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MANDATED REPORTING OF CHILD MALTREATMENT

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MANDATED REPORTING OF CHILD MALTREATMENT Powered By Docstoc
					 MANDATORY REPORTING OF
    CHILD SEXUAL ABUSE
            and
     OTHER ROLES FOR
PSYCHOLOGISTS IN CSA CASES


     L. Dennison Reed, Psy.D.
             CAVEAT
Although this presentation focuses on
mandated reporting of child sexual abuse,
reporting responsibilities also apply to
other forms of child maltreatment, e.g.,
physical abuse, psychological abuse,
medical neglect, etc.
The Prevalence of Child Sexual
  Abuse in the United States
    The most methodologically
 sophisticated prevalence studies
 (using multiple screen questions
 and random samples) have found
           that at least:

 20% of women report being sexually
  abused during childhood
 5-10% of men report being sexually
  abuse during childhood
                        (Finkelhor, 1994)
 Prevalence of a CSA History in
      Clinical Populations

36-51% Inpatient and outpatient
        samples (across studies)


70%     Randomly selected
         non-psychotic psychiatric
         Emergency Room patients
                        (Briere & Zaidi, 1989)
Given the ubiquity of child sexual
  abuse, any psychologist who
 provides services to children or
   adults will almost certainly
   encounter clients who have
      suffered such abuse
 Who is responsible for reporting
      child maltreatment?

Pursuant to Florida Statute 39.201(1)(a):
 “Any person who knows, or has
 reasonable cause to suspect, that a
 child is abused, abandoned, or
 neglected. . . shall report such
 knowledge or suspicion to the
 department” [i.e., DCF‟s central abuse
 hotline]
     “Professionally Mandatory
            Reporters”
“Although every person has a responsibility
 to report suspected abuse or neglect,
 some occupations [including mental health
 professionals] are specified in Florida law
 as required to do so. These occupations
 are considered „professionally mandatory
 reporters.‟”
          Reporting Abuse of Children and
          Vulnerable Adults (2007). DCF.
          (Available on FPA‟s web site)
Psychologists are required by law
to notify the central abuse hotline
            when they:
 “know” or
 have a “reasonable cause to
  suspect” that a child has been
  abused/neglected
 Rarely would a psychologist “know” for
  a fact that a child was sexually abused,
  absent some highly reliable form of
  corroboration (e.g., the psychologist
  personally witnessing the abuse)
         What distinguishes a
        “reasonable” suspicion
      from just „any‟ suspicion?

“. . . standards for reporting „reasonable‟
suspicions imply a degree of discretion
and evaluation. It is within a practitioner‟s
professional role to follow up suspicions
with questions and queries in the context
of evaluation or treatment.”
                Foreman & Bernet (2000)
What constitutes a "reasonable
    cause to suspect” ??




Vague legal thresholds for
reporting child maltreatment
create confusion . . .
Poor training of mandated reporters
    adds to the confusion . . .
           and frustration!
         .
   “Mandated but not educated”

Although every state in the country
 requires mandated reporters to report
 known or “reasonably suspected” child
 sexual abuse (and other maltreatment),
 only a few states require mandated
 reporters to complete any training at all
 with regard to screening for child
 sexual abuse
    Mental health professionals rarely
  receive adequate training with regard
   to screening for child sexual abuse
As early as 1989, APA‟s Ad Hoc Committee on
Child Abuse Policy recommended that state
licensing boards consider requiring a child abuse
knowledge base for purposes of licensure, and
recommended that the APA require course work
or training experiences in child abuse for graduate
program accreditation (L.E. Walker et al, 1989, p.
11). Yet, to this day, few licensing boards
(including Florida‟s) require such training. And
APA-accredited graduate programs still do not
require any coursework/training relating
specifically to screening for child sexual abuse
Attempting to determine whether
there exists a “reasonable cause
  to suspect” CSA can also be
        quite challenging
      There are no empirically
    validated symptoms that are
         diagnostic of CSA
Symptoms vary widely among sexually
 abused children—who range from
 „asymptomatic‟ (approx. one-third) to
 highly symptomatic
No symptoms are unique to sexually
 abused children, and the same
 symptoms observed in sexually abused
 children overlap with symptoms observed
 in non-sexually abused children
                Kendall-Tackett et al (1993)
  Perpetrators of CSA rarely confess
their clandestine abusive activities to
 psychologists or to anyone else who
 would be likely to report them to the
              authorities


