In 2013 and 2014 Pennsylvania enacted numerous changes to the Child Protective Services Law. This training is designed to review legal, ethical, risk management, and clinical decisions related to the changes in the law. The training will review the signs leading to the recognition of child abuse and also the reporting requirements for suspected child abuse in Pennsylvania. The topics to be covered include a description of child welfare services in Pennsylvania, important definitions related to the child abuse reporting law, responsibilities of mandated reporters, ways to recognize child abuse and other topics. We will review clinical scenarios that challenge ethical issues, legal requirements, risk management concerns, and clinical choices.

1. John Gavazzi, PsyD ABPP
Penn State Harrisburg
April 29, 2015
Child Abuse Reporting
Guidelines: Ethical and Legal
Issues

2. Program Overview
• Definitions: Clinical, Legal, Risk Management
and Ethical Issues
• Child Welfare Services
• Important Definitions related to Reporting
▫ Types of Abuse
▫ Perpetrators
• Responsibilities of Mandated Reporters
• Ways to Recognize Child Abuse and Other
Topics

3. Learning Objectives
At the end of the program, the participant should be able to:
1. Describe the child welfare system in Pennsylvania;
2. Define child, child abuse, perpetrators, and other
relevant terms;
3. Paraphrase the responsibilities of mandated reporters;
4. Recognize the signs of child abuse and situations where
child abuse must be reported; and,
5. Understand how to fulfill their responsibilities as
mandated reporters of child abuse.

4. • Clinical Decision-making
• Risk management
• Legal Decision-making
• Ethical Decision-making
▫ Professional Ethics
▫ Personal Ethics, Values, or Morality
Four Types of Decision-making

5. While these domains overlap,
there are unique
characteristics about each.

6. • What is the best clinical intervention for this
patient in this situation?
• What are the best psychological instruments to
answer the referral question?
• Am I conceptualizing this patient correctly?
• My patient continues to struggle after eight
sessions. What should I do?
Clinical Decision-making

7. • How do I work with a patient to minimize risk or
liability?
• Avoid types of work that have high liability risks,
such as custody evaluations or clinical complex
patients.
• Do I have essential paperwork signed? Informed
Consent or practice policies current
Risk Management

8. • Always have a suicidal patient sign a “no suicide”
contract
• Never touch a patient
• Always remain at a professional distance
emotionally and socially
• Boundary crossings vs. boundary violations
False Risk Management Strategies

9. • Am I compliant with state laws and regulations?
• Is my practice HIPAA compliant?
• Am I aware of relevant case law in my state?
• Questions are usually asked of an attorney
Legal Decision-making

10. Professional Ethics
• Do I follow the American Psychological
Association’s Code of Conduct?
• Am I aware of and do I comply with the APA’s
Guidelines for treatment?
• Am I performing at the minimum or reaching for
the aspirational ceiling?
Ethical Decision-making

11. Personal values, ethics, and morality
• Is what I am doing consistent with my values?
• What is my emotional response to the patient,
lifestyle, or behavioral issue?
Ethical Decision-making

12. Rules of Conduct – Profession/society
More external – Community (of peers)
Easier means to judge others’ actions
Can constrain individual choices or create dilemmas
Explicit/cognitive/external/measured
Ethics

13. Description of Child Welfare Services in
Pennsylvania
• The purpose of the Child Protective Services Law is to
“establish in each county protective services for the
purpose of investigating the reports [of abuse] swiftly
and competently, providing protection for children from
further abuse and providing rehabilitation services for
children and parents involved” (23 P.C.S.A. §6302 (b)).
• To reach this goal, the law establishes in each county “a
program of protective services with procedures to assess
risk of harm to a child” (23 P.C.S.A. §6302 (b)).

14. General Protective Services
Services are geared to prevent the potential for harm
to a child. Examples of General Protective Services
include, but are not limited to, a child who:
1. has been abandoned by his parents, guardian or
other custodian.
2. is without a parent, guardian or legal custodian.
3. is habitually and without justification truant from
school while subject to compulsory school
attendance.

