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2. Trainer’s Names: Organization: Venue: Date:

3. Housekeeping This training will last approximately 90 minutes with questions included Please follow along using the Mandated Reporter Training Notes Handout provided on page 11 of your packet

4. Objectives Understand how the laws around mandated reporting affect you Define four types of abuse and related indicators Describe the process for handling a disclosure of abuse Follow the basic procedure for reporting suspected child abuse Identify protective factors and strategies for preventing child abuse

5. Understanding a Mandated Reporter’s Role • Barriers? Ideally, mandated reporting is the early recognition of child maltreatment with the goal of preventing further abuse from occurring. Includes individuals who work or volunteer for organizations that serve children and/or families.

6. Prevention Primary Before anything has happened Tertiary After the behavior or event has occurred Prevention is a continuum What are some other examples of Primary Prevention?

7. Why is Prevention so Important

8. Healthy Adult Effects of Child Maltreatment Poorer Health Outcomes Decrease in Adult Job Productivity Involvement in Criminal Activity Less Likely to Graduate Increase School Absence Decrease Vocabulary Poor or Little Parent Child Interaction Decrease Mental Health Learn violent behavior Infancy Behavior Problems

9. Call 1-800-CHILDREN (1-800-244-5373) Se Habla Español Connects Families to Supportive Programs and Resources in your Community • The 1-800-CHILDREN Helpline Includes: • Courts/ Criminal Justice/ Public Safety • Education/ Employment • Family and Community Resources • Food/ Clothing/ Shelter • Healthcare • Abuse/ Domestic Violence • The 1-800-CHILDREN Helpline is For: • Professionals that work with families • Parents, Foster Parents, • Grandparents, Kin, and/or Friends • Crime Victims or Survivors of Abuse  • Faith Communities New Online Resource Map The 1-800-CHILDREN Helpline contains over 3,000 resources that can also be found on PCA Georgia Online Resource Map. Go to: http://abuse.publichealth.gsu.edu/map/

10. Abuse & Neglect Nationally and in Georgia • Georgia ranked 39th in the nation for child wellbeing 97 Fatalities in GA

11. 70% 70%

12. Abuse & Neglect in Georgia • 70% of maltreatment related child deaths are in children under 3 years old • The leading cause of death in children under 1 year old is ___________ • About 80% of perpetrators are the child’s biological parent(s) • The majority of abuse takes place inside the home sleep related

13. Parental & Family Factors Maturity level of parent/ caregiver Unrealistic expectations of child Social isolation Unmet emotional needs Frequent crisis Poor childhood experiences Drug or alcohol problems Mental illnesses Poor family boundaries Dangerous home environment

14. Cost of Child Maltreatment The national estimated total cost of substantiated child maltreatment from 2015 is more than $428 Billion. The estimated annual cost of child abuse and neglect in Georgia in 2015 is approximately $18 billion. The total lifetime cost for ONE abused or neglected child in the United States $830,928.

15. Recognizing Child Maltreatment

16. How does Georgia define abuse? O.C.G.A. § 15-11-2 (2) (A) (2015)Any non-accidental physical injury or physical injury which is inconsistent with the explanation given for it suffered by a child as the result of the acts or omissions of a person responsible for the care of a child. Expanded Definition “Physical injury or death inflicted upon a child by a parent or caretaker thereof by other than accidental means; provided, however, physical forms of discipline may be used as long as there is no physical injury to the child…” • O.C.G.A. § 19-7-5 (2016)

17. Physical Abuse- Non-accidental physical injury of a child PHYSICAL INDICATORS • Unexplained bruises and welts • Unexplained burns • Unexplained fractures /dislocations • Bald patches on the scalp BEHAVIORAL INDICATORS • Feels deserving of punishment • Wary of adult/physical contact • Frightened of parents/afraid to go home • Self-destructive behaviors • Wears clothing to cover body – inappropriate for weather

