Observe for Signs of Abuse and Neglect

Guide

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ACTIVITY ID: 15336

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The following tables provide information about what you might see or hear in your programs. It also provides some guidance about what to say and do in these situations. The tables are also provided as an interactive graphic on the website, so you can click through them to read all of the information. You can use this printable set of scenarios as a resource for discussion with staff members.

Note: The specific procedures and policies for reporting suspected child abuse and neglect vary across states, services, and installations. The tables provide an overview of reporting procedures and contain military-specific procedures that may not be relevant to your program. Program leaders will be responsible for collaborating with local authorities including Child Protective Services (CPS), law enforcement and the military installation’s Family Advocacy Program (FAP) office to develop specific procedures for your program.

Observe for Signs of Abuse or Neglect in the Family

Physical Abuse: Familial
You See	You Say	You Do
Kendra, a 6-month-old baby has been out of the program for a week. Kendra’s family said they had been out of town. Vida, the infant caregiver notices purple, brown, and yellow bruises on the baby’s inner thighs and buttocks while changing Kendra’s diaper. Vida calls you to come to the room and look at the bruises. Vida asks if you could be in the room when the family picks up. When Vida asks the baby’s parent about the bruises, they say that the baby fell from the crib with the rails up. Vida looks at you. You both know the baby does not yet pull up or climb, so this explanation seems unlikely. The parent seems very defensive and rushes out of the room with the infant before you can talk.	To the caregiver: “It sounds like you’re concerned about the baby. Let’s write down everything you’ve noticed.” “I heard you say you’re not sure what’s going on. I wonder if you suspect something is wrong…” “Remember, we don’t investigate maltreatment or need to be certain. Do you think the child was harmed? Do you think the child is unsafe? If you answer yes, we need to make a call.”	Stay with the caregiver if they need your support while making a report to FAP, law enforcement, and CPS.
Claire, a 2-month-old infant is dropped off in the morning. The caregiver notices right away that Claire’s eyes aren’t focusing and she doesn’t seem like herself. Her mother seems upset. You can hear the caregiver and mother talking as you walk down the hallway. You hear the mother say, “Claire fell off the couch. She’s fine.” You enter the room and ask if you can help.	To the mother: “I’m worried that Claire might have gotten hurt. We don’t want to take any chances with head injuries. I think we should call 911.”	Call 911 or EMS. Regardless of whether this is an example of abuse, neglect, or maltreatment, the baby might have experienced head trauma. Help the caregiver complete an incident report or other documentation about their observations.
A preschool teacher escorts a child to the front desk, so the management team can look at an injury. The child appears to have a set of human bite marks on their arm. When you ask what happens, they say, “I bit my brother, so mom bit me back.”	This is a situation where it might be best not to ask any additional questions. Rather, call FAP, law enforcement and the local CPS right away so they can begin an investigation.	Call FAP, law enforcement, and CPS. Document the child’s injury on an injury/illness form and follow your program’s procedures for notifying families.
It’s the first warm day of spring, and Jordyn, age 10, is wearing shorts. You notice she has circular burn marks up and down her thighs. They are the size and shape of a cigarette. You ask her what happened to her legs, and she says, “Nothing.”	To the child: “Jordyn, that looks like it really hurt. I want to help you. You can tell me what happened.”	Call FAP, law enforcement, and CPS. Document the child’s injury on an injury/illness form and follow your program’s procedures for notifying families.

Sexual Abuse: Familial
You See	You Say	You Do
A two- year- old girl sits and plays with dolls. She touches the genitals and says, “It hurts, but it’s OK.”	To the classroom staff: “Have you noticed anything like this before? Has anything changed recently in her life? New people? New house?”	Document the observation. Call FAP, law enforcement, and CPS and describe what was observed.
The infant staff calls you for support. An 11-month-old boy is screaming and trying to prevent a bowel movement. His anus is red, swollen, and has dried blood around it.	To the caregiver: “When did the pain start? When was his last bowel movement?”	Document the observation. Call FAP, law enforcement, and CPS and describe what was observed. Ask for guidance. Call the family because the child should be examined by a doctor right away. If the injury seems like an obvious sexual assault, call EMS, FAP, and CPS right away.
Preschool staff members see Candice, age 4, lying on top of a boy in the dramatic play center. She is clearly making sexual movements and seems to have a very accurate knowledge of sexual behavior. The staff come to you because they are not sure what to do.	To the classroom staff: “Have you noticed Candice doing this before? Have you noticed any other sexual behaviors?”	Document the observation. Call FAP, law enforcement and CPS and describe what was observed. Ask for guidance.
Amelia’s 19-year-old brother is coming to pick her up today from the school-age program. She tells you she loves her brother and they have “secrets” in her room at night.	To the child: “Amelia, there are some kinds of secrets that it is OK to tell grown-ups and teachers about. We’re going to call some people who it’s ok to talk to.” To staff members: “Has Amelia said anything else today about her brother or secrets? Do you know her brother?”	Document the observation. Call FAP, law enforcement, and CPS and describe what was observed.