 But, can psychological testing reliably
   identify child molesters who are
          denying their guilt?
 “It is important to emphasize that there
   is no psychological test, method or
     technique that validly determines
 whether a person has or will engage in
          deviant sexual behavior”
                  (Myers, 2005)
Sex offender profiles are indistinguishable from
 profiles of non-offenders
Sex offenders comprise a very heterogeneous
 group psychologically, ranging from “within
 normal limits” to blatantly psychotic on
 psychological testing; no single profile
 represents even the „majority‟ of sex offenders
  Diagnostic Medical Evidence of child
    sexual abuse is surprisingly rare

Recent studies have shown that 85-95%
 of children who have given clear histories
 of being sexually abused have NO
 medical findings of acute or healed
 trauma
Even penile penetration of the anus or
 hymen may not result in findings of injury

     Adams, J. (2005); Bays, J. & Chadwick, D. (1993)
    Reasons for the absence of
    evidence of acute or healed
        genital/anal trauma
  among sexually abused children
 Many forms of sexual activity do not result in
  physical trauma, e.g., fondling, oral sex, acts
  performed on the perp., “simulated intercourse”
 The elasticity & structure of the hymen &
  anal sphincter permit penetration without
  trauma (especially when lubricants are used)
 Even when there is trauma, healing occurs
  quickly in children, often between 24 hours
  and    one week, and delays in obtaining
  medical exams are common among victims
             Buyer Beware:
     Not all Medical Exams for CSA
      are competently performed
In a 1987 study involving 129
 pediatricians and family practitioners,
 only 59% were able to correctly identify
 the hymen when shown a magnified
 photograph of a 6-year-old girl‟s genitalia
Hopefully, the medical field has
 advanced in recent years. But always
 consider the qualifications of the
 respective physician who is offering an
 opinion about medical signs of CSA
 Although the statements of suspected
     child/victims are most often the
    dispositive factor in CSA cases,
   research suggests that evaluators‟
  judgments about the validity of such
    statements are often erroneous-
  especially in the direction of judging
         false statements as true
 Hershkowitz et al. (2007) found that when 42
  highly trained Israeli „youth investigators‟ rated
  transcribed statements of high quality (NICHD)
  interviews as „likely false,‟ they were correct
  100% of the time. But when they judged
  statements „likely true,‟ they were correct only
  67% of the time [33% error rate]
       Research has found that
children‟s accurate reports of events
     they personally experienced
are sometimes indistinguishable from
false reports produced by suggestive
             interviewing
“Subjective ratings of children‟s reports after
suggestive interviewing reveal that . . . trained
professionals in the fields of child development,
mental health, and forensics . . . cannot reliably
discriminate between children whose reports are
accurate from those whose reports are inaccurate
as a result of suggestive interviewing techniques .
. . . The children who provided false reports spoke
sincerely and provided accounts laden with
emotion and perceptual details” (Ceci et al., 2007)
   Fortunately, mandated reporters
  need not „know‟ or be „convinced‟
   that a child was sexually abused
    before making an abuse report

If the mandated reporter has
 “a reasonable cause to suspect”
 CSA, the reporting threshold has
 been met and an abuse report
 must be made.
  What kinds of „reasonably
suspected‟ CSA cases must be
reported, and in what manner?
Abuse perpetrated by Caregivers

