§2 ch4: Investigation Response
4.1.3 Face to Face Safety Assurance of Victim
The Children's Service Worker shall contact family and subject child personally, according to Response Priority Level required timeframes. The Children's Service Worker must show a photo ID card when interviewing clients he/she has never met. When a worker is responding to or investigating a child abuse or neglect (CA/N) report, staff is prohibited from calling prior to a home visit or leaving a business card or other documentation when an attempt to make contact is unsuccessful, under the following circumstances:
- The alleged perpetrator resides in the home or the child's safety may be compromised if the alleged perpetrator becomes aware of the attempted visit; or
- The alleged perpetrator will be alerted regarding the attempted visit; or
- The family has a history of domestic violence or fleeing the community.
Workers are to use the above criteria for consideration when determining if alerting the alleged perpetrator would compromise the safety of the child, as well as considering their own safety in planning for home visits.
Alleged Victim Children
For Investigations as well as Family Assessments, every child identified as an alleged victim on the CA/N-1 must be seen face to face within the following Response Priority Level timeframes:
- Priority Level 1 = three (3) hours
- Priority Level 2 = twenty-four (24) hours
- Priority Level 3 = seventy-two (72) hours
Direct face to face contact should be made by the Children's Service Worker whenever possible. However, twenty-four (24) hour face to face contact may be made by a multidisciplinary team member, granted the child's safety can be assured with such contact.
When an alleged victim child's initial safety is assured by a multidisciplinary team member, staff must complete direct face to face contact with the child within seventy-two (72) hours from the date and time of the reported concern in order to obtain information for use in the analysis of caretaker protective capacities, child-specific vulnerabilities, present or impending danger and the application of safety threshold criteria in order to determine if the child is safe or unsafe in addition to completing a cursory investigative interview.
When children's safety is initially assured for every child involved in the CA/N Investigation or Family Assessment, staff must clearly document:
- The actions taken to assure child(ren)'s safety
- The knowledge or information obtained to assure child(ren)'s safety (whether by direct face to face contact or through the assistance of a multidisciplinary team member and specify how children's safety was assured)
- The initial contact which reflects whether initial safety was assured by a Children's Service Worker or a multidisciplinary team member
In investigation reports, it is critical to document physical evidence. In cases of alleged physical or sexual abuse, it is often difficult to determine severity until the child is actually seen by a professional. Analysis of the child(ren)'s safety must be documented in FACES, including the Safety Assessment (CD-17) and if required the Safety Plan (CD-18).
If initial children's safety cannot be assured by a multidisciplinary team member, direct face to face contact with all alleged victim and other household children must be made by the Children's Service Worker.
Other Household Children
Every child residing in the household must be seen face to face by the Children's Service Worker within seventy-two (72) hours of the CA/N report. When other household children's initial safety is assured by a multidisciplinary team member, staff must complete direct face to face contact with the child within seventy-two (72) hours from the date and time of the reported concern, and document their assurance of initial safety as outlined above.
Children Residing Outside of the Home
Staff shall assure the safety of any child located out of county or state, including face to face contact, by contacting the appropriate county's or state's Children's Division (or Child Protective Service agency) staff and requesting a courtesy interview (or transfer to other Missouri county as appropriate) within required timeframes. Additionally, any county assuring safety must complete a Safety Assessment (CD-17) and, when necessary, a legible, signed Safety Plan (CD-18), which must be sent to the requesting county within specified timeframes.
Response Priority Level 1: Three (3) Hour (Emergency) Face to Face Contact
CA/N Investigations determined to require an emergency response (Response Priority Level 1) require an immediate response (within three (3) hours). Safety may be assured through observation of the alleged victim(s) by a multidisciplinary team member, just as it would for twenty-four (24)-hour safety assurance, however, the Children's Service Worker should make every effort to have direct observation whenever possible. If immediate safety cannot be determined by a multidisciplinary team member, then direct observation by the Children's Service Worker with the alleged victim(s) must occur within Response Priority Level timeframes. All household children must be seen by the Children's Division within seventy-two (72) hours on all reports.
For Response Priority Level three (3) reports, see the subject child, and all other household children, within seventy-two (72) hours.
220.127.116.11 Investigations Involving Reported Physical Injuries and/or Sexual Abuse
All reports indicating physical injuries due to CA/N require an examination of the reported child. Other children should be examined when there are visible signs of abuse or additional information indicates that abuse has occurred. If severe allegations are indicated, the Children's Division (CD) should encourage and support further medical testing and examinations, if necessary.
Refusal on the part of a parent/caretaker to allow an examination, depending upon the seriousness of the situation, should be referred to the juvenile court or law enforcement personnel.
Physical Abuse Examinations
In determining how to conduct an examination, the worker should inform the parent/caretaker of the following options available for obtaining the needed examination for the child:
- The parent/caretaker can take the child to a physician or hospital emergency room for a physical examination;
- If the child is Medicaid eligible the worker may:
- Request the parent take the child to a Medicaid physician, preferably a SAFE/CARE provider (Refer to listing at the end of Section 2, Chapter 4, Attachment A). This examination should be a comprehensive medical examination.
