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This course is approved by Pennsylvania Department of Human Services and the Pennsylvania Department of State, Bureau of Professional and Occupational Affairs. It fulfills the 2-unit renewal requirement for training in child abuse recognition and reporting for mandated reporters under Act 31. PA CE Provider #CACE000044; Program #CAPR000042; CE Course #ATE10002.
Course completions are reported to the PA Department of State within 24 hours.
This course is for healthcare providers and other professionals in Pennsylvania who are mandated to report suspected child abuse. It begins with historical information about child abuse recognition in the United States and continues with a description of child welfare and child protective services in Pennsylvania. Child abuse is defined, along with its components and categories. New regulations related to human trafficking are included. The reporting process is described, as well as responsibilities of mandated reporters, permissive reporters, reasonable cause, and penalties for failing to report. The course describes indicators of child abuse. It concludes with information about the prevention of child abuse.
ATrain Education, Inc. is an approved provider by the American Occupational Therapy Association. The following course information applies to occupational therapy professionals:
Accredited status does not imply endorsement by ATrain Education Inc. or by the American Nurses Credentialing Center or any other accrediting agency of any products discussed or displayed in this course. The planners and authors of this course have declared no conflict of interest and all information is provided fairly and without bias.
No commercial support was received for this activity.
This course will be reviewed every two years. It will be updated or discontinued on April 1, 2020.
Criteria for Successful Completions
80% or higher on the post test, a completed evaluation form, and payment where required. No partial credit will be awarded.
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This course is accepted by the Georgia State Board of Physical Therapy.
Approved by Pennsylvania Department of Human Services and the Pennsylvania Department of State, Bureau of Professional and Occupational Affairs. PA CE Provider #CACE00044; Program #CAPR000042; CE Course #ATE10002.
When you finish this course you will be able to:
Child abuse and neglect is not a new phenomenon-it has been documented for more than two thousand years. For most of human history children had no rights in the eyes of the law and it was unthinkable that the law would intervene in the domain of the family.
In the 1950s and early 1960s, articles published by several pediatricians drew attention to the occurrence of fractures and brain injuries in children at the hands of caretakers. In 1961 C. Henry Kempe, a physician and president of the American Academy of Pediatrics, convened a conference on "the battered child syndrome," in which he argued that doctors had a "duty" to the child to prevent "repetition of trauma." The Battered Child Syndrome Conference resulted in many states’ passing laws to protect children from physical abuse. By 1967 all 50 states had succeeded in passing mandatory child abuse reporting laws.
Child abuse is now recognized as a problem of epidemic proportions, with serious consequences that can cause indelible pain throughout the victim’s lifetime. Unfortunately, violent and negligent parents and caretakers serve as a model for children as they grow up. The child victims of today, without protection and treatment, may become the child abusers of tomorrow.
Protecting Pennsylvania’s children from abuse and neglect is a shared responsibility. It requires collaboration from the formal child protective services system, community partners, and our citizens to provide local safety nets for children and families who are facing challenges within our communities and neighborhoods.
Bev Mackereth, Formerly of
Pennsylvania Department of Human Services
In 2011 the Pennsylvania General Assembly created the Task Force on Child Protection, the job of which was to conduct a "comprehensive review of the laws and procedures relating to the reporting of child abuse and the protection of the health and safety of children" (KKSP, 2015). More than 20 pieces of legislation were enacted by the Pennsylvania General Assembly as a result.
The new laws, which took effect on December 31, 2014, affect all aspects of child abuse and neglect cases, including reports, investigations, assessments, prosecutions, and related judicial proceedings. Definitions for perpetrator and mandatory reporter have been updated and expanded, a streamlined reporting process has been implemented, and rules for mandatory reporting have been clarified. Revisions to the definition of child abuse and clarification of reporting requirements are seen as the most fundamental and substantive changes.
The new processes are intended to make reporter rules and responsibilities clearer, while the legislation that enabled use of a single shared database has facilitated development of the Child Welfare Information Solution (CWIS), which has sped up the processes for both reporting child abuse and obtaining clearance verifications by those who work with children (KKSP, 2015; Mason, 2015).
The CWIS, launched in January 2015, is a case management system that allows real-time electronic sharing of state and county information critical to administering the commonwealth’s child welfare program (KKSP, 2015a). ChildLine is the portal for new reports of suspected child abuse by mandated reporters.
The Pennsylvania Child Protective Services Law (CPSL) encourages more complete reporting of suspected child abuse. It involves law enforcement agencies in responding to child abuse and establishes protective services in each county for the purpose of:
Chapter 63 Child Protective Services Law
Title 23, Domestic Relations, Chapter 63 of the Laws of Pennsylvania is the Child Protective Services Law (CPSL). It provides critical definitions, provisions, and responsibilities for reporting abuse, the powers and duties of the Department of Human Services, the organization and responsibilities of child protective services, and certain miscellaneous provisions (PGA, 2016).
Title 55 Public Welfare, Chapter 3490
Title 55 Public Welfare, Chapter 3490 is currently under review.
Child protective services are those services and activities provided by the department and each county agency for child abuse cases (PGA, 2016). ChildLine receives all reports of child abuse (calls and electronically) and forwards those appropriate to the respective county children and youth agency for investigation and outcome. They intervene when children are abused or neglected and provide services and activities to children and their families (PGA, 2016). When a child remains in or returns to the home in which the neglect or abuse has occurred, CPS arranges for regular (weekly) visits to assess the situation. Each county is required to provide child protective services to its residents.
General protective services are those services and activities provided for non-abuse cases where intervention and support may help to avoid future abuse. Each county agency is responsible for administering a program of general protective services to children and youth. Services begin with a report or referral or when a parent or a person responsible for a child’s welfare requests assistance (PGA, 2016).
General protective services include education in parenting skills; counseling; emergency caretaker services, shelter care, and medical services; part-day services and out-of-home placement services. Therapeutic activities are also available for the child and family directed at alleviating conditions that present a risk to the safety and well-being of a child (PGA, 2016).
23 Pa.C.S. §6303 (a) General protective services
Those services and activities provided by each county agency for cases requiring protective services, as defined by the department in regulations.
General protective services are supports and services provided when protective services are required in non-abuse cases.
55 PA. CODE § 3490.223. General protective services—Services to prevent the potential for harm to a child who meets one of the following conditions:
The Juvenile Act
The first juvenile court act dealing with the treatment of youth who commit criminal acts was established in Pennsylvania in 1901. It has been amended many times in the intervening years, with significant revisions in 1995 (JSGC, 2015), at which time the Act was amended and the mission of Pennsylvania’s juvenile justice system was redefined to include the goals of Balanced and Restorative Justice (JCJC, 2017).
