Pennsylvania Child Abuse Recognition and Reporting

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Introduction   

For healthcare professionals who work with children in any capacity, there almost always comes a time when the very troubling issue of child abuse is encountered. Though disturbing, abusive situations for children are the reality for nearly 380,494 children nationally each year (7). Child abuse may encompass physical or sexual abuse, neglect, exposure to violence or drug use, or any other physically or psychologically harmful situation. The effects of child abuse can last long into adulthood, and children who are abused grow up to have higher rates of depression, anxiety, addiction, eating disorders, post-traumatic stress disorder (PTSD), and many other psychological and medical problems (10). 

Child Welfare in the State of Pennsylvania 

The Pennsylvania Child Protective Services Law (CSPL) (23 Pa.C.S. Chapter 63, Child Protective Services) (Pennsylvania General Assembly, 2021) was enacted in 1975 to protect children and provide a framework for law enforcement and persons identified as mandated reporters to take the appropriate action to ensure the safety and stability of the family. 

In order for abusive situations to be reported accurately and handled most effectively, it is first important to understand how the Child Welfare System works, specifically for this course, in the state of Pennsylvania. The state supervises and provides funding for each of the 67 counties which administer child welfare services. One of the roles of each county is to handle reports from both Child Protective Services (CPS) and General Protective Services (GPS). 

In the Commonwealth of Pennsylvania, child welfare is state-supervised and county-administered. When a case is reported, trained professionals categorize the report either as a CPS case, GPS case, or not needing further processing. Cases identified as CPS require abuse investigations because the alleged act or failure to act has been identified as one of the ten categories of abuse in the CPSL. 

Child Protective Services Cases 

Child Protective Services (CPS): The services and activities provided by the department and each county agency for child abuse cases.  

CPS handles reports that there is a reasonable suspicion a child is the victim of non-accidental physical injury, sexual abuse or exploitation, or injury resulting from neglect or omission of care by a parent or caregiver. These reports require an investigation (6).  

Examples of CPS cases:   

• Causing bodily injury to a child through any recent act or failure to act. 
• Fabricating, feigning, or intentionally exaggerating or inducing medical symptoms or disease results in potentially harmful medical evaluation or treatment to the child through any recent act. 
• Causing or substantially contributing to serious mental injury to a child through any act or failure to act or a serious of such acts or failures to act. 
• Causing sexual abuse or exploitation of a child through any act or failure to act. 
• Creating a reasonable likelihood of bodily injury to a child through a recent act or failure to act. 
• Creating a likelihood of sexual abuse or exploitation of a child through any recent act or failure to act. 
• Causing serious neglect of a child. 
• Engaging in the following recent per se acts. 
• Causing the death of the child through any act or failure to act. 
• Engaging a child in a severe form of trafficking in persons or sex trafficking, as those term are defined under section 103 of the Trafficking Victims Protection Act of 2000. 

General Protective Services Cases 

General Protective Services (GPS): Those services and activities provided by each county agency for cases requiring protective services. As defined by the department in regulations.  

GPS responds to reports that do not quite reach the level of abuse or neglect but require intervention to prevent serious harm from occurring. These incidents include issues like improper shelter or hygiene, school truancy, inappropriate discipline, and being left without a parent or guardian for longer than is age-appropriate or abandoned altogether. These allegations are less severe and do not require a full investigation, mostly offering an opportunity for parents or caregivers to receive education on how to improve conditions to best support a child's health and development (3). In these cases, the act or failure to act is detrimental to a child but does not fall under the 10 categories of child abuse as per the CPSL. These services can assist parents in being able to recognize and correct the conditions that are harmful to their children.   

Cases identified as GPS require an assessment for services and support. In these cases, the act or failure to act is detrimental to a child but does not fall under the ten categories of child abuse as per the CPSL. These services can assist parents in being able to recognize and correct conditions that are harmful to their children.  

Examples of GPS (Services to prevent the potential for harm to a child who meets one of the following conditions):  

• Is without proper parental care or control, subsistence, education as required by law, or other care or control necessary for his physical, mental, or emotional health or morals.  
• Has been placed for care or adoption in violation of the law.  
• Has been abandoned by his parents, guardian, or other custodian.  
• Is without a parent, guardian, or legal custodian.  
• Is habitually and without justification truant from school while subject to compulsory school attendance.  
• Has committed a specific act of habitual disobedience of the reasonable and lawful commands of his parent, guardian, or other custodian and who is ungovernable and found to be in need of care, treatment, or supervision.  
• Is under ten years of age and has committed a delinquent act.  
• Has been formally adjudicated dependent under section 6341 of the Juvenile Act (relating to adjudication), and is under the jurisdiction of the court, subject to its conditions or placements and who commits an act which is defined as ungovernable in subparagraph (VI).  
• Has been referred to under section 6323 of the Juvenile Act (relating to informal adjustment), and who commits an act which is defined as ungovernable in subparagraph (VI). 

It should be noted that the person filing the report may list their claim as suspected child abuse, but it is ultimately up to the person conducting the investigation to determine if abuse or maltreatment has occurred and if the suspicion qualifies for filing through CPS or GPS. The child abuse investigator for the county is responsible for conducting the investigation and officially classifying the reports; mandated reporters should not attempt to investigate the situation or gather further information than what first prompted their report (6).  Discuss in framework of duties of the mandated reporter and reasonable suspicion of abuse. 

Case Study  

Case Study No. 1- please read the scenario and reflect on the type of abuse that is occurring. 

A mother of two small children aged six and nine is planning to go on a three-day weekend trip with her new boyfriend. She is unable to find adequate childcare for the children and does not want to take them along on the trip, so she decides she will leave her children alone for three days. She figures there is enough food and water to keep them satisfied for three days. She gives them strict instructions not to answer the door or the phone to anyone and to not make loud noises. The neighbors notice some strange noises coming from the house and go by to check in. They discover the children are alone at home. They tell the neighbors they are hungry and fear being in the house by themselves, when asked where their mother is, the children say she went on a trip the day before. The neighbors take the children to their home and call law enforcement. 

Are children aged six and nine competent enough to care for themselves for an extended period without adult supervision? 

