1. Effects of Abuse and Neglect on
Dynamics of Abuse
and Neglect:
Signs of Maltreatment
Effects of Abuse and Neglect on
Child Development

2. Competencies for Social Workers
SW Understands the scope and types of child maltreatment
SW Ability to differentiate between poverty, homelessness, substandard living conditions and neglect and understand how poverty confounds child neglect
SW115-01: Ability to identify indicators of age appropriate development including stages, processes and milestones of normal development of infants, toddlers, preschool children, school-age children, preadolescent children, and adolescents.
SW119-02: Ability to recognize cultural factors that influence parenting tasks and their impact on a family’s response to CA involvement.
SW121-01: Ability to identify characteristics and behavioral indicators of developmental/mental health concerns in children and youth.
Review competencies

3. Debrief
Was there anything in this e- learning so far that surprised you?
Were there specific signs of abuse that you were not expecting to see?
Trainer Note: If you have already had a robust discussion of the e-learning you can skip this slide. Or, you can ask just a few of the questions below (four are repeated in the slide) to generate further conversation.
Was there anything in these e-learnings that surprised you?
Were you aware that CPS opens cases when there is no alleged abuse or neglect? What do you think of that? After all, we are a government agency intruding on the private lives of families.
Were you surprised at the low rates of sexual abuse? Does this fit with what you hear in the media about the role of CPS?
What about the relatively low rate of physical abuse? Did this surprise you?
What about the allegations of maltreatment linked with child deaths?
Were there specific signs of abuse or neglect that you were not expecting to see?
What about the effects of child maltreatment on child development?

4. Case Example: Physical Abuse
What physical, behavioral and developmental indicators are there that Tucker has been physically abused?
What steps would you take to find out what happened to Tucker? How quickly would you respond?
Hand out case example and address the questions in the slide. See the instructor’s guide to the case example.

5. Case Example: Physical Abuse
WAC (1) Physical abuse means the non- accidental infliction of physical injury or physical mistreatment on a child. Physical abuse includes, but is not limited to, such actions as:
(a) Throwing, kicking, burning, or cutting a child;
(b) Striking a child with a closed fist;
(c) Shaking a child under age three;
(d) Interfering with a child's breathing;
(e) Threatening a child with a deadly weapon;
(f) Doing any other act that is likely to cause and which does cause bodily harm greater than transient pain or minor temporary marks or which is injurious to the child's health, welfare or safety.
What is missing from this assessment?
Has Tucker been abused or neglected?
Should law enforcement be notified?
Is Tucker safe to go home after school? If not, what safety measures should be put in place?
Would you place either Tucker or Wilfred?
Let’s go over these questions from the second part of the case example:
What is missing from this assessment?
Risk issues have not been assessed
Gathering questions have not been addressed
So far, this is an incident-based assessment with no family functioning assessment
Has Tucker been abused or neglected?
Let’s review the definition of physical abuse:
WAC (1) Physical abuse means the non-accidental infliction of physical injury or physical mistreatment on a child. Physical abuse includes, but is not limited to, such actions as:
(a) Throwing, kicking, burning, or cutting a child;
(b) Striking a child with a closed fist;
(c) Shaking a child under age three;
(d) Interfering with a child's breathing;
(e) Threatening a child with a deadly weapon;
(f) Doing any other act that is likely to cause and which does cause bodily harm greater than transient pain or minor temporary marks or which is injurious to the child's health, welfare or safety.
Remember, CPS is only authorized to investigate allegations concerning parents, or those acting in loco parentis, and licensed facilities. Thus we would not make a finding concerning Wilfred.
WAC : Who may receive child protective services?
Children and families may receive child protective services when there is an allegation that a child has been abused or neglected:
(1) By a parent, legal custodian, or guardian of the child; or
(2) In a DSHS licensed, certified, or state-operated facility; or
(3) By persons or agencies subject to licensing under chapter 74.15 RCW, including individuals employed by or volunteers of such facilities.
Although the mother left injuries on Tucker, it is clear these were done when she was trying to protect him from Wilfred. Thus, normally we would not make a finding on the mother for this action.
Should law enforcement be notified?
2571. Mandated Reports to Law Enforcement
The social worker or supervisor shall report, as required by RCW (4) and (3), to law enforcement within 24 hours of receipt of a report by the department in cases where the response time is labeled "emergent" and the child's welfare is believed to be in immediate danger. With the exception of a child fatality, which the social worker or supervisor shall report immediately, the social worker or supervisor shall notify law enforcement within 72 hours of receipt of any reported incident of:
Sexual abuse.
Non-accidental physical injury of a child.
Incidents where the investigation reveals reasonable cause to believe that a crime against a child may have been committed.
Unless otherwise agreed in a local written working agreement with law enforcement, developed in consultation with the Attorney General's Office, DCFS staff making an oral report to law enforcement shall, within five days of receipt of the intake, also report in writing. The person making the report shall file a copy in the department case record or in an administrative file when no case record exists. A FamLink Law Enforcement Report or a legibly completed Report of CA/N, DSHS (X), may be used to comply with the requirement for a written referral.
Social workers and supervisors are not required by statute to report to law enforcement instances of CA/N where no criminal misconduct is reported or discovered. Parenting, child rearing practices, or other life circumstances which may be reported to the department for social assessment are not required to be reported to law enforcement when they do not indicate criminal misconduct against children.
Given this, it is clear that the social worker is required to report Wilfred’s assault on Tucker to law enforcement. There is nothing in this policy which requires the assault to have been committed by a parent.
Is Tucker safe to go home after school? If not, what safety measures should be put in place?
Not safe in that something needs to be done to protect Tucker from Wilfred.
What assistance can be given to the mother to protect Tucker? Possible:
Wilfred stay with a relative
Mother not to leave Tucker alone with Wilfred
Wilfred confined to his room until his father gets home so that mother has support in protecting Tucker
Would you place either Tucker or Wilfred?
Placement is not called for here. The mother was able to intervene and an in-home safety plan with the parents can be developed.
If any child was to be placed, it would be Wilfred. However, what affect do you think Wilfred’s placement would have on the ongoing safety issues for the family?