Emotional Abuse: Familial
You See	You Say	You Do
A mother walks through the front door of your program while you are standing at the front desk. She grabs her toddler by the arm and says, “Be good today, or I won’t pick you up this afternoon.”	To the mother: “Is everything ok? We’re glad you’re here, and Toby will definitely have a great day.” Ask the mom if she has a few minutes to chat on her way out or in the afternoon. “I wonder if it makes Toby scared to think you won’t pick him up…”	Schedule a time to talk to the mother. Document the observation and look for patterns.
A staff member comes to you upset. They say they don’t know what to do about Dora’s father. Sometimes when he comes to pick Dora up from the program he says mean things to her. Today he told her to stop being “slow and stupid like her mom.” Yesterday he said how much easier life would be if he didn’t have to worry about her.	To the staff member: “It sounds like you’re really concerned for Dora. Tell me more about what you’ve observed…”	Call FAP, law enforcement, and CPS to make a report. Organize or help connect the family with education events on positive parenting. Talk to your program’s mental health professional about what has been observed and resources or supports for Dora’s father and family.
The school-age program is making a family quilt. A 7-year-old, Tommy, says there is nothing he likes to do with his parents. He refuses to make a square for the quilt. The team has noticed he ignores his family when they arrive at the program.	To the child: “Tommy, I’ve noticed you seem upset with your family. Are you OK?”	Continue observing for patterns and document what you see. Counsel staff to continue observing for signs of maltreatment. Check in with the family to see if everything is okay at home and if there is any support your program can provide

Neglect: Familial
You See	You Say	You Do
A father drops his child off with a diaper that clearly has not been changed since the previous afternoon. The child’s diaper rash is quite severe, and parents have not responded to your request for medication.	To the father: “Mr. Thomas, we’re really worried about Madeleine’s rash. It looks like it is painful. We will make sure we check her diaper every hour and make sure she gets completely dry each change. There are also some ointments that could be helpful. Have you tried anything that works at home? What else can we do to help?”	Make sure the family knows about community resources if they are having a hard time affording diapers or ointment. Provide information about or model healthy diapering procedures. Continue monitoring the situation. If the situation does not improve or there are other signs of maltreatment, call FAP, law enforcement, and CPS.
6-year-old Marjorie tells you she had to make dinner for her two younger siblings (ages 1 and 2) when her mom went to work. No other adults were in the home.	To the child: “Wow, I bet that was hard.” With a child of this age, it might be best not to elaborate on the story.	Call FAP, law enforcement, and CPS and report what you heard. Find out if the family needs help finding babysitters or building social connections.
Zach’s mom has not brought in a replacement for his empty rescue inhaler. Zach has severe asthma and needs the medication.	To the mother: “Mrs. Jones, Zach’s emergency inhaler is empty. We can’t keep him here safely without the inhaler.”	Make sure Zach’s mom has access to needed medical services. Provide Zach’s mother with a deadline and then deny care until emergency medication is received. If the problem persists, call FAP, law enforcement and CPS.

Observe Children for Signs of Abuse in the Program

Physical Abuse: Institutional
You See	You Say	You Do
A staff member in the pre-toddler room has had a very hard day. Fiona, 18 months, has been crying and throwing herself on the floor for 10 minutes. It’s time to get the kids outside. In frustration, the staff member grabs Fiona by the top of the arm and yanks her up to walk. They squeeze so hard that Fiona has bruises around her upper arm in the shape of a hand.	To the staff member: “I think you need to go take a break in the office right now. I’ll cover the classroom and be up to talk in a few minutes.”	Call FAP, law enforcement, and CPS. Talk to management and make sure the staff member is removed from contact with children while the incident is investigated. �Թ�� staffing in the classroom to ensure adequate supervision. �Թ�� management to follow procedures for serious incident reporting and notifying the family.
The manager lets you know that FAP just called to let her know that a suspicion of abuse was reported in the program. A staff member called to say that another staff member spanked a child. You find out that the staff member was reported to grab a child and say, “I know his mom and she would not want him to get away with this.” The staff member reportedly took the child around the side of the building out of sight. When they came back, the child was crying and holding his backside.	To the manager: “What can I do to help?”	Talk to management and make sure the staff member is removed from contact with children while the incident is investigated. �Թ�� staffing in the classroom to ensure adequate supervision. Cooperate with FAP’s investigation.