Current Patterns of Abuse 

Though anyone under the age of 18 can be a victim of child abuse, not all children are at equal risk of maltreatment. Pennsylvania statutes §6303 defines a child is an individual under 18 years of age. Young children are at the greatest risk, largely because they have limited verbal abilities to ask for help or tell someone what is going on. Children under 12 months of age are at the highest risk, with 45.6% being the victim of some form of abuse or neglect.  

Abuse can take many forms as well, with neglect being the most common form of child abuse nationally at 76% of affected children. Physical abuse accounts of 16% of cases, sexual abuse is 10.1%, and psychological/emotional is 6.4% (1). Many children also experience more than one type of abuse.  

Tragically, abuse and neglect are sometimes lethal, with nearly 1,820 children dying from maltreatment in 2021. A staggering 66.2% of those children were under the age of 3 (1).  

Child abuse occurs in homes of all races, socioeconomic statuses, educational levels, and religions. Being a victim of abuse has the potential for lifelong consequences for children, increasing their risk of teen pregnancy, drug and alcohol abuse, criminal activity, and even incarceration as an adult. About 30% of the time, abused children enter a cycle of abuse and grow up to abuse their own children as well (1).  

Understanding who is most at risk can help healthcare professionals identify potential victims of abuse within the populations they serve. Early and accurate detection of maltreatment can not only remove a child from a dangerous situation, but it can also set them on a better trajectory for their future and even quite literally save their life.  

Child Welfare in the State of Pennsylvania 

In addition to understanding when and how to report abuse, healthcare professionals must be able to recognize when abuse might be occurring. The common signs vary by type of abuse and no two situations are likely to be the same, but there are common indicators that should be used to alert healthcare providers to potentially ominous situations.  

Definition of Child Abuse 

Definition of Child Abuse according to the Pennsylvania Child Abuse Services Law    

Pennsylvania Child Protective Services Law (CPSL) (23 Pa.C.S. Chapter 63, Child Protective Services) states the term "child abuse" shall mean intentionally, knowingly, or recklessly doing any of the following:  

• Child:  An individual under 18 years of age 
• Act or failure to act; Recent act; Recent act or failure to act; or a series of acts or failures to act 
  • Act:  Something that is done to harm or cause potential harm to a child 
  • Failure to act:  Something that is NOT done to prevent harm or potential harm to a child 
  • Recent act:  Any act committed within two (2) years of the date of the report to DHS or county agency 
  • Recent act or failure to act:  Any act or failure to act committed within two (2) years of the date of the report to DHS or county agency 

• Intentionally, knowingly, or recklessly 
  • Intentionally:  Done with the direct purpose of causing the type of harm that resulted 
  • Knowingly:  Awareness that harm is practically certain to result 
  • Recklessly:  Conscious disregard of substantial and unjustifiable risk 

• Doing any of the following: 
  • Causing bodily injury to a child through any recent act or failure to act. 
  • Fabricating, feigning, or intentionally exaggerating or inducing a medical symptom or disease which results in a potentially harmful medical evaluation or treatment to the child through any recent act.  
  • Causing or substantially contributing to serious mental injury to a child through any act or failure to act or a series of such acts or failures to act.  
  • Causing sexual abuse or exploitation of a child through any act or failure to act. 
  • Creating a reasonable likelihood of bodily injury to a child through any recent act or failure to act.  
  • Creating a likelihood of sexual abuse or exploitation of a child through any recent act or failure to act.  
  • Causing serious physical neglect of a child. 
  • Engaging in any of the following recent acts: 
    • Kicking, biting, throwing, burning, stabbing or cutting a child in a manner that endangers the child.  
    • Unreasonably restraining or confining a child, based on consideration of the method, location or the duration of the restraint or confinement.  
    • Forcefully shaking a child under one year of age. 
    • Forcefully slapping or otherwise striking a child under one year of age. 
    • Interfering with the breathing of a child. 
    • Causing a child to be present at a location while a violation of 18 Pa.C.S. § 7508.2 (relating to operation of methamphetamine laboratory) is occurring, provided that the violation is being investigated by law enforcement.  

• Leaving a child unsupervised with an individual, other than the child's parent, who the actor knows or reasonably should have known:  
  • Is required to register as a Tier II or Tier III sexual offender under 42 Pa.C.S. Ch. 97 Subch. H (relating to registration of sexual offenders), where the victim of the sexual offense was under 18 years of age when the crime was committed.  
  • Has been determined to be a sexually violent predator under 42 Pa.C.S. § 9799.24 (relating to assessments) or any of its predecessors.  
  • Has been determined to be a sexually violent delinquent child as defined in 42 Pa.C.S. § 9799.12 (relating to definitions).  

• Causing the death of the child through any act or failure to act. 
• Engaging a child in a severe form of trafficking in persons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000 (114 Stat. 1466, 22 U.S.C §7102). 

Definitions of Types of Child Abuse 

Sexual Abuse or Exploitation 

"Sexual abuse or exploitation" is considered any of the following:  

The employment, use, persuasion, inducement, enticement, or coercion of a child to engage in or assist another individual to engage in sexually explicit conduct, which includes, but is not limited to, the following:  

• Looking at the sexual or other intimate parts of a child or another individual for the purpose of arousing or gratifying sexual desire in any individual.  
• Participating in sexually explicit conversation either in person, by telephone, by computer or by a computer-aided device for the purpose of sexual stimulation or gratification of any individual.  
• Actual or simulated sexual activity or nudity for the purpose of sexual stimulation or gratification of any individual.  
• Actual or simulated sexual activity for the purpose of producing visual depiction, including photographing, videotaping, computer depicting or filming.  

This paragraph does not include consensual activities between a child who is 14 years of age or older and another person who is 14 years of age or older and whose age is within four years of the child's age.  

Any of the following offenses committed against a child: 

• Rape as defined in 18 Pa.C.S. § 3121 (relating to rape). 
• Statutory sexual assault as defined in 18 Pa.C.S. § 3122.1 (relating to statutory sexual assault).  
• Involuntary deviate sexual intercourse as defined in 18 Pa.C.S. § 3123 (relating to involuntary deviate sexual intercourse).  
• Sexual assault as defined in 18 Pa.C.S. § 3124.1 (relating to sexual assault). 
• Institutional sexual assault as defined in 18 Pa.C.S. § 3124.2 (relating to institutional sexual assault).  
• Aggravated indecent assault as defined in 18 Pa.C.S. § 3125 (relating to aggravated indecent assault).  
• Indecent assault as defined in 18 Pa.C.S. § 3126 (relating to indecent assault). 
• Indecent exposure as defined in 18 Pa.C.S. § 3127 (relating to indecent exposure). 
• Incest as defined in 18 Pa.C.S. § 4302 (relating to incest). 
• Prostitution as defined in 18 Pa.C.S. § 5902 (relating to prostitution and related offenses).  
• Sexual abuse as defined in 18 Pa.C.S. § 6312 (relating to sexual abuse of children). 
• Unlawful contact with a minor as defined in 18 Pa.C.S. § 6318 (relating to unlawful contact with minor).  
• Sexual exploitation as defined in 18 Pa.C.S. § 6320 (relating to sexual exploitation of children).  

