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UWHC,UWMF,

Policies,Clinical,UW Health Clinical,Administrative,Legally Driven Care

Suspected Child Abuse and Neglect (1.2.4)

Suspected Child Abuse and Neglect (1.2.4) - Policies, Clinical, UW Health Clinical, Administrative, Legally Driven Care

1.2.4


UW HEALTH CLINICAL POLICY 1
Policy Title: Suspected Child Abuse and Neglect
Policy Number: 1.2.4
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: May 26, 2017

I. PURPOSE

To direct consistent and accurate identification, documentation and intervention of suspected child abuse or
neglect including suspected child abuse involving a fetus.

II. DEFINITIONS

A. Child
i. A person who is less than 18 years of age.
B. Fetus
i. For the purposes of this policy, the term “fetus” means a human being from the time of fertilization
to the time of birth.
C. Child abuse
i. Physical injury inflicted on a child by other than accidental means, including, but not limited to:
a. Lacerations
b. Fractured bones
c. Burns
d. Internal injuries
e. Severe or frequent bruising
f. Bodily injury that creates a substantial risk of death, causes serious permanent
disfigurement, or causes a permanent or protracted loss or impairment of the function of
any bodily member or organ, or other serious body injury.
ii. Permitting, allowing, or encouraging a child to engage in prostitution
iii. Manufacturing methamphetamine in violation of Wisconsin Statutes section 961.41(1)(e) under any
of the following circumstances:
a. With a child physically present during the manufacture.
b. In a child’s home, on the premises of the child’s home, or in a motor vehicle located on the
premises of a child’s home.
c. Under any other circumstances in which a reasonable person should have known that the
manufacture would be seen, smelled, or heard by a child.
iv. Emotional damage
a. Harm to a child’s psychological or intellectual functioning for which the child’s parent,
guardian or legal custodian has neglected, refused or been unable for reasons other than
poverty to obtain the necessary treatment or to take steps to ameliorate the symptoms.
b. “Emotional damage” may be evidenced by one or more of the following characteristics
exhibited to a severe degree:
1. Anxiety
2. Depression
3. Withdrawal
4. Outward aggressive behavior
5. Substantial and observable change in behavior, emotional response or cognition
that is not within the normal range for the child’s age and stage of development
v. Sexual abuse as described in Section II.E.
D. Abuse of a fetus: See Section IV.F.iii.
E. Sexual Abuse
i. Sexual intercourse, or other acts of a sexual nature with a child including:
a. Sexual intercourse or sexual contact with a child under 16 years of age (see section IV.B.
for potential reporting exception).
b. Any sexual intercourse or sexual contact with a child without consent.
c. Sexual assault: sexual intercourse without consent, by use or threat of use of a dangerous
weapon or any article fashioned in a manner to lead the victim reasonably to believe it to
be a dangerous weapon, by use or threat of force or violence, with a person who the actor
knows is unconscious, with a person who is under the influence of an intoxicant to a
degree which renders that person incapable of giving consent



UW HEALTH CLINICAL POLICY 2
Policy Title: Suspected Child Abuse and Neglect
Policy Number: 1.2.4

d. Sexual contact: Intentional touching, whether direct or through clothing, if that intentional
touching is either for the purpose of sexually degrading; or for the purpose of sexually
humiliating the child or sexually arousing or gratifying the actor or if the touching causes
bodily harm
e. Sexual exploitation including employing, using, persuading, inducing, enticing, or coercing
any child to engage in sexually explicit conduct for the purpose of recording or displaying
in any way or recording or displaying in any way a child engaged in sexually explicit
conduct
f. Trafficking of a child including knowingly recruiting, enticing, providing, obtaining, or
harboring or knowingly attempting to recruit, entice, provide, obtain, or harbor any child for
the purpose of commercial sex acts
g. Intentionally causing a child to view or listen to sexual activity if the viewing or listening is
for the purpose of sexually arousing or gratifying the actor or humiliating or degrading the
child
h. Child enticement
i. Use of a computer to facilitate a child sex crime
j. Exposing genitals, pubic area, or intimate parts to a child or causing a child to expose
genitals or pubic area to another person, for purposes of sexual arousal or sexual
gratification
F. Neglect
i. Failure, refusal, or inability on the part of a caregiver, for reasons other than poverty, to provide
necessary care, food, clothing, medical or dental care, or shelter so as to seriously endanger the
physical health of the child. The focus in evaluating suspected child neglect should be based upon
an assessment of whether the lack of care threatens the child’s health or safety, or is likely to
cause long-range or permanent impairment to the child’s development.
G. Mandated Reporters
i. Any medical or mental health professional who has reasonable cause to suspect that a child seen
by the person in the course of professional duties has been abused or neglected or who has
reason to believe that a child seen by the person in the course of professional duties has been
threatened with abuse or neglect and that abuse or neglect of the child will occur, is a “Mandated
Reporter” of child abuse or neglect under Wisconsin law. Mandated reporters include: physicians,
advanced practice providers (physician assistants, nurse practitioners, etc.), nurses, other clinical
staff (nursing assistants, medical assistants, patient care technicians, physical therapist assistants,
etc.), dentists, physical, occupational, and speech therapists, audiologists, social workers, marriage
and family therapists, professional counselors, administrators, emergency medical technicians and
any other medical or mental health professionals not otherwise specified in this paragraph.