The Juvenile Act mandates ". . . balanced attention to the protection of the community, the imposition of accountability for offenses committed, and the development of competencies to enable children to become responsible and productive members of the community." All interventions and all decisions, from intake to aftercare, must be aimed at achieving these fundamental goals-community protection, offender accountability and competency development- consistent with the protection of the public interest (JCJC, 2017).
In Pennsylvania a distinction is made between child protective services (CPS) and general protective services (GPS). Reports that involve non-serious injury or neglect are treated by the agency as General Protective Service (GPS) cases and can include inadequate shelter, truancy, inappropriate discipline, hygiene issues, abandonment, lack of appropriate supervision, or other problems that threaten a child’s opportunity for healthy growth and development. GPS services are intended to help parents recognize and correct conditions that are harmful to their children.
Child Protective Services (CPS) cases require that the alleged abuse falls under the definition of child abuse as provided in the Child Protective Services law. As a reporter of suspected abuse or neglect, it is not necessary to know if the child and family in question might need CPS or GPS. If you suspect possible abuse or neglect, make the report! Child welfare professionals who staff ChildLine are trained to take the information and make the proper referrals.
Under Pennsylvania law, child abuse has three components:
An act is something that is done to harm or cause potential harm to a child. A failure to act is when something is not done to prevent harm or potential harm to a child. Child abuse can occur from either an act that causes harm or a failure to act that causes harm.
In Pennsylvania law, “recent act or failure to act” is any act or failure to act committed within two years of the date of the report to the Department or agency.
By Pennsylvania law, a “perpetrator” is a person who has committed child abuse and is a parent of a child, a person responsible for the welfare of a child, an individual residing in the same home as the child, or a paramour of the child’s parent (PA Code, 2016). The term includes the following:
*Consanguinity: a blood relation, someone descended from the same ancestor as another person.
A perpetrator of child abuse for failing to act can be:
Pennsylvania law specifies that the term “perpetrator” also includes any person who has direct or regular contact with a child through any program, activity, or service sponsored by a school, for-profit, or religious or other not-for-profit organization such as camps; athletic programs; enrichment programs; or troops, clubs, or similar organizations (PDHS, 2015).
A perpetrator can be a stranger, and abuse by a stranger is reportable.
Did You Know . . .
When a healthcare provider makes a report of suspected abuse, he or she should avoid referring to the suspect as a perpetrator—it is a prejudicial term when used in this manner and can be construed in family law court or criminal court as showing that the reporting party was not being objective. It is not the role of a healthcare provider to make a judgement—it crosses the line into an investigatory role, which is the domain of law enforcement and social services.
Inclusion of School Employees
Prior to December 31, 2014, only incidents of sexual abuse or exploitation and serious bodily injury by a school employee were considered child abuse under the CPSL. There was a separate reporting and investigation process in place for other types of abuse. Now the current law allows for school employees to be considered perpetrators under the definition provided for “person responsible for the child’s welfare” or person “having direct contact with children.”
§ 6303. Definitions:
Pennsylvania School Law requires that all applicants for employment in public and private schools, employees of independent contractors seeking business with public and private schools, and student teacher candidates undergo background checks if they will have direct contact with students. The following three background checks are required:
Under Pennsylvania’s Child Protective Services Law, school volunteers who are responsible for the child’s welfare or who have "direct volunteer contact" with children at a school (i.e., the care, supervision, guidance, or control of children and routine interaction with children) are required to have background checks (PDOE, 2016).
Pennsylvania’s Child Protective Services Law recognizes different categories of abuse in its definitions. In general, actions that are intentional1, knowing2, or reckless3 are considered child abuse if the victim is under the age of 18. The law also defines and describes the categories of child abuse.
1Intentional: intending to cause the harm that occurred. A person acts intentionally when they consciously engage in conduct of that nature or cause such a result and are aware of such circumstances or believe or hope that they exist (PDHS, 2016)
2Knowing: knowing that the result is practically certain. A person acts knowingly when they are aware that their conduct is of that nature or that such circumstances exist and they are aware that it is practically certain that their conduct will cause such a result (PDHS, 2016).
3Reckless: deliberately disregarding foreseeable risk. A person acts recklessly when they consciously disregard a substantial and unjustifiable risk that the material element exists or will result from their conduct. The risk must be of such a nature and degree that, considering the nature and intent of the conduct and the circumstances known to them, its disregard involves a gross deviation from the standard of conduct that a reasonable person would observe in the situation (PDHS, 2016).
Child abuse is intentionally, knowingly or recklessly doing any of the following:
*Bodily injury: an injury that impairs a child’s physical condition or causes substantial pain (Penn State Hershey Center for the Protection of Children).
Note: The new definition of child abuse applies to schools, school employees, and students, whereas before only allegations of serious bodily injury, sexual abuse, or sexual exploitation were considered. Also, before December 31, 2014, allegations of abuse of students by school employees followed a separate reporting and investigation process. Now all distinctions have been removed and reports go directly to ChildLine.
Sexual abuse or exploitation is any of the following:
This paragraph does not include consensual activities between a child who is 14 years of age or older and another person who is 14 years of age or older and whose age is within four years of the child’s age.
Serious mental injury is a psychological condition, as diagnosed by a physician or licensed psychologist, including the refusal of appropriate treatment, that:
Serious physical neglect is any of the following when committed by a perpetrator that endangers a child’s life or health, threatens a child’s well-being, causes bodily injury or impairs a child’s health, development or functioning:
Exclusions to child abuse are outlined in § 6304. These situations must still be reported; however, a CPS investigation may deem the report unsubstantiated and determine that the child has not been abused.
No child shall be deemed to be physically or mentally abused based on injuries that result solely from environmental factors, such as inadequate housing, furnishings, income, clothing and medical care, that are beyond the control of the parent or person responsible for the child’s welfare with whom the child resides. This subsection shall not apply to any child-care service as defined in this chapter, excluding an adoptive parent.
If, upon investigation, the county agency determines that a child has not been provided needed medical or surgical care because of sincerely held religious beliefs of the child’s parents or relative within the third degree of consanguinity and with whom the child resides, which beliefs are consistent with those of a bona fide religion, the child shall not be deemed to be physically or mentally abused. In such cases the following shall apply:
Subject to subsection (d), the use of reasonable force on or against a child by the child’s own parent or person responsible for the child’s welfare shall not be considered child abuse if any of the following conditions apply:
Nothing in this chapter shall be construed to restrict the generally recognized existing rights of parents to use reasonable force on or against their children for the purposes of supervision, control and discipline of their children. Such reasonable force shall not constitute child abuse.
An individual participating in a practice or competition in an interscholastic sport, physical education, a recreational activity or an extracurricular activity that involves physical contact with a child does not, in itself, constitute contact that is subject to the reporting requirements of this chapter.
