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Standards of Care

Domestic Violence Standard of Care
Child Abuse/Neglect Standard of Care
Elder Abuse/Neglect Standard of Care

Child Abuse/Neglect Standard of Care

Introduction
Child abuse and neglect are frightening, traumatic events for their victims and for their families. Each  state has clearly defined statutes and regulations governing the reporting and management of abused and neglected children. Clinicians need to provide safe and private time for examination and interview of  the child and the responsible adults.

Identifying Child Abuse
The spectrum of child abuse includes inflicted injuries resulting in bruises, welts, cuts, burns, fractures,  poisoning, drugging, etc. Sexual abuse is the subjection of a child by a person responsible for the child’s  care, by a person who has a significant relationship to the child, or by a person in a position of authority, to any act regarding criminal sexual conduct, prostitution or solicitation, or child pornography. Sexual  abuse includes threatened sexual abuse. Neglect of children may involve nutritional deprivation, withholding of appropriate medical care, abandonment, lack of supervision, lack of provision of  appropriate shelter, and significant inattention to normal childhood emotional or developmental needs.

Indicators
1. Family Indicators

  • Domestic Violence
  • Physical or mental health problems
  • Alcohol and substance abuse
  • Isolation
  • Delay or failure in seeking medical attention
  • Homelessness
  • Prior history of abuse
     

2. Physical Abuse/Behavioral Indicators

  • Unexplained bruises, welts and/or bite marks
  • Unexplained burns
  • Unexplained fractures or dislocations
  • Unexplained lacerations or abrasions
  • Afraid to go home
  • Will not cry when approached by examiner
  • Indiscriminately seeks attention
  • Reports injury by parent(s) and/or caretaker(s)
     

3. Physical Neglect/Behavioral Indicators

  • Underweight, poor growth patterns, failure to thrive
  • Consistent lack of supervision
  • Abandonment
  • Alcohol of drug abuse
  • Aggressive behavior, delinquency
  • Depression/Regression
  • Significant decline in school performance
  • Domestic Violence Observed by the Child
     

4. Sexual Abuse/Behavioral Indicators

  • Difficulty walking or sitting
  • Torn, stained or bloody underclothing
  • Pain, swelling or itching in genital area
  • Bruises, bleeding or laceration in external genitalia, vaginal or anal areas
  • Venereal disease
  • Pregnancy
  • Hypersexual behavior, reports of sexual acts on other children
  • Prostitution
  • Suicide attempts or self-injurious behaviors
  • Running away
     

Direct Questioning
Specific, clear and non-judgmental questions can be asked in a confidential setting. The child and the caretaker(s) must be interviewed separately.

Procedure

  1. Any suspicion of abuse or neglect should be communicated to appropriate personnel.
  2. The child should be medically examined by appropriate clinicians.
    If abuse is revealed or suspected, the situation is referred to a social worker.
  3. The social worker
     

Assesses the situation (interviewing the child and caretaker(s) separately). Provides counseling. Reports the situation to appropriate city, county and/or state authority. Ensures the child’s safety and  arranges for alternative living arrangements, if indicated. Assesses the safety of other children in the home and ensures a safe plan for them. Ensures follow up coordinated care for the children and caretaker(s).

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