known)
• Detailed description of injuries (see text image to the right)
• Any other information or physical evidence relevant to the
patient’s injuries
IMAGE: 4013.JPG
Point 13 of 20
4014
Documentation: Photographs
Photographs should not replace a full written description of injuries.
However, photos can provide valuable additional evidence.
IMAGE: 4014.JPG
When taking photographs of injuries:
• Photograph injuries before treating them, if possible
• Use color film and a color standard
• Photograph bite marks in both black-and-white and color, if
possible
• Hold up a coin, ruler, or other object to show the size of
the injury
• Include the victim’s face in at least one picture
• Take at least two pictures of every major injury
• Carefully label all photographs
Point 14 of 20
4015
Documentation: Forensic Evidence
Each state has an established set of procedures for collecting
forensic evidence of sexual assault. This set of procedures is
called a “rape kit.”
IMAGE: 4015.JPG
Evidence collected during a rape kit exam is used to:
• Establish the time and place of the assault
• Establish the identity of the attacker
The rape kit exam is only useful within 72 hours of an assault.
Therefore, rape kits are not generally used in cases of child sexual
abuse. This is because:
• The child is often a victim of ongoing, undisclosed abuse.
• The victim is unlikely to see a healthcare provider within 72
hours of any given abusive incident.
If the child is seen immediately after a sexual assault, however,
forensic evidence can be important. In this case, be sure to follow
the rape kit protocol when collecting evidence. This helps ensure
that the evidence can be used in a court of law.
Point 15 of 20
4016
Forensic Evidence: Typical Protocol
A typical rape kit protocol has the following steps:
• The patient takes off his or her clothes on a clean cloth or
sheet.*
• The patient places each item of clothing in a separate
paper bag.*
• The patient places the cloth or sheet in another paper
bag.*
• The patient puts on a gown and lies on the exam table.
• The clinician uses a Wood’s light to look for dried semen
on the patient. The clinician records the location(s) of
semen.
•
The clinician performs a full physical exam. During the
exam, samples of semen, blood, hair, and saliva may be
taken.
•
The patient gives a urine specimen.
IMAGE: 4016.JPG
* During these steps, a healthcare worker can help the patient, if
necessary. The worker must wear clean gloves.
Important notes:
• The steps described in this “typical” protocol may not be used
in your state. Other procedures may apply. Check with your
supervisor or a legal expert.
• Throughout the rape kit exam, be careful to follow chain-ofevidence [glossary] protocols.
Point 16 of 20
4017
Referrals
All facilities should be prepared to refer victims of abuse to outside
sources of support.
IMAGE: 4017.JPG
Some facilities may not have staff who are trained and qualified to
assess suspected victims of abuse. These facilities also must be
prepared to refer victims for assessment. Children with suspected
abuse should not be discharged from the facility without consulting
the appropriate child protective services agency.
For a list of agencies and resources on child abuse and neglect,
see:
•
•
childabuse.pdf [link to childabuse.pdf]
childsexabuse.pdf [link to childsexabuse.pdf]
Point 17 of 20
4018
Review
A full child abuse assessment should be performed as soon as a
suspected victim is identified.
a. True
b. False
TRUE / FALSE INTERACTION
Correct answer: B
Feedback for A: Incorrect. In most cases, the assessment
should be scheduled for a follow-up visit. Assess a
suspected victim right away only when there is forensic
evidence to collect.
Feedback for B: Correct. In most cases, the assessment
should be scheduled for a follow-up visit. Assess a
suspected victim right away only when there is forensic
evidence to collect.
Point 18 of 20
4019
Review
When photographing injuries as evidence of suspected abuse:
a. Use black-and-white film only.
b. Hold up a common object to show the size of the injury.
c. Protect the victim’s confidentiality by not including his or
her face in any of the photographs.
d. All of these are correct.
e. None of these is correct.
MULTIPLE CHOICE INTERACTION
Correct answer: B
Feedback for A: Incorrect. Black-and-white film should be
used for bite marks. For all other injuries, color film should
be used. The correct answer is B.