15. Child Protective Services
The Child Protective Services is designed to:
1. Protect abused children from further abuse.
2. Preserve and stabilize families.
3. Implement the Child Protective Services Law.
4. Involve law enforcement agencies in responding to child
abuse.
5. Prioritize the response and services to children most at risk.
6. Encourage more complete reporting of suspected child
abuse.

16. PA Stats on Founded Abuse 2013
Sexual Abuse – 64%
Physical Abuse – 26%
Neglect – 5%
Abuse to Occur Imminently – 5%
Emotional Abuse – 1%

17. Founded Abuse Reported by
Psychologists 2013
Physical Abuse – 40%
Sexual Abuse – 32%
Emotional Abuse – 15%
Imminent Neglect – 5%

18. Important Definitions
All of these definitions can be
found in 23 Pa. C. S. A. §6303

19. Child and Perpetrator
Child
Perpetrator
1. Parents
2. Paramour or Paramour of child’s parent
3. 14 y.o. or older + responsible for child’s welfare
4. 14 y.o. or older + resides in same home as child
5. 18 y.o. or older – not in same home, but within
third degree of consanguinity or affinity by
birth or adoption
6. School employees

20. Most Abuse Occurs through
Action
Some abuse occurs by failing to
act.

21. Relationships May commit Abuse May commit abuse by
failing to act
Parent of the child YES YES
Spouse or former spouse of child’s parents YES YES
Paramour or former paramour of the child’s parent YES YES
Person 14 years of age or older and responsible for
the child’s welfare
YES YES, except for persons
14-17
An individual 14 years of age or older who resides
in the same home as the child
YES YES, except for persons
14-17
An individual 18 years of age or older who does
not reside in the same home as the child but is
related within the third degree of consanguinity or
affinity by birth or adoption to the child
YES NO
Table 1:Perpetrators

22. National Classification of Child Abuse
Causing Serious Physical Neglect of a Child
(previously called non-accidental injury)
Sexual Abuse
Emotional or Mental Abuse
Neglect

23. The Nine Definitions as per the Revised Child
Protective Services Law

24. Causing Serious Physical Neglect (9)
1. Causing bodily injury to
a child through any recent
act or failure to act.
2. Fabricating, feigning or
intentionally exaggerating
or inducing a medical
symptom or disease which
results in a potentially
harmful medical evaluation
or treatment to the child
through any recent acts.
3. Causing or substantially
contributing to serious
mental injury to a child
through any act or failure
to act or a series of such
acts or failures to act.
4. Causing sexual abuse or
exploitation of a child
through any act or failure
to act.

25. Causing Serious Physical Neglect (9)
5. Creating a reasonable
likelihood of bodily injury
to a child through any
recent act or failure to act.
6. Creating a reasonable
likelihood of sexual abuse
or exploitation of a child
through any recent act or
failure to act.
7. Causing serious physical
neglect of a child.
8. Causing the death of the
child through any act or
failure to act.

26. Causing Serious Physical Neglect (9)
9. Engaging in any of the
following 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
consideration of the method,
location or the duration of the
restraint or confinement.
• Interfering with the breathing
of a child.
• Causing a child to be present
at a location [where meth is
being produced illegally]. . .
• Leaving a child unsupervised
with an individual, other than
the child’s parent, who the
actor knows or reasonably
should have known [was a sex
offender]. . .

28. Definition: Neglect
(of Failure to Supervise)

29. Neglect is defined as follows:
any of the following when committed by a perpetrator that
endangers a child’s life or health, threatens a child’s well-
being, causing bodily injury or impairs a child’s health,
development, or functioning:
1. A repeated, prolonged or unconscionable egregious
failure to supervise a child in a manner that is
appropriate considering the child’s developmental age
and abilities.
2. The failure to provide a child with adequate essentials
of life, including food, shelter or medical care.”