Reasonable force for self-defense or the defense of another individual, consistent with the provisions of 18 Pa.C.S. §§ 505 and 506, shall not be considered child abuse.
Exclusions refer to a finding of “substantiated” when the Department evaluates a report, not exclusions to the requirement to report. There are no exclusions to reporting. If a mandated reporter has reasonable cause to suspect child abuse then they are required to report.
In an effort to integrate human trafficking elements into Pennsylvania’s child abuse law, the General Assembly now recognizes human trafficking as a form of child abuse and neglect. Act 115 of 2016 added “engaging a child in a severe form of trafficking in persons or sex trafficking” as part of the definition of child abuse. This includes both sex trafficking and labor trafficking of children.
Act 115 of 2016:
The scale of human trafficking is atrocious. The silence that conceals this crime is disgraceful. We have to speak out because the victims are living in fear for their lives. We have to raise our voices for them. That means confronting the social and economic conditions that abet this crime. It means arresting the traffickers. And above all, it means protecting the victims.
Former U.N. Secretary General
Human trafficking is the recruitment, harboring, transportation, provision, or obtaining of a child or adult for sex, labor, or services through the use of force, fraud, or coercion. It is a widespread problem, affecting about 21 million people worldwide. As with many other countries, the United States is both a source and a destination for U.S. citizens and foreign nationals who are subjected to sex trafficking and forced labor (Hemmings et al., 2016).
Adults and children are exploited in both legal and illegal industries, including in commercial sex, hospitality, traveling sales crews, agriculture, seafood, manufacturing, janitorial services, construction, restaurants, healthcare, care for persons with disabilities, salon services, fairs and carnivals, peddling and begging, drug smuggling and distribution, child care, and domestic work (USDOS, 2017).
In Pennsylvania during 2016, the National Human Trafficking Hotline received 580 phone calls, 96 emails, and 68 online tip reports related to human trafficking in the state. This was the twelfth highest call volume in the country (NHTH, 2017). These calls resulted in 151 reports of human trafficking, of which 72% were related to sex trafficking and 16% were for labor trafficking. A little more than a quarter of the reported cases involved minors.
Any child under the age of 18 who is manipulated or forced to engage in sex acts for money (or for anything of value) is a victim of sex trafficking. Severe forms of human trafficking include sex trafficking in which a commercial sex act* is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age.
*Commercial sex act: any sex act in which anything of value is given to or received by any person.
When a child under 18 years of age is recruited, enticed, harbored, transported, provided, obtained, patronized, solicited, or maintained to perform a commercial sex act, proving force, fraud, or coercion is not necessary for the offense to be prosecuted as human trafficking. There are no exceptions to this rule: no cultural or socioeconomic rationalizations alter the fact that children who are exploited in prostitution are trafficking victims (USDOS, 2017).
The use of children in commercial sex is prohibited under U.S. law and by statute in most countries. Sex trafficking has devastating effects on children, causing long-lasting physical and psychological trauma, disease (including HIV/AIDS), drug addiction, unwanted pregnancy, malnutrition, social ostracism, and even death (USDOS, 2017).
Source: Department of Homeland Security. From: https://www.dhs.gov/blue-campaign/infographic.
Labor trafficking is the use of force, fraud, or coercion to recruit, harbor, transport, or obtain a person for the purpose of subjection in involuntary servitude, peonage1, debt bondage2, or slavery3.
1Peonage: paying off debt through work.
2Debt bondage: debt slavery, bonded labor, or services for a debt or other obligation.
3Slavery: a condition compared to that of a slave in respect of exhausting labor or restricted freedom.
Labor trafficking includes agricultural, factory, and domestic service workers who are underpaid or not paid at all, physically abusive traveling sales crews that force children to beg, sell legal items (such as magazines), or illegal items (such as drugs). It also includes workers in restaurants, hair, and nail salons who are abused, confined, or not paid (PAFSA, 2017).
Although children may legally engage in certain forms of work, children can also be found in slavery or slavery-like situations. Some indicators of forced labor of a child include situations in which the child appears to be in the custody of a non-family member who requires the child to perform work that financially benefits someone outside the child’s family and does not offer the child the option of leaving (USDOS, 2017).
Source: Department of Homeland Security. From: https://www.dhs.gov/blue-campaign/infographic.
Victims of human trafficking come from almost every region of the world. The top three countries of origin of federally identified victims in fiscal year 2016 were the United States, Mexico, and the Philippines (USDOS, 2017). Populations at particular risk for victimization in the United States include:
Individuals with certain histories—such as sexual abuse, violence, substance abuse, family dysfunction, or untreated mental health disorders—are considered at increased risk for human trafficking. Adults and children who enter the United States with or without legal status have been identified as trafficking victims. There is ongoing concern about the risk of human trafficking in global supply chains, including in federal contracts (USDOS, 2017).
Source: Department of Homeland Security. From: https://www.dhs.gov/blue-campaign/infographic.
Human trafficking is associated with high levels of physical and sexual violence prior to and during trafficking as well as a range of health problems in the post-trafficking period. Studies with survivors have identified a high prevalence of depression, anxiety, and post-traumatic stress disorder, and symptoms such as headache, fatigue, dizziness, and back and stomach pain (Hemmings et al., 2016).
Medical and psychological care is urgently needed, although there is little evidence-based guidance available on how to plan, assess, or provide for the health needs of trafficked adults and children. Many healthcare professionals feel they have insufficient knowledge and lack confidence about how to respond appropriately to the needs of trafficked people (Hemmings et al., 2016).
Recognizing warning signs and key indicators for human trafficking of young people is the first step in identifying victims. Healthcare providers must be aware of these warning signs in boys and girls under that age of 18:
Human trafficking is a criminal form of extreme exploitation and abuse, from which individuals suffer multiple physical, psychological, and sexual and reproductive health problems. Responding to survivors’ needs requires that healthcare providers adopt trauma-informed and culturally sensitive approaches, conduct comprehensive health assessments, and participate in a reliable referral network, including law enforcement and voluntary support services (Hemmings et al., 2016).
Training should include information about referral and support options for trafficked people as well as reporting requirements. At the local level, healthcare providers should establish referral pathways, create trustworthy points of contact, and share information with relevant agencies. More research is urgently needed to enable healthcare providers to identify, refer, and care for victims of trafficking (Hemmings et al., 2016).
In Pennsylvania, a mandated reporter is required to make a report to ChildLine when he or she has a reasonable cause to suspect that a child is the victim of child abuse or neglect. A permissive reporter is encouraged to report suspected child abuse but is not required to do so by law.
