Mandatory Reporter Training for Child Abuse PowerPoint Presentation

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

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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

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Iowa Code Sections 232.67 through 232.75 Civil vs. Criminal Code

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3 C’s Child Caretaker Circumstance

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Definitions Child—anyone under the age of 18

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

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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

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Circumstance—abusive incident What abuse is suspected?

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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

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

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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

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

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

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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 Indicators of Physical Abuse in Ascending Order of Severity

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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

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

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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

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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

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

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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

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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

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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

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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

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

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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

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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

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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

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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

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

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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

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

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

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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

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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

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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

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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

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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

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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

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

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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

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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

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Skin problems Dental problems Decreased physical growth Delayed motor development

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Psycho-social problems Irritability Memory Emotional control Hyperactivity Attention span

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Learning disabilities Sleep disturbances Personality disorders Depressive symptoms

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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

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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

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DHS must notify law enforcement since this is a criminal act

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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

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Iowa Alliance for Drug Endangered Children

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Bestiality in the Presence of a Minor Commission of a sex act with an animal in the presence of a minor As a result of acts or omissions of a person responsible for the care of the child

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DHS must report this type of allegation to law enforcement This is a criminal act under child endangerment

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Allows Access by a Registered Sex Offender A caretaker knowingly allows unsupervised access to a child by a registered sex offender or allows a registered sex offender to have custody or control of a child up to age 14 or Up to age 18 if the child has a mental or physical disability

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Exceptions The registered sex offender is a parent of the child, or is married to the person responsible for the care of the child, or is a minor residing in the home of their parent, guardian, or a person having custody or control over the minor

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DHS must report this type of allegation to law enforcement This is a criminal act under child endangerment

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These cases can be considered Denial of Critical Care

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Allows Access to Obscene Materials Caretaker knowingly allows access to obscene materials Exhibits obscene materials to a child Disseminates obscene materials to a child

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Iowa Code Section 728.1 Definitions

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DHS 2010

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Confirmed or Founded Cases 2010 Age

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Percentage of Confirmed Reports 2010

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Facts 75% of all victims have no prior history of victimization Abuse victims are equal male and female, except for sexual abuse Most abuse happens between ages 0-3 years, during toilet training

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Persons responsible for abuse are generally the parents or female caretakers Child abuse is 15 times more likely to occur in homes where adult domestic violence is present Domestic violence is the major precursor to child abuse and neglect fatalities

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Child homicides—shaken, slammed baby: 1st: father 2nd: mother’s boyfriend 3rd: mother

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