FS 39.201(1)(a) mandates the reporting
of known/suspected abuse perpetrated
by “caregivers” only:
“Any person who knows, or has
reasonable cause to suspect, that a child
is abused, abandoned, or neglected by a
parent, legal custodian, caregiver, or
other person responsible for the child's
welfare . . . shall report such knowledge
or suspicion to the department”
      What if the suspected
  perpetrator is not a caregiver?
 Florida Statute 39.201 (1)(a) does not
  mandate the reporting of known/suspected
  child sexual abuse perpetrated by non-
  caregivers. And when such reports are
  received by the Abuse Hotline, the reporter is
  transferred to the appropriate law
  enforcement agency.
 Conflicts about reporting non-caregiver cases
  arise when reporting such cases entails
  breeching confidentiality, e.g., when the
  parents of a minor child do not want the abuse
  by a non-caregiver reported to the authorities
            Reporting Suspected CSA
          perpetrated by Non-caregivers
Woody (2006) suggests that, even though the reporting
of suspected abuse by a non-caregiver is not legally
mandated, “The report of child abuse should still be
made. . .” (p. 5). Woody reasons that professional ethics
and public policy potentially support that a psychologist
should want to protect vulnerable children; therefore,
taking reasonable steps to protect a vulnerable child are
seemingly logical. And when the central abuse hotline
transfers the psychologist to law enforcement or
otherwise encourages a report to law enforcement, it
would seem that the psychologist is likely shielded to
some degree from liability, e.g., malicious prosecution
(2009). Others caution that, when reporting suspected
abuse by a non-caregiver involves breeching
confidentiality, an abuse report should not be made.
Suspected CSA by Non-caregivers
 when Confidentiality is at Issue:
   To Report or Not to Report?
Psychologist face a dilemma when trying
 to decide whether or not to report
 suspected CSA perpetrated by non-
 caregivers when doing so would involve
 breeching confidentiality.
Optimally, these cases should be
 reviewed on a case-by-case basis. And
 psychologists would be wise to seek
 advice from knowledgeable colleagues
 and/or attorneys in such cases.
What manner of reporting can be
used for making a report to the
    central abuse hotline?
Reports can submitted via phone, fax
 or via the web 24 hours a day, 7 days
 a week
Phone: 1-800-96-ABUSE
 (1-800-962-2873)
Fax: 1-800-914-0004
Web reporting:
 http://www.state.fl.us/cf_web
   Are psychologists who make
 “anonymous” child abuse reports
     acting in compliance with
            Florida law?
NO.
“A professionally mandatory reporter of
 child abuse is required by Florida Statute
 to provide his or her name to the Abuse
 Hotline Counselor when reporting.”
    Reporting Abuse of Children and Vulnerable
    Adults (2007) DCF
        Qualified Confidentiality
              for Reporters
F.S.39.202(5): “The name of any person
reporting child abuse, abandonment, or neglect
may not be released to any person other than
employees of the department responsible for
child protective services, the central abuse
hotline, law enforcement, the child protection
team, or the appropriate state attorney, without
the written consent of the person reporting. This
does not prohibit the subpoenaing of a person
reporting child abuse, abandonment, or neglect
when deemed necessary by the court, the state
attorney, or the department, provided the fact
that [the identity of] such person [that] made the
report is not disclosed.”
How soon must a report of known
  or suspected CSA be made?

Pursuant to Chap. 39, Florida Statutes:
 A report to the abuse hotline is to be
 made “immediately” upon determining
 that the reporting threshold has been
 met (i.e., as soon as the reporter
 „knows‟ or „reasonably suspects‟ that a
 child has been abused)
Who is considered to be a “child”
    for reporting purposes?

Florida Statute 39.01(12) defines
 a “child” or “youth” as:
 any unmarried person under
 the age of 18 who has not
 been emancipated by order of
 the court”
     Is “child-on-child” sexual abuse
                reportable?