Feedback for B: Correct.
Feedback for C: Incorrect. The victim’s face should be
included in at least one photograph, to establish his or her
identity. The correct answer is B.
Feedback for D: Incorrect. Black-and-white film should be
used for bite marks. For all other injuries, color film should
be used. The victim’s face should be included in at least
one photograph, to establish his or her identity. The correct
answer is B.
Feedback for D: Incorrect. The correct answer is B.
Point 19 of 20
4020
Summary
You have completed the lesson on assessment and referral.
NO IMAGE
Remember:
• The child abuse assessment has two basic parts: the
physical health check and the interview. Know the
guidelines for each of these procedures.
• Carefully document all evidence during the child abuse
assessment.
• Documentation of the abuse assessment should include a
written record. Photographs of injuries can provide
valuable additional evidence.
• Forensic evidence may be important in some cases of
sexual abuse. If so, collect all evidence according to your
state’s rape kit protocol.
Point 20 of 20
Lesson 5: Reporting Requirements
5001
Introduction & Objectives
Welcome to the lesson on reporting requirements.
FLASH ANIMATION
After completing this lesson, you should be able to:
• Recognize the importance of learning the reporting
requirements in your state
• Recognize typical reporting requirements and procedures.
List potential consequences of failing to report when
required to do so by law
Lesson 5: Reporting Requirements
• What to report
• How to report
• Implications of reporting/not reporting
Point 1 of 9
5002
Variation in Reporting Requirements
Healthcare providers are mandatory reporters of child abuse and
neglect in all states.
IMAGE: 5002.SWF
This means that all states have laws that require healthcare
providers to report suspected child abuse and neglect.
http://www.childwelfare.gov/systemwide/laws_policies/
statutes/mandaall.pdf
However, state laws differ in their:
• Definitions of child abuse and neglect
• Reporting procedures
Learn the laws in your state, including:
• What you are required to report
• How to report
Point 2 of 9
5003
Typical Reporting Requirements
In most states, clinical healthcare professionals must report
suspected abuse or neglect in two different types of situations.
IMAGE: 5003.JPG
These are:
1. A healthcare provider notices certain signs and symptoms
in a pediatric patient under his or her direct care. The
provider suspects abuse or neglect. This provider must
make a report to Child Protective Services (CPS).
2. An adult who is legally responsible for the care of a child
suspects abuse or neglect. The adult talks to a healthcare
provider. This provider must make a report to CPS.
Non-clinical staff who have contact with pediatric patients also
must report suspected abuse. These staff members should report
their suspicions to a supervisor. The supervisor decides whether or
not the suspicion is substantial enough to report to CPS.
Point 3 of 9
5004
Typical Reporting Procedures
Remember: Reporting procedures differ from state to state.
IMAGE: 5004.JPG
In general, when a report is required:
1. The mandatory reporter must contact CPS immediately by
phone.
2. The mandatory reporter must file a written report within a
certain amount of time.
Point 4 of 9
5005
Immunity from Liability
Mandatory reporting laws protect mandatory reporters from legal
liability.
NO IMAGE
To ensure legal protection, the report must be made in good faith.
Point 5 of 9
5006
Mandatory Reporting vs. Patient Confidentiality
When a healthcare provider reports suspected abuse or neglect,
he or she may need to share confidential patient information.
IMAGE: 5006.JPG
Because of the circumstances, this is not considered a violation of
patient-provider privilege.
Providers must report suspected abuse or neglect. Patient
confidentiality is not a legal excuse for not reporting.
Point 6 of 9
5007
Penalties for Not Reporting
Most states have criminal penalties for not reporting suspected
abuse or neglect.
IMAGE: 5007.JPG
The crime is a misdemeanor in most states. Penalties may include:
• Fines
• Jail time
Providers who do not report also risk civil liability. At some later
time, the patient or the patient’s family could sue the provider for
not reporting.
Point 7 of 9
5008
Review
All 50 of the United States require healthcare workers to report
suspected child abuse or neglect.
a. True
b. False
TRUE / FALSE INTERACTION
Correct answer: A
Feedback for A: Correct. This statement is true.
