Learning Objectives:

1. Abuse Prevention, Mandated Reporter, Confidentiality, Bill of Rights, Code of EthicsIn-service for BVS Behavioral Health Programs

2. Learning Objectives: • Identify types of child abuse • Be aware of Mandated Reporter requirements • Be aware of how to report incidents of suspected abuse, protocol, method and procedures at BVS

3. Learning Objectives (continued) • Identify the physical and behavioral indicators of abuse • Increase awareness of how to handle disclosures of abuse • Review BVS policies • Code of Ethics, • Confidentiality, • Bill of Rights

4. The Purpose of New York State’s Child Protective Laws: • Abused and maltreated children in New York State need an effective child protective service to prevent them from suffering further injury and impairment

5. Abuse Facts: • Nationally, Child abuse is reported - on average - every 10 seconds • In 1998, an estimated 1,100 children died of abuse and neglect - • On average 3 children die from abuse per day • Of these fatalities, more than three-quarters were under the age of five; • 38% were under the age of one.

6. Abuse Facts(continued) • NYS Central Registry receive approximately 1,000 calls per day • Of the substantiated cases of abuse, • 45% were for neglect • 25% for physical Abuse, • 16 % for sexual abuse, and • 14 % were for other forms of maltreatment

7. Abuse Facts(continued) • Young children are most at risk for being abused and neglected. • Infants represent the largest proportion of victims; almost 40 percent of the victims are under age 6. • Both child maltreatment and domestic violence occur in an estimated 30 to 60 percent of families where there is some form of family violence.

8. Example from Social Services • A 12 year old girl comes to school with two bruises. One is on the upper left arm and one is on the lower area of her neck. She states that her mother was upset yesterday and threw her against the refrigerator. • Is this a reportable incident of physical abuse? • Yes • No

9. An “Abused Child” is One Who: • Is less than 18 years of age • Whose parents or other person legally responsible for the child’s care: • Inflicts or allows to be inflicted on the child serious physical injury by other than accidental means; • Creates or allows to be created a substantial risk of such injury; • Commits or allows to be committed a sex offense against such child (e.g. incest)

10. Example from Social Services • A school principal calls the State Central Registry and reports that a 10-year told him that he does not get enough to eat at home. The child appears pale and eats excessively at the school lunch program. • Is this a reportable incident of neglect and / or maltreatment? • Yes • No

11. A Neglected Child is One Who • Is less than 18 years of age • Whose physical, mental, or emotional condition has been impaired or is in danger of becoming impaired due to parents’ failure to provide • adequate food, clothing, shelter, medical care or education; • failure to provide proper supervision or guardianship; • Infliction of excessive corporal punishment; or • Abandonment of child.

12. Example from Social Services • A young boy has missed 34 of a possible 95 days of school. He has submitted excuses for 10 of his absences. The school has attempted to contact the parents but they have not responded to the contacts. • Is this a reportable incident of possible neglect? • Yes • No

13. In New York State, an abused child can also mean: • A child residing in a group residential care facility under the jurisdiction of the Office of Children and Family Services (OCFS), Office of Mental Health (OMH), Office of Mental Retardation and Developmental Disabilities (OMRDD), or the State Education Department (SED) • A child with a handicapping condition who is 18 years or older who is defined as an abused child in residential care and who is in residential care in one of the following facilities: a private residential school which has been designed for special education, a special act school district or a state supported school for the deaf or blind which has a residential component, etc.

14. A Maltreated Child: • A Maltreated Child includes a child: • Less than eighteen years of age defined as a neglected child by the Family Court Act • Who has had serious injury inflicted upon him/her by other than accidental means. • Is eighteen years of age or older, is neglected and resides in one of the special residential care institutions previously listed

15. Example from Social Services • A grandmother calls the State Central Registry and states that her daughter-in-law treats her 8-year grandson terribly. • She states that her daughter-in-law verbally abuses the child by calling him filthy names and makes him cry. • Reportable Situations? • Yes • No

16. Example from Social Services • A five-year old boy, is continually brought to the school nurse for an advanced case of head lice. • Is this a reportable incident of possible neglect and maltreatment? • Yes • No

17. “Person legally responsible” • “Person legally responsible” includes the child’s custodian, guardian, or any other person responsible for the child’s care at the relevant time. • Custodian may include any person continually or at regular intervals found in the same household as the child when the conduct of such persons causes or contributes to the abuse or neglect of the child. • A Legal Caregiver or person legally responsible is a: • Guardian • Foster parent • Custodian • Any other person responsible for the child’s care at the relevant time.