YES. Pursuant to FL§39.201(2)(f): “Reports
 involving a known or suspected juvenile
 sexual offender or a child who has exhibited
 inappropriate sexual behavior shall be made
 and received by the department”
However, „inappropriate‟ is subjective; and
 sexual „abuse‟ by a minor should be
 distinguished from developmentally normal
 sexual activity, e.g., „playing doctor,‟
 consensual sexual activity between
 teenagers
 Empirical data is now available
 regarding sexually abused and
 non-sexually-abused children‟s
        sexual behaviors
Child Sexual Behavior Inventory
 (Friedrich, 1992)
Available through:
 Psychological Assessment Resources,
                   Inc.
               PO Box 998
            Odessa, FL 33556
           Ph. (800) 331-TEST
   Description of the CSBI
The CSBI was developed to help
 distinguish between normal and
 abnormal sexual behaviors in children
 ages 2 to 12 years old.
The CSBI consists of 38 items relating
 to a broad range of affectional and
 sexual behaviors. Normative and clinical
 data was derived from reports of
 mothers/primary caregivers of children
 who were either believed to have been
 sexually abused or not abused
     EXAMPLES OF
  DEVELOPMENTALLY
      ABNORMAL
  SEXUAL BEHAVIORS
IN CHILDREN AGES 2 -12
The following behaviors were observed in
less than 2% of the non-sexually-abused
  sample of 2-12 year-olds (n = 1114):
 Puts mouth on another child‟s or adult‟s sex
  parts [Only two children in the sample of 1,114]
 Tries to have sexual intercourse with another
  child or adult
 Asks others to engage in sex acts
 Tries to French kiss others
 Puts objects in vagina or rectum
 Touches animals‟ sex parts
 Pretends toys are having sex
     The presence or absence of
  developmentally „abnormal‟ sexual
  behaviors alone is not sufficient for
 determining whether abuse occurred
 Only about 1/3 of sexually abused children
  display abnormal sexual behaviors
 Factors other than sexual abuse can account
  for abnormal sexual behaviors seen in non-
  sexually abused children (e.g., vicarious
  exposure to others engaging in sex)
 In any case, further inquiry regarding the
  source of the behavior is generally warranted
 Again, “inappropriate” sexual behavior must
  be reported if reasonably suspected
  Certain Home Environments Lead to
      Increased Sexual Behavior
   in Non-Sexually-Abused Children
 Observing parents or others engaging in
  intercourse/oral sex (strongest predictor of
  sexually intrusive behaviors, e.g., engaging in
  intercourse/oral sex with other children)
 Observing parents or other adults naked
 Bathing and sleeping with parents
 Viewing adults having sex online or in other
  media (TV, magazines, videos)
 Exposure to domestic violence (increased self-
  soothing behaviors such as masturbation)
EVIDENCE OF CSA THAT IS LIKELY
 TO FALL ABOVE OR BELOW THE
    REPORTING THRESHOLD
 Evidence of child sexual abuse
   that is generally above the
       reporting threshold
Unambiguous allegations of abuse
 made to the mandated reporter by the
 child (suspected victim) or by a
 perpetrator of CSA
Ambiguous allegations by a very young
 child should be explored further (e.g.,
 “Daddy touched my pee-pee” could
 refer to innocuous hygiene or medical
 practices)
   Evidence of child sexual abuse
     that is generally above the
         reporting threshold
• When a parent/caregiver tells a mandated
  reporter that their child made a non-
  ambiguous allegation of probable sexual
  abuse to the parent, this typically warrants
  an abuse report
• For example: A 4-year-old boy spontaneously
  says, “Mommy, when Uncle Johnny babysits
  me, he likes to suck on my pee-pee; and he
  put his pee-pee in my mouth, too”
       Third-party Allegations to
          Mandated Reporters
      (e.g., by the child‟s parent)

Take such reports seriously and assess
 the possibility of abuse within the scope
 of your normal professional role.
If, after competently assessing for abuse,
 you do not suspect abuse, a discussion
 with the third party may resolve the
 situation (i.e., third party no longer
 suspicious; third party makes a report).
     If a third-party (e.g., a parent)
    confides to a psychologist that
  he/she believes a child was sexually
  abused, must the psychologist make
             an abuse report?
 If after performing a competent assessment
  the psychologist does not personally have a
  reasonable suspicion that abuse occurred,
  he/she is not legally required to make an
  abuse report
 However, dismissing a third party‟s abuse-
  related concerns without performing a
  competent assessment could certainly result in
  a well-founded complaint of malpractice
   Evidence of possible CSA that
     generally falls below the
        reporting threshold:

Generic psychological symptoms,
 e.g., nightmares, anxiety, depression,
 regressive behaviors, conduct
 disorder
      Evidence of possible CSA
    that generally falls below the
         reporting threshold

Vague or unclear statements by a
 child (absent other evidence)
Example: 3 year-old child tells
 therapist, “Daddy hurt my pee-pee.”
Further inquiry and clarification is
 warranted in such cases
   Psychological symptoms and
   vague statements should not
      be dismissed without
        further evaluation
An effort should be made by a
 competent professional to explore the
 likely sources of concerning symptoms
 and to clarify ambiguous statements.
 This may involve further questioning of
 the parent and/or child. If medical
 symptoms are reported, consultation with
 a qualified physician may be indicated.
 DOCUMENTATION IS CRITICAL!
Ideally, the allegations of the alleged
 victim and the manner in which they
 were elicited should be documented
 verbatim (e.g., verbatim Qs & As)
This is especially critical when young
 children (preschoolers) are involved due
 to concerns about “leading.”
Keep a tape-recorder nearby and include
 permission to tape at your discretion on
 your “informed consent” form—signed at
 the outset of treatment/evaluation
    Is child sexual abuse that was
    perpetrated against someone
   who is now an adult reportable?
 The Abuse Hotline will not accept nor
  investigate reports of past CSA involving a
  victim who is presently 18 or older—UNLESS
  other children are currently believed to be at
  risk. In the latter case, they “may” or “may not”
  investigate (per an Abuse Hotline worker on 10/9/07)
 Such cases can be pursued with the respective
  police department (where the crime was
  committed) if the statute of limitations has not
  expired
 The alleged victim might also be able to bring a
  civil suit against the offender
          Out-of-State Cases
FS 39.201(2): If the report involves an
 instance of known or suspected child
 abuse that occurred out of state and the
 alleged offender and alleged victim
 currently live out of state, the central
 abuse hotline shall transfer the report to
 the appropriate state.
It is the central abuse hotline—not the
 mental health practitioner—that has the
 legal duty to contact the other state
 (Woody, 2006)
   Is it necessary to make another
        Abuse Report if one was
            already made?
YES!
You can‟t necessarily trust that a prior
 report was, in fact, made
Your report may have new and
 important information that was not
 contained in earlier reports
DCF may be more likely to take the
 case more seriously when there are
 multiple reports on the same case
When in doubt about whether a case
 is reportable, contact the Abuse
      Hotline for clarification
   Ethical and Practical
Considerations in Mandated
    Reporting of CSA
    Psychologists should operate only
     within their areas of competence
      and defined professional roles
Mental health professionals who have not
 acquired the requisite knowledge for
 competently screening for abuse/neglect
 should not be making reporting decisions
 independently.
Typically, a referral should be made to a
 competent professional. At times, close
 supervision or consultation with a competent
 professional may be adequate.
       Cases Requiring the Greatest
          Level of Competence
 Suspected victim is a preschooler (<6 years old)
    Conducting forensic interviews of preschoolers is the
     “brain surgery” of forensic interviewing due to their
     developmental limitations (e.g., suggestibility, language
     limitations)
 Custody litigation is ongoing or is likely
 When both of the above are involved, DO NOT
  UNDERTAKE SUCH EVALUATIONS UNLESS YOU
  HAVE „YEARS‟ OF TRAINING AND SUPERVISED
  EXPERIENCE IN CONDUCTING SUCH
  EVALUATIONS!
 Avoid situations and roles that may impair
objectivity, competence, or effectiveness, and
 beware of commenting on „ultimate issues‟

