California Mandated Reporter Training for Addiction counselors

1. California Mandated Reporter Training forAddiction counselors

3. Introduction • Child Maltreatment 2009* • Most recent report of data from the National Child Abuse and Neglect Data System (NCANDS) • Approximately 3.6 million reports of suspected abuse or neglect • 20% were substantiated, meaning approximately 720,000 children were found to be victims of child abuse or neglect in 2009 * US Dept of Health &Human Services

4. Introduction • California passed it’s first child abuse reporting law in 1963 • Stated that physicians must report physical abuse of children • CANRA was passed in 1974 in California • Child Abuse Neglect and Reporting Act • Has been amended over the years • Expanded list of who is mandated to report • Thanks to CAADE & CAADAC, addiction counselors on the list since 2009

5. Who are Mandated Reporters? • Complete list includes 38 categories, refer to penal code 11165.7 • Generally includes anyone who works or comes into contact with children in their job • Does not include volunteers • Can report, but not mandated

6. What must be reported? • Under CANRA, suspicions of the following must be reported in California • Physical abuse (only 19% of abuse cases) • Sexual abuse • Emotional abuse • Neglect • When the victim is under the age of 18, and the perpetrator is any age

7. Identifying Child Abuse • Requires first the understanding that child abuse can occur in any family, regardless of socio-economic status, religion, education, ethnic background, or other factors. • Cultural beliefs may affect our perception of this • Secondly, the professional must be aware of and alert to the signs of child abuse.

8. Culture • Aset of beliefs, attitudes, values, and behavior that is passed down from generation to generation • Shaped by many factors including race, religion, and ethnicity • Influences attitudes and ideas about acceptable child behavior and discipline • Also affects perceptions of stress, trauma, abuse and reactions to all of those

9. Cultural Sensitivity • It is natural to see one’s own culture as the normal or correct culture • We must be aware of our own values, beliefs and biases, and how those influence our expectations of others so that we • are best able to understand differences in parenting • avoid unnecessary reports • meet the needs of all children in a sensitive manner

10. What to Report - Physical Abuse • CANRA defines as a physical injury inflicted by other than accidental means on a child • Also includes unlawful corporal punishment or injury, willfully inflicted, resulting in a traumatic condition • Spanking or corporal punishment is not necessarily illegal, it should be “reasonable and age-appropriate”

11. Physical Abuse • A physical injury or action of harming a child • Bruises, bites, burns, fractures, abusive head trauma • Although the injury is not an accident, the parent or caretaker may not have intended to hurt the child • May result from excessive discipline or inappropriate physical punishment • The injury may be the result of a single episode or of repeated episodes and can range in severity from minor bruising to death

12. Physical Abuse • Type, location, and pattern of skin injuries may help distinguish accidental injuries from suspected physical abuse • However, any injury, even a small bruisein a very young infant is concerning • Young infants are not mobile • Completely dependent on their caregivers • Any injury in this age group should raise concern for the possibility of inflicted injury

13. Child Motor Development • Developmental abilities of a child should be considered when evaluating injuries • If a child is unable to roll over or crawl, they are unlikely to have sustained an injury on their own

14. Physical Abuse • Once children are toddlers, and capable of crawling or walking, bruises are very common • Location and pattern of the injury needs to be considered • Common locations for accidental bruises in toddlers and children include bony areas such as shins, elbows, knees, forehead, and chin, among others • Common locations of abusive injuries include the back, buttocks, ears, face (particularly the soft tissues of the cheek), neck, and genitalia

15. Location of Bruises ***This is not a complete list or a perfect rule, it is a guide

16. Physical Abuse • Abusive bruises and burns may also be patterned, or have a distinct outline • Accidental bruises usually do not leave a clear pattern or outline • While an outline or pattern should raise concern, abusive injuries are not always patterned, and may look very similar to accidental bruises • Some common patterns of INFLICTED bruises are shown next

23. Bruises

24. Abnormal Bruising Patterns

25. Abdominal Trauma

26. Massive Bruising

27. Broken Teeth

28. Mouth Trauma

29. Scald Burns

30. Eye Trauma

31. Retinal Hemorrhage

32. Young victim of Domestic Violence

33. Hand slaps on 1 month old

36. Beating from hair brush

37. Pattern of bruises on the jaw line.

38. Obvious bite mark, probably inflicted by an adult

41. Fading bite mark: same child

42. Shaken Baby Syndrome(Abusive Head Trauma)

43. Mechanism of Injury • Repeated shakes ? 3-4 • Can kill in 1-2- seconds! • To lay observer, force used obviously harmful to the child • Similar to fall from major height • NOT playful tossing /bouncing

44. Patterns of infant shaking based on characteristics and distributions of injuries and descriptions by assailants

45. Effect of severe shaking on brain movement

46. Acute subdural ematoma

47. ABUSIVE HEAD TRAUMA: IMPACT INJURY

48. A few of the fatalities from 2002

49. Perpetrators • Father 44% • Boyfriend 23% • Mother 9% • Babysitter 8% • Stepfather 2% • Other relatives 2%

50. Mongolian Spots