18. Sexual Abuse: • The sexual offender in the vast majority of cases is known to the family • 77 percent of sexual abuse victims were girls and 23 percent were boys. • Long range effects: • One study indicated that children who were sexually abused were 28 times more likely than a control group of non-abused children to be arrested for prostitution as an adult

19. Example from Social Services • A mother brings her four-year daughter to the emergency room because of a vaginal discharge. • The child is diagnosed to have gonorrhea. • Is this a reportable incident of sexual abuse? • Yes • No

20. Who Should Report Abuse and Maltreatment? • Any person who has reasonable cause to suspect a child is abused or maltreated should report this information • A special telephone number has been assigned to handle calls from Mandated Reporters (1-800-635-1522).

21. New York State Social Services Law, Section 414 and 413 New York State Social Services Law requires mandatory reporting by designated professional officials. Mandated Reporters make up about 60% of all the calls received by the New State Central Registry

22. Mental Health Professionals School Officials Social Service Workers, Law Enforcement Officials Medical Examiners Registered Nurses, Child care or foster care worker Physicians Hospital personnel Surgeons Teachers The following persons are required to report situations of suspected Child Abuse and Maltreatment (under NYS law)

23. Reporting Requirements • All BVS employees are responsible to directly report to the Statewide Central Register of Child Abuse and Maltreatment (SCR) and then their supervisor any incident, or action, or reasonable suspicion which might constitute physical, emotional abuse, sexual abuse, drug abuse or improper supervision and neglect by another staff member (from Baker Victory Services or an outside agency), the client’s legal guardian or any person legally responsible for care of the client.

24. Reporting of Abuse Allegations • “Reporting any incidents” includes any incidents you become aware of through: • direct observation; • discussion with other staff or family members; • from the client themselves; or • any other person who appears before you in your professional capacity.

25. Mandated Reporters are required, under the penalty of Class-A misdemeanor to report any suspected cases of physical abuse, sexual abuse, drug abuse or improper supervision and neglect. Possible personal liability under the provisions of Social Services Law (may also be civilly liable for the damages caused by failure to report). Failure to report incidents of abuse may result in disciplinary actions against the employee and or personal liability under the provisions of the Social Services Law 413. The length of time that has passed since the incident occurred does not relieve you of responsibility to notify the SCR and a supervisor as soon as the incident comes to your attention. What happens if Mandated Reporters do not report suspected abuse?

26. The “good faith”of any person required to report shall be presumed. Any person or institution making a report of suspected child abuse in “good faith” has immunity from civil or criminal liability which might otherwise be incurred (Social Service Law, Section 419) BVS will not take any retaliatory personnel action (discharge, suspend, demote or invoke any other adverse employment action) against any employee for making a report to the SCR In addition the agency does not place any other conditions, need for prior approval or prior notification on Mandated Reporters related to calling in reports to the SCR. Can a Person Incur Liability by Reporting Suspected Abuse?

27. The mandated reporter’s report to the SCR (1-800-635-1522) must include (to the best of his / her knowledge) the name, title and contact information for every staff person believed to have direct knowledge regarding the allegations in the report. The mandated reporter should not delay in making the call to the SCR in order to attempt to determine a complete list of all staff members who also have direct information about the alleged abuse or maltreatment. Making reports to the State Central Registry (SCR)

28. Making reports to the State Central Registry (SCR) • If you are informed that another mandated reporter has appropriately reported the specific incident to the SCR you are not required to make a separate report. • However, it can not be assumed that another mandated reporter has reported the incident. • All staff who are aware of an incident must notify a supervisor. • The mandated reporter who makes the call to the SCR must advise other mandated reporters that a call was made and whether the call was accepted or not accepted.

29. Making reports to the State Central Registry (SCR) • If the call was accepted, the staff who made the call will have the SCR number. • If you are informed that the call was not accepted and you believe there remains reasonable cause that abuse or maltreatment occurred, or you have additional information, you must call the SCR yourself and attempt to make a report. • (Mandated reporters must not compare or discuss the specifics of the incident with the intent or purpose of falsifying, conspiring or colluding the preparing any report of the alleged abuse or maltreatment).

30. Notifications • For the OMH & OMRDD programs, the Commission on Quality of Care will also be contacted. • At the onset of the allegation, the following administrative people need to be notified: • Department Head, • Division Administrator, • Division Vice President, and • Director of Human Resources when an employee is cited in the allegation of abuse.

31. Notifications Cont. • In any incident of suspected abuse / neglect, the client's parents / guardians must be notified. • Baker Victory Services will notify all the appropriate Governing agencies within the required time frames. • All allegations of abuse / neglect should be written up a on a Significant Incident Report.

