Actual and Suspected Child

Abuse Requirements
2024 Staff Training
 Report Abuse or Neglect

By Phone: 1-800-252-5400
Online: https://www.txabusehotline.org/Login/Default.aspx

Call the Abuse Hotline toll-free 24 hours a day, 7 days a week, nationwide, or
report with the secure website and get a response within 24 hours. Do NOT use this
website to report emergency situations. Call 911 or local law enforcement first, then file the
report.

Texas Department of Family and Protective Services will not accept fax or
email reports of suspected abuse or neglect.
YOU Are Responsible For Reporting Child Abuse
In Texas, anyone who
Nursing suspects that a child is being
abused or neglected has a
legal obligation to report it.
Counseling Clinical

All Waco Family Medicine

employees are required by
law to report suspicion of
abuse or neglect within 48
Lab Dental
hours.

Radiology
This can not be delegated to
others to complete
How does the Department of Family and Protective Services define ABUSE?

• is deliberate actions resulting in injuries to a child or genuine threats of such

Physical abuse actions, or concerns about physical injuries of an unexplained or suspicious
nature.

• Sexual indecency, sexual assault, or aggravated sexual assault.

Sexual abuse • Failing to make a reasonable effort to prevent sexual conduct to a child.
• Using the child for the creation of obscene or pornographic material.

• is an emotional or mental injury caused by the parent or caregiver that results in

Emotional abuse an observable effect on the child.

• Psychological state - Concerns about the child's mental stability, as demonstrated
by mood, behavior, and thoughts.

• Labor trafficking - parent or caregiver forcing a child into labor or services that

Trafficking are unhealthy or harmful to the child.

• Sex trafficking - parent or caregiver receiving compensation for forcing a child to
engage in prostitution or other sex acts.
How does the Department of Family and Protective Services define NEGLECT?

• means improper supervision of a child left alone which could have resulted in
Neglectful supervision substantial harm.

• is failure to seek, obtain or administer medical treatment that could result in

Medical neglect substantial harm.

• is the failure to provide a child with the necessary food, clothing, and shelter to
Physical neglect maintain a healthy life.

• are where the parent or caregiver left the child in a potentially harmful situation
Abandonment and refusal to and did not plan to return for the child.
accept parental responsibility • Refusal to accept parental responsibility - Child has been out of the home for any
reason, and parent/caregiver refuses to allow the child to return home.
 Suspect Abuse/Neglect when you see:
Physical Sexual Emotional Neglect
• Frequent injuries such as bruises, • Physical signs of sexually • Over compliance • Obvious malnourishment
cuts, black eyes, or burns without transmitted diseases • Low self-esteem • Lack of personal cleanliness
adequate explanations • Evidence of injury to the genital • Severe depression, anxiety, or • Torn or dirty clothing
• Frequent complaints of pain area aggression • Stealing or begging for food
without obvious injury • Pregnancy in a young girl • Difficulty making friends or doing • Child unattended for long periods
• Burns or bruises in unusual • Difficulty in sitting or walking things with other children of time
patterns that may indicate the use • Extreme fear of being alone with • Lagging in physical, emotional, and • Need for glasses, dental care, or
of an instrument or human bite; adults of a certain sex intellectual development other medical attention
cigarette burns on any part of the
• Sexual comments, behaviors or • Caregiver who belittles the child, • Frequent tardiness or absence
body
play withholds love, and seems from school
• Lack of reaction to pain unconcerned about the child’s
• Knowledge of sexual relations
• Aggressive, disruptive, and beyond what is expected for a problems
destructive behavior child’s age
• Passive, withdrawn, and • Sexual victimization of other
emotionless behavior children
• Fear of going home or seeing
parents
• Injuries that appear after a child
has not been seen for several days
• Unreasonable clothing that may
hide injuries to arms or legs
Waco Family Medicine Employees UNDERSTAND:
 All children need protection
 Child abuse reporting is the Law – failing to report in a timely fashion is a
criminal offense and puts WFM at a great risk.
 We must follow specific procedures for reporting suspected child abuse
 Not a HIPAA violation to report suspected child abuse.
 Immunity – a person who reports abuse in good faith is immune from civil or
criminal liability. The Texas Family Code also specifies that an employer may
not suspend or terminate the employment of, or otherwise discriminate
against, a person who is a professional and who makes a report about
suspected child abuse or neglect in good faith.
Three Required Documentation pieces
-even if a report to DFPS is not needed
1. Appropriate documentation in the patient’s chart using system
smartphrase
2. Place the Child Abuse Reporting Order in Epic
 Doing this will let EPIC know that you are aware and it will turn off the alerts
3. Fill out the Child Abuse Requirements Checklist
 Scan the completed form into the chart

Remember to DOCUMENT to provide evidence that you are aware

of the issue and it was reviewed and addressed.
 1. Documentation Template in EPIC
Child Abuse Reporting:

All patients under 17 years of age who are sexually active must be assessed for childhood sexual abuse per DFPS guidelines and the discussion documented in the
chart.
Is the patient under 17 years of age? {yes no:314532}

Does the patient have an Affirmative Defense?

This means TRUE answers to all of the following statements:
The partner is/was not more than 3 years older than the patient? {TRUE FALSE:629}
No duress or force was used? {TRUE FALSE:629}
Partner is of the opposite sex? {TRUE FALSE:629}

If any of the statements are FALSE, a report must be made to DFPS using the form available HERE and the "Child Abuse Reporting Completed" order must be placed.
If the patient has an affirmative defense, please complete the FORM and scan to this encounter.