18. Identifying Physical Abuse • Bruises • unexplained or have conflicting explanations • Not logical with age of child • Various stages of healing • Patterned (shape may resemble an article used to inflict the injury) • Location • Ears, soft part of cheek, neck, inner thighs/ genitals, trunk, buttocks, hands/ feet

19. Identifying Physical Abuse Diagnostic Imaging of Child Abuse http://pediatrics.aappublications.org/content/123/5/1430.full Evaluating Physical Abuse http://pediatrics.aappublications.org/content/119/6/1232.full.pdf+html • Burns • Accidental burns vary in depth of burn; can look like splash marks; and have indistinct borders • Skeletal • Unexplained fractures with inconsistent histories • Head Trauma • Shaken Baby Syndrome

20. Reported by Medical Personnel Only Prenatal Abuse § 15-11-2(56) Exposure to chronic or severe use of alcohol or the unlawful use of any controlled substance, which results in: • Symptoms of withdrawal in a newborn or the presence of a controlled substance or a metabolite in a newborn’s body, blood, urine, or meconium that is not the result of medical treatment or • Medically diagnosed and harmful effects in a newborn’s physical appearance or functioning. Infant must be born and identified by medical personnel as being affected by substance abuse or withdrawal symptoms due to drug exposure or Fetal Alcohol Spectrum Disorder (FASDs).

21. Reported by Medical Personnel Only Affected Includes the Following Criteria: • A mother tested positive for illegal substances or prescription drugs due to misuse during pregnancy; • A mother self-disclosing at birth a substance or alcohol use problem and use during pregnancy; • An infant is experiencing symptoms of withdrawal, or exhibiting harmful effects in his/her physical appearance or functioning;   • An infant testing positive for the presence of a substance or a metabolite in his/her body, blood, urine or meconium; or has symptoms of a Fetal Alcohol Spectrum Disorder.  A mother testing positive at birth for illegal substances or prescription drugs due to misuse;  

22. Reported by Medical Personnel Only Reporting Suspected Prenatal Abuse • Report must be made to DFCS within 24 hours • Report must be from a medical provider/hospital staff • Medical providers must make a notification even if there is no allegation of maltreatment • DFCS will work with medical providers, the family and other community providers to develop a Plan of SafeCare for the birth mother, infant and family support system

23. Plan of Safe Care A process that involves a multi-agency partnership with families affected by prenatal substance and/or alcohol exposure to develop a written plan to: • Ensure the safety and well-being of infants following release from the care of healthcare providers; • Address the health and substance use disorder treatment needs of the infant and affected family or caregiver; • Identify and obtain agreement regarding a responsible party for referrals, provision of services for the mother, other caregivers, infant and other children in the home; and • Identify and obtain agreement regarding a responsible agency to monitorthe Plan of Safe Care, if the case will not be opened for child welfare services.

24. Important Points to Remember Up to 50% of fractures in the first year of life are related to abuse “Those who don’t cruise rarely bruise” Consistent history is often a determining factor Corporal punishment is legal, physical abuse or injury is not Photos- GA law says photos may be taken of child’s injury without parental permission only by hospital employees or volunteers, law enforcement, school officials, or employees or volunteers of child protective agencies (O.C.G.A. 19-7-5 (e))

25. Neglect Georgia Code (O.C.G.A. § 49-5-180(5)(B));The Definition of Child Neglect (current as of 2016): “The failure to provide proper parental care or control, subsistence, education as required by law, or other care or control necessary for a child's physical, mental, or emotional health or morals; the failure to provide a child with adequate supervision necessary for such child's well-being; or the abandonment of a child by his or her parent, guardian, or legal custodian.”