Bodily Injury 

"Bodily injury" is defined as impairment of physical condition or substantial pain.  

• Impairment: If, due to the injury, the child’s ability to function is reduced temporarily or permanently in any way 
• Substantial pain:  If the child experiences what a reasonable person believes to be substantial pain 

Serious Mental Injury 

"Serious mental injury" A psychological condition, as diagnosed by a physician or licensed psychologist, including the refusal of appropriate treatment, that:  

• Renders a child chronically and severely anxious, agitated, depressed, socially withdrawn, psychotic or in reasonable fear that the child's life or safety is threatened; or  
• Seriously interferes with a child's ability to accomplish age-appropriate developmental and social tasks.  

Serious Physical Neglect 

"Serious physical neglect" Any of the following when committed by a perpetrator that endangers a child's life or health, threatens a child's well-being, causes bodily injury or impairs a child's health, development or functioning:  

• A repeated, prolonged or egregious failure to supervise a child in a manner that is appropriate considering the child's developmental age and abilities.  
• The failure to provide a child with adequate essentials of life, including food, shelter or medical care. 

Recognizing Indicators for Child Abuse 

Categories and Indicators of Child Abuse per the PA Department of Human Services (2023) 

Bodily Injury 

• Unexplained bruises or injuries 
• Inconsistency when explaining how an injury occurs or providing extraordinary/unbelievable descriptions. 
• Bruises that you would not typically see in their age group. 
• Multiple bruises that all appear to be in different stages of healing. 
• Bruises that resemble the shape of an object (eg. a hand mark from a slap). 

Serious Mental Injury 

• Fearful 
• Shy/difficulty maintaining relationships with other peers 
• Dependence on adults 
• Eating and/or Speech disorders 
• Bed-wetting 
• Self-harm 
• Low self-esteem and feelings of inadequacy 

Sexual Abuse  

Indicators: 

• Sexually promiscuous 
• Developmental age-inappropriate sexual play and/or drawings 
• Cruelty to others 
• Cruelty to animals  
• Fire setting 
• Anxious 
• Withdrawn 
• Sleep disturbances 
• Bedwetting 
• Pain or irritation in genital/anal area 
• Difficulty walking or sitting. 
• Difficulty urinating 
• Pregnancy 
• Positive testing for sexually transmitted disease(s) (e.g., HIV) 
• Excessive or injurious masturbation 

Serious Physical Neglect  

Indicators: 

• Not registered in school 
• Inadequate or inappropriate supervision 
• Poor impulse control 
• Frequently fatigued  
• Parentified behaviors 
• Lack of adequate medical and dental care 
• Often hungry 
• Lack of shelter  
• Weight is significantly lower than normal for their age and gender 
• Developmental delays 
• Persistent (untreated) conditions (e.g., head lice, diaper rash) 
• Exposure to hazards (e.g., illegal drugs, rodent/insect infestation, mold) 
• Clothing that is dirty, inappropriate for the weather, too small, or too large 

Components, Categories, and Exclusionary Criteria of Child Abuse 

A clear understanding of who is involved in an abuse or neglect situation and what actions (or inactions) specifically qualify as abuse is necessary for mandated reporters like healthcare professionals.  

When considering a child abuse scenario, a child is anyone under the age of 18.  

A perpetrator is someone “who has committed child abuse as defined in this section.” 

The term includes only the following: 

• A parent of the child. 
• A spouse or former spouse of the child's parent. 
• A paramour or former paramour of the child's parent. 
• A person 14 years of age or older and responsible for the child's welfare or having direct contact with children as an employee of a childcare services, a school, or through a program, activity, or service. 
• An individual 14 years of age or older who resides in the same home as the child. 
• An individual 18 years of age or older who do not reside in the same home as the child but is related within the third degree of consanguinity or affinity by birth or adoption to the child.  
• An individual 18 years of age or older who engages a child in severe forms of trafficking in persons or sex trafficking, as those terms are defined under section 103 of the Trafficking Victims Protection Act of 2000. 

Only the following may be considered a perpetrator for failing to act, as provided in this section:  

• A parent of the child. 
• A spouse or former spouse of the child's parent. 
• A paramour or former paramour of the child's parent. 
• A person 18 years of age or older and responsible for the child's welfare. 
• A person 18 years of age or older who resides in the same home as the child. 

Please Note: 

• Nothing under the PA CPSL requires a person who has reasonable cause to suspect a child is a victim of child abuse to identify the person responsible for the child abuse in order to make a report of suspected child abuse. 

The CPSL allows for school employees to be considered perpetrators under the definition provided for "person responsible for the child's welfare" or person "having direct contact with children."       

School employee: An individual who is employed by a school or who provides a program, activity, or service sponsored by a school. The term does not apply to administrative or other support personnel unless the administrative or other support personnel have direct contact with the children.  

Person responsible for the child's welfare: A person who provides permanent or temporary care, supervision, mental health diagnosis or treatment, training or control of a child in lieu of parental care, supervision, and control. 

Direct contact: The care, supervision, guidance or control of children OR routine interaction with children.  

As mentioned previously, child abuse falls into four main categories: neglect, physical abuse, sexual abuse, and serious mental injury. Many different acts fall into each category, but in general, intentionally causing harm to a child in any of these ways or failing to care for a child in a way that prevents harm from occurring is considered abuse (2).  

Case Study 

Case study No. 2 – Please read the scenario below and take a moment to reflect and examine how this untimely tragedy could have been prevented. 