Pennsylvania enacted its first law mandating certain professionals to report suspected child abuse in 1963. Because some of the definitions within Pennsylvania law were unclear or required a high threshold to be considered child abuse, Pennsylvania’s child abuse reporting rates have historically been 9 to 10 times lower than the national average. The new child abuse laws addressed these issues by clarifying the definition of child abuse and lowering the threshold for mandated reporting.
Mandated reporters are certain adults who are required to make a report of suspected child abuse if they have reasonable cause to suspect that a child is a victim of abuse (PDHS, 2016). In general, any individual paid or unpaid, who, on the basis of the individual’s role as an integral part of a regularly scheduled program, activity or service, is responsible for the child’s welfare or has direct contact with children is now considered a mandated reporter. Mandated reporters are required to report suspected child abuse if they have reasonable cause to suspect that a child is a victim of child abuse.
Mandated reporter must familiarize themselves with the following changes and clarifications to Pennsylvania child abuse law:
Another key change involves school employees—if you are a school employee and you suspect abuse has occurred, you are now required to call or electronically report to ChildLine directly and then notify someone in the school district of the report.
Under Pennsylvania law, the following adults are considered mandated reporters and are required to report suspected child abuse if they have reasonable cause to suspect that a child is a victim of child abuse:
In 2012 the Task Force on Child Protection recommended that attorneys be added to the list of persons required to report child abuse. Disagreement to the recommendation arose, partly related to the feeling that requiring attorneys to report child abuse would encroach on the Supreme Court’s authority to regulate the legal profession and affect attorney/client privilege (Thompson, 2014).
Eventually a compromise was reached and now an attorney affiliated with an agency, institution, organization or other entity, including a school or regularly established religious organization that is responsible for the care, supervision, guidance or control of children is a mandated reporter.
To address the issue of privileged and confidential communications, the following changes were made to statute § 6311.1, which also describes confidential communications with the clergy:
Child Protective Services Law defines permissive reporters—persons encouraged to report suspected child abuse—saying that any person may make an oral or written report of suspected child abuse. Although permissive reporters are encouraged to report suspected child abuse, they are not required to do so by law.
Permissive reporters can make a report at any time they suspect a child is the victim of child abuse and, as with mandated reporters, they do not have to determine whether the person meets the definition of perpetrator in order to make the report (KKSP, 2015c).
Permissive reporters can make a report to ChildLine by calling 800 932 0313, and there is nothing more for the reporter to do after making that report. The county children and youth agency must begin an investigation within 24 hours if the report is a Child Protective Services case.
ChildLine is the division of the Pennsylvania Department of Human Services mandated by state law to receive, record, and refer reports of suspected child abuse and neglect. ChildLine is available 24 hours a day, 7 days a week to receive child abuse and neglect reports. ChildLine also receives and is responsible for referring General Protective Services reports, which are non-abuse cases that still warrant an assessment of the child’s well-being (C4CJ, 2015).
If, when reviewing the history, physical examination, and the results of any laboratory and imaging tests, you conclude that abuse reasonably fits in the differential diagnosis, then you must report.
David Turkewitz, MD, FAACP
Pediatric Emergency Medicine, York, PA
Reasonable cause is based upon what you have seen, what you have been told, your training and experience, and whether you feel that a child has been harmed or is in danger of being harmed as a result of an act or omission by the person legally responsible for the child. You do not need proof of harm or potential harm; you must make a report when you suspect something is wrong. Direct or firsthand observation of abuse is not required nor is the reporter required to identify the person responsible for the child abuse to make a report of suspected child abuse.
Mandated reporters are required to make a report of suspected child abuse if they have reasonable cause to suspect that a child is a victim of child abuse under any of the following circumstances:
The child does not have to come before the mandated reporter in order for the mandated reporter to make a report of suspected child abuse. Concerns related to the safety of children can be referred to ChildLine or the county children and youth agency for assessment as general protective services cases (KKSP, 2015b).
Mandated reporters should not attempt to conduct an investigation and do not have to determine, and should not attempt to determine, whether the person meets the definition of perpetrator in order to make the report. Attempts on the part of the reporting party to conduct an investigation or substantiate allegations may result in the reporter’s crossing the line between reporting and investigating. Investigation is the role of the investigating agency and/or law enforcement.
In addition to reasonable cause, there is a second consideration: whether the child who meets criteria for reasonable suspicion is in imminent danger. If so, the reporting party is obligated to arrange for immediate protection of the child. Reporters must make it clear when they report suspected abuse that releasing the child to the caretaker is likely to place the child at imminent danger. In that case, an official who has the legal authority to detain a child and place him in protective custody must be present.
The Child Protective Services Law has clarified the former definition of imminent risk to include the following recent acts referred to as “per se acts”:
Neither mandated nor permissive reporters have to determine the relationship of the perpetrator to the child or even if the person meets the definition of perpetrator to make a report. Similarly, they do not have to identify the person responsible for the child abuse to make a report of suspected child abuse. It is not a reporter’s responsibility to determine if the person who allegedly committed child abuse or harm to a child is a perpetrator.
***It is not a reporter’s responsibility to determine if the person who allegedly committed child abuse or harm to a child is a perpetrator.
When child abuse is suspected, a mandated reporter must make an immediate and direct report of suspected child abuse to ChildLine either electronically at http://www.compass.state.pa.us/cwis or by calling 800 932 0313.
The child abuse reporting process has been streamlined as follows:
Oral reports are required to be followed up within 48 hours with a written report that is sent to the investigating agency.
The approved written reporting form (Report of Suspected Child Abuse CY47) can be found at www.keepkidssafe.pa.gov. The form is under the forms tab (located on the left-hand side of the main page). This is only required if the report is completed orally and not done via electronic submission. If a reporter completes the electronic submission through the portal they have completed their mandated requirement without completing any other forms or notifications.
Child welfare professionals at ChildLine will accept reports of suspected abuse and neglect and refer them to the appropriate investigating agency. In cases where the children require other services, ChildLine can refer the report to the appropriate county agency for assessment.
Immediately after making the report to ChildLine, mandated reporters are required to notify the person in charge of the institution, school, facility, or agency where they are employed, or the designated agent of the person in charge. In the past, reporters were directed to make a report to the person in charge at their institution who would then make the report to ChildLine, but with the changes in statute a mandated reporter now makes the report directly themselves (KKSP, 2015b).
The law specifies the information to be included in a written report, if available [49 Pa. Code § 21.502(d)]:
Once a report is made, ChildLine will determine who is to respond to the report. This is dependent upon the information reported, such as the identity (if known) of the person who allegedly acted to abuse or harm a child. ChildLine will immediately transmit oral or electronic reports they receive to the appropriate county agency and/or law enforcement official.