   Although a competent psychologist who has
    performed an competent evaluation may make a
    determination about whether the reporting threshold
    has been met (i.e., “reasonable cause to suspect”), it
    is typically NOT appropriate for a psychologist acting
    as a therapist to render an opinion about whether a
    particular patient was „sexually abused.‟
   be capable of determining whether the functioning as
    a therapist or as an evaluator It is inappropriate for a
    therapist screening a patient for sexual abuse
    generally lacks critical information for sexual abuse
      Advise child‟s legal guardians and
     child (in age-appropriate fashion) of
       the limits of confidentiality at the
    outset of the professional relationship
Both verbally and in writing
Informed consent form should explicitly discuss
 psychologist‟s obligation to report child abuse
Obtain signature of the child‟s legal guardians and
 assent/consent from child as age-appropriate
Document (in the patient‟s file) the fact that the
 limits of confidentiality were discussed and
 appeared to be understood by legal guardians (and
 child, as age-appropriate)
       Parents or guardians should be
      informed in advance that a report
      will be filed unless doing so would
        be likely to endanger the child
When the parent or guardian is the suspected
 perpetrator or if they are likely to undermine
 the child‟s safety, i.e., by retaliating against the
 child or threatening the child not to discuss the
 alleged abuse, advance notification for that
 parent is generally contraindicated.
When advance notice is appropriate, explain
 the basis for your concern.
  Parents or guardians should be
 informed in advance that a report
 will be filed unless doing so would
   be likely to endanger the child
When the parent or guardian is the
 suspected perpetrator or if they are likely
 to undermine the child‟s safety, e.g., by
 retaliating against the child or threatening
 the child not to discuss the alleged
 abuse, advance notification is generally
 contraindicated.
When advance notice is appropriate,
 explain the basis for your concern.
   What happens when an abuse
         report is made?
The abuse hotline worker gathers
 information from the reporter
If the suspected perpetrator is not a
 caregiver to the child, the caller is
 immediately transferred to the
 appropriate sheriff's office
 Is a psychologist who makes an
abuse report entitled to info about
  the status of the investigation?
YES. “Any person who reports a case of child
abuse or neglect may, at the time he or she
makes the report, request that the department
notify him or her that a child protective
investigation occurred as a result of the report.
Any person . . . who makes a report in his or her
official capacity may also request a written
summary of the outcome of the investigation.
The department shall mail such a notice to the
reporter within 10 days after completing the child
protective investigation.” F.S.39.202(5)
    What happens after an abuse
          report is made?
DCF and/or law enforcement investigate
 the allegations contained in the report
 and determine whether the case is
 founded/unfounded and/or whether
 probable cause exists to make an arrest
DCF may refer the family for services
Dependency court and/or criminal court
 proceedings may ensue
   RISKS FOR PSYCHOLOGISTS
  WHO FAIL TO REPORT KNOWN
  OR REASONABLY SUSPECTED
     CHILD MALTREATMENT

1. Criminal charges
2. Disciplinary complaints
3. Civil suits (malpractice)
             Criminal Penalties
             for failing to report
  Florida Statute 39.205 (1)
  “A person who is required to report known
  or suspected child abuse . . . and who
  knowingly and willfully fails to do so, or who
  knowingly and willfully prevents another
  person from doing so, is guilty of a
  misdemeanor of the first degree . . .”
If convicted, both a fine and incarceration
may be imposed
Mandated reporters can not be held
„criminally‟ liable for reports made
  in “good faith” (without malice)
This is true even when the ensuing
 investigation by DCF and/or law
 enforcement fails to substantiate the
 suspected child maltreatment
Nevertheless, complaints to the Board of
 Psychology, and civil suits may be
 brought against psychologists who
 purportedly fail to competently assess the
 case before making an abuse report
Potential Disciplinary Sanctions for
    failing to report reasonably
suspected abuse and for failing to
   competently screen for CSA
 A „public record‟ of being disciplined
 Fines
 Temporary suspension of license
 Revocation of license
 Potential (malpractice) Judgment
      against psychologist
A judgment for damages ($) may be
 levied against a psychologist who is
 found to have engaged in malpractice
 by failing to report known or reasonably
 suspected child abuse—or for failing to
 competently screen for abuse before
 deciding not to report
  Even if the psychologist “prevails” in
  defending against criminal charges,
   ethics complaints and malpractice
   suits, the costs can be enormous
Financial costs for legal representation
 and lost income from time spent defending
 oneself can be quite substantial
Emotional costs can include intense stress
 and anxiety associated with protracted
 litigation with an uncertain outcome and
 potentially devastating consequences
    Most importantly, failing to
   report known or reasonably
  suspected CSA has potentially
 devastating consequences for an
    abused child and for other
         potential victims
An abused child may continue to be
 abused and fail to receive much-needed
 support and services (e.g., therapy)
The perpetrator may sexually abuse
 other children (in addition to the identified
 victim)
       RISKS ASSOCIATED WITH
          REPORTING ABUSE
   If the report was not legally mandated (i.e., a non-
    caregiver case) and it involves breeching
    confidentiality, this could result in a complaint to the
    Board of Psychology
   Intrusion into the family by DCF
   Disrupting treatment/therapeutic relationship
   Loss of income
   Although reporters who make „good faith‟ reports are
    granted civil and criminal immunity, defending
    against such complaints can still be costly and time-
    consuming. Also, immunity does not apply for
    malpractice (e.g., incompetent assessment,
    negligence)
      Criminal Penalties for knowingly
     and willfully making a false report
 Any person who knowingly and willfully makes
  a false report or counsels another to make a false
  report is guilty of a felony of the third degree
  punishable by up to five years in prison.
 In addition, the department may impose a fine not
  to exceed $10,000 for each violation. A false
  report is a report of child abuse, neglect or
  abandonment or adult abuse, neglect or
  exploitation that is made to the central abuse
  hotline which is not true and is made maliciously,
  e.g., for the purpose of: harassing or harming
  another person; financial gain; acquiring custody
  of a child.
   RISK MANAGEMENT STRATEGIES

