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The Role of First Responders in Child Maltreatment Cases: Disaster and Nondisaster Situations
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Author(s):
Office on Child Abuse and Neglect, Children's Bureau.
Cage, Richard., Salus, Marsha K. |
Year Published: 2010 |
Appendix D
Reference Guide for Responding to Cases of Suspected Child Maltreatment
The following handy reference guide for first responders in cases of suspected child maltreatment contains highlights of the information provided throughout this manual and addresses signs of possible abuse, interviewing the alleged victim and perpetrator, assessing for risk, and testifying in court.
Signs of possible physical abuse (Chapter 2)
- Fractures unexpectedly discovered in the course of an otherwise routine medical examination (e.g., discovering a broken rib while listening to the child's heartbeat)
- Injuries that are inconsistent with, or out of proportion to, the history provided by the caretaker or with the child's age or developmental stage (e.g., a 3-month old burning herself by crawling on top of the stove)
- Multiple fractures, often symmetrical (e.g., in both arms or legs), or fractures at different stages of healing
- Fractures in children who are not able to walk
- Skeletal trauma (e.g., fractures) combined with other types of injuries, such as burns
- Subdural hematomas, which are hemorrhages between the brain and its outer lining that are caused by ruptured blood vessels
- Burns on the buttocks, around the anogenital region, on the backs of the hands, or on both hands, as well as those that are severe
Signs of possible sexual abuse (Chapter 2)
Children may have been sexually abused if they:
- Have bruises in the inner thigh or genital area
- Have difficulty walking or sitting
- Complain of genital or anal itching, pain, or bleeding
- Frequently vomit
- Become pregnant at a young age
- Have any sexually transmitted diseases
Additionally, children may have been sexually abused if they exhibit:
- Exceptional secrecy
- More sexual knowledge than is age appropriate, especially in younger children
- Indepth sexual play with peers that is not developmentally appropriate
- Extreme compliance or withdrawal
- Overt aggression
- An inordinate fear of males or females
- Seductive behavior
- Sleep problems or nightmares
- Crying without provocation
- A sudden onset of wetting or soiling of pants or bed
- Suicide attempts or thoughts of wanting to kill themselves
- Numerous attempts at running away from home
- Cruelty to animals (especially those that would normally be pets)
- Setting fires and enjoying watching them burn
- Self-mutilation (e.g., cutting or scratching to draw blood)
Signs of possible neglect (Chapter 2)
- Seem inadequately dressed for the weather (e.g., wearing shorts and sandals in freezing weather)
- Appear excessively listless and tired (due to no routine or structure around bedtimes)
- Report caring for younger siblings (when they themselves are underage or are developmentally not ready to do so)
- Demonstrate poor hygiene or smell of urine or feces
- Seem unusually small or thin or have a distended stomach (indicative of malnutrition)
- Have unattended medical or dental problems, such as infected sores or badly decayed or abscessed teeth
- Appear withdrawn
- Crave unusual amounts of attention, even eliciting negative responses in order to obtain it
Signs of possible psychological maltreatment (Chapter 2)
- Extremes in behavior (e.g., manically happy or very depressed)
- Withdrawal (e.g., no verbal or physical communication with others)
- Self-destructive behavior (e.g., cutting oneself)
- General destructive behavior (e.g., setting fires)
- Cruelty to others, including animals
- Rocking, thumb-sucking that is developmentally inappropriate, or head-banging
- Enuresis (i.e., wetting one's pants) or soiling at an age or a developmental level when such behavior is inappropriate
- Substance abuse
- Physical manifestations, such as frequent stomachaches or headaches or an unexplained weight loss or gain
Behavioral clues that may indicate possible child maltreatment (Chapter 2)
- Be aggressive, oppositional, or defiant
- Cower or demonstrate a fear of adults
- Act out, displaying aggressive or disruptive behavior
- Be destructive to self or others
- Come to school too early or not want to leave school—indicating a possible fear of being at home
- Show fearlessness or extreme risk-taking
- Be described as "accident prone"
- Cheat, steal, or lie (may be related to too high expectations at home)
- Be a low achiever
- Be unable to form good peer relationships
- Wear clothing that covers the body and that may be inappropriate in warmer months, such as wearing a turtleneck sweater in the summer (Be aware that this may possibly be a cultural issue instead.)