Feedback for B: Incorrect. This statement is true.
Point 8 of 9
5009
Summary
You have completed the lesson on reporting requirements.
NO IMAGE
Remember:
• Healthcare providers in all 50 states are required by law to
report suspected child abuse and neglect.
• Reporting requirements and procedures differ from state to
state.
• Learn the laws in your state.
Point 9 of 9
Glossary
#
Term
Definition
chain-of-evidence protocols
maltreatment
neurological
trauma
intestinal perforation
procedures (including documentation and testimony) that ensure that evidence is not altered or
tampered with in any way after being obtained; also referred to as chain-of-custody protocols
belief that one’s own behavior doesn't matter much and that what happens in life is generally
outside of one’s control
cruel or inhumane treatment
of or relating to the nervous system
physical injury caused by external violence; severe emotional or psychological shock or distress
a hole in the wall of the large or small intestine
pancreatic injury
damage to the pancreas
bilateral injuries
injuries on both sides of the body
external locus of control
epidemiology
study of the incidence, distribution, and control of disease in a population
shaken baby/shaken impact
syndrome
Inflicted head trauma caused by direct blows to the head, dropping or throwing a child, or shaking a
child
Pre-Assessment
1. The most visible form of child maltreatment tends to be:
a. Neglect
b. Sexual abuse
c. Physical abuse
d. Emotional abuse
Correct: Physical abuse
Rationale: Physical abuse tends to be most visible.
2. A father physically abuses a child. If the abuse is not identified and stopped by a third party, it is likely that:
a. The abuse will become less and less severe over time.
b. The abuse will become more and more severe over time.
c. The father will stop the abuse if he ever injures the child severely.
d. The father will choose to stop the abuse within six months in 90% of cases.
Correct: The abuse will become more and more severe over time.
Rationale: If physical abuse is not stopped, it tends to become more and more severe over time.
3. Child prostitution is a form of:
a. Neglect
b. Sexual abuse
c. Physical abuse
d. Emotional abuse
Correct: Sexual abuse
Rationale: Child prostitution is sexual abuse.
4. A type of emotional abuse is:
a. Punching a child
b. Terrorizing a child
c. Sexual contact with a child
d. Failing to provide food for a child
Correct: Terrorizing a child
Rationale: Terrorizing a child is emotional abuse.
5. With regard to PSYCHOLOGICAL effects, child abuse has:
a. Long-term effects only
b. Short-term effects only
c. Both short-term and long-term effects
d. Neither short-term nor long-term effects
Correct: Both short-term and long-term effects
Rationale: Child abuse does both short-term and long-term psychological damage.
6. Of the following, abused children are most likely to feel:
a. Safe
b. Loved
c. Isolated
d. Confident
Correct: Isolated
Rationale: A short-term psychological effect of child abuse is isolation.
7. Consider the behavioral consequence of child abuse. Which statement is correct?
a. Victims of child abuse tend to perform well in school.
b. Victims of child abuse tend to be law-abiding citizens.
c. Victims of child abuse are unlikely to become abusive parents.
d. Victims of child abuse are at increased risk for substance abuse.
Correct: Victims of child abuse are at increased risk for substance abuse
Rationale: One long-term effect of child abuse is increased risk of substance abuse.
8. Which of the following is a risk factor for child abuse?
a. The child is a boy.
b. The child is outgoing.
c. The child is aggressive.
d. The child is over the age of ten.
Correct: The child is aggressive.
Rationale: Aggressive children are at increased risk for abuse.
9. A parent is more likely to abuse a child if:
a.
b.
c.
d.
The parent is married.
The parent is a teenager.
The parent has social supports.
The parent has few children living at home.
Correct: The parent is a teenager.
Rationale: Teen parents are more likely to abuse their children.
10. Choose the true statement about burns as a sign of child abuse
a. All kids have accidents. Burns are never a sign of abuse.
b. Burns can be a sign of abuse. Patterned burns are highly suspicious.
c. Burns are a sign of abuse only if the child says he or she has been abused.
d. Burns are always a sign of abuse and should be reported to your supervisor immediately.
