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BHIPP Bulletin

Child Abuse Reporting
Volume 2, Issue 9
March 2017

An estimated  three million cases of child abuse and neglect involving nearly 5.5 million children are reported annually, and thousands die as a result. Most states recognize four types of maltreatment, including physical abuse, emotional abuse, sexual abuse, and   neglect. This edition of the BHIPP  newsletter will focus on Maryland’s state laws regarding child abuse and neglect reporting.

 What is Child Abuse and Neglect?
CODE OF MARYLAND REGULATIONS (COMAR) defines child abuse and neglect as:
  • Physical injury not (necessarily visible) of a child under circumstances that indicate that a child’s health or welfare is harmed or at substantial risk of being harmed.
  • The failure to give proper care and attention to a child, leaving a child unattended where the child’s health or welfare is harmed or a child is placed in substantial risk of harm.
  • An act or acts involving sexual molestation or exploitation whether physical injuries are sustained or not.
  • Identifiable and substantial impairment of a child’s mental or psychological ability to function.
  • Finding credible evidence that has not been satisfactorily refuted that physical abuse, neglect or sexual abuse occurred.
For those children who are survivors of abuse and neglect, the emotional trauma may be long-lasting. Early recognition is important, not only to keep the child safe, but also to get the child into treatment in order to minimize the long-term sequelae of abuse. Children may not openly disclose past or current abuse. Children who are maltreated may present in a variety of ways: 

 A child might be potentially experiencing physical abuse if he or she:
  • Has frequent injuries or unexplained bruises, welts or cuts or explanation is incongruent to the injury
  • Have injuries that appear to have a pattern such as marks from a hand or a belt
  • Attempts to hide body parts that previously were exposed without concern (arms, legs, neck, etc.)
  • Has unusual, unexplained burn marks, bite marks, broken bones
  • Shies away from touch, flinches at sudden movements, or is afraid to go home.
 A child might be potentially neglected if he or she:
  • Have untreated illnesses or physical injuries that present a significant risk to the child if left untreated
  • Experiences a lack of adequate or appropriate supervision (taking into account the age and capabilities of the child)
  • Has been abandoned
  • Experiences parental/caretaker substance abuse or use or mental illness that interferes with ability to provide appropriate care and supervision of the child
  • Experiences deprivation of food, shelter or clothing
A child might be potentially experiencing sexual abuse if he or she:
  • Has a sexually transmitted disease
  • Demonstrates sexualized behavior that is not age appropriate and/or is highly overt or repetitive
  • Is withdrawn or isolates self
  • Frequently runs away from home
  • Is abnormally secretive and socially isolated
  • Experiences unexplained painful urination or defecation
  • Has unexplained change in behavior (aggressive, withdrawn, self-destructive)
 A child might be potentially showing the signs of mental injury if he or she:
  • Is excessively withdrawn, fearful, or anxious about doing something wrong
  • Demonstrates extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive)
  • Does not seem to be attached to the parent or caregiver
  • Demonstrates a noticeable decline in cognitive abilities
Source:Maryland Department of Human Resources
Mandated Reporters
Whenever a child says he or she has been abused, or if abuse is suspected, it must be taken seriously and be reported immediately to ensure the safety and well-being of the child and other children that may now be in the same home as the alleged abuser. 

Reporting does NOT require PROOF that child abuse or neglect has occurred. Incidents are to be reported as soon as they are suspected. Waiting for proof may involve grave risk to the child and impede services to the family. Witnesses to child abuse and neglect are rare. Professional judgment and knowledge should be used to evaluate any suspicion.

Please note that effective October 1, 2016, if a local department has reason to believe that a mandated reporter knowingly failed to make a report of suspected abuse or neglect of a child, the local department must file a complaint with the appropriate licensing board or employer of the mandated reporter. Anyone making a “good faith” report is immune from civil liability and criminal penalty.

It is important to provide as much information as possible to assist in the determination of maltreatment and whether investigative action (forensic assessment) will be taken.

Source: Maryland Department of Human Resources
When & Where to Report
According to DHR:  “Mandated reporters are required to notify the local department of social services or the appropriate law enforcement agency about suspected cases of child abuse or neglect as soon as possible. Reporting form DHR/SSA 180 must be completed within 48 hours following the verbal report. The verbal report should be made immediately upon the reporter having a suspicion that child abuse or neglect has occurred. Please select the local department of social services for the jurisdiction where you believe the incident(s) occurred to make a report. A copy of the form must also be provided to the local State’s Attorney’s office.”

