0070-529.10 | Revision Date: 10/24/22
This policy provides an overview for assessing allegations of physical abuse and provides instructions on observing, gathering, and assessing evidence.
TABLE OF CONTENTS
Forensic Evaluation <![CDATA[ ]]>
Medical Hub Referral
Forensic Evaluation Results
Medical Hub Referral Follow Up
Investigating a Referral Alleging Physical Abuse
Obtaining a Forensic Evaluation
Reviewing the Results of a Forensic Evaluation
Referenced Policy Guides
This policy was updated from the 07/01/14 version, to align with current policy and practice for assessing suspected or known physical abuse during an emergency response (ER) investigation or throughout the life of an open case. Additionally, clarification on when to refer to a Medical Hub for consultation and obtaining forensic evaluations have been included.
Physical abuse, which refers to non-accidental bodily injury inflicted on a child, can include a single incident ranging from “over-discipline” (e.g. the caregiver loses control and inflicts a mark or bruise on a child) to the extreme case of child death. The longer the physical abuse continues, the more serious the consequences. Early identification of child physical abuse and effective intervention is critical.
Regardless if a child has already been treated for an accidental injury, CSWs shall not assume all injuries are accidental.
Indicators of physical abuse include, but are not limited to:
Physical abuse is a criminal offense. A child may be removed from the custody of a parent/legal guardian due to physical abuse. As a result, law enforcement must be involved in all investigations when there are allegations of physical abuse. As mandated reporters, CSWs must cross-report all allegations of physical abuse. In many cases, a child may be referred to DCFS after law enforcement has already detained the child and/or the child’s siblings.
CSWs must be familiar with the physical and emotional indicators of physical abuse by being observant and conducting interviews that address issues of discipline, punishment and physical abuse during all contacts with DCFS- supervised children.
For every instance in which there are allegations or concerns of physical abuse, CSWs shall submit a referral for consultation with a medical hub (Hub) to determine the need for a forensic evaluation.
Any time marks or bruises are observed and/or when investigating physical abuse allegations, the CSW must complete the DCFS 550 Body Chart form, in its entirety, according to the instructions on the form. The completed Body Chart form must be placed in the child’s physical case file. CSWs are encouraged to upload a legible DCFS 550 Body Chart Form in CWS/CMS (green folder). Uploading the DCFS 550, Body Chart form in CWS/CMS is not a substitute for documenting written details in the CWS/CMS Delivered Services Log. Additionally, a consult or conversation with the SCSW will assist in assessing physical abuse indicators, even in situations where physical abuse was not initially suspected, not part of an allegation, or not the reason for an open case.
A forensic evaluation is comprised of a physical examination and clinical assessment to determine the presence and extent of injuries and/or signs of abuse and/or neglect (e.g. If there are marks, such as bites; fractures; burns; and/or bruises); and/or sexual abuse, and/or Commercial Sexual ExploitationConduct involving matter depicting a minor engaged in obscene acts in violation of Section 311.2 (preparing, selling, or distributing obscene matter) or subdivision (a) of Section 311.4 (employment of minor to perform obscene acts). Any person who knowingly promotes, aids or assists, employs, uses, persuades, induces or coerces a child, or any person responsible for a child's welfare who knowingly permits or encourages a child to engage in, or assist others to engage in, prostitution or a live performance involving obscene sexual conduct or to either pose or model alone or with others for the purpose of preparing a film, photograph, negative, slide, drawing, painting or other pictorial depiction involving obscene sexual conduct. 'Person responsible for a child's welfare' means a parent, guardian, foster parent, or a licensed administrator, or employee of a public or private residential home, residential school, or other residential institution. Any person who depicts a child in, or who knowingly develops, duplicates, prints, or exchanges, any film, photograph, video tape, negative, or slide in which a child is engaged in an act of obscene, sexual conduct, except for those activities by law enforcement and prosecution agencies and other persons described in subdivisions (c) and (e) of Section 311.3.' (CSE). It includes the provision of clinical care for all injuries and effects of abuse and/or neglect. This may include old injuries that may not be clinically obvious and the initiation of treatment.
Forensic evaluations interpret the physical findings regarding the likelihood that they are the result of abuse and/or neglect and may involve evidence collection, including evidence of sexual assault and STIs; and, may include photo documentation of injuries, including but not limited to, sexual assault injuries.
Forensic evaluations may include diagnostic imaging such as a skeletal survey or full body radiograph, Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). Diagnostic imaging is critical in detecting previous or hidden injuries and in obtaining accurate diagnosis and treatment for children. It is an essential element in documenting the evidence needed in both Juvenile and Criminal Court to protect a child from further injury and death.
Medical Hub Referral
Medical Hub referrals are required in all cases of suspected physical abuse.
• CSWs are reminded that abuse, neglect and CSE may occur either during an ER investigation or throughout the life of an open case.
Whenever allegations of physical abuse or sexual abuse or CSE of a child comes to the attention of a CSW, as soon as practically possible, the CSW shall submit a Medical Hub referral. The referral will initiate a consult with a Hub medical provider (aka, Specialist) who has specialized training in the detection and treatment of child abuse and neglect. It is the responsibility of the Specialist to determine if a forensic evaluation is appropriate. If it is determined that a forensic evaluation is necessary, an additional referral to the Hub is not needed.