One of the most extreme cases of child abuse occurred in Indiana in 1965 to a child named Sylvia Likens. The child was 16 years old when she was placed in the care of a neighborhood woman named Gertrude due to her family experiencing financial instability at the time. During her time at Gertrude’s house, Sylvia suffered all sorts of abuse daily at her hand. She was beaten, humiliated, deprived of basic life necessities and even forced to undress in front of a group of neighborhood boys on one occasion. Gertrude eventually had Sylvia stop going to school. Throughout her experience, neighborhood children and some adults witnessed her abuse and never reported it to the authorities. School officials at the time failed to recognize the common indicators of abuse and sadly Sylvia eventually died, succumbing to injuries and serious physical neglect. Although extremely tragic, her case led to Indiana’s Mandated Reporter Law, with the aim of preventing such atrocities as what Sylvia had to experience from ever happening again. 

Were there opportunities for someone to report this abuse to the authorities? What types of abuse did Sylvia endure? 

Exclusions of Child Abuse  

An exclusion is determined when substantiating a report, not when making a report.  

Pennsylvania Child Protective Services Law states:  

Definitions (23 Pa.C.S. § 6303): 

• Restatement of culpability – Conduct that causes injury or harm to a child or creates a risk of injury or harm to a child shall not be considered child abuse if there is no evidence that the person acted intentionally, knowingly or recklessly when causing the injury or harm to the child or creating a risk of injury or harm to the child. 
• Child abuse exclusions -- The term "child abuse" does not include any conduct for which an exclusion is provided in section 6304 of the PA CPSL (relating to exclusions from child abuse). 

Please Note: 

• Nothing in the PA CPSL requires a person who has reasonable cause to suspect a child is a victim of child abuse to consider the exclusions from child abuse before making a report of suspected child abuse. 
• Exclusions from child abuse are considered/determined by DHS or the investigating agency after receipt of a referral/report. 

Such exclusions under Pennsylvania Child Protective Services Law include:    

Environment Factors 

Environmental factors that may cause harm but are out of a caretaker's control, like inadequate shelter, clothing, medical care, or financial instability that are beyond the control of the parent or person responsible for the child's welfare with whom the child resides. This shall not apply to any childcare services as defined in this chapter, excluding an adoptive parent. 

Practice of Religious Beliefs (23 Pa.C.S. § 6304) 

“If, upon investigation, the county agency determines that a child has not been provided needed medical or surgical care because of sincerely held religious beliefs of the child's parents or relative within the third degree of consanguinity and with whom the child resides – which beliefs are consistent with those of a bona fide religion” –  

• The county agency shall closely monitor the child and the child's family and shall seek court-ordered medical intervention when the lack of medical or surgical care threatens the child's life or long-term health.  
• All correspondence with the subject of the report and the records of the Department and the county agency shall not reference child abuse and shall acknowledge the religious basis for the child's condition.  
• The family shall be referred for GPS, if appropriate. 
• This subsection shall not apply if the failure to provide needed medical or surgical care causes the death of the child.  
• This subsection shall not apply to any childcare service as defined in this chapter, excluding an adoptive parent.  

Use of force for supervision, control, and safety purposes 

Subject to rights of parents. 

The use of reasonable force on or against a child by the child's own parent or person responsible for the child's welfare shall not be considered child abuse if any of the following conditions apply:  

• The use of reasonable force constitutes incidental, minor, or reasonable physical contact with the child or other actions that are designed to maintain order and control.  
• The use of reasonable force is necessary: 
• to quell a disturbance or remove the child from the scene of a disturbance that threatens physical injury to persons or damage to property;  
• to prevent the child from self-inflicted physical harm; 
• for self-defense or the defense of another individual; or 
• to obtain possession of weapons or other dangerous objects or controlled substances or paraphernalia that are on the child or within the control of the child. 

Rights of Parents 

Rights of parents - Nothing in the PA CPSL shall be construed to restrict the generally recognized existing rights of parents to use reasonable force on or against their children for the purposes of supervision, control, and discipline of their children. Such reasonable force shall not constitute child abuse. 

Participation in events that involve physical contact with child –  (23 Pa.C.S. § 6304) 

“An individual participating in a practice or competition in an interscholastic sport, physical education, a recreational activity, or an extracurricular activity that involves physical contact with a child does not, in itself, constitute contact that is subject to the reporting requirements of the PA CPSL.” 

Child-on-child contact –(23 Pa.C.S. § 6304) 

“Harm or injury to a child that results from the act of another child shall not constitute child abuse unless the child who caused the harm or injury is a perpetrator as defined by the CPSL.” 

Notwithstanding the above, the following shall apply: 

• Acts constituting any of the following crimes against a child shall be subject to the reporting requirements of the PA CPSL:  
• Rape as defined in 18 Pa.C.S.§3121B.Involuntary deviate sexual intercourse as defined   in 18 Pa.C.S. §3123C. 
• Sexual assault as defined in 18 Pa.C.S.§3124.1D. 
• Aggravated indecent assault as defined in 18 Pa.C.S.§3125E. 
• Indecent assault as defined in 18 Pa.C.S.§3126F. 
• Indecent exposure as defined in 18 Pa.C.S.§3127. 
• No child shall be deemed to be a perpetrator of child abuse based solely on physical or mental injuries caused to another child in the course of a dispute, fight, or scuffle entered into by mutual consent. 
• A law enforcement official who receives a report of suspected child abuse is not required to make a report to DHS if the person allegedly responsible for the child abuse is a non-perpetrator child. 

Defensive Force 

Defensive force: Reasonable force for self-defense or the defense of another individual (relating to the use of force in self-protection) and (relating to the use of force for the protection of other persons), shall not be considered child abuse. 

Case Study 

Case Study No. 3 – please read the following scenario and answer the questions below: 

A three-year-old child is brought to the emergency department (ED) with fever, rash, sore throat, and worsening lethargy for six days. Upon arrival to the ED, she is limp and unresponsive, and the mother reports it has been nearly 24 hours since she was last awake. The family decided to take her to the hospital when she had a seizure at home an hour before. A history reveals that the family are Christian Scientists, and the child is unvaccinated and does not receive regular medical care as the family does not believe modern medicine is necessary or beneficial. The child is diagnosed with measles encephalitis and transferred to the pediatric intensive care unit (PICU), where she later dies. The PICU physician files a report with CPS.  

• Do the religious beliefs of the parents exclude them from potential child abuse allegations? Yes/No 

Correct Answer  

No – in this case there has been serious physical neglect caused by the delay from seeking medical attention which has caused the death of the child. 

