0070-531.10 | Revision Date: 07/07/22
This policy reviews how to conduct a visual inspection of a child which includes the removal or adjustment of clothing in accordance with best social work practices, as well as, state and federal legal requirements.
TABLE OF CONTENTS
When Should a CSW Visually Inspect a Child?
Authorization Required to Disrobe a Child
Conducting a Visual Exam of the Child
Referenced Policy Guides
This policy guide was updated from the 07/01/14 version to provide more detailed guidance as to when a CSW should do a visual inspection of a child as well as the documentation of the visual inspection in the CSW/CMS Delivered Service Log and the DCFS 550, Body Chart form.
Emergency Response (ER) CSWs need to conduct visual inspections of a child during the investigative stages when assessing for physical harm resulting from an act of abuse or neglect, other than sexual abuse or exploitation.
Continuing Services (CS) and Dependency Investigator (DI) CSWs need to conduct visual inspections of a child during the first home visit to establish a baseline for the child’s appearance and/or during any following visits, when any of the following concerns are expressed regarding a child who has an open case:
The CS CSW should assess whether or not they need to have the child or parent/legal guardian/caregiver disrobe or rearrange the clothing of the child during face-to-face visits and/or whether a referral to the medical Hub for a forensic and/or medical assessment is appropriate.
If there are allegations of malnutrition, the child being under weight, suspicion of failure to thrive, and/or allegations that the child is not being fed enough, the CSW should conduct a visual inspection to assess the child’s physical condition. It is particularly critical that this be done for children 0-36 months of age. The CSW should submit a referral for consultation to utilize the in-office Public Health Nurse (PHN) to obtain professional opinions, resources, and technical assistance and to address the appropriateness of a referral to the Medical Hub for medical assessment.
A visual inspection of a child may necessitate having the child or the parent/legal guardian rearrange a child’s clothing or disrobe. Whenever possible, have the non-offending parent/legal guardian assist with rearranging/disrobing of the child’s clothing. Having the child or the parent/legal guardian rearrange a child’s clothing or disrobe the child should be done only when the CSW has reasonable cause to believe that physical harm occurred or any other situation where there may be physical evidence observed on a child’s body and the CSW has either consent, exigent circumstances, or a court order.
Before conducting a visual inspection of any child, it is important to talk to the child and make sure they understand the need for the disrobing or rearranging, and are comfortable with it. If the child reports that they are not comfortable, this should be documented. Since non-verbal children cannot consent to having their clothing rearranged or being disrobed, CSWs are to seek the parent/legal guardian/caregiver’s consent.
The process of rearranging clothing or disrobing any child under five (5) years of age must stop if the child appears to be uncomfortable and/or says “no.” If this occurs, ask if the parent or caregiver will take the child to a HUB/medical facility for an examination; the CSW can accompany them. If the parent/legal guardian does not consent to this, determine whether exigent circumstances exist or if a court order is necessary for visual inspection, rearranging, and/or disrobing of a child.
Any child nearing puberty or older (i.e. a child who is nearing physical, emotional and/or psychological maturity) should not be disrobed or be asked to disrobe by the CSW. An alternative for children of this age is to ask for their consent to a limited visual inspection, which can consist of them rearranging their clothing, e.g., raising shirt sleeves or pant legs and/or changing into active wear, e.g., a short-sleeved shirt or shorts.
If the CSW is the person having the child or the parent/legal guardian rearrange a child’s clothing or disrobe a child five (5) and under, the CSW must have an adult witness.
For allegations and/or suspicions of sexual abuse or exploitation, the CSW is not to disrobe or rearrange the child’s clothing. The CSW must immediately submit a referral for a forensic evaluation at a Medical Hub. The Medical Hub forensic practitioner will determine whether a forensic evaluation is needed and the timing of the evaluation.
Back to Policy
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 to the Green Folder in CWS/CMS. 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 dialogue around 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.
Back to Policy
A CSW must have one of the following to have the child or the parent/legal guardian rearrange a child’s clothing or disrobe a child when investigating allegations of physical harm to the child or any other situation where there may be physical evidence on a child’s body:
Back to Policy
The CSW can have the child or the parent/legal guardian rearrange a child’s clothing or disrobe a child if the CSW has obtained permission from the child’s parent/legal guardian.
A child twelve (12) years of age or older, who is a suspected victim of abuse or neglect, and who, in the opinion of the CSW, is mature to understand the purpose of the interview, can consent to a limited visual inspection by a CSW. Conversely, a child twelve (12) or older may overrule a parent/legal guardian's consent for disrobing. For suspected victims of physical abuse, a parent/legal guardian’s objection would overrule the child’s desire to show injuries.
Back to Policy
ER/CS/DI CSW Responsibilities
Back to Procedure
DCFS 550, Body Chart
0070-524.10, Assessment of Failure to Thrive
0070-529.10, Assessing Allegations of Physical AbuseNon-accidental bodily injury that has been or is being willfully inflicted on a child. It includes willful harming or injuring of a child or endangering of the person or health of a child defined as a situation where any person willfully causes or permits any child to suffer, or inflicts thereon, unjustifiable physical pain or mental suffering, or having the care or custody of any child, willfully causes or permits the person or health of the child to be placed in a situation such that his or her person or health is endangered.
0070-548.20, Taking Children into Temporary CustodyThe removal of a child from the home of a parent or legal guardian and placement or facilitation of placement of the child in the home of a non-offending parent, relative, foster caregiver; group home or institutional setting.Temporary custody also includes: placing hospital holds on children; situations in which the CSW interrupts an established Family Law Court custody or visitation orders when the CSW believes that if the order is carried out, the child would be placed in immediate risk of abuse, neglect or exploitation and the child is allowed to remain in the home of the non-offending parent; situations in which DCFS requests that law enforcement remove a child from the home of his or her parent/legal guardian and the CSW places the child with a relative or unrelated caregiver; and situations in which the child is living with a relative or an unrelated caregiver and all of the following conditions exist: child’s parent is asking for the child to be returned home, CSW believes that the return of the child to his or her parent would place the child at risk of abuse, neglect or exploitation, CSW does not allow the child to be returned to his or her parent; and, the child remains in the home of the relative or is placed in out-of-home care.
0070-560.05, Joint Response Referral: Consulting with PHN
0070-570.10, Obtaining Warrants and/or Removal Orders
0600-500.00, Medical Hubs
Penal Code Section 11165.3 - defines “the willful harming or injuring of a child or the endangering of the person or health of a child,” as a situation in which any person willfully causes or permits any child to suffer, or inflicts thereon, unjustifiable physical pain or mental suffering, or having the care or custody of any child, willfully causes or permits the person or health of the child to be placed in a situation in which their person or health is endangered.
Welfare and Institutions Code Section 300 (a) - states that “The child has suffered, or there is a substantial risk that the child will suffer, serious physical harm inflicted non-accidentally upon the child by the child’s parent or guardian. For the purposes of this subdivision, a court may find that there is a substantial risk of serious future injury based on the manner in which a less serious injury was inflicted, a history of repeated inflictions of injuries on the child or the child’s siblings, or a combination of these and other actions by the parent or guardian which indicate the child is at risk of serious physical harm. For the purpose of this subdivision, “serious physical harm” does not include age-appropriate spanking to the buttocks where there is no evidence of serious physical injury.
Back to Helpful Links