Not all reports are sent to the county agency for investigation; some are sent to law enforcement. Mandated reporters must understand that not all reports are treated the same way. It is not the job of a mandated reporter to determine what type of report it is and who it should be sent to—trained professionals at ChildLine will do this.
Only if the person does not meet the definition of a perpetrator and the behavior reported includes a criminal violation does the report go to law enforcement. It is not sent to law enforcement just because an investigation is warranted and the definition of a perpetrator is not met.
Mandated reporters are protected from liability for reporting, cooperating with investigations, and testifying in court as a result of the report, among other things. As long as you make the report without malice (with good intentions based on your suspicions), you cannot be sued or receive any adverse action from your employer. The good faith of a mandated reporter is assumed.
Pennsylvania Family Support Alliance
The law provides that any person, who in good faith, makes a report of child abuse, cooperates with an investigation, testifies in a related proceeding, or takes other actions allowed by the law is immune from criminal and civil liability (23 Pa.C.S. § 6318).
Mandatory and permissive reporters are also protected from retaliatory employment actions as long the report was made in good faith. Employees may be eligible for damages or relief in a lawsuit if they were fired or discriminated against as a result of making a report (23 Pa.C.S. § 6320).
The identity of the person making the report is kept confidential with the exception of being released to law enforcement officials or the district attorney’s office. Institutions are also required to protect the identity of staff members make reports or participate in investigations [23 Pa.C.S. § 6340(c)].
§ 6318. Immunity from liability:
You are a nurse practitioner working in a busy, suburban emergency department. A 14-month-old boy is brought in by his mom and dad with swelling and pain to the left arm and shoulder and a bruise on his forehead. The mom reports that her son won’t stop crying. During your examination, you notice bruising of various sizes and colors on his trunk, including both abdomen and back.
The father reports that the child fell off the bed earlier in the day while his wife was at work. He seems overly protective and won’t allow the mom to answer any questions. She manages to timidly say “He’s my son, you haven’t been living with us and don’t know him.” By now, the child is crying uncontrollably and screams and pulls away from the father when he tries to touch the child.
You send a nurse and the mom for an x-ray of the boy’s arm, which shows a buckle fracture of the humerus. You ask the father to wait in the room but he is becoming increasingly agitated and impatient and says he is going to take his son home. When the boy returns from his x-ray, the doctor recommends that the boy be admitted for more tests.
You are concerned that the child is being abused. You and your colleagues believe the child is also in imminent danger due to a combination of the fracture, bruising of different levels of healing, depth of bruising, and atypical locations, as well as the child’s fearful reaction to the father.
Atypical bruising caused by inflicted trauma include: bruises inconsistent with the mechanism of injury, bruises on soft parts of the body such as the ears or neck, patterned or clustered bruises, and bruises that are not consistent with a child’s developmental level (Chapple, 2015).
Your suspicions are aroused further when the father tells you he is going to get a cup of coffee. On his way out he says “There’s nothing wrong with the kid—he’s just being a baby, he’s just a mama’s boy.” The father does not return.
Test Your Learning
What Action Do You Take?
You correctly decide to make an immediate report to ChildLine. Because you believe the child is imminent danger, you also call the police. Unfortunately, law enforcement does not arrive in a timely manner. Until law enforcement arrives, hospital personnel are in a bind. The parents can leave at this point against medical advice although this will not look good for them if there is a CPS or criminal hearing. The situation is fraught with ethical and legal issues for healthcare providers.
The bottom line is: Do your duty, make your report to ChildLine, call the police, and let go of the outcome.
Home Health Scenario
You are a home health nurse assigned to work with a 76-year old man who had a stroke about a month ago. His daughter had recently taken her father to the ER with a decubitus ulcer on his left buttock. The father is mentally alert and aware and competent to handle personal and financial matters. He uses a wheelchair independently around the house but needs help with toileting and bathing.
Your client lives with his daughter, son-in-law, and their 18-month old child. When you arrive at 11 a.m., the blinds are still closed, and when the daughter answers the door she is clearly drunk, as is her husband. Her speech is slurred.
Her son is lying quietly in a crib and seems neglected, with an exaggerated startle reflex. When you ask the daughter if she helps her father with his toileting and bathing she replies “I’ve seen enough of this guy’s dick in my lifetime.” She admits that her father had molested her as a child and that she drank heavily throughout her pregnancy.
The father is wealthy and has the resources to hire a caregiver but expects his daughter to take care of him. He has the ability to say whether he is comfortable with this situation. Despite the fact that there are enough resources to care for the grandchild, the nurse suspects the child is being neglected. Although the grandfather is competent enough to decide to stay in an abusive relationship, the child clearly is not able to make this decision.
Test Your Learning
What Action Should You Take?
What is your role in this situation? You are there to treat the assigned client—not to assess the child for neglect. You suspect the child is neglected based on the condition of the house, the child’s unusual quietness, the drunken parents, and the daughter’s admission that she was abused by her father when she was a child. You also feel it is odd that the father has the resources to pay for a caregiver but insists his daughter care for him. The child seems to be caught in the middle of an extremely dysfunctional situation.
The bottom line is: Treat the father’s ulcer, focusing on the reason you were at the house in the first place. However, you cannot ignore the suspected child neglect and as a mandated reporter you must report your suspicions to ChildLine personally and immediately. You must refrain from assessing the child yourself, even though you are qualified to do the assessment. Your responsibility is to the assigned client—the grandfather. You must make your ChildLine report, stating your objective findings, and continue on to your next client.
You later learn that CPS conducted an investigation and eventually removed the child from this dysfunctional home. The boy was placed with the mother’s sister.
Upon notification, the person in charge or the designated agent, if any, shall facilitate the cooperation of the institution, school, facility or agency with the investigation of the report. Any intimidation, retaliation or obstruction in the investigation of the report is subject to the provisions of 18 Pa.C.S. § 4958 (relating to intimidation, retaliation or obstruction in child abuse cases). This chapter does not require more than one report from any such institution, school, facility or agency.
A mandated reporter who willfully fails to report child abuse is breaking the law. Penalties range from a misdemeanor of the second degree to a felony of the second degree (KKSP, 2015b):
Continuing course of action:
If a person’s willful failure continues while the person knows or has reasonable cause to believe the child is actively being subjected to child abuse, the person commits a misdemeanor of the first degree, except that if the child abuse constitutes a felony of the first degree or higher, the person commits a felony of the third degree.
A person who commits a second or subsequent offense commits a felony of the third degree, except that if the child abuse constitutes a felony of the first degree or higher, the penalty for the second or subsequent offenses is a felony of the second degree.
Statute of limitations:
The statute of limitations for an offense shall be either the statute of limitations for the crime committed against the minor child or five years, whichever is greater.