• Is it the mandated reporter’s responsibility to determine if child abuse has occurred? Yes/No 

Correct Answer  

No – the mandated reporter only has a duty to report when they have reasonable belief that abuse may have occurred. The determination of whether child abuse has occurred will be made by CPS. 

Provision and Responsibilities for Reporting Suspected Child Abuse 

Persons Encouraged to Report 

Persons encouraged to report (23 Pa.C.S.§6312) 

While reporting suspected or known abuse should be a compulsion of anyone who encounters it, many people are considered persons encouraged to report and are encouraged to make reports when necessary, but not required by law. Persons encouraged to report may make an oral or written report of suspected child abuse or cause a report of suspected child abuse to be made to the Department, county agency, or law enforcement, if that person has reasonable cause to suspect that a child is a victim of abuse. Written reports must be submitted electronically. 

Hotline Number: 1-800-932-0313 

Child Welfare Portal 

Persons Required to Report: Healthcare Professionals 

Persons Required to Report (23 Pa.C.S.§6311) 

As a healthcare professional, you are considered a mandated reporter, meaning there are certain situations where you are required by law to make a report of suspected or confirmed abuse. 

• "Reasonable cause to suspect" may be a determination you make based on your training/experience and all known circumstances – to include “who”, “what”, “when”, and “how””, observations (e.g., indicators of abuse or "red flags", behavior/demeanor of the child(ren), behavior/demeanor of the adult(s), etc.), as well as familiarity with the individuals (e.g., family situation and relevant history or similar prior incidents, etc.). It is also important to recognize how your feelings and personal biases may influence your conclusions and actions. 
• Some indicators may be more apparent than others depending on the type of abuse and/or depending on the child's health, development, and well-being, as well as may be physically visible on the child's body while other indicators may be present in the child's behaviors. It is also worth acknowledging that some indicators may overlap and suggest a child is a victim of more than one type of child abuse. 

Basis For Reporting 

Persons required to report suspected child abuse (23 Pa.C.S. § 6311) section (b) 

(b) Basis to report  

• A mandated reporter enumerated in section 6311(a) of the PA CPSL shall make a report of suspected child abuse in accordance with section 6313 (relating to reporting procedure) if the mandated reporter has reasonable cause to suspect that a child is a victim of child abuse under any of the following circumstances: 
• The mandated reporter comes into contact with the child in the course of employment, occupation, and practice of a profession or through a regularly scheduled program, activity, or service. 
• The mandated reporter is directly responsible for the care, supervision, guidance, or training of the child, or is affiliated with an agency, institution, organization, school, regularly established church or religious organization, or other entity that is directly responsible for the care, supervision, guidance, or training of the child. 
• A person makes a specific disclosure to the mandated reporter that an identifiable child is the victim of child abuse. 
• An individual 14 years of age or older makes a specific disclosure to the mandated reporter that the individual has committed child abuse. 
• Nothing in section 6311 of the PA CPSL requires a child to come before the mandated reporter in order to make a report of suspected child abuse. 
• Nothing in section 6311 of the PA CPSL requires the mandated reporter to identify the person responsible for the child abuse in order to make a report of suspected child abuse. 

Persons Required to Report: Other Professions 

There are many other professions who are mandated reporters; in the state of Pennsylvania, this includes: 

• A person licensed or certified to practice in any health-related field under the jurisdiction of the Department of State.  
• A medical examiner, coroner, or funeral director. 
• An employee of a healthcare facility or provider licensed by the Department of Health, who is engaged in the admission, examination, care, or treatment of individuals.  
• A school employee. 
• An employee of a childcare service who has direct contact with children in the course of employment.  
• A clergyman, priest, rabbi, minister, Christian Science practitioner, religious healer or spiritual leader of any regularly established church or other religious organization.  
• An individual paid or unpaid, who, based on the individual's role as an integral part of a regularly scheduled program, activity or service, is a person responsible for the child's welfare or has direct contact with children. 
• An employee of a social services agency who has direct contact with children in the course of employment.  
• A peace officer or law enforcement official. 
• An emergency medical services (EMS) provider certified by the Department of Health. 
• An employee of a public library who has direct contact with children in the course of employment.  
• An individual supervised or managed by a person listed under paragraphs (1), (2), (3), (4), (5), (6), (7), (8), (9), (10), (11), and (13), who has direct contact with children in the course of employment.  
• An independent contractor. 
• An attorney affiliated with an agency, institution, organization, or other entity, including a school or regularly established religious organization that is responsible for the care, supervision, guidance or control of children.  
• A foster parent. 
• An adult family member who is a person responsible for the child's welfare and provides services to a child in a family living home, community home for individuals with an intellectual disability or host home for children which are subject to supervision or licensure by the Department under Articles IX and X of the act of June 13, 1967, (P.L. 31, No. 21), known as the Public Welfare Code. 

Persons Required to Report: Staff Members of Institutions 

Persons required to report suspected child abuse ((23 Pa.C.S. § 6311) section (c) 

(c) Staff members of institutions, etc.  

• Whenever a person is required to report under section 6311(b) of the PA CPSL in the capacity as a member of the staff of a medical or other public or private institution, school, facility, or agency, that person shall report immediately in accordance with section 6313 (relating to reporting procedure) and shall immediately thereafter notify the person in charge of the institution, school, facility, or agency or the designated agent of the person in charge. 
• Upon notification, the person in charge or the designated agent, if any, shall facilitate the cooperation of the institution, school, facility, or agency with the investigation of the report. 
• Any intimidation, retaliation, or obstruction in the investigation of the report is subject to the provisions of 18 Pa.C.S. § 4958 (relating to intimidation, retaliation, or obstruction in child abuse cases). 
• The PA CPSL does not require more than one report from any such institution, school, facility, or agency. 

Privileged/Confidential Communications 

Privileged/Confidential Communications (23 Pa.C.S. § 6311.1) 

Mandated reporters may encounter situations where they have a reasonable suspicion of abuse through several different circumstances; including contact with the child through their job, direct involvement in the supervision or caretaking of the child, another person discloses the knowledge of abuse that is occurring to the child, or another person discloses that they themselves have abused the child. The child is not required to make a claim of abuse or even talk to the mandated reporter about it. Situations that reveal potential abuse must be reported even if the information is disclosed within a confidential relationship and reporting such incidents does not violate confidentiality laws (9).  