- Show regressive or less mature behavior
- Dislike or shrink away from physical contact (e.g., may not tolerate physical praise, such as a pat on the back)
Risk factors for maltreatment (Chapter 2)
- Born prematurely or low birth weight
- Perceived as unusual or different in terms of appearance or temperament
- Be unhealthy or with congenital abnormalities
- Have a physical, emotional, or developmental disability
- Be irritable or display behaviors that are contrary to the expectations of the parents
- Live in poverty
- Live in an environment in which there is drug abuse, crime, or violence
- Live in a single-family home
- Have parents who lack education
- Have parents who abuse substances
Child interview guidelines (Chapter3)
- Avoid jumping to conclusions
- Be at the child's eye level, if possible
- Leave a comfortable space between the interviewer and the child
- Create a child-friendly environment (e.g., have toys available)
- Use body diagrams or dolls to help the child clarify body parts that are discussed
- Be mindful of responder's facial expressions and body language
- Minimize the use of yes or no and multiple-choice questions
- Follow up all closed-ended questions with open-ended questions (types of questions are discussed later in this chapter)
- Listen carefully and completely (e.g., do not rush the child)
- Assess the child's understanding of key concepts (e.g., being able to tell the truth, understanding timeframes), which will help to establish credibility as the interview proceeds into sensitive areas
- Reduce vocabulary problems by using the child's vocabulary, when appropriate, and clarifying any areas of confusion
- Avoid using double negatives (e.g., "So your father didn't not hit you with the belt?")
- Observe the child's nonverbal communication and body language
- Document the interviewer's and child's words carefully and completely, perhaps by audio-or videotaping the interview
- Be attuned to the developmental capabilities and limitations of the child as the interview progresses
Questions to ask non offending adults (Chapter 3)
- What happened?
- How did the injury happen?
- Who injured the child?
- Who was with the child?
- Who saw the injury happen?
- Where did the injury happen?
- Where were the other household members?
- When did the injury happen?
What to be aware of during alleged offender interview (Chapter3)
- A disclosure by the alleged offender that maltreatment did take place
- No explanation for an injury or suspect incident
- An explanation for an injury that is inconsistent with either the severity or the type of injury observed
- Different or changing explanations for an injury or incident
- A delay in obtaining medical treatment for an injury
Guidelines for documenting interviews (Chapter 3)
- Follow the agency's or department's protocols
- Give the child permission to correct statements
- Document both the questions and answers, when possible
- Listen carefully to answers
- Read answers back to the child for clarification, when appropriate
- Write notes clearly and concisely
- Quote direct statements, when possible
- Videotape or photograph the crime scene for accuracy
- Try to have an investigative team that consists of one interviewer and one note taker
What to observe at the scene (Chapter3)
- The physical condition of the child, including any observable effects of maltreatment
- The emotional status of the child, including mannerisms, signs of fear, and developmental status
- The reactions of the parents or caregivers to the first responder's concerns
- The emotional and behavioral status of the parents or caregivers during the interview process
- The interactions between family members, including verbal and body language
- The physical status of the home or site of maltreatment, including cleanliness, structure, safety hazards, signs of excessive alcohol use, and signs of illicit drug use (e.g., drug paraphernalia, evidence of a methamphetamine lab)
- The climate of the neighborhood, including the level of violence or drug use, and the accessibility of transportation, telephones, or other methods of communication
What to obtain or make note of (Chapter3)
- Broken items or holes in the wall
- Stains from blood or semen (visible with a black light and/or luminol)
- Minute evidence, such as hair, fibers, or semen
- "Souvenirs" of the alleged abuser, such as items of a child's clothing or pictures of the child
- Lures, such as toys or games
- Sexual aids, such as lubricants, dildos, and vibrators
- Drugs or alcohol
- Adult or child pornography, in print or on computer
- Cameras and film processing equipment
- An address book containing the victim's information
- Bedding
- Clothing
- Contents of trash cans
- Bills, banks records, and receipts, which may be used to show items that were purchased by the suspect for the victim
- Phone records
- Work records showing if the suspect was available to spend time with the child at the time of the maltreatment
- Weapons or other implements used to abuse a child (e.g., belts, cords, coat hangers, other instruments matching the injuries inflicted)
- Other items noted by the victim or the witnesses during the interviews
Conducting a safety assessment (Chapter 3)
- Identify the behaviors or conditions that increase concern for the child's safety and consider how they affect each child in the family
- Identify the behaviors or conditions (e.g., strengths, resiliencies, support, resources) that may protect the child
- Examine the relationships among the risk factors and determine if, when combined, they increase safety concerns
- Determine whether family members or other community partners are able to address safety concerns without CPS intervention
- Consider the services required to address the specific behaviors or conditions for each risk factor directly affecting the child's safety
- Identify who is available (e.g., CPS, other community partners) to provide the needed services or interventions in the frequency, timeframe, and duration required by the family to protect the child
- Evaluate the family's willingness to accept—and its ability to use—the intervention or services at the level needed to protect the child
Elements of a safety plan (Chapter 3)
- Direct and immediate impact on one or more of the risk factors determined during the assessment to cause the child to be unsafe
- Accessible to the family
- Available in the frequency and for the duration with which they are needed to control the risk factors
- Fills the gaps in the caregiver's protective factors and strengths in order to ensure the child's protection
Guidelines for testifying (Chapter 4)
- Be prepared
- Listen to each question and pause before answering
- Ask for clarification if needed
- Answer only the question asked
- Do not be afraid to respond "I don't know"
- Do not give an opinion unless asked to do so
- Avoid taking sides
- Speak a little louder, slower, and more distinctly than normal
- Make eye contact
- Use an open body posture
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