Correct: Burns can be a sign of abuse. Patterned burns are highly suspicious.
Rationale: Burns can be a signs of abuse. Suspect possible abuse if burns form a pattern (e.g., in the shape of an iron or grill).
11. STDs are very likely to be signs of sexual abuse in children before puberty, if the STD did not come from the mother at or around the time of
birth. Which of the following STDs is a CERTAIN sign of sexual abuse?
a. HIV
b. Gonorrhea
c. Genital herpes
d. Bacterial vaginosis
Correct: Gonorrhea
Rationale: Both gonorrhea and syphilis are certain signs of sexual abuse. Other STDs are possible or probably signs.
12. Which of the following behavioral signs is most consistent with sexual abuse?
a. High self-esteem
b. Distorted body image
c. Good grades in school
d. Strong peer relationships
Correct: Distorted body image
Rationale: Sexually abused children may have a distorted body image.
13. A child abuse or neglect assessment has two basic parts. One part is a physical health check of the child. The other part is:
a.
b.
c.
d.
Police investigation of the child's caretakers
A physical health check of the child's siblings
Interviews with the child and his or her caretakers
Taking statements from the child's neighbors, school teachers, etc.
Correct: Interviews with the child and his or her caretakers
Rationale: One part of the child abuse assessment is a physical exam. In addition, the child and his or her caretakers should be interviewed.
14. When physically examining a possible victim of child abuse, a best practice is:
a. Use restraint as needed
b. Do not explain the exam
c. Ask for the child's permission before each step of the exam
d. If sexual abuse is suspected, perform the exam in private without anyone else present
Correct: Ask for the child's permission before each step of the exam
Rationale: During a child abuse assessment, it is very important not to re-traumatize or re-victimize the child. Ask for permission before each step
of the exam.
15. Healthcare providers are in a position to identify many cases of child abuse and neglect. Choose the true statement about REPORTING these
cases of maltreatment:
a. Providers must report all cases of suspected maltreatment to the proper authorities in their state.
b. Providers may use their own judgment in choosing whether or not to report suspected maltreatment.
c. Providers may be sued for reporting suspected maltreatment, even if the report is made in good faith.
d. Providers are not permitted to report suspected maltreatment if reporting would violate patient confidentiality.
Correct: Providers must report all cases of suspected maltreatment to the proper authorities in their state.
Rationale: Healthcare providers are mandated reporters of child abuse and neglect.
FINAL EXAM
1. Beating or burning a child is a form of:
a. Neglect
b. Sexual abuse
c. Physical abuse
d. Emotional abuse
Correct: Physical abuse
Rationale: Beating or burning a child is physical abuse.
2. A parent repeatedly tells a child that she is useless. This is a form of:
a. Neglect
b. Sexual abuse
c. Physical abuse
d. Emotional abuse
Correct: Emotional abuse
Rationale: Degrading a child is emotional abuse.
3. An example of neglect is:
a. Punching a child
b. Terrorizing a child
c. Sexual contact with a child
d. Failing to provide food for a child
Correct: Failing to provide food for a child
Rationale: Failing to provide for a child's basic needs is neglect.
4. Long-term abuse can cause a stress response. This can lead to:
a. Paralysis
b. Blindness
c. Hyperactivity
d. Cerebral palsy
Correct: Hyperactivity
Rationale: Abused children may have problems with hyperactivity due to an overactive stress response.
5. Of the following, abused children are most likely to be:
a. Fearful
b. Content
c. Trusting
d. Unconcerned
Correct: Fearful
Rationale: Fear is a common psychological effect of abuse.
6. Consider the behavioral consequence of child abuse. Which statement is correct?
a. Victims of child abuse tend to perform well in school.
b. Victims of child abuse tend to be law-abiding citizens.
c. Victims of child abuse are unlikely to abuse drugs or alcohol.
d. Victims of child abuse are more likely to become abusive parents.
Correct: Victims of child abuse are more likely to become abusive parents.