*Confidential communications apply to member of clergy as well as communications made to an attorney.  

Case Study 

Case Study No. 4 – read the following scenario and answer the questions below: 

A four-month-old child is brought to the pediatric clinic for a diaper rash. Upon measuring his length and weight, the nurse notes that the child has grown in length since his last visit two months ago but has only gained 3 oz, dropping from the 40th percentile to 5th percentile, and is now considered “Failure to Thrive.” Other than the diaper rash, the child is clean, though thin, and the mother shows appropriate affection for him in the office. When the nurse comments on his lack of growth, the mother admits she is having a hard time affording formula and has been diluting it to make it last longer. The nurse provides education about properly mixing formulas and information for the local Women Infants and Children (W.I.C.) program so that she can receive supplemental formula. Then, as a mandated reporter, the nurse contacts the Department of Human Services (DHS) for the county to report the situation.  

• Is there reasonable cause to suspect child abuse? Yes/No 

Correct Answer:  

Yes – failure to provide a child with the necessities of life can be considered neglect. Even though it is due to reported financial instability, the mandated reporter has a responsibility to report, and DHS will investigate further and make the determination if there is an exclusion or not. 

• Is this a scenario which has a basis to report in which the nurse must report as a mandated reporter? Yes/No 

Correct Answer:  

Yes – nurses are considered mandated reporters. The nurse has encountered the child through the practice of their profession.  

• Which of the following entities must the nurse notify of the suspected abuse? 
  • The child’s mother 
  • Supervisor of the pediatric clinic 
  • Law enforcement 
  • Department of Human Services 

Correct Answer: 

B and D – the nurse must notify DHS via the statewide toll-free telephone number and notify their supervisor or other designated person in the clinic in charge of following up with such cases. 

Human Trafficking 

Examples of severe forms of human trafficking include: 

Labor Trafficking 

Labor Trafficking is labor obtained by use of threat of serious harm, physical restraint, or abuse of legal process. An example of human trafficking is being forced to work for little or no pay in such a climate as a farm or a factory; domestic servitude in providing services within a household from 10-16 hours per day performing duties such as childcare, cooking, cleaning, yard work, and gardening.  

Another example would be the recruitment, harboring, transportation, provision, or obtaining a person for labor of services through force, fraud, or coercion for the subjection of involuntary servitude.  

• Peonage: paying off debt through work 
• Debt Bondage: debt slavery, bonded labor, or services for a debt or other obligation 
• Slavery: a condition compared to that of a slave in respect of exhausting labor or restricted freedom 

Sex Trafficking 

Sex trafficking is another form of severe human trafficking. It occurs when a commercial sexual act is induced by force, fraud, or coercion, or in which the person induced to perform such an act is not 18 years of age.  

Defined, Sex trafficking: the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a commercial sex act. 

A commercial sex act is defined as any sex act on account of anything of value is given to or received by any person.  

At risk youth populations for human trafficking include, but not limited to, youth:  

• In the foster care system 
• Who identify as LGBTQ 
• Who are homeless or runaway 
• With disabilities 
• With mental health and/or substance abuse disorders 
• With a history of sexual abuse 
• With a history of being involved in the welfare system 
• Who identify as native or aboriginal 
• With family dysfunction 

Victim identification or warning signs to look out for in these populations include, but not limited to:  

• A youth that has been verified to be under 18 and is in any way involved in the commercial sex industry or has a record of prior arrest for prostitution or related charges. 
• Has an explicitly sexual online profile. 
• Excessive frequenting of internet chat rooms or classified sites. 
• Depicts elements of sexual exploitation in drawing, poetry, or other modes of creative expression. 
• Frequent or multiple sexually transmitted diseases or pregnancies. 
• Lying about or not being aware of their true age. 
• Having no knowledge of personal data, such as but not limited to: age, name, and/or date of birth. 
• Having no identification. 
• Wearing sexually provocative clothing.  
• Wearing new clothes of any style, getting hair and/or nails done with no financial means. 
• Secrecy about whereabouts. 
• Having late nights or unusual hours. 
• Having a tattoo that she/she is reluctant to explain.  
• Being in a controlling or dominating relationship. 
• Not having control of own finances. 
• Exhibit hyper-vigilance or paranoid behaviors. 
• Express interest in or in relationships with adults or much older men/women. 

Substance Exposed Infants and Plans of Safe Care 

Notification of Substance Exposed Infants by Healthcare Providers and Plans of Safe Care 

According to Act 54, a healthcare provider shall immediately give notice to the department if the provider is involved in the delivery or care of a child under one year of age and the healthcare provider has determined based on professional practice that the child was born affected by substance use or withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol disorder.  

A health care provider is defined as: A licensed hospital or health care facility or person who is licensed, certified, or otherwise regulated to provide health care services under the laws of Pennsylvania, including a physician, podiatrist, optometrist, psychologist, physical therapist, certified nurse practitioner, registered nurse, nurse midwife, physician’s assistant, chiropractor, dentist, pharmacist, or an individual accredited or certified to provide behavioral health services. 

Notification to the department can be made to ChildLine electronically through the Child Welfare Portal or at 1-800-932-0313. 

This notification is for the purpose of assessing a child and the child's family for a plan of safe care and may not constitute a child abuse report.  

After notification of a child born affected by substance use or withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder: 

• A multidisciplinary team meeting must be held prior to the child's discharge from the healthcare facility. 
• The meeting will inform an assessment of the needs of the child and the child's parents and immediate caregivers to determine the most appropriate lead agency for developing, implementing, and monitoring a plan of safe care. 
• The child's parents and immediate caregivers must be engaged to identify the need for access to treatment for any substance use disorder or other physical or behavioral health condition that may impact the safety, early childhood development and well-being of the child. 
• Depending upon the needs of the child and parent(s)/caregiver(s), ongoing involvement of the county agency may not be required. 

Reporting Process    

All reports, whether mandated or not, should be made immediately by contacting the Pennsylvania Department of Human Services through the ChildLine hotline. 

(1-800-932-0313) 

Electronic Reporting 

Electronic reporting (23 Pa.C.S. § 6305) section (b) 

(b) Confirmation of reports – A confirmation by DHS of the receipt of a report of suspected child abuse submitted electronically shall relieve the person making the report of making an additional oral or written report of suspected child abuse, subject to section 6313 (relating to reporting procedure). 