The need for a forensic evaluation is determined by the Hub medical provider on a case-by-case basis; some children may not require one. If it is determined that a forensic evaluation is necessary, the hub will determine the timing of the evaluation.
For siblings or other children who live in the same home and/or have contact with the alleged perpetrator (companion referrals or cases), the Hubs will request the CSW to provide complete information at intake from the CSW’s interview of each child.
In circumstances where the alleged victim is under the age of five (5) or is non-verbal, the Hub may request that older siblings or children/youth identified in companion referrals/cases accompany the alleged victim to the Hub to assist in providing history. In some instances, the alleged victim may be examined first and the other child(ren) may not require a (complete) forensic evaluation.
Forensic Evaluation Results
The results of the Hub forensic evaluation are documented in E-mHub and sent to the currently assigned DCFS regional CSW within ten (10) business days of the appointment, or ten (10) business days after the receipt of all requested medical records needed to complete the forensic evaluation.
Medical Hub Referral Follow Up
Any child/youth with serious acute medical concerns may be referred to the Emergency Department or hospitalized, if needed, to address these conditions. The Hub medical provider will attempt to contact the DCFS CSW who submitted the Medical Hub referral by phone if urgent forensic concerns are identified, or in case of hospitalization. Hub clinics may provide follow-up care for identified forensic medical concerns if a child does not have a primary care physician that is able to adequately address these issues.
Forensic evaluations require:
Absent the above requirements, a request for an investigative / evidentiary medical examination, such as a forensic evaluation, should be made via:
When completing a warrant consultation, specify the need for a forensic evaluation.
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Back to Procedure
Submit a Medical Hub referral for a forensic evaluation.
Consult with a Hub medical provider (aka, Specialist) who has specialized training in the detection and treatment of child abuse injuries and child neglect. Out-stationed CSWs are available to facilitate consultations with the Hub medical providers.
Back to Procedure
Staff are reminded that when reviewing any medical reports, such as the forensic evaluation results, to consider the totality of the information received and observed through interviews, etc. and not just the forensic evaluation results. Forensic evaluations are only one tool amongst many that CSWs are to consider when assessing the safety and risk of a child as the absence of physical injuries does not necessarily indicate that abuse and/or neglect has not occurred.
Back to Procedure
LA County Medical Hub Core Services - Escalation Decision Tree for CSWs
SS 8572, Suspected Child AbuseThe non-accidental commission of injuries against a person. In the case of a child, the term refers specifically to the non-accidental commission of injuries against the child by or allowed by a parent(s)/guardian(s) or other person(s). The term also includes emotional, physical, severe physical, and sexual abuse as defined in CDSS MPP Section 31-002(c)(9)(D). Report (SCAR)
SS 8583, Child Abuse Investigation Report
DCFS 550, Body Chart
DCFS 5402, Notice to Child's/NMDs Attorney Re: Case Status
0050-502.10, Child Protection Hotline
0070-525.10, Assessment of Shaken Infant Syndrome
0070-531.10, Visual Inspection of Children
0070-548.10, Disposition of Allegations and Closure of Emergency Response Referrals
0070-548.24, Structural Decision Making (SDM)
0070-548.25, Completing the Structured Decision Making (SDM) Safety Plan
0070-560.05, Joint Response Referral: Consulting with PHN
0070-570.10, Obtaining Warrants and/or Removal Orders
0400-503.10, Contact Requirements and Exceptions
0600-500.00, Medical Hubs
Penal Code Sections 11165.3 – Refers to a situation in which any person willfully causes or permits any child to suffer, or inflicts thereon, including unjustifiable physical pain or mental suffering.
Penal Code Sections 11165.4 – States, in part, that "unlawful corporal punishment or injury" means a situation where any person willfully inflicts upon any child any cruel or inhuman corporal punishment or injury resulting in a traumatic condition.
Penal Code Sections 11171 (a), (1) & (2) – States, in part, that adequate protection of victims of child physical abuse or neglect has been hampered by the lack of consistent and comprehensive medical examinations. Enhancing examination procedures, documentation, and evidence collection relating to child abuse or neglect will improve the investigation and prosecution of child abuse or neglect as well as other child protection efforts.
Welfare and Institutions Code Section 300 (a) – States, in part, that a juvenile court may adjudge that a child to be a dependent of the court should the child have suffered, be at risk of suffering physical harm inflicted non-accidentally, by the child's parent or guardian.
Welfare and Institutions Code Section 324.5 (a) – States that whenever allegations of physical or sexual abuse of a child come to the attention of a local law enforcement agency or DCFS and the child is taken into protective custody, that agency may, as soon as possible, consult with a medical practitioner to determine whether a physical examination of the child is appropriate. The examination shall be performed within 72 hours of the time the child was taken into protective custody or within 72 hours of the time the allegations were made, if the child is already in custody at the time of the allegations.
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