26. Neglect Most common form of child maltreatment Can be difficult to identify Parents who abuse substances (alcohol & drugs) and/or have inadequate parenting skills are responsible for many of the neglect cases Because so many cases go unreported, child abuse and neglect is a much larger problem than statistics indicate

27. The Science of Neglect

28. Different Types of Neglect • Emotional • Failure to provide love, affection, security, and emotional support that result in serious cognitive, affective, or other behavioral health problems • Physical • Failure to provide adequate food, shelter, clothing, hygiene and/or supervision • Medical • Failure to provide necessary medical or mental health treatment • Educational • Failure to educate a child or attend to special educational needs

29. Neglect BEHAVIORAL INDICATORS • Self-destructive behaviors • Begging, stealing food • Extended stays at school (early arrival and late departures) • Constant fatigue, listlessness • Assuming adult responsibilities • Says no caretaker at home • Frequently absent / tardy • PHYISCAL INDICATORS • Consistent hunger/underweight • Poor hygiene • Consistent lack of supervision • Unattended physical/medical needs • Failure to thrive/poor growth • Distended stomach • Inappropriate dress

30. Emotional/ Psychological Abuse • Behaviors that harm a child’s self-worth or emotional well-being • Repeated pattern of damaging interactions between caregivers and child • Examples • Name calling • Shaming • Rejection • Withholding love • Threatening

31. Emotional/ Psychological Abuse • Potential Indicators • Speech disorders • Lags in physical development • Failure to thrive • Disruptive behavior • Sleep disorders • Disorganization

32. Sexual Abuse The exploitation of a child for the sexual gratification of an adult or older child. Sexual abuse is most commonly perpetrated by an individual known to the victim. Rarely is the offender a stranger. One-third of all sexual abuse is perpetrated by another child Includes: fondling, sodomy, rape, child prostitution, indecent exposure and exhibitionism, utilizing the internet as a vehicle for exploitation. Commercial Sexual Exploitation of Children (domestic minor sex trafficking)

33. Sexual Abuse • Physical Indicators • Difficulty walking or sitting • Torn, stained or bloody underclothes • Pain, swelling or itching in the genital area • Pain on urination • Bruises, bleeding or laceration in external genitalia area • Presence of STI • Frequent urinary or yeast infections • Behavioral Indicators • Inappropriate sex play or advanced sexual knowledge and promiscuity • Hysteria, lack of emotional control • Sudden school difficulties • Withdrawal or depression • Excessive worrying about siblings • Difficult peer relationships, resists involvement with peers • Self-imposed social isolation • Avoidance of physical contact or closeness • Sudden massive weight change (loss or gain)

34. Sexual Abuse • Report suspicions of child sexual abuse to DFCS • DFCS will refer children to local Child Advocacy Centers (CACs) • Seek the Darkness to Light Stewards of Children sexual abuse prevention training • Led by the Georgia Center for Child Advocacy • Educate staff on healthy childhood sexual development

35. Types of disclosure • Indirect Hints (“I don’t like staying with ____) • Disguised Disclosures (“I know someone who…”) • Disclosures with Strings Attached (“I’ll tell you if …”)

36. When a Child DisclosesMaltreatment • Respect the child’s need for confidentiality • Leave investigative work to professionals – Minimize the number of questions you ask – Avoid the use of leading questions – Don’t try to get all of the details • Report the disclosure immediately to designated reporter (or CPS/police)

37. Trauma Informed-Approach Realize the widespread impact of trauma Recognize the signs and symptoms of trauma Respond by fully integrating knowledge about trauma into policies Seek to actively resist re-traumatization.

38. Mandated Reporting

39. Mandated Reporting-Who is mandated to report? • Physicians licensed to practice medicine; interns/residents • Registered professional nurses / Licensed practical nurses • Hospital or medical personnel, Dentists, Podiatrists • Professional counselors, social workers, or marriage and family therapists • Staff andvolunteersat child and family- serving agencies • Reproductive health care facility or pregnancy resource center personnel and volunteers • Clergy- however not within the confines of confession * Mandated reporters should know and follow the child abuse reporting protocol in their agency Georgia law requires certain individuals to report suspected child abuse: • schoolteachers/administrators • School guidance counselors, visiting teachers, school social workers, school psychologists • Child Service organizational personnel • Child welfare agency personnel • Child counseling personnel • Law enforcement personnel • Licensed psychologists (interns)

40. Your Role Not Your Role Investigating information an individual or child has told you or injuries of a child You are legally required to report your suspicion to the DFCS centralized intake office or to your organization’s designated mandated reporter. Familiarize yourself on your organization’s reporting policy. Advocate for child safety policies in your workplace or community.