Based upon the questions, does the patient have an "Affirmative Defense?" {yes no:314532}
Other details about case: ***
How was the case reported? {ABUSE REPORTING METHODS 14-17:632}

If you have any questions about this process it is important to involve your supervisor quickly as there is a 48 hour limit in which childhood sexual abuse must be
reported.
2. Other ORDER: Child Abuse
Reporting Order in Epic

Ordering this ‘other’ order is

the ONLY thing that will ‘turn
off’ the alert for child abuse,
indicating appropriate steps
have been completed.
3. Child Abuse
Requirement
Checklist
Required to complete:
• Patient Name
• Patient DOB
• Patient MR#
• Staff Member Name
_______________________________

Abuse Type

Correctly check the

appropriate boxes
_______________________________

MINOR –Under 14

Check the appropriate box for

evidence of Sexual Abuse.
Affirmative Defense
Check appropriate boxes for
each question.
If YES to any –MUST REPORT
If NO to ALL- NOT required to
report to DFPS

We do not expect clinicians to check

the sex offender registry every time.
_______________________________

Action Taken
• Do you have to REPORT?
• If so, by what means did
you report?
• If you report what is the
confirmation #
• Staff name and Date
 DO I NEED TO REPORT TO Department
of Family Protective Services?

Reporting Anonymously
Effective September 1, 2023, DFPS cannot accept anonymous reports of abuse and neglect involving children
and their families. Reporters must provide a first and last name and home or business phone number to
meet new reporting requirements. Anonymous reports of child abuse and neglect may be made to local and
state law enforcement agencies instead. Reporters’ names are confidential by law.
When should I REPORT child sex abuse to the Department of
Family Protective Services - DFPS?

- Any child that is sexually active and is under the age of 14. Under Texas law,
minors less than 14 years of age CANNOT consent to sexual activity, Texas law considers this Sexual Assault

- Any sexual activity of unmarried patients from 14 to 16 years old IF:

- The partner is MORE than 3 years older. Ex: Pregnant patient is 15 and partner is 19
- The partner is of the same sex. Ex. 14 year old female is positive for STD and partner is a female
- Duress or force WAS used. Ex: patient did NOT consent to the sexual activity

- Known cases where the partner is a registered sex offender MUST be reported
AFFIRMATIVE DEFENSE
An Affirmative Defense is the proof established when we are not required
to report.

Any time an “Affirmative Defense” is established we do NOT have to report

to DFPS

How to establish a defense:

• Is the partner more than 3 years older than the patient?
• Was force or duress used?
• Is the partner of the same sex as the patient?

The answer to All Three questions must be NO in order to establish a defense

for the patient and NOT Report to DFPS.
 When should I consider reporting?
A minor (16 years of age or younger)
asks for a pregnancy test
and/or
ask for contraception
and/or
requests testing for STD

Using the Child Abuse template to address the above topics is

ideal as well as using the Child Abuse Requirements Checklist.
A child may not be sexually active in the above situations but
the documentation demonstrates that the clinician
considered the possibility and ruled it out.
 New and Different Event
A new Child Abuse Documentation, Order, and Child Abuse Requirement
checklist must always be completed, and if appropriate, a new report to
DFPS.
- new STD
- new pregnancy
- new sexual partner,

Example: An established 16 year old pregnant patient comes in for 8 month

labs and is positive for a STD.
 A Child Abuse Requirement Checklist was completed and documented appropriately
during the Welcome OB.
 A NEW Child Abuse Requirement Checklist must be completed for this new event
(STD) at the 8 month visit.
 Abuse Diagnosis in the Problem List

If a patient has an Abuse diagnosis in their problem list, Epic will

notify staff every 9 months to address the Abuse diagnosis, until
the patient turns 18 years old.
The same 3 requirements MUST be addressed every time EPIC
notifies you.
• Document in the chart
• Place Child Abuse Reporting order in Epic – this is the only element that
will “turn off” the abuse notification.
• Determine if a REPORT is required

If a parent/guardian tells you there is already a case open, you MUST confirm
with a case number. If this can not be obtained, you MUST REPORT.
Summary of Online Reporting

People What Safety Report

Involved Happened Concerns Summary
Report child abuse or neglect in two ways:
Telephone Internet
You may call the Texas Abuse Hotline at You may report your allegations to the Texas
1-800-252-5400 to report abuse or neglect. Abuse Hotline through the Internet at
The hotline is answered by DFPS Intake http://www.txabusehotline.org. This secure
Specialists (who are all degreed website provides a way to explain your
professionals) 24 hours a day, 365 days a concerns in writing.
year.
You must provide your name and a valid e-
You will be asked to provide your name and mail address. Your identity remains
contact information. confidential and will not be provided directly
to the accused person by any DFPS
You will be asked to explain your concerns. employee.
The Intake Specialist might ask additional
questions to determine if the situation that Once an Intake Specialist processes your
you describe meets the Texas Family Code's report, you will receive a confirmation e-mail
definitions of abuse or neglect. with a Call Identification Number. The e-mail
will also tell you whether or not your report
was forwarded to a local DFPS office for
further investigation.
Required Test for completion