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).
Reasonable Cause to Suspect vs. Conducting an Investigation
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:
- They come into contact with the child in the course of employment, occupation, and practice of a profession or through a regularly scheduled program, activity, or service.
- They are directly responsible for the care, supervision, guidance, or training of the child, or are affiliated with an agency, institution, organization, school, regularly established church or religious organization, or other entity that is directly responsible for the care, supervision, guidance, or training of the child.
- A person makes a specific disclosure to the mandated reporter that an identifiable child is the victim of child abuse.
- An individual 14 years of age or older makes a specific disclosure to the mandated reporter that the individual has committed child abuse. (KKSP, 2015b)
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”:
- Kicking, biting, throwing, burning, stabbing, or cutting a child in a manner that endangers the child;
- Unreasonably restraining or confining a child based on the method, location, or duration;
- Forcefully shaking, slapping, or otherwise striking a child under 1 year of age;
- Interfering with the breathing of a child;
- Causing the child to be present at a methamphetamine lab, provided there is a law enforcement investigation occurring;
- Knowingly leaving a child unsupervised with an individual, other than the child’s parent, who is required to register as a sexual offender, sexually violent predator, or sexually violent delinquent. This also includes individuals whom the parent reasonably should have known is required to register in one of the categories above. (PDHS, 2016)
Reporting without Having to Determine the Relationship of the Perpetrator to the Victim Child
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.
- A mandated reporter enumerated in subsection (a) shall make a report of suspected child abuse in accordance with section 6313 (relating to reporting procedure), if the mandated reporter has reasonable cause to suspect that a child is a victim of child abuse under any of the following circumstances:
- The mandated reporter comes into contact with the child in the course of employment, occupation and practice of a profession or through a regularly scheduled program, activity or service.
- The mandated reporter is directly responsible for the care, supervision, guidance or training of the child, or is affiliated with an agency, institution, organization, school, regularly established church or religious organization or other entity that is directly responsible for the care, supervision, guidance or training of the child.
- A person makes a specific disclosure to the mandated reporter that an identifiable child is the victim of child abuse.
- An individual 14 years of age or older makes a specific disclosure to the mandated reporter that the individual has committed child abuse.
- Nothing in this section shall require a child to come before the mandated reporter in order for the mandated reporter to make a report of suspected child abuse.
- Nothing in this section shall require the mandated reporter 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.
Making a Report
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:
- A mandated reporter shall immediately make an oral report of suspected child abuse to the department via the statewide toll-free telephone number or a written report using electronic technologies under section 6305.
- A mandated reporter making an oral report of suspected child abuse shall also make a written report, which may be submitted electronically, within 48 hours to the department or county agency assigned to the case in a manner and format prescribed by the department.
- The failure of the mandated reporter to file the report shall not relieve the county agency from any duty under this chapter, and the county agency shall proceed as though the mandated reporter complied with paragraph (2).
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)]:
- The names and addresses of the child and the parents or other person responsible for the care of the child, if known.
- Where the suspected abuse occurred.
- The age and sex of the subjects of the report.
- The nature and extent of the suspected child abuse including any evidence of prior abuse to the child or siblings of the child.
- The name and relationship of the persons responsible for causing the suspected abuse, if known, and any evidence of prior abuse by those persons.
- Family composition.
- The source of the report.
- The person making the report and where that person can be reached.
- The actions taken by the reporting source, including the taking of photographs and X-rays, removal or keeping of the child or notifying the medical examiner or coroner.
- Other information which the Department of Public Welfare may require by regulation.
After a Report Is Made
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.
- If a person identified falls under the definition of perpetrator, ChildLine will refer the report to the appropriate county agency for an investigation.
- If the person identified is not a perpetrator and the behavior reported includes the violation of a crime, ChildLine will refer the report to law enforcement officials.
- If a person identified falls under the definition of perpetrator and the behavior reported includes a criminal violation, ChildLine will refer the report to the appropriate county agency and law enforcement officials.
- If a report indicates that a child is in need of other protective services, ChildLine will refer the report to the proper county agency to assess the needs of the child and provide services, when appropriate.
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.
Protections for Reporters
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:
- General rule.—A person, hospital, institution, school, facility, agency or agency employee acting in good faith shall have immunity from civil and criminal liability that might otherwise result from any of the following:
- Making a report of suspected child abuse or making a referral for general protective services, regardless of whether the report is required to be made under this chapter.
- Cooperating or consulting with an investigation under this chapter, including providing information to a child fatality or near-fatality review team.
- Testifying in a proceeding arising out of an instance of suspected child abuse or general protective services.
- Engaging in any action authorized under section 6314 (relating to photographs, medical tests and X-rays of child subject to report), 6315 (relating to taking child into protective custody), 6316 (relating to admission to private and public hospitals) or 6317 (relating to mandatory reporting and postmortem investigation of deaths).
- Departmental and county agency immunity.—An official or employee of the department or county agency who refers a report of suspected child abuse for general protective services to law enforcement authorities or provides services as authorized by this chapter shall have immunity from civil and criminal liability that might otherwise result from the action.
- Presumption of good faith.—For the purpose of any civil or criminal proceeding, the good faith of a person required to report pursuant to section 6311 (relating to persons required to report suspected child abuse) and of any person required to make a referral to law enforcement officers under this chapter shall be presumed.
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 Knowledge
What Action Do You Take?
- Monitor the situation.
- Report your concerns to the hospital administrator.
- Make an immediate report to ChildLine.
- Ask the sheriff to arrest the father for leaving the hospital.
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 Knowledge
What Action Should You Take?
- You are not there to assess the child so you should treat the father and move on to your next patient.
- Assess the child, treat the father, and call the police.
- Leave the house immediately without treating the father and make a report to ChildLine.
- Treat the father and report your suspicions of child abuse to ChildLine immediately and personally.
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.
Penalties for Failure to Report
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):
- A person or official required to report a case of suspected child abuse or to make a referral to the appropriate authorities commits an offense if the person or official willfully fails to do so.
- An offense under this section is a felony of the third degree if:
- the person or official willfully fails to report;
- the child abuse constitutes a felony of the first degree or higher; and
- the person or official has direct knowledge of the nature of the abuse.
- An offense not otherwise specified in paragraph (2) is a misdemeanor of the second degree.
- A report to law enforcement or the appropriate county agency by a mandated reporter, made in lieu of a report to the department, shall not constitute an offense, provided that the report was made in a good faith effort to comply with the requirements of this chapter.
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.
Mandated Reporter’s Right-to-Know
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:
- Whether the child abuse report is founded, indicated, or unfounded.
- Any services provided, arranged for, or to be provided by the county agency to protect the child.
Barriers to Reporting
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:
- A failure to recognize maltreatment
- Disagreement on what constitutes reasonable suspicion
- Lack of training on how to report child maltreatment
- A wish to avoid administrative hurdles
- A lack of trust in child protective services
- A suspicion that a report will not benefit the family (Lynne et al., 2015)