III. POLICY ELEMENTS

UW Health screens patients suspected to be victims of physical, sexual, or emotional abuse, and neglect,
provides supportive services whenever needed, and follows legal standards for duty to report in the best
interest of the patient.

IV. PROCEDURE

A. Investigation and Medical Examination of Suspected Victims
i. Children should not be interviewed by staff. Staff should listen to any comments/concerns children
have and document them, with quotes if possible, but should not ask additional questions unless
additional information is needed to proceed with the patient’s medical care. If further medical
evaluation is needed or there is suspicion of non-accidental injury page the Child Protection
Program.
ii. If there is concern of sexual abuse and an exam by a Forensic Nurse Examiner (FNE) is requested,
contact the Child Protection Program for a provider to conduct the exam and/or Meriter for an
available FNE program examiner.
B. Mandated Reporters’ Duty to Report
i. Mandated reporters shall report suspected abuse or neglect including threats of abuse or neglect
which they have reason to believe has or will occur to children seen in the course of their
professional duties. Reports should be made to the local county child protective services agency
where the child resides and to local law enforcement where the suspected abuse or neglect has



UW HEALTH CLINICAL POLICY 3
Policy Title: Suspected Child Abuse and Neglect
Policy Number: 1.2.4

occurred. If the child resides outside of the state of Wisconsin or it is unknown where the child
resides/or the incident occurred, reports should be made to Dane County Child Protective Services
and local law enforcement.
ii. If there is more than one Mandated Reporter involved in a situation, one person may make the
report but the other Mandated Reporter should confirm that a report has been made. The individual
with the most knowledge of the situation should generally make the mandatory report to facilitate
an accurate assessment of the situation by authorities.
iii. If the child appears to be in immediate danger, the primary treating provider should call Security if
located at the University Hospital, American Family Children’s Hospital, or The American Center, or
call law enforcement at all other locations.
iv. A Mandated Reporter who has not seen a child in the course of professional duties but has reason
to suspect abuse or neglect, or a threat of abuse or neglect to the child and that abuse or neglect
will occur, may report in the manner outlined above. Contact Risk Management and/or the UW
Health attorney on-call with any questions regarding this permissive reporting.
v. Reporting under this section does not apply to a fetus. See section IV.F.iii.
C. Exception to Reporting for Certain Reproductive Health Services:
i. Wisconsin law provides an exception from reporting requirements to allow physicians, advanced
practice providers, registered nurses, and licensed practical nurses to provide confidential health
services to a child for purposes of family planning, pregnancy testing, obstetrical health care or
screening, diagnosis or treatment for a sexually transmitted disease. This exception does not apply
if the sexual contact is with a caregiver, or if there is any reasonable doubt about the voluntariness
of sexual contact or the child’s ability to consent to the sexual contact (this includes children who
because of age or immaturity are incapable of understanding the nature or consequences of sexual
intercourse or sexual contact).
D. Questions about Reporting
i. Questions about reporting at University Hospital, American Family Children’s Hospital, and The
American Center should be directed to Social Work Services (outside of business hours page on
call social work). Questions about reporting at all other locations should be directed to Patient
Resources (outside of business hours contact county child protective services and/or law
enforcement).
ii. If there are questions about additional testing needed or a need for further medical evaluation, a
Child Abuse Consult should be requested and the Child Protection Program should be notified by
paging either the Child Protection Program Social Worker or the Child Protection Program
Physician on call.
iii. Questions regarding the interpretation of this policy should be directed to the Legal Department.
E. Immunity
i. Wisconsin law provides that no Mandated Reporter making a report in good faith may be
discharged from employment, disciplined or otherwise discriminated against in regard to
employment, or threatened with any such treatment for so doing.
ii. Wisconsin law provides immunity from any civil or criminal liability to any Mandated Reporter
participating in good faith in the making of a report or performing medical examinations of such a
child. The immunity does not apply to liability for abusing or neglecting a child.
iii. The law that provides immunity for Mandated Reporters who are reporting within the state of
Wisconsin may not apply to any reports made in any other states, and other states’ immunity
provisions may not apply to individuals who are not licensed in that state. Therefore, If the child
resides outside of the state of Wisconsin or it is unknown where the child resides/or the incident
occurred, reports should be made to Dane County Child Protective Services and local law
enforcement.
F. Non-Mandatory / Permissive Reporting
i. In some circumstances, reporting is permitted but is not mandatory, including in the following
situations:
a. When the individual who is not a Mandated Reporter has reason to suspect that a child
has been abused or neglected or who has reason to believe that a child has been
threatened with abuse or neglect and that abuse or neglect of the child will occur.
b. When a person who would otherwise be a Mandated Reporter suspects child abuse or
neglect but did not see the child in the course of professional duties (e.g., when a
physician is treating an intoxicated driver injured in a motor vehicle accident but is not
treating a child also injured in the same accident).
ii. Any UW Health employee who is not a Mandated Reporter is encouraged to inform his or her