32. Health and safety of client • Health and safety of the client is paramount and must be assured. • In any case of suspected abuse, medical follow up must be sought immediately. • In all cases, the health and safety of the client is extremely important.

33. It is the policy of BVS to investigate all allegations of abuse / neglect involving any client receiving our services, immediately, if possible. Staff will report the allegation to the SCR and their supervisor immediately, if the immediate supervisor is unavailable then the employee will continue up the chain of command. In all abuse investigations, staff will make every effort to preserve potential evidence, (i.e. blood stained clothing, torn clothing and photographs), when appropriate. Any staff members alleged to be involved in a suspected case of abuse may be suspended (or separated from contact with the client). This is done for the safety of all parties as the matter is fully looked into. Investigation all allegations

34. Do you have to “Prove” that Abuse Occurred? • The law does not require absolute certainty. • The law does require “reasonable cause” to suspect abuse or maltreatment. • You don’t have to prove that abuse happened; Certainty is not required • But if you suspect abuse, it needs to be reported

35. Timeliness for Reporting • Contact NYS State Central Registry and notify your supervisor when the incident comes to your attention. • The length of time since the incident took place does not relieve mandated reporters of responsibility to report it. • Often times, the report does not originate with our agency or school and can go back some length of time.

36. Supervisors are responsible: • Supervisors are responsible: • For ensuring that appropriate abuse reporting procedures are followed • All medical follow up is conducted as per agency policy, etc.

37. If immediate supervisor is not available • If the immediate supervisor is not available • Continue “up the chain of command” • Namely, reporting of the suspected abuse needs to occur

38. Physical Characteristics of Physical Abuse • Unexplained bruises on face, neck, back, eyes, • “Grab marks” on arms or shoulders • Lacerations to mouth, legs, external genitalia

39. Physical Characteristics of Physical Abuse (continued) • Fractures: • To skull, nose, face • Spiral fractures, • Injuries in various stages of healing • Fractures “accidentally discovered during exam”

40. Physical Characteristics of Physical Abuse (continued) • Head injuries: • Absence of hair • Eye injury • Jaw and nasal fractures • Tooth injury • Subdural hematoma (Hemorrhage beneath the outer covering of the brain) • Retinal hemorrhage due to shaking

41. Behavioral Indicators of Physical Abuse • Wary of contacts with other adults • Reports injury by parents • Low self-esteem • Shows behavioral extremes such as • aggressiveness or • withdrawal or • extreme mood changes

42. Behavioral Indicators of Physical Abuse(continued) • Displays Self-injurious behaviors • May wear long sleeves or other concealing clothing to hide physical indicators of abuse (inappropriate to the season) • Suicide attempts

43. Neglect: Physical Indicators • Failure to thrive (physically or emotionally) • Consistent hunger • Consistent lack of supervision, especially in dangerous activities or for long periods • Unattended physical problems or medical needs • Abandonment

44. Neglect: Physical Indicators(continued) • Positive indicator of toxicology, especially in newborns • Poor hygiene (skin, teeth, ears, etc) • Chronic truancy • Inappropriate dress for the season • Lags in physical development

45. Neglect: Behavioral Indicators • Begging, stealing food • Extended stays at school (early arrival or late departure) • Constant fatigue, listlessness or falling asleep in class • Alcohol or drug abuse • Delinquency • Runaway behavior

46. Neglect: Behavioral Indicators(continued) • The child may display overly adaptive behavior: • Inappropriately adult • Inappropriately infant • The child may lag in mental and or emotional development

47. Neglect: Behavioral Indicators(continued) • Attempted suicide • States there is no caretaker • Neurotic traits (sleep disorders, inhibition of play) • Behavior extremes: • Compliant, passive • Aggressive, demanding

48. Sexual Assault of Children • Convicted rape and sexual assault offenders serving time in State prisons report that two-thirds of their victims were under the age of 18. • One of every seven victims of sexual assault reported to law enforcement agencies were under the age of six • 90% of the children knew the offender, according to police-recorded incident data.

49. Sexual Abuse: Physical Indicators • Most sexual abuse cases do not present apparent physical evidence so indicators and identification of sexual abuse is often difficult. • The vast majority of child molesters are family members or friends of the child or his/her family. This makes disclosure difficult for them to report.

50. Sexual Abuse: Physical Indicators(continued) • Difficulty in walking, sitting • Torn, stained, bloody clothing or underwear • Genital pain, itching • Bruises, bleeding in genital, vaginal or anal areas • Sexually transmitted diseases, including venereal oral infections