Pennsylvania child protective services law now includes a “right-to-know” provision for mandated reporters.
If a report was made by a mandated reporter under section 6313 (relating to reporting procedure), the department shall notify the mandated reporter who made the report of suspected child abuse of all of the following within three business days of the department’s receipt of the results of the investigation:
Certain factors create challenges for healthcare professionals dealing with the reporting of suspected child abuse. These can include a poor understanding or confusion about state laws and regulations related to who are mandated reporters and what precisely they are required to do (Herendeen et al., 2014). This is especially true with child sexual abuse (NSVRC, 2012).
Healthcare professionals may question their own ability to identify abuse and may be dissuaded by others (colleagues, coworkers) who do not agree with their analysis. A lack of confidence in child protective service agencies, whether based on perception or previous experience, is also cited as a barrier to reporting (Herendeen et al., 2014).
Other factors associated with a reluctance to report child abuse:
An indicator is an alert or warning that you need to give more attention to a situation. Indicators of abuse can be obvious: for example, a child with the mark of a belt showing on his or her back or burns in the shape of an iron or cigarette tip gives clear support for reasonable cause to suspect child abuse. Often, however, your suspicion will rest on less obvious physical or behavioral indicators.
Indicators must always be considered within the context of how a child behaves, how he or she looks, what you know about the child, and the child’s family situation and history. Children do not react the same way to similar circumstances and many abused children may not show any of the indications discussed below. Nevertheless, learning to recognize high-risk situations and the signs and symptoms of abuse is an important skill for a mandated reporter. Indicators can alert you to physical, sexual, and mental abuse or neglect.
Indicators of physical abuse do not, in and of themselves, prove that a child has been abused. Keep in mind that injuries occur accidentally when children play. Physical abuse should be considered when the explanation does not fit the pattern or frequency of injury. When physical abuse has occurred, indicators can be behavioral as well as physical.
Physical indicators of physical abuse include:
Behavioral indicators of physical abuse include:
Shaken Baby Syndrome
Shaken baby syndrome/abusive head trauma (SBS/AHT) is a special type of physical abuse. It is a term used to describe the constellation of signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child.
Infants 2 to 4 months of age are at the greatest risk of injury from shaking, because their brains are softer and their skulls are thinner than those of adults. An infant’s head is also larger in proportion to its body than an adult’s head and its neck muscles, tendons, and ligaments are weaker than those of an adult.
Shaking a baby may cause bruising, swelling, and bleeding (intracerebral hemorrhage) of the brain, which may lead to permanent severe brain damage or even death. It usually occurs in children younger than 2 years old but may be seen in children up to the age of 5 (Reilly & Martin, 2015).
There are various signs of SBS/AHT, and in less severe cases the child may not be seen by a medical professional and properly diagnosed. In most severe cases a child quickly becomes unconscious with “rapidly escalating central nervous system dysfunction.” Injuries from SBS/AHT can result in severe disability or death and if you suspect a child has been shaken you should seek immediate medical attention.
Recently in Pennsylvania the sexual abuse of children within an institutional setting has been a public concern. The hierarchical structure of institutions can give a perpetrator an easy way to exploit the dependence that often defines relationships between youth and their caregivers (Spröber et al., 2014).
In general, whether in an institution or a familial situation, victims of sexual abuse or exploitation may be threatened with negative consequences in order to keep them silent. Certain factors contribute to silence, including secrecy, helplessness, entrapment, accommodation, and the fear of not being taken seriously when revealing abuse (Spröber et al., 2014).
Despite common beliefs that sexual abusers are strangers, in more than 80% of cases the abuser is likely to know the child they are sexually abusing.
Physical indicators of sexual abuse or exploitation include:
Behavioral indicators of sexual abuse or exploitation include:
Mental and emotional injury may be the most prevalent type of child abuse; however, it is also the most hidden, underreported, and least studied (Ba-Saddik & Hattab, 2012). Literature on mental and emotional injury is limited because it is the most difficult form of abuse to research, due to lack of a consistent definition, and difficulty detecting, assessing, and substantiating the abuse (Ba-Saddik & Hattab, 2012). Researchers have noted that individuals with social anxiety disorder* have higher rates of childhood emotional abuse and emotional neglect compared to healthy controls (Kuo et al., 2011).
*Social anxiety disorder: persistent fear of social or performance situations in which an individual is at risk for embarrassment, humiliation, or possible scrutiny by unfamiliar persons (Kuo et al., 2011).
Physical indicators of serious mental injury include:
Behavioral indicators of serious mental injury include:
Physical neglect is an act of abuse. It accounts for over three-quarters of confirmed cases of child maltreatment in the United States—far more than physical or sexual abuse—but it continues to receive less attention from practitioners, researchers, and the media (CWIG, 2012).
Identifying serious physical neglect in children may seem more difficult than identifying other forms of abuse because neglect usually involves the absence of a certain behavior, rather than its presence. A thorough investigation of the child’s safety and risk followed by a comprehensive family assessment can help determine what kinds of services and supports the family may need (CWIG, 2012).
Physical indicators of serious physical neglect include:
Behavioral indicators of serious physical neglect include:
Healthcare providers must differentiate between neglectful situations and poverty. For example, if a family living in poverty was not providing adequate food for their children, it would be considered neglect only if the parents were aware of but chose not to use food assistance programs. Taking poverty into consideration can prevent unnecessary removals and place the focus on providing concrete services for families to protect and provide for their children (CWIG, 2012).
Risk factors are characteristics associated with child abuse and neglect—they may or may not be direct causes. A combination of individual, relational, community, and societal factors contribute to the risk of child maltreatment. Although children are not responsible for the harm inflicted upon them, certain characteristics have been found to increase their risk of being maltreated (CDC, 2016a).
Individual Risk Factors for Victims
Individual Risk Factors for Perpetration
Family Risk Factors
Community Risk Factors
Reacting to child maltreatment is only part of the solution. We need to be proactive in preventing it.
Centers for Disease Control and Prevention
Child Abuse Is a Public Health Issue
The overreaching goal of prevention is to stop child abuse and neglect from happening in the first place. Safe, stable, and nurturing relationships and environments for children and families are a tremendous deterrent. Influencing individual behaviors, improving relationships among families and neighbors, and encouraging community involvement are keys to the prevention of child abuse (CDC, 2016b).
Protective factors buffer children from abuse and neglect. Protective factors have not been studied as much as risk factors but nevertheless, identifying and understanding protective factors is a critical component in reducing child abuse (CDC, 2016a).
Six protective factors have been linked to a lower incidence of child abuse and neglect:
Family Protective Factors
Community Protective Factors
Successful prevention strategies include programs that focus on individual behavior and attitude change, as well as efforts that change policies and societal norms to create environments that support safe, stable, nurturing relationships for children and families (CDC, 2016b).
