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NEW
Brownsville Community Health Center
REVISED
2137 E. 22nd Street, Brownsville, TX 78521
POLICY & PROCEDURE STATEMENT
X
SUPERCEDES
DATED
ISSUED BY
David Gerard Gaytan,
Social Services Supervisor
APPROVED BY
Emily Alpert
Operations Director
Paula S. Gomez,
Executive Director
APPROVED BY
EFFECTIVE DATE
December 15, 2003
Henry Imperial, M.D.
Medical Director
Revised: February 15, 2010
SUBJECT: Child Abuse Screening, Documenting and Reporting: Compliance With Rider 23
POLICY: Brownsville Community Health Center, Campus Care Centers and its affiliated medical sites shall
adopt the DSHS Child Abuse Screening, Documenting, and Reporting Policy for Contractors/Providers and will
comply with all provisions of the TDSHS policy. Employees of BCHC will report any occurrence to the proper
authorities.
PROCEDURE:
Training: All new staff and providers will receive training regarding child abuse recognition and reporting policies
and procedures. Staff must be informed during training that the staff person who conducts the screening or has
cause to suspect that abuse has occurred is legally responsible for reporting. A joint report may be made with the
Supervisor or member of the Social Services staff.
On an annual basis, clinic staff will be provided training regarding child abuse screening, documentation
requirements, and reporting requirements. All training provided for both new employees and regular employees
will be documented in the Human Resources office with the General Staff sign in sheet and the New Employee’s
Orientation sign in sheet. The Child Abuse Policy and Procedure must be reviewed and/or updated annually by the
Social Services Supervisor.
Adult Abuse: All disclosures of abuse, neglect, or exploitation of adults must be thoroughly documented in the
medical record. A report must be made to the police and/or Adult Protective Services.
Child Abuse: Each staff person will comply with the provisions of state laws as set forth in chapter 261 of the
Texas Family Code relating to investigations or reports of child abuse and neglect. The reporting process for
minors under the age of 14 and those age14, but under the age of 17 will be clearly defined during training and in
the BCHC internal policy.
Child abuse is defined as “mental and/or emotional injury to a child and /or physical injury that result in substantial
harm to the child or the genuine threat of substantial harm from physical injury to the child.” This is a type of
family/interpersonal violence. Sexual abuse is another type of child abuse and is defined as:
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Sexual conduct harmful to the child’s mental, emotional or physical welfare.
Failure to make a reasonable effort to prevent sexual conduct harmful to a child.
Compelling or encouraging a child to engage in sexual conduct.
Any client younger than 17 years of age who has sexual relations with a person more than three years older than
they are.
Sexual activity in which a person of any age uses duress, force, or threat.
The Texas Family Code, Chapter 261, requires other reporting of other instances of sexual abuse. Other types of
reportable abuse may include, but are not limited to, the actions described in:
1.
2.
3.
4.
5.
Penal Code 21.11 relating to indecency with a child;
Penal Code 21.01 (2) defining “sexual contact”;
Penal Code, 43.01 (1) or (3) – (5)
Penal Code, 22.01(a)(2) relating to sexual assault of a child; or
Penal Code, 22.021 relating to aggravated sexual assault of a child.
RECOGNITION
1. An assessment of abuse must be made each time a minor has a health care appointment.
2. Consider the possibility of child abuse if any of the following are observed in a client under the age of
eighteen:
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Lacerations and /or bruises observed
Extent or type of injury not consistent with the client’s explanation
Signs and symptoms of drug and/or alcohol abuse
Early age at first intercourse (13)
First sex not wanted
Extreme anxiety with pelvic exam
Repeated vaginal infections and/or sexually transmitted diseases (STDs)
Severe dysmenorrhea and pelvic pain
Pregnancy at a young age
3. If abuse is suspected in a minor patient under the age of 17, the patient must be screened using the Child
Abuse Reporting form at the initial visit and all subsequent visits, if warranted. The completed form must
be placed in the client’s medical record. Staff must document on the form whether a report to Child
Protective Services was made or not made, reason for reporting or not reporting and the case
number if a report was made.
a. The original reporting form must be retained in the client’s record.
b. A copy of the form should also be kept in the Department where the report was made (i.e. Pediatrics,
Women’s Center, CCC or Adult Medicine).
c. A copy must be submitted to the Social Services Supervisor immediately for compliance purposes.