41. What are the rights of a mandated reporter? Rights of the Mandated Reporter • Anonymity or confidentiality • Limited Liability • Knowledge of the outcome only of a report • Whether the case was substantiated or not • Turning Over Images or Materials • Designated mandated reporters MUST submit all reports made to them • Penalty for not reporting: misdemeanor

42. Report by calling 1-855-GACHILD (422-4453) 1-855-GACHILD • Required to report immediately, but at least within 24 hours • Mandated reporters in good faith possession of any illegal materials or images of children should give them over to police within 72 hours. (O.C.G.A §16–3–22.1(2016) • Immediate Danger call 911 • It is helpful to know • Demographic information of child • Care takers, who is in the house • Injury/ situation specifics • Risk factors • Prior concerns • Child’s current safety

43. Electronic Ways to Report Mandated Reporters have the choice of two options for submitting this completed form electronically. Option One: E-mail the completed Georgia Mandated Reporter From to cpsintake@dhs.ga.gov. You will receive an auto-reply stating that the CPS report has been received. You will also receive a return phone call within 2 hours to acknowledge your report and collect any additional information needed. This return phone call satisfies the legal requirement to speak with a DHS employee. Please include on the report a number where you can be reached. To request a PDF version of the form, please contact customer_services_dfcs@dhr.state.ga.us. You can also fax the form to 229-317-9663).

44. Electronic Ways to Report Option 2: Complete the digital form located at https://cps.dhs.ga.gov. A private code is needed to access the digital form. This code will be given upon completion of mandated reporter training. The online mandated reporter training can be found at https://www.prosolutionstraining.com/hosted courses/hostcode.cfm?hostid=18

45. When to call 911 Report Child Maltreatment by calling 1-855-GACHILD • Present Danger: • Currently occurring • Serious unexplained injury • Left unattended in a parking lot • Parent is unconscious due to drugs and there are young children in the home, or parent behavior is very bizarre • Calling 911 and DFCS may be necessary. Law enforcement is designed to respond within minutes, whereas DFCS may respond as soon as they get the report or within 24 hours.

46. After the Report is Made • DFCS must send confirmation notification of report to mandated reporter within 24 hours of the intake report. • Includes process for the reporter to obtain the outcome of the case • School personnel • Will receive confirmation of report, additionally they will also receive case outcome within 5 days of completion of investigation if the case is substantiated • You may report anonymously, and your identify will not be given to the family. • You may be called back to gather more information needed or to clarify. • There is the potential that you will need to appear in court.

47. How does DFCS Screen Calls and Assign Response Times? Report Child Maltreatment by calling 1-855-GACHILD The extent of maltreatment The circumstances surrounding maltreatment The level of child functioning The level of adult functioning Parent behavior/ decisions Discipline

48. Substantiated Child Maltreatment Family Services (Unsubstantiated) Family Services (Unsubstantiated) Screened Out Investigation • Assigned In-Person • Response Time • Immediately • 24 hours • 72 hours Report Child Maltreatment by calling 1-855-GACHILD

49. Screened In Calls Report Child Maltreatment by calling 1-855-GACHILD • Criteria • Have an alleged maltreater • A child 0-18 years of age • Known or suspected allegations of child maltreatment per Georgia statute and DFCS policy • Calls may be screened out because there is not enough information or the report does not rise to the level of defined maltreatment.

50. Summary of Screening Calls Report Child Maltreatment by calling 1-855-GACHILD Maltreatment + present danger situation = immediate response assignment Maltreatment + impending danger safety threat = 24 hour response assignment Maltreatment + no present danger or impending danger safety threat = 72 hour response assignment