Many state, local, and tribal governments sponsor prevention activities and provide a variety of prevention services. Some prevention efforts are intended for everyone, such as public service announcements (PSAs) aimed at raising awareness about child maltreatment within the general population. Others are speciﬁcally targeted for individuals and families who may be at greater risk for child abuse or neglect (CWIG, 2013).
The most important prevention strategy is the development of safe, stable, and nurturing relationships. Other prevention strategies include:
See the Resources section for information and contact details for a number of support organizations that can provide assistance to Pennsylvania families.
Safe Haven of Pennsylvania, also known as the Newborn Protection Act, states that a parent of a newborn may leave a child in the care of a hospital or a police officer at a police station without being criminally liable as long as the child is no older than 28 days and is not harmed. Safe Haven gives parents a safe, legal, and confidential alternative to abandoning a baby.
To speak to someone about Safe Haven, call confidentially at: 1-866-921-SAFE (7233). Additional information, including promotional materials, can be found at the Safe Haven website: www.secretsafe.org (KKSP, 2015d).
Over the last decade, Pennsylvania residents learned of multiple incidences of child abuse by trusted members of the public. First, a grand jury investigation uncovered widespread child sexual abuse and a subsequent cover-up within the Roman Catholic Archdiocese of Philadelphia. Then in 2012 Jerry Sandusky, a former assistant football coach at Penn State, was convicted of more than 40 counts of child sexual abuse. These abuse cases shocked the public and government and public health officials moved quickly to review and update child abuse recognition and reporting laws in Pennsylvania.
The new laws, which went into effect on December 31, 2014, resulted in sweeping changes and updates to child abuse laws in Pennsylvania. The new laws clarified the rules for mandated reporting, revised the definition of child abuse, updated and expanded definitions for perpetrator and mandatory reporter, added child labor and sex trafficking to its definition of child abuse, and streamlined the reporting process.
The goal of the new laws is to improve recognition of child abuse and provide an understanding that, if you suspect child abuse is occurring, the most important action you can take is to report the suspected abuse to ChildLine and allow trained public health officials to determine further action.
Child abuse can be stopped. To do so requires determination, education, community support, and strategies that support the development of safe, stable, and nurturing relationships.
1-800-932-0313 (to report child abuse in Pennsylvania)
Department of Human Services
Mandated reporters: http://www.compass.state.pa.us/cwis
Child Welfare Information Solution
Keep Kids Safe PA
Designed to serve as the hub for information related to critical components impacting child protection including a link for mandated reporters to make reports of suspected child abuse electronically, training on child abuse recognition and reporting, information related to clearances and general information related to child protection.
Prevent Child Abuse Pennsylvania
Prevent Child Abuse Pennsylvania, a program of the PA Chapter, American Academy of Pediatrics, is one of 50 state chapters of Prevent Child Abuse America. Public awareness & participation in prevention, policy and advocacy, use & promote evidence-based prevention programs.
Pennsylvania Child Welfare Resource Center
University of Pittsburgh, School of Social Work
403 East Winding Hill Road
Mechanicsburg, PA 17055
Phone: 717 795 9048
Fax: 717 795 8013
Pennsylvania Family Support Alliance
Phone: 800 448 4906 / 717 238 0937
Fax: 717 238 4315
2000 Linglestown Rd. Suite 301
Harrisburg, PA 17110
Task Force on Child Protection
Information about formation and composition of the Task Force and its meetings, with agendas, handouts, testimony, and audio/videos of some meetings. Provides link to the final task force report.
The Center for Children’s Justice
P.O. Box 396
Bernville, PA 19506
Centers for Disease Control and Prevention
Child Maltreatment Prevention website
Annie E. Casey Foundation
A private, charitable organization dedicated to helping build better futures for disadvantaged children in the United States. Partners with and forges collaborations among institutions, agencies, decision makers, and community leaders. Funds research, provides technical assistance, and puts together demonstrations that support public schools, juvenile justice agencies, and child welfare systems. Delivers services, identifies and measures what works, and shares lessons learned to help reform public policies and services for children and their families.
410 547 6600 / 410 547 6624
Center for Law and Social Policy
Develops and advocates for federal, state, and local policies to strengthen families and create pathways to education and work.
202 906 8000
Child Welfare Information Gateway /
U.S. Department of Health Human Services
Resources on child abuse prevention, protecting children from risk of abuse, and strengthening families. Includes information on supporting families, protective factors, public awareness, community activities, positive parenting, prevention programs, and more.
Child Welfare League of America
A coalition of hundreds of private and public agencies serving vulnerable children and families since 1920. Provides expertise, leadership and innovation on policies, programs, and practices help improve the lives of millions of children in all fifty states.
202 688 4200
Ba-Saddik ASS, Hattab AS. (2012). Emotional abuse towards children by schoolteachers in Aden Governorate, Yemen: A cross-sectional study. BMC Public Health 2012, 12:647. Retrieved November 10, 2016 from http://www.biomedcentral.com/1471-2458/12/647.
Bishop M, Rosenstein D, Bakelaar S, Seedat S. (2014). An analysis of early developmental trauma in social anxiety disorder and posttraumatic stress disorder. Annals of General Psychiatry 2014, 13:16. Doi:10.1186/1744-859X-13-16. Retrieved November 10, 2016 from http://www.annals-general-psychiatry.com/content/13/1/16#B21.
Center for Children’s Justice (C4CJ). (2015). Child Protection FAQ: ChildLine (PA’s Child Abuse Reporting Hotline). Children’s Justice & Advocacy Report. Retrieved November 10, 2016 from: http://www.c4cj.org/files/ChildLineFAQ22015.pdf.
Centers for Disease Control and Prevention (CDC). (2015b—2016a). Child Maltreatment: Risk and Protective Factors. Retrieved November 10, 2016 from http://www.cdc.gov/violenceprevention/childmaltreatment/riskprotectivefactors.html.
Centers for Disease Control and Prevention (CDC). (2015c—2016b). Child Maltreatment: Prevention Strategies. Retrieved November 10, 2016 from http://www.cdc.gov/violenceprevention/childmaltreatment/prevention.html.
Centers for Disease Control and Prevention (CDC). (2014). Adverse Childhood Experiences. Retrieved November 10, 2016 from http://vetoviolence.cdc.gov/apps/phl/resource_center_infographic.html.
Chapple D. (2015). More than just a bruise: Recognizing child physical abuse. BCMJ, Vol. 57, No. 7, September 2015. Retrieved May 10, 2017 from http://www.bcmj.org/articles/more-just-bruise-recognizing-child-physical-abuse.