6. Case Example: Physical Abuse
If in-home services are offered, what would those be?
Let’s read the final section of the physical abuse case example.
If in-home services are offered, what would those be?
Support the parents’ in reaching their goals of improving Wilfred’s behavior.
Monitoring counseling for Wilfred and ensure it involves the parents to learn how to help Wilfred control his behavior and emotions.
Assess whether Tucker needs assistance due to his experience of trauma.
Develop an ongoing safety plan to help prevent a recurrence.

7. Definition of Neglect
WAC (5) Negligent treatment or maltreatment means an act or a failure to act, or the cumulative effects of a pattern of conduct, behavior, or inaction, on the part of a child's parent, legal custodian, guardian, or caregiver that shows a serious disregard of the consequences to the child of such magnitude that it creates a clear and present danger to the child's health, welfare, or safety. A child does not have to suffer actual damage or physical or emotional harm to be in circumstances which create a clear and present danger to the child's health, welfare, or safety. Negligent treatment or maltreatment includes, but is not limited, to: (a) Failure to provide adequate food, shelter, clothing, supervision, or health care necessary for a child's health, welfare, or safety. Poverty and/or homelessness do not constitute negligent treatment or maltreatment in and of themselves; (b) Actions, failures to act, or omissions that result in injury to or which create a substantial risk of injury to the physical, emotional, and/or cognitive development of a child; or (c) The cumulative effects of a pattern of conduct, behavior or inaction by a parent or guardian in providing for the physical, emotional and developmental needs of a child's, or the effects of chronic failure on the part of a parent or guardian to perform basic parental functions, obligations, and duties, when the result is to cause injury or create a substantial risk of injury to the physical, emotional, and/or cognitive development of a child.

8. Case Example: Neglect
What physical, behavioral and developmental indicators are there that any of the children have been neglected?
How would the hospital call to intake be screened into CPS?
What steps would you take to complete your assessment of the risks and safety threats?
Hand out the case example on neglect and address the questions in the slide. See the instructor’s guide to the case example.

9. Case Example: Neglect What is missing from this assessment?
Have Robert and Reggie been neglected (if you suspect that they have, another report should be made to intake)?  
Should law enforcement be notified? 
Are the children safe to go home with Gwendolyn and Peter? What about with Jerold?  
What would you put in place to support an in-home plan for any of the children? 
What would you put in place to support an out-of-home plan for the children?
See the instructor’s guide to the case example.