- Request a physician's statement as to whether or not the injuries were due to CA/N.
- If the provider is in the SAFE-CARE Network, obtain a copy of the SAFE-CARE medical form.
- The worker may work with the family to access other options available to assure a child receives an adequate physical examination of reported CA/N injuries by qualified medical personnel;
- If the child is at school, and the parent/caretaker cannot be reached and local procedures have been developed with individual school districts to allow examination by the school nurse, the worker should request that the school nurse examine the child.
Cursory Physical Examinations
A cursory physical examination is the observation of a child's external, physical condition which may require that the child's clothing be removed or rearranged.
- The worker and parent/caretaker may conduct a cursory physical examination of a child under five (5) years-old.
- A worker of the opposite gender to a child, five (5) years-old or older shall not observe or otherwise examine the child's genitalia.
- A worker of the same gender may observe the child's genitalia, if the child and parent/caretaker request the exam and another adult is present during the examination.
Genitalia includes: female breasts, vulva, penis, and testes
Sexual Abuse Examinations
- Physical examinations of children alleged to be sexually abused must be conducted by a physician or other personnel, not the worker;
- Staff are encouraged to utilize SAFE-CARE (Sexual Assault Forensic Examination - Child Abuse Resource and Education) network providers for these examinations. Each county office should maintain a list of current providers;
- HIV screening (ELISA Test) should be included as a part of the medical exam, if the worker has reason to believe that the child, parent(s), or perpetrator is HIV positive or at risk for AIDS; or
- The parent/caretaker can take the child to a physician or hospital emergency room for sexual abuse examination.
18.104.22.168 Investigations Involving Children Under the Age of Four
Pursuant to Section 210.146, RSMo., all investigations involving children under the age of four must include either an examination of the child or a review of the child’s case file and any photographs by a SAFE-CARE provider.
Children’s Service staff should complete the SAFE-CARE Provider Evaluation Referral form (CD-231) and e-mail it, along with any relevant medical records and photographs to:
Once received, the designated Child Abuse Resource Center will ensure the referral is evaluated within twenty-four (24) hours and will return the completed and signed form to the Children’s Division further advising as to whether (1) a direct examination of the child by a SAFE-CARE provider is needed; (2) a direct examination of the child by a board certified child abuse pediatrician is needed due to complex needs of the child; (3) a review of the case file and photographs by a SAFE-CARE provider is needed, or (4) if further evaluation is not necessary. Staff should then follow their local protocols for referral to a SAFE-CARE provider when option 1 or option 3 is recommended. If the local SAFE-CARE provider is unable to complete a case review or medical evaluation, staff should utilize one of the three Child Abuse Resource Centers. When a direct examination is recommended and the local SAFE-CARE provider is unable to examine the child and transportation cannot be arranged to one of the three Child Abuse Resource Centers, staff should ensure the child is seen by a local medical provider and follow up with a case review by a SAFE-CARE provider.
To ensure this process is not only completed timely, but in a manner that allows the best chance of a proper evaluation and follow up response, Children’s Division staff should complete and submit the CD-231 as soon as possible after the child has been seen by either the Children’s Division investigator or other member of the multidisciplinary team and sufficient preliminary information has been gathered for the Children’s Division investigator to complete the CD-231. If the child has already been seen by, or it is known the child will be referred to a local SAFE-CARE provider, the investigator does not need to complete the CD-231 and should follow local referral protocols. Nothing in this protocol should preclude the Children’s Division from facilitating timely medical attention care for a child in need.
In accordance with best practices, investigators should make every effort to facilitate the occurrence of medical exams or case file reviews in a manner that not only ensures a thorough and timely investigation, but minimizes the need for multiple examinations, unnecessary delays, or undue hardship on families whenever possible. If it is determined that the child’s needs can be met by a case file review and the child has not or will not, be examined by a SAFE-CARE provider, the Children’s Division worker will need to facilitate obtaining the necessary medical records to provide to the local SAFE-CARE provider.
22.214.171.124 Investigations Involving Child Fatality or Serious Physical Injury
CA/N Investigations which involve a child fatality or serious physical injury to a child constitute the potential for serious concerns related to parent/caretaker protective capacities, child specific vulnerabilities, present or impending danger and safety threshold criteria for all household children. Therefore, all household children involved in such cases must be seen face to face by the Children's Service Worker or multidisciplinary team member within three (3) hours from the date and time of the report. When other household children's initial safety is assured by a multidisciplinary team member, staff must complete direct face to face contact with the child within seventy-two (72) hours from the date and time of the report. Staff should clearly document the assurance of initial safety and any ongoing safety assurances as outlined above.
Chapter Memoranda History: (prior to 1/31/07)