30. Neglect in 3 situations
1. allowing a child to be in the presence of a meth
lab;
2. allowing a child to be supervised by a sexual
predator;
3. Munchausen by proxy which is defined as
fabricating or exaggerating a child’s symptoms
to induce a harmful medical procedure.

32. Definition: Bodily Injury

33. Bodily injury is defined as
1. “impairment of physical condition or
substantial injury”, and,
2. serious bodily injury is defined as a bodily
injury “which creates a substantial risk of
death or which causes serious permanent
disfigurement or protracted loss of impairment
of function of any bodily member or organ.”

34. Bodily injury could include:
1. an action qualifying under the definitions of bodily
injury or serious bodily injury as found in 23 Pa. C.
S. A §6303;
2. any of the explicit acts identified in 23 Pa. C. S. A
§6303 (b) dealing with slapping small children,
etc.;
3. “creating a reasonable likelihood of bodily injury
to a child through any recent act or failure to act;”
and,
4. causing the death of a child.

35. Corporal punishment
• Corporal punishment is not in and of itself child
abuse.
• A finding of physical abuse includes burning,
fractures, welts, bite marks, sprains, dislocations, or
internal hemorrhaging
• Bruises can also lead to a substantiation of child
abuse, although not all bruises involve loss of
functioning of a bodily member or organ or severe
pain.

36. Others Actions of Bodily Injury
• kicking, biting, throwing, burning, stabbing or
cutting a child “in a manner that endangers the
child” constitutes child abuse, as does
“interfering with the breathing of a child”
• “unreasonably restraining or confining a child
based on consideration of the method, location
or the duration of the restraint or confinement”

37. Bodily Injury of Children Under Age 1
triggering a Report of Abuse
• “forcefully slapping or otherwise striking”, or
• “forcefully shaking” a child under one year of
age.

38. Recklessness occurs when a person
consciously disregards a substantial and
unjustifiable risk that the material element exists
or will result from his conduct. The risk must be of
such a nature and degree that, considering the
nature and intent of the actors conducts and the
circumstance known to him, its disregard involves
a gross deviation from the standard of conduct
that a reasonable person would observe in the
actor’s situation” (18 Pa C. S. A. §302 (b) (3)).

39. Some Statistics on Physical Abuse
• More common in homes where unrelated adults
live
• More common when the child suffers with a
disability
• 19% occurred when the child lived in poverty
• However, statistics are not helpful in deciding
when and when not to report

40. Signs of Physical Abuse
1. Unexplained physical injuries
2. Changes in sleep, appetite, and behavior
3. Regression
4. Fear of going home, reluctance to leave office,
or running away
5. Risk taking behavior
6. Social withdrawal

43. Definition: Serious Mental Injury
Public statistics indicate emotional
abuse as high as 19%. However,
the founded rated of abuse is far
lower than that.

44. Definition of Serious Mental Injury
A psychological condition, as diagnosed by a physician
or licensed psychologist, including the refusal of
appropriate treatment that:
1. Renders a child chronically and severely anxious,
agitated, depressed, socially withdrawn, psychotic
or in a reasonable fear that the child’s life or safety
is threatened; or
2. Seriously interferes with a child’s ability to
accomplish age-appropriate developmental and
social tasks” (23 Pa. C. S. A. §6303).

45. Serious Mental Injury
Despite this very broad definition, emotional
abuse or mental injury is seldom founded in
Pennsylvania (in 2013, only 31 cases or well less
than 1% of all founded incidents involved
emotional abuse).

46. Signs of Mental or Emotional Abuse
1. Psychosomatic issues (frequent headaches,
illness, nausea, etc.)
2. Changes in sleep, appetite, and behavior
3. Regression
4. Fear of going home, reluctance to leave office,
or running away
5. Increase in depression and anxiety
6. Social withdrawal

48. Definition: Sexual Abuse

49. The Definitions of Sexual Abuse are
Derived from:
1. the definitions section;
2. the statutes referenced in the definition
section; and,
3. the list of 9 types of abuse found in section
6303 (b).