10. Definition of Neglect
WAC (5) Negligent treatment or maltreatment means an act or a failure to act, or the cumulative effects of a pattern of conduct, behavior, or inaction, on the part of a child's parent, legal custodian, guardian, or caregiver that shows a serious disregard of the consequences to the child of such magnitude that it creates a clear and present danger to the child's health, welfare, or safety. A child does not have to suffer actual damage or physical or emotional harm to be in circumstances which create a clear and present danger to the child's health, welfare, or safety. Negligent treatment or maltreatment includes, but is not limited, to: (a) Failure to provide adequate food, shelter, clothing, supervision, or health care necessary for a child's health, welfare, or safety. Poverty and/or homelessness do not constitute negligent treatment or maltreatment in and of themselves; (b) Actions, failures to act, or omissions that result in injury to or which create a substantial risk of injury to the physical, emotional, and/or cognitive development of a child; or (c) The cumulative effects of a pattern of conduct, behavior or inaction by a parent or guardian in providing for the physical, emotional and developmental needs of a child's, or the effects of chronic failure on the part of a parent or guardian to perform basic parental functions, obligations, and duties, when the result is to cause injury or create a substantial risk of injury to the physical, emotional, and/or cognitive development of a child.

11. Case Example: Neglect Could Richard be placed with his father?
What would be the conditions of that placement?
See instructor’s guide to the case example.

12. Documenting Observations: with specifics
Statements: who made the statements and clarifying what are quotes and what is paraphrasing
Collateral contacts: who contacted, when, what they were asked as well as information they contributed
Expert opinions: what information provided, opinion received verbally, reports received
The purpose of today’s session is not to rehash what you learned in your e-learnings, but to use the knowledge you gained to practice identifying when child maltreatment has occurred and the effects on the child. When you have a clear picture of that, you will be able to professionally document your observations in a way that is consistent with your conclusions. As we discuss the case examples, think about how you would document what you observed, statements made, information from collateral contacts and experts.
It may work for the Supreme Court to say that they know pornography when they see it – but it doesn’t work for the Children’s Administration to say that they know child maltreatment when they see it. You will need to explain your findings and actions based on the information you have gathered. These e-learnings were the first step in that process and in this session we will practice putting into action what you have learned.

13. Signs of Abuse and Neglect Training for RCT
Findings
Documented on the Investigative Assessment
Letters sent to parents informing them the investigation is closed and the result of the investigation
If there is a founded finding, the documentation from the Investigative Assessment that reflects the reasons for the findings are sent to the subject along with a letter explaining the appeal process
Findings have significant impacts on subjects
Whether there is a finding of abuse or neglect does not determine if a case will be opened for services.
CPS FAR does not make findings of abuse or neglect, but whether the child has suffered from maltreatment and the nature and extent of that maltreatment is an important part of the FAR Family Assessment (fondly known as the FARFA).
Only in CPS Investigations and DLR CPS are findings made. From the e-learning, you understand the definitions of the different forms of child maltreatment and findings are based on these definitions. The investigation determines what happened, and the findings are made comparing the information gathered about the event(s) to the definition of child maltreatment. If, more likely than not, the events that occurred were within the scope of a definition of child maltreatment, the finding of the investigation will be “founded.” The findings, along with an explanation of why the findings were made, are documented in the Investigative Assessment. The subjects of the investigation are notified of the findings at the conclusion of the investigation. If there is a founded finding, the subject is also notified of their right to appeal the finding to an Administrative Law court.
It is important to realize that the findings made by CPS investigations can have significant impacts on people’s lives. Positions that provide unsupervised access to children or vulnerable adults have background checks completed that include a review of any findings of abuse or neglect. If there is a finding, the subjects will be denied employment working in child care, as home health aides, or as medical professionals. People with findings of abuse and neglect are also denied volunteer roles with children, such as foster parent, scout leader, coach, or even to volunteer in their children’s schools. For this reason, it is very important that findings are taken seriously and supported with clear documentation.