Sexual Abuse: Institutional
You See	You Say	You Do
A staff member offers to take Jerusha inside for a diaper change. Jerusha screams, “No” and hides behind another staff member’s legs. “No hurt,” she screams.	To the classroom staff: “Have there been any changes in Jerusha’s behavior lately?” Have you noticed a diaper rash or any signs of illness?	It’s not uncommon for toddlers to avoid diaper changes, but continue to look for patterns. If this child consistently reacts negatively to a particular adult, you might suspect a problem.
A staff member has a “favorite” child. They often force the child to snuggle, sit on their lap, and be held when they don’t not want to be. You notice the staff member massaging the child’s back in a way that makes you feel uncomfortable.	To the staff member: If the touching is clearly sexual, you would tell the staff member to leave the classroom.	Make a report to FAP, law enforcement, and CPS. Even if the investigation concludes that no sexual abuse occurred, the staff member is in violation of the Guidance and Touch policy. Follow you program’s procedures for documenting and responding to policy violations.
A child tells you Mr. Jay’s (staff member) “pee-pee is bigger than his.”	This is a situation in which it is best to say nothing. You do not want to bias or influence the child’s story. Report what you heard.	Call FAP, law enforcement, and CPS and report what you heard.
Two 11-year-old girls are hunched over a cell phone giggling. You approach to remind the girls to put the device somewhere safe. You notice a clearly sexual picture on the phone of a man’s partially naked body. Quickly the girls navigate away from the picture, but you see that the girl’s wallpaper is a picture of a 19-year-old staff member making a kissing face and a suggestive pose.	It is probably best not to say anything more. You do not want to bias the future investigation or do anything that would cause the girls or the staff member to delete pictures before investigators can intervene.	Call FAP, CPS, and law enforcement to make a report. Make sure the staff member has no contact with children.

Emotional Abuse: Institutional
You See	You Say	You Do
A staff member calls a 2-year-old boy a “stupid baby” when he soils his pants.	To the staff member: “I’m concerned about what I just heard…”	Follow your program’s procedures for documenting and responding to policy violations. Monitor the staff member’s behavior for patterns of inappropriate responses to children and provide necessary training and support.
A staff member joins in when children begin ridiculing another child’s body size. They call the child “fat and lazy.”	To the staff member: “We are role models for the children, and our first job is to keep them physically and psychologically safe. Is that happening for Mallorie?”	Consult with FAP to determine if a report is needed. Talk to community health organizations or the medical center staff about staff education events related to body image and obesity prevention. Follow your program’s procedures for documenting and responding to policy violations. Document the observation and follow-up communication.
A staff member forces a child to stay in their soiled clothes after a toileting accident so they “learn a lesson.”	To the staff member: “What do you think Drew is learning about our program and adults?”	Call FAP, law enforcement, and CPS to make a report. Provide additional training and modeling on appropriate ways to support toilet learning or respond to accidents in older children. Provide additional training on positive guidance. Follow your program’s procedures for documenting and responding to policy violations.
Reginald tells a child that he wishes the child would stay home tomorrow. He says the program is better when the child is not there.	To the staff member: “All children are welcome in our program at all times. I wonder what Doug thinks when he hears things like that…”	Consult with FAP to determine if a report is needed. Provide additional training on positive guidance. Follow your program’s procedures for documenting and responding to policy violations.

Neglect: Institutional
You See	You Say	You Do
A staff member walks out of the room and leaves her their co-worker out of ratio.	To the staff member: “Tell me about what happened today that lead you to stepping out.”	Provide immediate staffing coverage to make sure children are adequately supervised. Follow your program’s procedures for documenting and responding to policy violations. Review staffing and ratio requirements with the staff member. Review options with her for what to do in the future if she needs a break.
A staff member takes an unscheduled break and leaves children unsupervised.	To the staff member: “Tell me about what happened today that lead you to stepping out.”	Provide immediate staffing coverage to make sure children are adequately supervised. Follow your program’s procedures for documenting and responding to policy violations. Review staffing and ratio requirements with the staff member. Review options with her for what to do in the future if she needs a break. Leaving children completely unsupervised is a serious policy violation, so consult with management about next steps.
A staff member fails to take a child’s epi-pen on a field trip because she does not believe it is necessary.	To the staff member: “Our job is to keep children safe. Children with emergency rescue medications need to have access to them at all times.	Act immediately to make sure life-saving medication is available to the child. Follow your program’s procedures for documenting and responding to policy violations. This is a serious policy violation that could potentially put a child’s life a risk, so consult with management about next steps.

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Observe for Signs of Abuse or Neglect in the Family

Observe Children for Signs of Abuse in the Program

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