EXAMINATION
1. If abuse was disclosed or is suspected, family members or friends will be firmly excluded from the
exam room so as not to inhibit honesty.
2. It is important to give clients who have experienced abuse more time than may be allocated for other
clients, especially if that abuse was sexual.
3. While in the exam room, clients will be observed for any of the following indications:
 Extreme anxiety reaction or overly compliant behavior during pelvic exam
 Refusal or extreme hesitation to undress
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 Poor hygiene or excessive bathing
 Pain, swelling, itching, lacerations, bruises in genital area
 Unexplained burns, abrasions, or welts
 Difficulty in walking or sitting
4. All observations that support the disclosure or suspicions of client abuse will be documented.
TREATMENT
1. Any medical condition will be treated as indicated.
2. An assessment will be made as to the immediate safety of the client.
3. The most important message to be delivered to the victim of child abuse is that what occurred is not
his/her fault. Many survivors of abuse believe they are responsible for what has happened to them
and do not realize that what has occurred maybe a crime punishable by law.
4. Furnish the client with appropriate referrals for further services as needed and document them.
WHAT TO REPORT: (A report must be made again regardless if staff thinks or knows that a report was
previously made by another provider or organization.
1. All cases of physical abuse or neglect to persons under the age of 18. This includes seeing marks or bruises
on the client, if the patient volunteers information, or anytime staff suspects abuse is occurring. There is no
limit as to how long ago the reported abuse occurred.
2. All cases of minor sexual abuse where the client experienced or is currently experiencing duress, force,
coercion or threats to engage in sexual contact or intercourse.
3. All clients age 16 and under who are having sexual relations with a person more that three years older than
the client.
4. All clients age 14, 15, and 16 who are having sexual relations with a person of the same sex. (under Texas
law, there is no affirmative defense for same-sex couples. See explanation of Affirmative Defense that
follows.)
5. All clients 13 years old and younger who are pregnant or have a confirmed STD acquired in a manner other
than through perinatal transmission or transfusion. (There is no affirmative defense for abuse of a minor
under the age of 14.)
6. All clients age 13 and under who state that they are sexually active. This includes sexual contact and sexual
intercourse. (There is no affirmative defense for abuse of a minor under the age of 14.)
7. The circumstances listed below depend on age and situation. If the minor is 13-years old and under, a
report must be made. If the minor is 14, 15, or 16-years old, a report does not need to be made if all of the
criteria under the affirmative defense clause are true. (See Affirmative Defense Section for criteria.)
 Minor clients age 14, 15, and 16 who are engaging in sexual activity that do not have acceptable
affirmative defense. (See Affirmative Defense criteria that follows.)
 Minor clients who are postpartum, pregnant, or have a child.
 Minor clients who request a pregnancy test.
Affirmative Defense – According to Texas law, a minor who is under the age of 17 cannot legally consent to
engage in sexual conduct. However, Texas has an “affirmative defense to prosecution” clause which may consider
the act (sexual conduct) not a criminal offense if all of the criteria listed below applies. If all of the criteria are true,
then staff does not have to make a report. Affirmative defense can only apply to partners of clients who are 14, 15,
and 16-year old minors. There is no affirmative defense for minors age 13 and under. All minors 13-years old
and under who engage in sexual activity must be reported to authorities.
To reiterate: the affirmative defense applies for minors age 14, 15, and 16 only.
If all of the following criteria are true, then a report does not need to be made:
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The partner is not more than three years older than the client,
The clients is 14 years of age or older at the time of the sexual conduct,
The partner is of the opposite sex, and
The partner did not use duress, force or a threat against the victim at the time of the offense.