14. Only One Part of Your Assessment
Looking for signs of child maltreatment and effects of maltreatment on child development is an important part of your assessment
Will also consider:
Whether there is a safety threat
The risk of future maltreatment
The family functioning
The family’s resources
As we move forward in RCT, you will learn about the assessments that are done in the Children’s Administration in all of its programs. This involves more than if a child has been abused or neglect. Your goal is to prevent future harm to a child through maltreatment, and other factors enter into that determination.
That said, recognizing when abuse and neglect has occurred is very important for all staff. It is a critical part of determining if a child is safe. Documenting indications that maltreatment has occurred is also important in order to take action with the courts to protect children.
While this may be counter-intuitive, the finding of abuse or neglect does not directly inform the decision whether the department will remain involved to help protect the child or children. That decision is based on whether the child is safe now, and whether there is a high risk of abuse or neglect in the future.
Who can think of a situation where we might make a finding of child maltreatment, but close a case
A mother goes to a family party and has more wine than she is used to. She plans to spend the night with her family, so was not careful in the amount that she drank. She has two small children with her at the party. While she is there, she receives a call that her husband’s car is broken down. She makes the decision to go get her husband and changes her plans to spend the night at her own home, so takes the children with her. She is pulled over for DUI. This is her first DUI. She says that she did not realize how intoxicated she was and admitted that her judgment was probably impaired. Family, friends, the children’s doctor, the mother’s doctor, the children’s day care provider and mother’s employer all report that they have not seen signs of a substance use disorder. They also report that the children are well cared for and are, in fact, above average in intelligence and are well-behaved. In this situation, the mother clearly neglected the children by endangering them while driving drunk. However, the children do not appear to be in danger now. This case can be closed.
Who can think of a situation where we might determine that an allegation is unfounded, but we still open services for a family?
A doctor makes a referral for neglect of a 3 month old as the child is losing weight and she has found no medical cause. She refers the family to Children’s Hospital for more evaluation and intervention for the failure to thrive. The doctor is also concerned that the mother appears often to be “out of it” and admitted to regularly using heroin. The father also reportedly uses heroin and is very angry at times. He has been seen to yell at the infant when the infant is crying. The hospital also is concerned with the parents not comforting or holding the baby. When Children’s Hospital is consulted, they have found a medical cause for the failure to thrive and the parents are following through with treatment. Given this information, the allegation of neglect is unfounded. However, because of the parents’ substance abuse disorders, neither parent showing an ability to comfort and attach to the child, and the father’s inappropriate yelling at the child, this is a high-risk situation. The child is in the period of highest risk for purple crying, has a medical issue that can be life threatening, and both parents are at times unresponsive due to substance abuse. The department should offer services to the family and may even file a dependency petition if the parents are not responsive to the services offered.
In summary, findings are very important, but aren’t the only thing you assess. The concern is the safety of the child.

15. What are some of the key learning points from the e-learnings and today’s discussion?
At your tables, come up with five key learning points from today’s training.
What are some of the key learning points from the e-learnings and today’s sessions?
Trainers Note: At their tables (or in a larger group if you have a small class), ask them to come up with five key learning points from today’s training. Then go around the room to each table to have them state one of the take-aways from the training. Keep this up until you have exhausted their answers.
Child maltreatment is not always easy to identify – injuries may be accidental, behaviors in child may result from other causes, poverty can play into child maltreatment and be difficult to separate
While we want to engage the family in helping us assess the situation, it is also important to check out what they are saying. “Trust but verify.”
You have experts to help you and you should use them. These include the medical consultants, law enforcement and service providers.
Support what you have learned by talking with collaterals and obtaining available information on the family.
Child safety is our priority. There are some forms of maltreatment or conditions in children that require immediate action:
Starvation
Abdominal injuries
Failure to Thrive
Serious physical abuse
Sexual abuse

16. Nadine Burke Harris: How Childhood Trauma Affects Health across a Lifetime
Before move on, let’s take a minute to look at a Ted Talk about how childhood trauma affects health across a lifetime. When we talk about trauma, we are not just talking about physical and sexual abuse. We are also talking about children who suffer from neglect, the most common type of child maltreatment.
Trainer Note: Watch Video then allow for classroom discussion.
What do you take away from this video?
The effects of trauma are not just in in the injuries children suffer to their bodies. The long-lasting effects are the changes made to the brain and how the brain is able to process. This affects all aspects of children’s function including development, emotional health, physical health, relationships, perceptions, ability to learn, etc. And the effects are not something that can be just taught away, these effects are to the unconscious thoughts and reactions. In order for children to overcome the effects of childhood trauma, they need a relationship with a person they can trust and a person who will give them security.