Child Welfare Information Gateway (CWIG). (2013). Preventing Child Abuse and Neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Retrieved November 10, 2016 from https://www.childwelfare.gov/pubs/factsheets/preventingcan/.
Child Welfare Information Gateway (CWIG). (2012). Acts of Omission: An Overview of Child Neglect. Retrieved November 10, 2016 from https://www.childwelfare.gov/pubs/focus/acts/.
Hemmings S, Jakobowitz S, Abas M, et al. (2016). Responding to the health needs of survivors of human trafficking: A systematic review. BMC Health Services Research 2016 16:320. Doi:10.1186/s12913-016-1538-8. Retrieved August 9, 2017 from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1538-8.
Herendeen PA, Blevins R, Anson E, Smith J. (2014) Barriers to and consequences of mandated reporting of child abuse by nurse practitioners. Journal of Pediatric Health Care 28(1):e1-e7. Retrieved November 10, 2016 from http://www.jpedhc.org/article/S0891-5245(13)00214-9/fulltext.
Joint State Government Commission (JSGC). (2015). General Assembly of the Commonwealth of Pennsylvania. Juvenile Delinquency and Dependency: Juvenile Act Revisions and Review of Juvenile Life Without Parole. Retrieved May 9, 2017 from http://jsg.legis.state.pa.us/resources/documents/ftp/publications/2015-414-Final%20JAAC%20Report%207.31.15%20240pm.pdf.
Juvenile Court Judges’ Commission (JCJC). (2017). Our Balanced and Restorative Justice Mission. Retrieved May 9, 2017 from http://www.jcjc.pa.gov/Balanced-Restorative-Mission/Pages/default.aspx.
KeepKidsSafe.PA.gov (KKSP). (2015). Child Protective Services Laws. Retrieved November 10, 2016 from http://www.keepkidssafe.pa.gov/laws/index.htm.
KeepKidsSafe.PA.gov (KKSP). (2015a). Department of Human Services Launches Child Protection Information System. Press Release, January 7, 2015. Retrieved November 10, 2016 from http://www.keepkidssafe.pa.gov/cs/groups/webcontent/documents/document/c_135048.pdf.
KeepKidsSafe.PA.gov (KKSP). (2015b). Mandated Reporter Frequently Asked Questions. Retrieved November 10, 2016 from http://keepkidssafe.pa.gov/cs/groups/webcontent/documents/document/c_137646.pdf.
KeepKidsSafe.PA.gov (KKSP). (2015c). Permissive Reporter Frequently Asked Questions. Retrieved November 10, 2016 from http://keepkidssafe.pa.gov/cs/groups/webcontent/documents/document/c_137647.pdf. KeepKidsSafe.PA.gov (KKSP). (2015d). Safe Haven Law. Retrieved November 10, 2016 from http://keepkidssafe.pa.gov/safehavenlaw/index.htm. See also http://www.secretsafe.org.
Kuo JR, Goldin PR, Werner K, et al. (2011). Childhood trauma and current psychological functioning in adults with social anxiety disorder. J Anxiety Disord. 2011 May; 25(4): 467–73. Retrieved November 10, 2016 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074005/?tool=pubmed.
Lynne EG, Gifford EJ, Evans KE, Rosch JB. (2015). Barriers to reporting child maltreatment: Do emergency medical services professionals fully understand their role as mandatory reporters? North Carolina Medical Journal 76(1):13–18. Doi: 10.18043/ncm.76.1.13. Retrieved November 4, 2016 from http://www.ncmedicaljournal.com/content/76/1/13.long.
McAlpine A, Hossain M, Zimmerman C. (2016). Sex trafficking and sexual exploitation in settings affected by armed conflicts in Africa, Asia and the Middle East: Systematic review. BMC Int Health Hum Rights. 2016; 16: 34. Doi:10.1186/s12914-016-0107-x. Retrieved August 9, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192570/.
National Sexual Violence Resource Center (NSVRC). (2012). Understanding child sexual abuse definitions and rates. Retrieved November 11, 2016 from http://nsvrc.org/sites/default/files/NSVRC_Publications_TalkingPoints_Understanding-Child-Sexual-Abuse-definitions-rates.pdf.
Pennsylvania Code (PA Code). (2016). § 3490.4. Definitions. Retrieved November 11, 2016 from http://www.pacode.com/secure/data/055/chapter3490/s3490.4.html.
Pennsylvania Department Education (PDOE). (2016). Background Checks. Retrieved May 17, 2017 from http://www.education.pa.gov/Teachers%20-%20Administrators/Background%20checks/Pages/default.aspx#tab-1.
Pennsylvania Department of Human Services (PDHS). (2016). Annual Child Protective Services Report 2015. Retrieved November 7, 2016 from http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_226999.pdf.
Pennsylvania Department of Human Services (PDHS). (2015). Mandated Reporter Frequently Asked Questions. Retrieved November 11, 2016 from http://keepkidssafe.pa.gov/cs/groups/webcontent/documents/document/c_137646.pdf.
Pennsylvania Family Support Alliance (PAFSA). (2017). Changes in the Child Protective Services Law (CPSL). Retrieved August 8, 2017 from http://www.pa-fsa.org/Mandated-Reporters/Resources-for-Mandated-Reporters/Changes-in-the-Child-Protective-Services-Law-CPSL.
Pennsylvania General Assembly (PGA). (2016). Consolidated Statutes. Title 23 Domestic Relations. Retrieved November 11, 2016 from http://www.legis.state.pa.us/cfdocs/legis/LI/consCheck.cfm?txtType=HTM&ttl=23.
Reilly J, Martin S. (2015). Child Abuse recognition and reporting. A self-study guide for people working with children. UNCE Special Publication 09-11 Updated November 2015. Retrieved November 11, 2016 from: http://www.unce.unr.edu/publications/files/cy/2009/sp0911.pdf.
Spröber N, Schneider T, Rassenhofer M, et al. (2014). Child sexual abuse in religiously affiliated and secular institutions: A retrospective descriptive analysis of data provided by victims in a government-sponsored reappraisal program in Germany. BMC Public Health 2014, 14:282. doi:10.1186/1471-2458-14-282. Retrieved November 11, 2016 from http://www.biomedcentral.com/1471-2458/14/282.
Thompson C. (2014). Bills would change child abuse reporting requirements in Pa., defining who reports and how. In: The Patriot News April 4, 2014. Retrieved November 11, 2016 from http://www.pennlive.com/midstate/index.ssf/2014/04/bills_beefing_up_child_abuse_r.html.
United States Department of State (USDOS). (2017). Trafficking in Persons Report, 2017. Retrieved August 9, 2017 from https://www.state.gov/documents/organization/271339.pdf.
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