Recognizing, Reporting and Preventing Child Abuse

The medical definitions provided in this module were obtained or adapted from the Centers for Disease Control and Prevention, Developmental Science, Emergency Medicine Clinics of North America quarterly, the Mayo Clinic, Mosby's Medical Dictionary 8th edition, the National Institute on Alcohol Abuse and Alcoholism, Psychology Dictionary, Stanford University, the U.S. Department of Health and Human Services, and the U.S. National Library of Medicine.

• Adverse Childhood Experiences. A series of graphics from the CDC that portray how adverse childhood experiences (ACES) affect individual lives and society, with resources and references.
• Building Community, Building Hope 2016 Prevention Resource Guide, U.S. Department of Health and Human Services. Information, strategies, and resources to help communities support and strengthen families and promote the well-being of children and youth.
• Centers for Disease Control and Prevention. Sex Trafficking. Information on the risks, signs and consequences of sex trafficking, and a list of resources.
• The Child Abuse Prevention and Treatment Act (CAPTA). U.S. Department of Health and Human Services.
• Child Welfare Information Gateway. A federal clearinghouse of information promoting child and family well-being; public awareness and creative, supportive communities; prevention programs; and evidence-based practice.
• Children’s Advocacy Centers of Texas. A membership association representing all local children’s advocacy centers in the state.
• Children’s Safety Network. A National Resource Center for Injury and Violence Prevention that provides technical assistance on injury prevention planning, programs, and best practices; analyzes and interprets injury data; disseminates the latest injury prevention research; conducts trainings and presentations; and produces publications.
• Darkness to Light, a national nonprofit dedicated to ending child sexual abuse, offers “Stewards of Children,” a sexual abuse training program focused on increasing knowledge, improving attitudes, and changing child-protective behaviors. It addresses sexual abuse signs and situations in which abuse is most likely to occur, as well as prevention and protection strategies.
• Docs for Tots. Nonprofit, nonpartisan, advocacy organization to encourage doctors to fulfill their important role as active advocates for infants, toddlers, and preschoolers on the national, state, and local levels.
• Effective Discipline to Raise Healthy Children. This policy statement from the American Academy of Pediatrics (AAP) provides guidance for pediatricians and other child health-care providers on educating parents about positive and effective parenting strategies of discipline for children at each stage of development as well as references to educational materials.
• Essentials for Childhood: Steps to Create Safe, Stable, Nurturing Relationships and Environments. This document from the Centers for Disease Control and Prevention’s Division of Violence Prevention proposes strategies that communities, including professional groups, can consider to promote the types of relationships and environments that help children grow up to be healthy and productive citizens that can, in turn, build stronger and safer families and communities for their children.
• The Evaluation of Suspected Child Physical Abuse, AAP Committee on Child Abuse and Neglect. Outlines the role of the physician, which may include identifying and reporting child abuse, supporting families who are affected by child abuse, coordinating with other professionals to provide treatment to children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.
• Eco-Bio-Developmental Model of Human Health and Disease from the AAP. The Adverse Childhood Experiences (ACE) Study and others demonstrate strong associations between early childhood adversity, including abuse and neglect, and a wide array of sub-optimal adult outcomes in physical and mental health and prosperity. Early childhood has lifelong effects on development of adaptive behaviors, learning capacity, physical and mental health, and economic productivity. An integrated approach to health care is referred to as the “ecobiodevelopmental” framework. The AAP provides resources on applying this model to patient care.
• Literacy Promotion. Participation in Reach Out and Read is associated with improved parent-child interactions and many other benefits. The AAP recommends that pediatric providers promote early literacy development for children beginning in infancy and continuing at least until kindergarten. Recommendations include counseling parents about developmentally appropriate shared-reading activities, providing developmentally appropriate books at medical checkups for high-risk and low-income young children, and using a robust spectrum of options to support and promote these efforts. 
• Maltreatment of Children With Disabilities. An AAP policy statement about the need for early recognition and intervention of child abuse and neglect of children with disabilities, as well as the ways that a medical home can facilitate the prevention and early detection of child maltreatment.
• Maltreatment Risk in Communities. A series of maps from the University of Texas System intended to provide communities in Texas with information about their maltreatment risk and insight into factors associated with that risk.
• National Alliance of Children’s Trust and Prevention Funds. Free online training courses to support implementation of the Strengthening Families™ Protective Factors Framework in multiple settings.