Source: Maryland Department of Human Resources

A listing of local DSS offices can be found here.

 What Happens after Reporting to CPS?
 According to DHR:  “The local Department of Social Services will screen the allegation to determine whether or not what you have reported meets the legal criteria for child abuse and neglect. If the allegation does meet the legal criteria the screener will “screen in” the report and the screening supervisor will then determine the pathway to which the case will be assigned; Alternative Response or Investigative Response. The screening supervisor is responsible for determining the pathway only after review of all information gathered.

It is important that you provide as much information as possible to assist in both the determination of maltreatment as well as to aid in the determination of the appropriate pathway assignment.

Maryland now has a dual pathway system for all CPS cases. Alternative Response is a pathway utilized for lower risk cases which involves a family assessment and family engagement response and in which no “finding” is made.

Investigative Response is the traditional investigation, which focuses more on forensic assessment and in which a “finding” is made.

The intake worker will ask multiple questions to gather as much information as possible regarding the allegation to determine both validity and/or urgency of the referral. If the report does not meet the legal criteria for maltreatment and/or CPS intervention, the worker may refer the caller to other agencies who can provide services to the family.

The local department cannot share with the caller the status of the referral i.e. screened in or screened out.

The intake worker may request name and contact information in the event that additional information is required at a later time. However, you are not required to give your name.

If the case is “screened in” it will be immediately assigned to a Child Protective Service worker who will make contact with the family to assess the needs of the family and to provide appropriate services.

Cases that are “screened out” may still be referred for services if the case is assessed as being able to benefit from services.”

Source: Maryland Department of Human Resources
Additional Resources on Child Abuse & Neglect
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BHIPP Announcements

BHIPP Holiday Closures Calendar

The BHIPP telephone consultation line will be closed on the following days:
  • Monday, May 29, 2017
  • Tuesday, July 4, 2017
  • Monday, September 4, 2017
  • Monday, October 9, 2017
  • Friday, November 10, 2017
  • Thursday, November 23, 2017
  • Friday, November 24, 2017
  • Monday, December 25, 2017
BHIPP is a Community Champion of the Children's Mental Health Matters! Campaign

And you can be too! 

Help raise awareness about the importance of children's mental health in your community! Join the Children's Mental Health Matters! Campaign to promote Children's Mental Health Awareness Week in Maryland (May 1-7, 2017). 

For more information, visit the Campaign's website



Maryland Chapter AAP offers
Free Webinar -
Developmental Screening in Pediatric Offices: Practical Strategies and Updates

Date: Thursday, March 30, 2017
Time: 12:30-1:30 pm

Presenters: Diana Fertsch, MD, FAAP & Debbie Badawi, MD, FAAP

Connection information:
Dial-in: 872-240-3412
Access code: 659-184-541

For more information:
Loretta Hoepfner, Executive Director
Maryland Chapter, AAP
Maryland Chapter AAP offers Free
In-Office Training - Developmental Screening 

The one-hour training reviews Maryland's current approved and recommended developmental screening tools, as well as information on interpreting and documenting screening results and coding and billing for services. 

View flyer.

For more information:
Emily Evers, MPH, CHES


BHIPP Bulletin Newsletter Archive

February 2017: Trauma and Adverse Childhood Experiences (ACEs)
January 2017: FAQs about Stimulant Dosing
December 2016: Bullying
November 2016: Learning Disorders and Intellectual Disability
October 2016: Educational Services: Know Your Rights and Resources
September 2016: Goodbye Summer, Hello School (Refusal)
August 2016: College Students and ADHD
July 2016: It's Summertime! ADHD and "Drug Holidays"
June 2016: Understanding Vyvanse
May 2016: Children's Mental Health Awareness Week, May 1-7, 2016
April 2016: "Universal" approaches for child mental health problems
March 2016: Pharmacological interventions for sleep concerns
February 2016: Behavioral interventions for sleep concerns
January 2016: Assessment of sleep disorders
November 2015: 5S's: Key questions for consultation
October 2015: Case discussion regarding school refusal
Copyright © 2017 Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP), All rights reserved.

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