Reporting Procedures 

Reporting procedure (23 Pa.C.S. § 6313) section (a) 

(a) Report by mandated reporter 

• A mandated reporter shall immediately make an oral report of suspected child abuse to DHS via the Statewide toll-free telephone number under section 6332 (relating to establishment of Statewide toll-free telephone number) (1-800-932-0313) or a written report using electronic technologies under section 6305 (relating to electronic reporting) (via the self-service Child Welfare Portal). 
• A mandated reporter making an oral report of suspected child abuse to the DHS via the Statewide toll-free telephone number under section 6332 (relating to establishment of Statewide toll-free telephone number) shall also make a written report (CY-47), which may be submitted electronically, within 48 hours to DHS or county agency assigned to the case in a manner and format prescribed by DHS. 
• The failure of the mandated reporter to file the written report (CY-47) described in the paragraph immediately above shall not relieve the county agency from any duty under the PA CPSL, and the county agency shall proceed as though the mandated reporter complied. 

This line is available 24/7 and will guide you through the reporting process specific to your scenario. Electronic submission will likely need to accompany your verbal report.  You can complete an online electronic submission through the Child Welfare portal. Oral reports are required to be followed up within 48 hours with an electronic report sent to the investigating agency through the portal. 

Reporting procedure (23 Pa.C.S. § 6313) section (b) 

(b) Contents of report -- A written report of suspected child abuse, which may be submitted electronically, shall include the following information, if known: 

• The names and addresses of the child, the child's parents, and any other person responsible for the child's welfare. 
• Where the suspected abuse occurred 
• The age and sex of each subject of the report 
• The nature and extent of the suspected child abuse, including any evidence of prior abuse to the child or any sibling of the child. 
• The name and relationship of each individual responsible for causing the suspected abuse and any evidence of prior abuse by each individual. 
• Family composition 
• The source of the report 
• The name, telephone number and e-mail address of the person making the report. 
• The actions taken by the person making the report, including those actions taken under section 6314 (relating to photographs, medical tests, and X-rays of child subject to report), 6315 (relating to taking child into protective custody), 6316 (relating to admission to private and public hospitals) or 6317 (relating to mandatory reporting and postmortem investigation of deaths) 
• Any other information required by Federal law or regulation. 
• Any other information that DHS requires by regulation. 

Reporting procedure (23 Pa.C.S. § 6313) section (e) 

(e) Applicability of Mental Health Procedures Act – Notwithstanding any other provision of law, a mandated reporter who makes a report of suspected child abuse or who makes a report of a crime against a child to law enforcement officials shall not be in violation of the act of July 9, 1976 (P.L.817, No.143), known as the Mental Health Procedures Act, by releasing information necessary to complete the report. 

Release of Confidential Information 

Release of information in confidential reports (23 Pa.C.S. § 6340) section (c) 

(c) Protecting identity – Except for reports under section 6340(a)(9) and (10) of the PA CPSL and in response to a law enforcement official investigating allegations of false reports under 18 Pa.C.S. § 4906.1 (relating to false reports of child abuse), the release of data by DHS, county, institution, school, facility, or agency or designated agent of the person in charge that would identify the person who made a report of suspected child abuse or who cooperated in a subsequent investigation is prohibited. Law enforcement officials shall treat all reporting sources as confidential informants. 

Confidentiality of reports (23 Pa.C.S. § 6339)  

Except as otherwise provided in subchapter C of the PA CPSL (relating to powers and duties of department) or by the Pennsylvania Rules of Juvenile Court Procedure, reports made pursuant to the PA CPSL, including, but not limited to, report summaries of child abuse and reports made pursuant to section 6313 (relating to reporting procedure) as well as any other information obtained, reports written, or photographs or X-rays taken concerning alleged instances of child abuse in the possession of DHS or a county agency shall be confidential. 

ChildLine receives the report and determines who is to respond dependent upon the information reported, such as the identity, if known, of the person who allegedly acted to abuse or harm a child.  

ChildLine will immediately transmit oral or electronic reports that they receive to the appropriate county agency and or law enforcement official: 

• If a person identified falls under the definition of perpetrator, ChildLine would refer the report to the appropriate county agency for an investigation. 
• If the person identified is not a perpetrator and the behavior reported includes a violation of a crime, ChildLine will refer the report to law enforcement officials. 
• If a person identified falls under the definition of perpetrator and the behavior reported includes a criminal violation, ChildLine will refer the report to the appropriate county agency and law enforcement officials. 

If a report indicates that a child may need other protective services, ChildLine will refer the report to the proper county agency to assess the needs of the child and provide services, when appropriate. 

If a report was made by a mandated reporter, the department will notify the mandated reporter who made the report of DHS's receipt of the results of the investigation. 

A child abuse investigation must be determined within 30 days whether the report is: 

• founded, indicated, unfounded or pending. 
• Any services provided, arranged for or to be provided by the county agency to protect the child. 

An investigation may take up to 60 days if there is a valid reason, such as when waiting for results from a medical report or from another evaluation. 

While mandated reporters are not able to remain anonymous, they are offered certain protections from legal action as long as the report was made in good faith. Mandated reporters are immune from litigation involving photographs taken during an investigation, medical exams performed, or backlash from family members or perpetrators in situations where abuse was or was not actually found to be occurring. Their names are also kept confidential unless the situation evolves to one where the reporter's identity must be revealed, such as testifying in court (4).    

Immunity From Liability 

Immunity from liability (23 Pa.C.S. § 6318) section (a) 

(a) General rule – A person, hospital, institution, school, facility, agency, or agency employee acting in good faith shall have immunity from civil and criminal liability that might otherwise result from any of the following: 

• Making a report of suspected child abuse or making a referral for general protective services, regardless of whether the report is required to be made under the PA CPSL. 
• Cooperating or consulting with an investigation under the PA CPSL, including providing information to a child fatality or near-fatality review team. 
• Testifying in a proceeding arising out of an instance of suspected child abuse or general protective services. 
• Engaging in any action authorized under 23 Pa.C.S. § 6314 (relating to photographs, medical tests and X-rays of child subject to report), § 6315 (relating to taking child into protective custody), § 6316 (relating to admission to private and public hospitals), or § 6317 (relating to mandatory reporting and postmortem investigation of deaths). 