UW HEALTH CLINICAL POLICY 4
Policy Title: Suspected Child Abuse and Neglect
Policy Number: 1.2.4

supervisor/manager if the employee suspects that child abuse or neglect is occurring or has
occurred. If the employee believes a dangerous situation exists, the employee should follow the
standard security plan for the clinic or other health care location.
iii. Abuse of a Fetus: if a UW Health staff member is considering reporting a suspicion of abuse of a
fetus, he or she should first initiate a discussion with appropriate members of the patient’s care
team to discuss the issue. If reporting is still being considered following that conversation, due to
recent changes in applicable law the staff member should call the legal department.
iv. UW Health will not discharge an employee from employment, discipline or otherwise discriminate
against the employee in regard to employment, or threaten him or her with any such treatment for
informing a supervisor or manager of suspected child abuse or neglect or of suspected abuse of a
fetus or for following the security plan for the health care location, if the employee believes in good
faith that the situation warrants such action.
G. Failure to Report
i. Wisconsin law provides criminal and/or monetary penalties for intentional failure of a Mandated
Reporter to report suspected child abuse or neglect.
H. Documentation
i. Documentation in the medical record should address assessment, treatment, referral(s), and other
activity specific to this episode of care. The reporting party should document any report to a child
protection agency and law enforcement, and include specific contact information. This
documentation should be in the form of a progress note in the electronic medical record.
ii. History
a. The name and relationship of the individual suspected of causing the alleged abuse or
neglect or injury.
b. How the injury occurred.
c. The explanation of the cause of the injuries.
d. Any factual inconsistency between the explanation of how the injury(ies) occurred and the
placement and extent of the injuries.
iii. Physical
a. Be as complete and descriptive as possible. Utilize a body map and indicate location and
description of physical trauma. Measure and describe the injuries. Note the description of
any emotional or psychological trauma.
1. Example: A 3 cm swollen ecchymotic area on left cheek consistent with a wound
from a punch. X-Ray shows fracture of the nasal bone sustained from incident of
reported domestic abuse. Patient appears traumatized and fearful of continued
physical abuse.
b. Preserve physical evidence when applicable for possible referral to law enforcement
and/or legal proceedings.
iv. Accounting of disclosures. Reports of abuse to the appropriate authorities must be documented
using the “Quick Disclosure” in Health Link (Refer to UWHC policy #6.23, Accounting of Protected
Health Information Disclosures; UWMF policy, Accounting of Disclosure Policy and Guidelines).
v. Disclosure of information over the phone. If a telephone request for information is received, verify
the requestor’s identity by requiring the person to send the request on letterhead (fax, scanned,
mailed) from the investigating organization.
I. Coroner’s Report
i. Mandated Reporters who have reasonable cause to suspect that a child died as a result of child
abuse or neglect are required to report the fact to the appropriate medical examiner or coroner.
Refer to UWHC policy #4.20, Death Reports to the Coroner.

V. COORDINATION

Author: Manager, Social Work and Spiritual Care Services
Senior Management Sponsor: SVP/Chief Nurse Executive
Reviewers: UW Health Legal Department; Patient Resources; Child Protection Program; Director, Nursing
Quality and Safety
Approval committees: UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: May 15, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics



UW HEALTH CLINICAL POLICY 5
Policy Title: Suspected Child Abuse and Neglect
Policy Number: 1.2.4

and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Peter Newcomer, MD
UW Health Chief Clinical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VII. REFERENCES

State of Wisconsin, (2015). WI Legislative Documents: Chapter 48- Children’s Code, specifically 48.02,
48.981; Chapter 961- specifically 961.41(1)(e). Retrieved from: https://docs.legis.wisconsin.gov/statutes
UWHC policy #6.23, Accounting of Protected Health Information Disclosures
UWMF policy, Accounting of Disclosures Policy and Guidelines
UWHC policy #4.20, Death Reports to the Coroner
UW Nursing Practice Guideline, Child Maltreatment: care for the child and family
Patient Resources Social Work Services Quick Resource Guide
https://uconnect.wisc.edu/depts/uwmf/patient-resources/social-guide/
Wisconsin Department of Children and Families Reporting Child Abuse and Neglect County Listing
https://dcf.wisconsin.gov/reportabuse

VIII. REVIEW DETAILS

Version: Revision
Last Full Review: June 8, 2016
Next Revision Due: June 2019
Formerly Known as: MF Suspected Child Abuse and UWHC policy #4.52, Abuse, Neglect and Domestic
Violence