Child Abuse and Neglect Services and Resources
During your care for a patient at Children’s you may become concerned that the child is being abused or neglected. You may also have questions about your responsibility to identify and report your suspicion, or about the availability of resources for responding to these situations. To assist you in your obligations under these circumstances, we have developed a summary of resources available to you at Children's.
By law (RCW 26.44) any practitioner, registered or licensed nurse, social service counselor, psychologist or pharmacist who has reasonable causeto believe that a child has suffered abuse or neglect is mandated to report these suspicions to the Department of Social and Health Services (Child Protective Services, "CPS") or to law enforcement within 48 hours of that suspicion. Although one may delegate reporting, each mandated reporter is, individually, legally responsible to assure that a report has been made. During the 2004 legislative session, SHB 3083 was passed. This law states that a person who, in good faith and without gross negligence, cooperates in an investigation arising as a result of a report made…shall not be subject to civil liability arising out of his or her cooperation.
Policies and Procedures
All the policies and procedures (P&Ps) relating to child abuse, neglect and domestic violence are posted online on the hospital’s intranet, CHILD. This information is also available on the Medical Staff website. These P&Ps outline the procedures to initiate when a provider suspects that a child is abused and/or neglected. Whenever there is a concern that maltreatment was involved in a child fatality, the attending is also obliged to contact the county medical examiner or coroner.
The complex, multiple medical, legal, social and psychiatric problems that are present in every case of suspected child abuse/neglect require the help of knowledgeable and skilled professionals. The Protection Program is available to assist staff and community physicians with assessing whether reasonable cause exists and to determine the most appropriate course of action.
SCAN (suspected child abuse or neglect)
Medical Consultant and Child Sexual Assault Consultant physicians, specializing in providing medical evaluations of these concerns, are available 24 hours a day. They can be contacted at Children’s by calling 206-987-2194. After hours (after 4 p.m. or on weekends or holidays) or when unreachable there, call Children's operator at 206-987-2000. Sexual Assault Consultants can be reached after hours by calling the Harborview operator at 206-731-3000 and requesting a Sexual Assault attending.
These physicians are available to provide advice or direct consultation to the provider, assist the evaluation of suspected abuse/neglect as well as help manage the delicate interaction between families, CPS and law enforcement. They become involved in cases of suspected abuse/neglect at the request of the child’s attending physician or the child’s resident after discussion with the attending physician.
Social Work should always be contacted if abuse, neglect or domestic violence is suspected. Social workers provide the psychological, social and protection assessment of the family and provide liaison with the legal, hospital and all other involved systems. Children’s social workers and Protection Team members (see below) are Children’s employees, and their role is to provide support and consultation to both the provider and family. They are not part of Child Protective Services (CPS), which is a state agency.
Social workers are present in-house during regular weekday and evening hours. They can be reached by calling Social Work Intake at 206-987-2760. After hours (after 4 p.m.) or on weekends and holidays, social workers are on call for all concerns of family violence and can be reached through Children’s operator at 206-987-2000.
Children's Protection Team (CPT)
The Children's Protection Team (CPT), a service of the Protection Program, is a medical center supported multidisciplinary team which is a resource for any questions regarding child abuse or neglect, including whether or not a Child Protective Service (CPS) or law enforcement referral is appropriate. Individual team members can provide assistance with medical and social evaluations for child maltreatment, aid collaboration with CPS, police, etc., and discuss discharge options.
CPT meets weekly on Tuesdays from 11:30 a.m. to 12:30 p.m. Ad hoc meetings can be arranged at other times. To request a case review with the Team, contact the Protection Program at 206-987-2194.
Clinical Action Safety Plan Evaluating Risk (CASPER)
Many children experiencing abuse and neglect also come from families under high stress. These families often experience problems with domestic violence, substance abuse, anger management or other impulse-control issues that may disrupt medical treatment.
All CASPERs are now entered into CIS; hard copies are in the process of being eliminated. If a CASPER exists on a patient, there will be CASPER alert in the online chart; background information on circumstances and plan are also in the chart note. Social Workers and Security are the only disciplines that can write CASPERs. If a concern arises that you believe may warrant a CASPER, please contact either Security or a Social Worker by calling Social Work Intake at 206-987-2760 or, after hours, the hospital operator.
Inpatient general medical attending services
Patients admitted for evaluation of abuse and neglect often require repeated interactions with the family and with outside agencies such as CPS, the police and the courts. If community physicians are unavailable to provide this level of involvement, the inpatient attending (“house”) physicians can manage the patient’s hospital stay.
Order set for physical and sexual abuse
Order sets for child physical and sexual abuse are currently available on CIS to ease selection of appropriate abuse evaluations. They are annotated with guidance about when specific tests are indicated and have links to the policies in CHILD governing care of abused or neglected children.
Referral Guideline for Community Healthcare Providers
To provide statewide consultation to community providers regarding medical findings in concerns of child abuse and neglect.
The SCAN (suspected child abuse and neglect) medical consultants are members of the faculty of the University of Washington School of Medicine Department of Pediatrics and are Child Abuse Board Certified.
Additional support: The social workers are licensed MSWs and employees of Seattle Children’s with an expertise in child maltreatment and intimate partner violence.