 Follow APA‟s Ethical Principles and Code of
  Conduct & APA‟s Guidelines for Psychological
  Evaluations in Child Protection Matters
 Stay within your boundaries of competence!
 Work based on established and current scientific
  and professional knowledge
 Obtain informed consent and notify participants of
  confidentiality limits at the outset
 Avoid situations and roles that may impair
  objectivity, competence, or effectiveness
 Document professional work consistent with
  professional and scientific standards
 In complex CSA cases, it is prudent
   to consult with a knowledgeable
   colleague or attorney about your
professional obligations and potential
 liabilities before becoming involved

The consultant/colleague should be
 knowledgeable about the pertinent ethical
 guidelines and the practices of Florida‟s
 Board of Psychology as well as pertinent
 legal statutes and practice guidelines.
     OTHER ROLES FOR
PSYCHOLOGISTS IN CSA CASES
  CLINICAL ROLES IN CSA CASES

Evaluation and treatment planning for
 children who are confirmed victims
Therapist for confirmed victims and
 their families
Therapist for child molesters
    FORENSIC ROLES IN CSA CASES
  Evaluation, Consultation and/or Testimony,
  regarding, for example:
Strengths/weaknesses of various theories re. the
 suspected CSA (dependency and family court;
 personal injury litigation)
Custody of the child (dependency and family court)
Treatment recommendations re. victim & offender
 and risk assessment re. offender (dependency and
 family court; personal injury litigation)
The psychological impact of the abuse (personal
 injury litigation- “damages”)
The disclosure process among sexually abused
 children (criminal court)
 Differences in Clinical and
Forensic Roles in CSA Cases
   In actual practice, clinical and
 forensic roles sometimes overlap
•Child in therapy for non-abuse issues
may make sexual abuse allegations
•Child in therapy for previously reported
sexual abuse may make new sex abuse
allegations
•In some case, it may be in the child‟s
best interest for the forensic evaluator to
see the child for therapy afterwards-but
beware of role confusion
       Qualifications of the
       Forensic Evaluator