50. Sexual Abuse is:
The employment, use, persuasion,
inducement, enticement or
coercion of a child to engage in or
assist another individual to engage
in sexually explicit conduct, which
includes but it not limited to:
1. Looking at the sexual or other
intimate parts of a child or another
individual for the purpose of
arousing or gratifying sexual desire
in an individual.
2. Participating in sexually explicit
conversation either in person, buy
telephone, by computer or by a
computer-aided device for the
purpose of sexual stimulation or
gratification of any individual.
3. Actual or simulated sexual
activity or nudity for the purpose
of sexual stimulation for
gratification of any individual.
4. Actual or simulated sexual
activity for the purpose of
producing visual depiction,
including photographing,
videotaping, computer depicting or
filming”

51. Sexual Behavior Issues
The definition section specifically states that it is
not sexual abuse for a child “who is 14 years of age
or older” to engage in consensual sexual activity
with “another person who is 14 years of age or
older and whose age is within four years of the
child’s age”

52. Criminal Behavior
The definitions section enumerates the sexual
offenses that trigger a report of suspected child
sexual abuse: rape, sexual assault, statutory sexual
assault, involuntary deviant sexual intercourse,
aggravated indecent assault, institutional sexual
assault, molestation, indecent assault, indecent
exposure, prostitution, sexual abuse, unlawful
contact with a minor, incest, and sexual
exploitation. A report of suspected abuse is
required regardless of who committed the offense.

53. Criminal Behavior
That is to say, the individual who committed the
crime against the child need not be a perpetrator
according to the definition in the Child Protective
Services Law. A report of suspected abuse is
required any time the mandated reporters have
reason to suspect that the crime occurred,
regardless of whether the mandated reporters saw
the abused child in their professional capacity.

54. Criminal Behavior
The definitions of sexual criminal offenses overlap
considerably. Understanding of the elements of
these offenses requires knowledge of the
Pennsylvania Crimes Code.
Table Two gives more information on the sexual
behaviors that can trigger a report of suspected
sexual abuse.

55. Activity Age of Child Found in Criminal Code Report
Non consensual sexual
intercourse
Anyone under 18 Rape ( §3121); involuntary
deviate sexual intercourse
(§3123);
sexual assault (§3124.1)
YES
“consensual” sexual intercourse One of the participants is
less than 13 years old
Rape; statutory sexual assault
(§3122.1); involuntary deviate
sexual intercourse; aggravated
indecent assault (§3125)
YES
“consensual” sexual intercourse One of the participants is 13,
14, or 15 and the other is 4
or more years older and they
are not married
Involuntary deviate sexual
intercourse; statutory sexual
assault
YES
“consensual” sexual intercourse
as resident of juvenile justice or
MH/MR facility
Anyone under 18 Institutional sexual assault
(§3124.2)
YES
Consensual sexual intercourse Youngest participant is 16
years old or older
Not a reportable crime NO
“consensual” touching of sexual
parts for the purpose of sexual
gratification
Anyone less than the age of
13 is incapable of giving
consent; anyone who is 13,
14, or 15 and the other party
is four or more years
older than they are and they
are not married
Indecent assault (§3126) YES
Table Two: Descriptions of Sexual Offenses Involving
Children

56. “consensual” sexual
intercourse between relative
and child
Anyone under 18 Incest (§4302) YES
Victim of indecent exposure Anyone under 18 Indecent Exposure (§3127) YES
Engaging in or being solicited
to engage in prostitution
Anyone under 18 Prostitution (§5902) YES
Any unlawful contact with a
minor associated with open
lewdness, prostitution,
obscenity, sexual abuse, or
sexual exploitation
Anyone under 18 Unlawful contact with minor
(§6318); Open lewdness
(§5901); prostitution (§5902),
obscenity (§5903); sexual
abuse (§6312), and sexual
exploitation (§6320)
YES
Being Procured for
pornography or disseminating
or being in knowingly in
possession of child
pornography
Anyone under 18 being
used for pornographic
purposes
Sexual exploitation; sexual
abuse
YES
Deliberately exposed to
alarming sexual activities
Anyone under 18 Open lewdness (§5901) YES
Deliberately sold pornography
or admitted to pornographic
event
Anyone under 18 Obscenity (§5903) YES
Table Two: Descriptions of Sexual Offenses Involving
Children

57. Another note on Sexual Offenses
It should be noted that the list of 9 child abuse
offenses in Section 6304 specifically states that
creating a likelihood of sexual abuse qualifies as
sexual abuse.