• National Human Trafficking Hotline website. Resources and information about safety planning and other topics for victims and survivors of human trafficking.
• Preventing Child Maltreatment and Promoting Well-Being. This resource guide from the Parent Child Center of Tulsa focuses on the protective factors proven to reduce the risk of abuse and neglect, and provides tools and strategies to integrate the protective factors into existing programs and systems.
• The Resilience Project. A project of the AAP, providing information on creating a medical home, types of violence and their prevalence, clinical assessment tools, and other resources.
• Prevention is Possible. Part of a video gallery provided by the Centers for Disease Control and Prevention, this three-minute video shows Shairi Turner, MD, MPH, and former Deputy Secretary for Health, Florida Department of Health, discussing child abuse and neglect prevention. 
• Recognizing, Reporting, and Preventing Child Abuse and Neglect. A Texas Health Steps video overview of the extent of child neglect and abuse in Texas, signs and symptoms that can be identified during a primary care medical checkup, and the health-care provider’s role in prevention of abuse and neglect. Share this video with staff members who have contact with patients.  
• Tanner Staging for Adolescents. Sexual Maturity Rating. A World Health Organization tool to help providers place adolescents in the appropriate stage of sexual maturity.
• Technical Assistance Center on Positive Behavioral Interventions and Supports. Information from the U.S. Department of Education about positive school-based behavioral interventions and support for advocacy efforts.
• Texas A&M AgriLife Extension Child Care Courses. Free training for child-care providers and educators, with most courses developed in cooperation with the Texas Department of Family and Protective Services (DFPS). Topics include guidance and discipline; developmentally appropriate activities; safety in the child-care setting; and preventing, recognizing, and reporting child abuse and neglect, among others. (Some courses require a fee to obtain a certificate of completion.)
• Texas Department of Family and Protective Services. Child Protective Services web page provides a variety of services to strengthen families so children can stay safe at home with their parents.  Find a Regional Office near you.
• Texas Department of State Health Services. (2010). Child Abuse Screening, Documenting, and Reporting Policy For Contractors/Providers.
• Texas Family Code  “TITLE 5. The Parent-Child Relationship And The Suit Affecting The Parent-Child Relationship, Subtitle E. Protection Of The Child, Chapter 261, Investigation Of Report Of Child Abuse Or Neglect, Subchapter A. General Provisions.”
• Texas Health Steps Periodicity Schedule. Download copies in a large color format, pocket-size, or laminated.
• Texas Home Visiting (THV). This Texas Department of Family and Protective Services includes two primary components: 1) provision of evidence-based home visiting services for at-risk pregnant women and parents/caregivers of children birth to through age 6 years, and 2) development/enhancement of early childhood coalitions that coordinate services and address broad, community-level issues that impact young children and families. For direct service delivery, THV uses three evidence-based home visiting programs: Nurse-Family Partnership (NFP), Parents as Teachers (PAT), and Home Instruction for Parents of Preschool Youngsters (HIPPY). 
• Texas Medical Child Abuse Resources and Education System. Find a list of child abuse pediatricians (CAPs) and specialist contacts in Texas on this Texas Department of State Health Services web page.
• Texas Protect our Kids Commission report includes a summary of the national and state work currently underway; an inventory of evidenced-based and promising practices to reduce child abuse fatalities in Texas; specific recommendations about abuse and neglect prevention, data collection, the state and local child fatality review team processes; and sustainability of the work already begun in Texas. Appendix A, a comprehensive chart of prevention programs in Texas, may be of particular interest to health-care providers. 
• Triple P - Positive Parenting Program. Multi-level system of family intervention developed through more than 30 years of clinical research trials. It aims to prevent severe emotional and behavioral disturbances in children by promoting positive and nurturing relationships between parent and child. It also offers training for organizations and practitioners as well as self-help and parent resources.
• United Against Human Trafficking. This Houston-based nonprofit provides professional education and youth and direct outreach programs to combat human trafficking. Victims of human trafficking are subjected to force, fraud, or coercion for the purpose of sexual exploitation or forced labor.
• U.S. Department of Health and Human Services, Child Welfare Information Gateway. About CAPTA: A Legislative History. This fact sheet summarizes the legislative history and purpose of the Child Abuse Prevention and Treatment Act (CAPTA), the key federal legislation addressing child abuse and neglect.
• U.S. Department of Health and Human Services, Administration for Children and Families. The Office on Trafficking in Persons provides victim assistance and resources and training to combat human trafficking.
• U.S. Department of Justice, Office for Victims of Crime. Through Our Eyes: Children, Violence, and Trauma. This web page includes videos and other resources to help anyone who plays a role in identifying, protecting, and treating children exposed to violence.