Rationale: Victims of child abuse are at increased risk for abusing their own children. This is referred to as the cycle of violence.
7. Which of the following is a risk factor for child abuse?
a. The child is outgoing.
b. The child was born prematurely.
c. The child has a long attention span.
d. The child is the product of a wanted pregnancy.
Correct: The child was born prematurely.
Rationale: Children with birth-related problems (premature birth, birth defects) are at increased risk for abuse.
8. A parent is more likely to abuse a child if:
a. The parent is trusting.
b. The parent is married.
c. The parent is impulsive.
d. The parent is employed.
Correct: The parent is impulsive.
Rationale: Parents with a tendency to be impulsive are at increased risk for abusing their children.
9. Choose the true statement about bruises as a sign of child abuse:
a. All kids get bruises. Bruises are never a sign of abuse.
b. Bruises can be a sign of abuse. Patterned bruises are especially suspicious.
c. Bruises are a sign of abuse only if the child says he or she has been abused.
d. Bruises are always a sign of abuse and should be reported to your supervisor immediately.
Correct: Bruises can be a sign of abuse. Patterned bruises are especially suspicious.
Rationale: All kids get bruises. In some kids, bruises may be a sign of abuse. Suspect abuse if bruises are in the pattern of an item used to beat a
child (e.g., hand, belt buckle).
10. Physical injuries are more likely to be a sign of abuse when:
a. The child has unilateral injuries.
b. The child has injuries in different stages of healing.
c. The child has an injury in an early stage of healing.
d. The child has an injury on a single area of the body.
Correct: The child has injuries in different stages of healing.
Rationale: All kids have accidents and get hurt. However, suspect abuse if a child has many injuries in different stages of healing.
11. STDs are very likely signs of sexual abuse in children before puberty, if the STD did not come from the mother at or around the time of birth.
Which of the following STDs is a CERTAIN sign of sexual abuse?
a. Syphilis
b. Chlamydia
c. Genital herpes
d. Yeast infection
Correct; Syphilis
Rationale: Syphilis and gonorrhea are the two STDs that are certain signs of abuse. Other STDs are possible or probable signs of sexual abuse.
12. Which of the following behavioral signs is most consistent with emotional abuse?
a. Failure to thrive
b. High self-esteem
c. Overachievement
d. Strong trust in adults
Correct; Failure to thrive
Rationale: Emotional abuse of infants can lead to failure to thrive.
13. A possible victim of child abuse is identified. It is critical to perform the physical health check right away:
a. In most cases
b. In cases of emotional abuse
c. If the child is unusually agitated
d. If forensic evidence needs to be collected
Correct: If forensic evidence needs to be collected
Rationale: A physical health check should be performed right away if there is a need to collect forensic evidence of abuse. Otherwise, the health
check may be scheduled for a follow-up visit.
14. When interviewing a possible victim of child abuse, a best practice is:
a. Interview the child with his or her caretakers present
b. Coax the child to answer your questions by offering a reward
c. Explain the reason for the interview in words the child can understand
d. Avoid answering if the child has questions about what will happen to his or her parents
Correct: Explain the reason for the interview in words the child can understand
Rationale: It is important to explain the reasons for the interview. Answer any questions the child might have about the interview or any other
concerns.
15. Photographs can help document evidence of abuse. A best practice for taking photos of injuries is:
a. Use black-and-white film
b. Take a single picture of every major injury
c. Include the victim's face in at least one photo
d. Photograph injuries only after treatment is provided
Correct: Include the victim's face in at least one photo
Rationale: To properly document evidence of abuse in photographs, include the victim's face in at least one photo.
16. A healthcare provider chooses not to report a case of suspected child abuse. Choose the true statement:
a. This is a misdemeanor crime in most states.
b. This is not a crime, but is considered malpractice.
c. The healthcare provider is protected from legal liability by rules of patient confidentiality.
d. The healthcare provider has the right not to report based on his or her own best judgment.
Correct: This is a misdemeanor crime in most states.
Rationale: Healthcare providers are mandated reporters of child abuse. If a provider fails to report, this is a misdemeanor.