58. Does sexual play by young children trigger a
report of suspected child abuse?
• 50% of children under age 13 engage in sexual
behavior
• This may include rubbing genitals, kissing,
simulated intercourse, mouth to genital contact,
and insertion of objects into the anus or vagina.
• Not always clear when ordinary sexual play
crosses the line into sexual abuse.

59. Sexual play of Children
• May be spontaneous or a the result of curiosity
• May be related to incidental or accidental
exposure to adult nudity or sexual behavior
• Access to pornography (substandard parenting
to intentional exposure)

60. Some Factors to Consider
• Did the sexual activity occur because of force or
the threat of force?
• Was there a large difference in the age (or a large
difference in maturity or cognitive ability)
between the children?

61. Signs of Sexual Abuse
1. Acting out in sexually inappropriate ways; hearing
new adult words for sexual body parts
2. Changes in sleep, appetite, and behavior
3. Regression
4. Fear of going home, reluctance to leave office, or
running away
5. Increase in depression and anxiety
6. Social withdrawal and becoming unusually
secretive

62. Exclusion to Child Abuse
Six Examples

63. Environmental Factors
Except for child-care services or adoptive parents,
no child will be considered abused based on
injuries that occur only because of inadequate
housing, furnishing, income, clothing, and
medical care “that are beyond the control of the
parent or person responsible for the child’s
welfare with whom the child resides.”

64. Practice of Religious Beliefs
No child will be considered abused because the parents
or caregiving relative (defined as “relative within the
third degree of consanguinity and with whom the child
resides”) has denied medical or surgical care based on
beliefs “consistent with those of a bona fide religion”
(§6304 (b)). However, in those situations the county
agency will closely monitor the child and shall seek
court-ordered medical intervention “when the lack of
medical or surgical care threatens the child’s life or
long-term health” ((§6304 (b)).

66. Use of force for supervision, control
and safety purposes
A parent or another person responsible for the
welfare of a child may use physical force
1. “to quell a disturbance or remove a child from
the scene of a disturbance that threatens
physical injury to persons or damage to
property;”
2. to prevent the child from self-inflicted physical
harm;

67. Use of force for supervision, control
and safety purposes
3. Or self-defense or the defense of another
individual; or
4. To obtain possession of weapons or other
dangerous objects or controlled substances or
paraphernalia that are on the child or within the
control of the child.”
*In addition, any adult may use reasonable force in
defense of themselves for their own protection or the
protection of another person.

68. Child to child scuffle
• Mutually agreed upon fights, disputes, or
scuffles between children are generally not
considered child abuse.
• However, it is child abuse if it involved rape,
sexual assault, involuntary sexual intercourse,
aggravated sexual assault, indecent assault, or
indecent exposure.

69. Reasonable physical force by a
parent
• Parents may “use reasonable force on or against
their children for the purposes of supervision,
control and discipline of their children.”

70. Reporting Child Abuse
All licensed professional and
Christian science practitioners

71. The People who Report is Wide
Non mental health professionals Mental Health
• School nurses
• Members of the clergy
• School administrators
• Day-care workers
• Any other child care worker
• Foster care worker
• Peace officer
• Law enforcement official
• Lawyers
• Psychologists
• Certified School Psychologists
• Psychology Trainees
• Psychology Students
• Employees of Psychologists
• Professional Counselors
• Social Workers
• All other mental health
workers

72. Lawyers as mandated reporters
• Except for confidential communications covered
under the attorney-client communication law,
lawyers are mandate reporters