Exceptions to Reporting – the following minors are not subject to reporting according to the Texas Family code
261.101:
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Married minors – If the partner is the spouse of the married minor, the minor is not considered to be a child
for purposes of reporting abuse by the spouse. Staff may request documentation of marriage or may choose
to rely on the minor’s statement regarding marital status. Staff must document the reason for not reporting
on the Child Abuse Screening form. Any suspected abuse must still be reported to law enforcement as a
criminal matter. A married minor who is the subject of a report of sexual contact with a person who is not
her or his spouse must also be reported.
Emancipated Minors – Under state law, a 16-year old who has a court order for emancipation of a minor for
general or all purposes makes the person an adult for legal purposes. Based on review of the order itself
and/or a statement from the minor, no report of child abuse should be made. If staff believe the order of
emancipation is for limited purposes, based on review of the court order and/or a statement from the minor,
a report of child abuse should be made if supported by the facts.
WHERE TO REPORT:
Brownsville Community Health Center staff must report any occurrence of abuse or suspected abuse to the Texas
Department of Family and Protective Services (DFPS) or to local law enforcement. Staff will request a case
number and must document it on the Child Abuse Screening form.
DFPS – Staff will report all physical abuse, sexual abuse, indecency with a child, or neglect that is occurring to
DFPS. Reports to DFPS can be made by:
1. Calling the Texas Abuse Hotline at 1-800-252-5400 operated 24 hours a day, 7 seven days a week.
2. Faxing a report to DFPS fax at 1-800-647-7410.
3. Going online to https://www.txabusehotline.org/Default.aspx. (print a copy of the reporting confirmation
number and a copy of the email that contains the reporting identification number. Place both copies and the
Child Abuse Screening form in the medical record and document both numbers on the Child Abuse
Screening form.)
Local Law Enforcement – Staff will report all physical abuse, sexual abuse, indecency with a child or neglect to the
local law enforcement agency.
TIMEFRAMES FOR REPORTING
Licensed staff must report no later than the 48th hour after the hour the professional first has cause to believe the
child has been or is currently being abused. Non-licensed staff must immediately make a report after they have
cause to believe that the child’s physical or mental health or welfare has been adversely affected by abuse.
CONTENT OF THE REPORT
The law requires that the following be reported:
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Name and address of the minor, if known;
The name and address of the parent or person responsible for the care, custody, or welfare of the minor; and
Any other pertinent information concerning the alleged or suspected abuse or neglect.
If a provider does not routinely collect other kinds of information that DFPS or local law enforcement may
request, the provider is not required by law or DFPS policy to ask the client for that information. Additional
information included in the report, however can be helpful in investigating the situation.
CONFIDENTIALITY
HIV/AIDS – Staff may not reveal whether or not the child has been tested or diagnosed with HIV or AIDS,
unless the child is 13-years old or younger and such test result or diagnosis is relevant to the report of abuse. If
the identity of the minor is unknown (e.g., the minor is at a provider’s office to anonymously receive testing for
HIV or an STD) no report is required. B261.001 Family code states that reporting requirements apply
regardless of professional confidentiality and licensing laws and rules for professionals. It is not a breach of
confidentiality to report child abuse.
Informing Minors – Minors must be informed that Texas law requires BCHC to report suspected incidents of
abuse and be told of any limits of confidentiality prior to being asked about abuse or intimate partner violence
or giving the minor a self-administered assessment form. Minors must also be told that such a report will not
affect their eligibility for services.
Minors are also informed regarding the information listed above by an attached “NOTICE” on all clipboards
that clients use to fill out paperwork (“Notice” is located at the end of this policy).
261.109 FAILURE TO REPORT: PENALTY
a. A person commits an offense if the person has cause to believe that a child’s physical, or mental health or
welfare has been or may be adversely affected by abuse or neglect and knowingly fails to report it.
b. An offense under this section is a Class B misdemeanor.
MONITORING
A reporting of abuse audit will be performed semiannually by the clinical Sections of the Performance
Improvement Committee to ensure compliance with child abuse reporting requirements. Random charts will be
pulled and reviewed. The review of medical records will involve the following:
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A report was made if required;
Documentation of reasons that a report was made or not made are present;
Timeframes for reporting were met; and
Consent form advising a minor of a break of confidentiality is present.