Immunity from liability (23 Pa.C.S. § 6318) section (b) 

(b) Departmental and county agency immunity – An official or employee of DHS or county agency who refers a report of suspected child abuse for general protective services to law enforcement authorities or provides services as authorized by the PA CPSL shall have immunity from civil and criminal liability that might otherwise result from the action. 

Immunity from liability (23 Pa.C.S. § 6318) section (c) 

(c) Presumption of good faith – For the purpose of any civil or criminal proceeding, the good faith of a person required to report suspected child abuse and of any person required to make a referral to law enforcement officers under the PA CPSL shall be presumed. 

Protection From Employment Discrimination 

Protection from employment discrimination (23 Pa.C.S. § 6320) section (a) 

(a) Basis for relief – A person may commence an action for appropriate relief if all of the following apply: 

• The person is required to report suspected child abuse or encouraged to report suspected child abuse. 
• The person acted in good faith in making or causing the report of suspected child abuse to be made. 
• As a result of making the report of suspected child abuse, the person is discharged from employment or is discriminated against with respect to compensation, hire, tenure, terms, conditions, or privileges of employment. 

Protection from employment discrimination (23 Pa.C.S. § 6320) section (b) 

(b) Applicability – This section does not apply to an individual making a report of suspected child abuse who is found to be a perpetrator because of the report or to any individual who fails to make a report of suspected child abuse as required and is subject to conviction for failure to report or to refer. 

Failure to Report  

Failing to report a suspected abuse case as a mandated reporter is an offense as a felony of the third degree if: 

• The person or officially willfully fail to report.  
• The child abuse constitutes as a felony of the first degree or higher AND.  
• The person has direct knowledge of the nature of the abuse.  

The offense not otherwise specified above is considered a misdemeanor of the second degree.  
 

Penalties for Not Reporting 

Penalties (23 Pa.C.S. § 6319) section (a) 

(a) Failure to report or refer 

1. A person or official required by the PA CPSL to report a case of suspected child abuse or to make a referral to the appropriate authorities commits an offense if the person or official willfully fails to do so. 

1. An offense under this section is a felony of the third degree if: 

• the person or official willfully fails to report. 
• the child abuse constitutes a felony of the first degree or higher; and 
• the person or official has direct knowledge of the nature of the abuse. 

1. An offense not otherwise specified above is a misdemeanor of the second degree. 

1. A report of suspected child abuse to law enforcement or the appropriate county agency by a mandated reporter, made in lieu of a report to DHS, shall not constitute an offense under this subsection, provided that the report was made in a good faith effort to comply with the requirements of the PA CPSL. 

Penalties (23 Pa.C.S. § 6319) section (b)  

(b) Continuing course of action – If a person's willful failure to report an individual suspected of child abuse continues while the person knows or has reasonable cause to suspect a child is being subjected to child abuse by the same individual, or while the person knows or has reasonable cause to suspect that the same individual continues to have direct contact with children through the individual's employment, program, activity, or service, the person commits a felony of the third degree…except that, if the child abuse constitutes a felony of the first degree or higher, the person commits a felony of the second degree. 

Penalties (23 Pa.C.S. § 6319) section (b) 

(c) Multiple offenses – A person who, at the time of sentencing for an offense under this section, has been convicted of a prior offense under this section commits a felony of the third degree…except that, if the child abuse constitutes a felony of the first degree or higher, the penalty for the second or subsequent offenses is a felony of the second degree. 

A child is not required to come before the mandated reporter for the mandated reporter to make a report of suspected child abuse. 

Penalties (23 Pa.C.S. § 6319) section (d) 

(d) Statute of limitations – The statute of limitations for an offense under this section shall be either the statute of limitations for the crime committed against the minor child or five years, whichever is greater. 

Case Study 

Case Study No. 5 - please read the following scenario and answer the questions below: 

A pediatric nurse is off duty and supervising her nine-year-old child and a few peers swimming in her backyard. She notices that one of the other children has a large fading bruise on his back. She is friends with this child's mother, Katie, and asks her what happened when she comes to pick the child up. Katie gets very quiet and then admits that the child's father sometimes is very rough when he gets angry and had grabbed the child by the arm a few nights ago and then hit him. Katie states not to worry, that the father has agreed to go to anger management, and she is hoping it won't happen anymore.   

• Is the nurse in this scenario required to report? Yes/No 

Correct answer: 

Yes – even if the nurse is off duty, “A person makes a specific disclosure to the mandated reporter that an identifiable child is the victim of child abuse. This statement does not require you to be "on the clock.” 

• What category of child abuse is presented in this scenario? 
  • Neglect 
  • Physical  
  • Sexual 
  • Mental 

Correct answer: 

B – physical abuse includes corporal punishment that leaves bruises and has the potential to injure the child. 

Adverse Childhood Experiences 

Adverse Childhood Experiences or ACE is an umbrella term to describe events that had a potentially traumatic impact and that occurred before the individual turned 18 (2). 

The Centers for Disease Control and Prevention (CDC) reports that approximately 64% of adults in the United States have experienced an ACE (2). These experiences can have long lasting effects on health, overall wellbeing, access to higher education, and job opportunities. The impact reaches far beyond just the individual. It can affect their family dynamics and can have societal implications. This is why preventing childhood abuse and promoting family stability needs to be a community effort and not just the responsibility of a select few. 

Community Strategies to Prevent ACE: 

• Increasing opportunities for families to have financial stability. 
• Providing education on how to prevent violence and how to approach these situations as a person required to report or person encouraged to report. 
• Community youth activities. 
• Early intervention. 
• Affordable access to high quality childcare. 

Conclusion

Obviously, even one child being abused is too many. However, as community advocates, teachers, healthcare professionals, and others working on correcting and eliminating the societal conditions that lead to child abuse in the first place, it is important for nurses and other healthcare professionals to continue working diligently to identify potential victims of abuse and activate the system in place to help them as quickly and efficiently as possible. By having an ability to identify who is at risk, an understanding of the reporting system, and knowledge on what being a mandated reporter entails, nurses can play an active role in curtailing the number of children seriously harmed by these situations. Children are one of our most vulnerable populations because of their dependency on others to meet their many needs. Advocacy for their safety is one of the most important roles a nurse can take on.

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