73. Mandate Reporters: Reason to Suspect
1. They “come into contact with the child in the course of
employment, occupation and practice of a profession”
(23 Pa. C. S. A. §6311 ((b) (1) ( i))
2. The mandated reporter is affiliated with “an
agency, institution, organization, school, regularly
establish church or religious organization or other
entity that is directly responsible for the care,
supervision, guidance or training of the child,” (23
Pa. C. S. A. §6311 ((b) (1) (ii);

74. Mandate Reporters: Reason to Suspect
3. “A person makes a specific disclose to the
mandated reporter that an identifiable child is
the victim of child abuse” (23 Pa. C. S. A. §6311
((b) (1) (iii)); and
4. “An individual 14 years of age or older makes a
specific disclosure to the mandated reporter
that the individual has committed child abuse”
(23 Pa. C. S. A. §6311 ((b) (1) ( iv))

75. Third Party Reports
• Credibility is a factor
• Sufficient detail in the report
• Beware of secondary motives

76. Starting January 1, 2015:

77. Caveat to Self-Report of 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” (23 Pa. C. S. A. §6311(b)
(3)).
Report the suspicion of abuse, but not necessarily
the individual perpetrator

78. Supervisors and Employees
Supervisees or employees must immediately
report child abuse and “thereafter notify the
person in charge of the institution, school, facility
or agency or the designated agent of the person in
charge” ((23 Pa. C. S. A. §6311 (c)).

79. Important Point to Remember
Although the mandated reporters must report any
time that they have reasonable cause to suspect
abuse; it is not their role to investigate the abuse.
The investigation is done by local Children and
Youth workers.

80. Making the Actual Report
What information is needed

81. Making the Report
• Through statewide phone number:
1-800-932-0313
• Electronic Submission: Child Welfare
Information Solutions (CWIS)
www.compass.state.pa.us/cwis
• Reporting must be made within 48 hours of
learning the abuse

82. Report must include:
1. Names and addresses of the child
and the parents or other persons
responsible for the care of the
child if known;
2. Where the suspected abuse
occurred;
3. The age and sex of the subject of
the report;
4. The nature and extent of the
suspected child abuse, including
the evidence of prior abuse to the
child or siblings of the child;
5. The name and relationship of the
persons or persons responsible for
causing the suspected abuse, if
known, and any evidence of prior
abuse by that person or persons;
6. Family composition;
7. The source of the report;
8. The person making the report and
where that person can be reached;
9. The actions taken by the reporting
source, including the taking of
photographs and X-rays, removal
of keeping of the child or notifying
the medical examiner or coroner;
and
10. Any other information the
department may require through
regulation.

84. What happens after a report is made?
1. After a report of child abuse is made, Children
and Youth workers will begin their
investigation.
2. Children and Youth will determine if the abuse
is substantiated or not .
3. Children and Youth will also provide needed
services to the child and family if indicated.

85. Mandated Reporters “Right to Know”
Mandated reporter has a right to receive follow-up
information
1. Whether the child abuse is indicated, founded
or unfounded
2. any services provided, arranged for or to be
provided by the county agency to protect the
child.
(23 P. C. S. A.§6340 (a) (12))

86. Protections and Penalties for
Mandated Reporters
What to know

87. Protections
Mandated reporters receive immunity for good
faith in making reports of suspected abuse,
cooperating with investigations, testifying in
proceedings arising out of suspected abuse, or
engaging in some other actions, such as taking X-
rays of abused children or reporting deaths.

88. Penalties
• Mandated reporters who willfully fail to report
suspected child abuse commits a misdemeanor
of the third degree for the first violation.
• Depending upon the facts of the case, the
grading of the potential criminal sanctions range
may increase up to a second degree to a felony of
the second degree.
• Expect greater scrutiny of cases

89. Important Points
• Know the law
• Secure consultation or legal advice in difficult
cases
• Exercise sound clinical judgment
• Maintain good written records

90. The End
Questions
Complete Assessment