Mandatory Reporter Training for Child Abuse

1. Mandatory Reporter Training for Child Abuse Diana E. Nicholls Blomme, RN 515-242-6333

2. Child Abuse • Not a new phenomenon • Documented for more than 2,000 years • First legal response occurred in 1874 • New York Society for the Prevention of Cruelty to Animals

3. Iowa Code Sections 232.67 through 232.75 Civil vs. Criminal Code

4. 3 C’s • Child • Caretaker • Circumstance

5. Definitions Child—anyone under the age of 18

6. Caretaker—anyone responsible for the care of the child Teachers and coaches are not caretakers, with 1 possible exception

7. Abuse by School Employees Chapter 102: Procedures for Charging and Investigating Incidents of Abuse of Students by School Employees Education [281] IAC 2/23/11

8. Circumstance—abusive incident What abuse is suspected?

9. Exception to the 3 C’s Sexual abuse, with the victim under the age of 12, must be reported to DHS even if there is no caretaker involved

10. Types of Offenders • Well-intentioned, but overwhelmed caregiver • Well-intentioned, but ignorant caregiver • Unwilling, could care less caregiver • Abusive personality • Sadistic personality

11. Ten Categories of Abuse • Physical abuse • Sexual abuse • Mental injury • Denial of critical care 5. Presence of illegal drugs in a child’s body 6. Child prostitution 7. Manufacture or possession of a dangerous substance • Bestiality in the presence of a minor • Allows access by a registered sex offender • Allows access to obscene materials

12. Physical Abuse • Non-accidental physical injury • At variance with history • By acts or omissions • Reasonably foreseeable • Injury does not have to be observable

13. Most important questions to ask: Have you been hurt before? Do you hurt anywhere else?

14. Indicators of Physical Abuse in Ascending Order of Severity Death Murder Paralysis Injuries from attempted murder Detached retina Hematoma Pressure sores Fractures Choke marks Dislocation Hypothermia Abnormal chemistry values Malnourishment Dehydration Contractures Sprains Punctures Pain on touching Welts Scalp injury Gag marks Cigarette burns Rope burns Scratches Cuts Bruises Source: Tomita and Quinn 1984

15. Physical and Dental Indicators Fractured teeth: force feeding, repeated trauma Burns on lips: force feeding of hot foods Bruises of lips: forced pacifier use Frenula bruises: force feeding

16. Oral or perioral syphilis or gonnorrhea: probable sexual abuse Palatal petechiae or erythema: probable sexual abuse Facial, head, and neck trauma

17. Sexual Abuse • A sexual offense • With or to a child • As a result of the acts or omissions • DHS must notify law enforcement within 72 hours

18. Sub-Categories • 1st, 2nd, or 3rd degree sexual abuse • Lascivious acts with a child • Indecent exposure • Assault with intent to commit sexual abuse • Indecent contact with a child • Lascivious conduct with a minor • Incest • Sexual exploitation by a counselor or therapist • Sexual exploitation of a minor • Sexual misconduct with offenders and juveniles • Invasion of privacy-nudity

19. Sex crimes are based on age • “Consensual” sex can be a crime based on age

20. Indicators—Sexual Abuse Physical symptoms of pain, swelling, bruising, discharge Hints about sexual activity Compulsive masturbation or persistent and inappropriate sex play Sexually aggressive or seductive towards others

21. Promiscuous New or detailed understanding of sexual behavior Regressive behaviors, or behavior characteristic of someone much younger Wearing multiple layers of clothing Urinating or defecating in clothing Pregnancy

22. Dentists probably see patients with childhood sexual abuse histories several time a week Evidence indicates between 15-30% of females and 3-15% of males

23. Parallels Between Aspects of Abuse and Dental Care • Trust the professional to know • what is best for them • Assure them that the experience may • be painful or unpleasant, but it will • be good for them

24. Expected to lie passively • Touching or intruding on parts of the body • Alone in the room with a professional

25. Child Pornography • 1977 there were 250 child porn magazines in the US • 1978 first federal law concerning child pornography passed • 1988 first laws passed referring to computers and child porn

