Tips for health care providers reporting child abuse and neglect

All individuals in Kentucky, regardless of profession, are required by law to report suspected child abuse or neglect. Health care providers, due to their knowledge and expertise, can offer investigators a wealth of information and insight into children’s medical conditions and injuries.

Making reports to investigators clearly, effectively and without delay can significantly alter the course of an investigation and may allow a maltreated child or children to be protected more quickly. To make a report, a “reasonable suspicion” is needed, so providers should not wait until they know for sure that maltreatment is occurring.

Sometimes coming to a final medical impression can take time, while a prompt report can allow for protection sooner.

There’s a benefit to giving your name

Anyone reporting suspected child maltreatment can remain anonymous. But as a health care provider, your observations and impressions “have a lot to offer in terms of the investigation,” so it’s especially helpful to give your contact information, said Jennifer C. Green, M.D., child abuse pediatrician with Norton Children’s Pediatric Protection Specialists, affiliated with the UofL School of Medicine, during a recent continuing medical education opportunity.

Communicating to investigators

Health care providers sometimes have their own language, jargon and shorthand references. Communicating concerns to Child Protective Services (CPS) and law enforcement investigators in nonmedical terms will help to make a report more effective. If medical terminology is necessary to make the report, give medical terms but then explain them as you might for a patient.

Sample phrasing:

“I am making a report due to concern for (general type of abuse or neglect) regarding (child’s name and age). The concern arose when (briefly how it came to your attention and what you observed).”

It’s important to state clearly the exact concern for abuse or neglect at the start.

“From the medical world, the language we use is very different. We have to use different language and verbal cues to be able to convey information to investigators,” Dr. Green said.

Provide details and, if making a telephone report due to urgency, prepare a list of the details before calling, as it is easy to forget information that can trigger an escalation in the case’s status.

Include the following information:

• History provided by the child or parent. A verbatim account is preferred.
• List of all injuries, where they are, color and sizes, if applicable.
• Any physical symptoms, such as vomiting, not eating, exceptionally fussy.
• Any past findings or disclosures from previous contact with the child or family that may be related to the concerns of suspected maltreatment.
• In cases of possible nutritional neglect, include height and weight percentiles and any available past growth data; also explain what these percentiles mean. List any diagnoses you were able to exclude that assisted in your suspicion of possible nutritional neglect.
• Regarding medical neglect, list present medical disorders, known prescribed medications and any missed or attended follow-up appointments.
• What actions you took (e.g., after you saw possible evidence of abuse or neglect, what did you do?):
  • Responses the child and/or adult gave to any of your questions
  • Any labs or imaging you ordered
  • Whether you consulted any medical subspecialists, including Norton Children’s Pediatric Protection Specialists
• Make the CPS report to the state where the child permanently or primarily lives to prevent the risk of a delay in starting the investigation.
• Include your direct observations of caregivers. Do not try to interpret the behavior — just say what they did and said.
• If the case was a near-fatality, say so with that language. Norton Children’s Pediatric Protection Specialists can help make this determination.