This role requires specialized
 training and supervision and a high
 level of competence.
           Basis for Involvement for
             Forensic Evaluators
Generally, the forensic evaluator should be
 court-appointed
This reduces the likelihood of bias and
 encourages the participation of all of the
 relevant parties.
It also reduces the risk of complaints to the
 Board of Psychology and law suits—
 especially in family court matters
              Principles of
          Forensic Evaluation
       in Child Protection Matters
The child‟s wellbeing is paramount
 (not the wishes of the parents or their
 attorneys). This is also dictated by law.
Objectivity and absence of bias are
 critical. Avoid multiple relationships, i.e.,
 the former therapist for any of parties
 should not       be     conducting such
 evaluations.
            Principles of
        Forensic Evaluation
     in Child Protection Matters
Appropriate informed consent should
 be obtained at the outset. This is true
 even when the evaluation has been
 court-ordered.
The participants should be informed
 about the disclosure of findings and
 the limits of confidentiality at the
 outset.
            Principles of
        Forensic Evaluation
     in Child Protection Matters
Financial arrangements should be
 clarified at the outset.
Psychologists should use multiple
 methods of data gathering, realize the
 limits of self-reports, and seek
 corroboration whenever possible.
 See Guidelines for Psychological Evaluations in
 Child Protection Matters for further information.
   “The profession has not reached consensus
       about whether making dispositional
recommendations in child protection evaluations
 is within the purview of psychological practice”
  APA Guidelines for Psychological Evaluations in Child Protection
                          Matters, 1999
 “[T]here remains intense debate regarding the evaluator‟s
  position on accepting an appointment order that directs him/her
  to answer the „ultimate issue‟ (i.e., whether events of CSA
  actually did or did not occur) . . . The evaluator‟s role is to
  assist the court by providing data on the strengths and
  weaknesses of the allegation, not to determine the truth of
  the sexual abuse allegations. Authoritative sources have
  argued that, given the current lack of a reliable scientific
  foundation for determining [whether CSA occurred], it is
  irresponsible or even unethical for forensic evaluators to offer
  expert opinions about whether or not abuse has occurred.”
                                   (Kuehnle & Kirkpatrick, 2005)
                         References
Adams, J. (2005) Medical and laboratory findings in cases of
   child sexual abuse. APSAC Advisor, Spring, 9-12.
Bays, J. & Chadwick, D. (1993). Medical diagnosis of the
   sexually abused child. Child Abuse and Neglect 17, 91-110.
Ceci, S., Kulkofsky, S., Klemfuss, J, Sweeney, D. & Bruck, M.
   (2007). Unwarranted assumptions about children‟s testimonial
   accuracy. Annual Review of Clinical Psychology, 3, 311-328.
Finkelhor, D. (1994). Current information on the scope and
   nature of child sexual abuse. In Behrman, R. (Ed.), The future
   of children: sexual abuse of children. Hoboken, NJ: Wiley &
   Sons.
Florida Statutes, Chapter 39 (2008) Mandatory reports of child
   abuse, abandonment, or neglect; central abuse hotline.
Foreman, T. & Bernet, W. (2000). A misunderstanding regarding
   the duty to report suspected abuse. Child Maltreatment, 5,
   190-196.
Friedrich, W.N. (1992) Child sexual behavior inventory. Odessa,
   FL. Psychological Assessment Resources.
                     References (continued)
Hershkowitz, I., Fisher, S., Lamb, M. E., & Horowitz, D. (2007).
  Improving credibility assessment in child sexual abuse
  allegations: The role of the NICHD investigative interview
  protocol. Child Abuse and Neglect, 312), 99-110.
Kalichman, S.C. (1999) Mandated reporting of suspected child
  abuse: Ethics, law and policy. Washington, DC: APA.
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993).
  Impact of sexual abuse on children: a review and synthesis of
  recent empirical studies. Psychological Bulletin, 113,164-180.
Koocher, G.P. (2009) Ethical issues in child sexual abuse
  evaluations. In K. Kuehnle & M. Connel (Eds.), The
  evaluation of child sexual abuse allegations, 81-98.
Kuehnle, K. & Connell, M. (Eds.). (2009). The evaluation of
  child sexual abuse allegations: A comprehensive guide to
  assessment and testimony. Hoboken, NJ: Wiley & Sons
Myers, J.E.B. (2005). Myers on evidence in child, domestic and
  elder abuse cases
Woody, R.H. (2006) When to report known or suspected child
  abuse and neglect in Florida. Tallahassee: FPA.
Woody, R.H. (2009) Personal communication July 19, 2009

				
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