26. 1 million + pornographic images of children on the Internet at any one time • 200 new images posted daily • 1 site had a million hits in 1 month

27. 1 offender possessed 450,000 images • Estimated 50,000 to 100,000 pedophiles in organized porn rings worldwide, with 1/3 of them in the US • 1 YAHOO e-group had 7,000 members with 4,600 of them living in the US

28. 1 US company had 5,700 websites, 390,000 subscribers in 60 countries, $1.4 million monthly turnover • 1 club had a membership of 180 individuals from 33 countries. Membership required production of 10,000 child porn images

29. Internet facilitates child sexual abuse: • It allows networking among perpetrators • It is used to seek out and groom victims----cyber-stalking

30. It is used to promote child sexual tourism • It is used in trafficking children Mail-order children are available over the Internet U.S. Department of Justice, Child Pornography on the Internet, May 2006

31. Mental Injury Observable substantial impairment in the ability to function within normal range of performance and behavior based on age

32. Diagnosed and confirmed by • a licensed physician or • a qualified, licensed mental health professional

33. Mental injury can be caused by: • Ignoring the child and failing to • provide stimulation, responsiveness, • and validation of worth • Rejecting the child’s values and needs • Isolating the child and denying normal • human contact

34. Terrorizing the child with • verbal assaults, climate of fear, • hostility, anxiety, lack of feelings of • safety and security • Corrupting the child by encouraging • and reinforcing destructive, • antisocial behavior

35. Verbally assaulting the child with • name calling, harsh threats, put • downs • Over-pressuring the child to grow • up fast, achieve more…until the • child feels they are never quite • good enough

36. Denial of Critical Care (Neglect) Failure to do something that results in danger of injury or death 8 sub-categories: food, shelter, clothing, health care, mental health care, unmet emotional needs, failure of supervision, failure to respond to life-threatening condition

37. Failure to provide when financially able to do so or when offered financial or other reasonable means to do so • Legitimate religious beliefs • Water and electricity

38. Dental Neglect Abused children have higher levels of untreated dental disease than non-abused peers Caregivers, advised of the extent of the oral condition and consequences of failure to treat, yet do nothing

39. Presence of Illegal Drugs in a Child’s Body • Cocaine, heroin, marijuana, amphetamines, methamphetamine—not alcohol, or prescription drugs • Confirmed by a lab report

40. Examples: • Illegal drugs were present in the • infant’s body due to the illegal drug • usage by the mother before the • baby’s birth • A 3 year old child tests positive for • illegal drugs due to exposure when the • caretakers used illegal drugs in the • child’s home

41. Indicators of Illegal Drugs in a Child’s Body • Physical challenges-Birth defects • Low birth weight • Failure to thrive • Rib malformation, eye problems, • cleft palate

42. Skin problems • Dental problems • Decreased physical growth • Delayed motor development

43. Psycho-social problems • Irritability • Memory • Emotional control • Hyperactivity • Attention span

44. Learning disabilities • Sleep disturbances • Personality disorders • Depressive symptoms

45. Child Prostitution • Child is encouraged or allowed to prostitute • Child does not actually have to engage in the sex act • The offer for sale or purchase is sufficient • Exchange can be money, goods, or services

46. Manufacturing or Possession of a Dangerous Substance • Manufacturing of a substance in the presence of a child where it can be seen, smelled, or heard • “Dangerous substances” • Amphetamines, Methamphetamines • Possession of precursors • Any chemical or combination posing a risk of explosion, fire, or other danger

47. DHS must notify law enforcement since this is a criminal act

48. Meth Precursors Ephedrine or pseudoephedrine Lithium batteries Starter Fluid Rock or table salt Drain cleaner Camping fuel Sulfuric Acid Acetone Heet (gas additives) Paint thinner Iodine Brake Cleaner Toluene Muriatic Acid Anhydrous Ammonia Matchbooks Coffee Filters Aluminum Foil Assorted glassware Propane Tanks Coolers Plastic Soda Bottles

50. Iowa Alliance for Drug Endangered Children