Resources for Parents and Caregivers

(The following resources can be printed out for or emailed to parents).

• Child Welfare Information Gateway. “Find Help with a Personal Situation” includes a list of resources to help parents deal with child abuse, domestic violence, parenting, and more.
• Darkness to Light, a national nonprofit dedicated to ending child sexual abuse. It offers resources and “Five Steps to Protecting Our Children”—Learn the Facts, Minimize the Opportunity, Talk About It, Recognize the Signs, and React Responsibly. 
• Help for Parents, Hope for Kids. A website from the Texas Department of Family and Protective Services that offers local resources to help parents, caregivers, child-care providers, community members, companies, and organizations give children hope for a brighter future. 
• Little Texans, Big Futures. Learning guide for infants, toddlers, and 3-year-olds, created by the Texas Early Learning Council to help Texans understand what very young children should know and be able to do at different points in their development. Discusses “Responsive Caregiving,” a style of interaction between caregiver and child that builds a solid foundation for future relationships and learning. It can play an important role in the prevention of child abuse and neglect.
• Stop Abuse for Everyone (Safe). A national nonprofit alliance to stop child abuse and neglect through an array of programs including housing, counseling, education, and advocacy.
• Supplemental Nutrition Assistance Program (SNAP). U.S.  Department of Agriculture program that provides food-buying assistance to individuals and families in need.
• Take Time Texas. A Texas Health and Human Services Commission project offering resources to find short-term relief, or “respite” services, for families and primary caregivers to restore and strengthen their ability to continue providing care for a child. Such services contribute to ensuring the safety of children by giving caregivers the opportunity to rest, recharge, and come back refreshed.
• Texas Council on Family Violence. Works to end family violence through partnerships, advocacy, and direct services for women, children, and men, including support of domestic violence shelters, and intervention and prevention programs; domestic violence-related resources library; and public awareness efforts about domestic violence in Texas and beyond.
• Report Child Abuse, Neglect, or Exploitation. The Texas Department of Family and Protective Services (DFPS) provides a central place to report child abuse and neglect. A person who reports abuse in good faith is immune from civil or criminal liability and DFPS keeps the name of the person making the report confidential. Anyone who does not report suspected abuse can be held liable for a misdemeanor or felony.
• Texas Parent to Parent (TXP2P). A nonprofit parent-to-parent peer support model to improve the lives of Texas children who have disabilities, chronic illness, and/or special health-care needs. Includes resource referral and education.
• The Period of PURPLE Crying. An informative website sponsored by the National Center on Shaken Baby Syndrome. The letters stand for Peak crying, Unexpected, Resists soothing, Pain-like face, Long-lasting, and Evening—characteristics of infant crying from about 2 weeks through 4 months of age. The program helps parents understand this early period in their baby’s life and includes practical, research-based strategies to guide how to soothe their infants and to cope. 
• Texas Poison Center Network. A 24/7 toll-free poison information help line at 800-222-1222 for health-care providers and the public. If you think someone has been poisoned or exposed to toxins, call immediately. Do not wait for the victim to look or feel sick. Callers can access a network of nurses, pharmacists, paramedics, and physicians with extensive education, training, and expertise in toxicology. If necessary, the poison network staff may refer callers to the nearest hospital and may assist in the caller's initial treatment and follow-up care.
• Women, Infants, and Children (WIC), a nutrition program for pregnant women, breastfeeding women, and families with children 4 years of age or younger.
• 2-1-1 Texas. A website and phone number with information to help Texans find the services they need from more than 60,000 state and local programs, including information to help parents and caregivers find a parenting class, someone who knows about parenting to come to the home, short-term child care in an emergency, and services for a child with special health-care needs.