CE/CME

Recognizing, Reporting and Preventing Child Abuse

Welcome to the training on Recognizing, Reporting and Preventing Child Abuse provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).

Credit Hours: 1.25 CE

Enroll

Goal

The goal of this module is to equip Texas Health Steps providers and other health care professionals who care for pediatric and adolescent patients to recognize, report and prevent child abuse and neglect.

Target Audience

Texas Health Steps providers and other interested health care professionals.

Specific Learning Objectives

After completing the activities of this module, you will be able to:

  1. Distinguish the risk factors, symptoms and consequences of physical, emotional and sexual child abuse and neglect.
  2. Apply ethical principles and legal requirements related to reporting suspected abuse or neglect. 
  3. Integrate routine screening and guidance practices that promote protective factors and reduce the likelihood of child abuse and neglect.

External links in this course are current as of 6/2022. These links may be bookmarked for future reference.

All data presented in the module reflect the most recent year for available data.

Note: The term “parent” in this module also includes guardians and other caregivers.

Please note this module expires on 7/20/2025.

This module was released on 7/20/2022.

Featured

American Academy of Pediatrics, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, & American Academy of Ophthalmology. (2018). Clinical Report: The Eye Examination in the Evaluation of Child Abuse. Pediatrics, 142(2): e20181411.

American Academy of Pediatrics. (2016). Textbook of Pediatric Care, 2nd Edition. Chapter 42, Safety and Injury Prevention & Chapter 44, Violence Prevention.

American Academy of Pediatrics, healthychildren.org. (2016). Childhood Exposure to Violence.

American Academy of Pediatrics. (2015). Clinical Report: The Evaluation of Suspected Child Physical Abuse. Pediatrics, 135(5), 0031-4005.

American Academy of Pediatrics. (2014). Policy Statement: Child Abuse, Confidentiality, and the Health Insurance Portability and Accountability Act. Pediatrics, 125(1), 197-201.

American Academy of Pediatrics. (2013). Clinical Report—The Evaluation of Sexual Behaviors in Children. Pediatrics, 124(3), 992-998.

American Academy of Pediatrics. (2008). Policy Statement: The Medical Home. Pediatrics, 110(1):184–186.

American Academy of Pediatrics. (n.d.). Medical Home for Children Exposed to Violence.

Azizi, M., & Shahhosseini, Z. (2017). Challenges of reporting child abuse by healthcare professionals: A narrative review. Journal of Nursing and Midwifery Sciences, 4(3):110-6.

Centers for Disease Control and Prevention. (2022). Fast Facts: Child Abuse & Neglect.

Centers for Disease Control and Prevention. (2022). Child Abuse & Neglect: Risk and Protective Factors.

Centers for Disease Control and Prevention. (2020). Trends in U.S. Emergency Department Visits Related to Suspected or Confirmed Child Abuse and Neglect Among Children and Adolescents Aged <18 Years Before and During the COVID-19 Pandemic — United States, January 2019–September 2020. Morbidity and Mortality Weekly Report (MMWR);69:1841–1847.

Centers for Disease Control and Prevention (2020). Preventing Child Abuse and Neglect.

Centers for Disease Control and Prevention. (2016). Fatal Abusive Head Trauma Among Children Aged <5 Years — United States, 1999–2014. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR), 65(20): 505–509.

Centers for Disease Control and Prevention. (n.d.). We Can Prevent Childhood Adversity: Understanding ACES. (Graphics).

Centers for Disease Control and Prevention. (n.d.). Preventing Child Maltreatment Through Promotion of Safe, Stable, and Nurturing Relationships Between Children and Caregivers.

Chung, E., Gubernick, R., LaNoue, M., & Abatemarco, D. J. (2019). Child Abuse and Neglect Risk Assessment: Quality Improvement in a Primary Care Setting. Academic Pediatrics, 19(2):227-235. (Abstract).

Collings, A., Farazi, M., Van Arendonk, K., Fallat, M. E., Minneci, P. C., Sato, T. T., . . . Flynn-O’Brien, K. T. (2022). Impact of “Stay-at-Home” orders on non-accidental trauma: A multi-institutional study. Journal of Pediatric Surgery.

Dubowitz, H., Feigelman, S., Lane, W., & Kim, J. (2009). Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model. Pediatrics, 123(3) 858-864.

Feldman, K., Tayama, T., Strickler, L., Johnson, L. A., Kolhatkar, G., DeRidder, C. A., . . . Taylor, J. A. (2020). A Prospective Study of the Causes of Bruises in Premobile Infants. Pediatric Emergency Care, 36(2):e43-e49. (Abstract)

Flaherty, E. G. (2019). Guide to Comprehensive Care of the Child Who Has Been Maltreated. AAP News.

Hillis, S., Mercy, J., Amobi, A., & Kress, H. (2016). Global Prevalence of Past-year Violence Against Children: A Systematic Review and Minimum Estimates. Pediatrics, 137(3).

Hoehn, E., Wilson, P., Riney, L. C., Ngo, V., Bennett, B., & Duma, E. (2018). Identification and Evaluation of Physical Abuse in Children. Pediatric Annals, online.

Horner, G. (2013). Child maltreatment: screening and anticipatory guidance. Journal of Pediatric Health Care, 27(4):242-50. (Abstract)

İnanici, S., Çelik, E., Hıdıroğlu, S., Özdemir, M., & İnanıcı, M. A. (2020). Factors Associated with Physicians’ Assessment and Management of Child Abuse and Neglect: A mixed-method study. Journal of Forensic and Legal Medicine, 73, 101972. (Abstract)

Jenny, C., & Crawford-Jakubiak, J. E. (2013). Clinical Report: The Evaluation of Children in the Primary Care Setting When Sexual Abuse is Suspected. Pediatrics, 132(2), e558–e567.

Jones, R., Flaherty, E. G., Binns, H. J., Price, L. L., Slora, E., Abney, D., . . . Sege, R. D. (2008). Clinicians’ Description of Factors Influencing Their Reporting of Suspected Child Abuse: Report of the Child Abuse Reporting Experience Study Research Group. Pediatrics, 122(2), 259-266. (Abstract)

Kairys, S. (2020). Child Abuse and Neglect: The Role of the Primary Care Pediatrician. Pediatric Clinics of North America, 67(2):325-339. (Abstract)

Lane, W. G. (2014). Prevention of Child Maltreatment. Pediatrics Clinics of North America, 61(5): 873-888. (Abstract)

Letson, M., Cooper, J., Deans, K. J., Scribano, P. V., Makoroff, K. L., Feldman, K. W., & Rachel P. Berger.(2016). Prior Opportunities to Identify Abuse in Children with Head Trauma. Child Abuse & Neglect, 60: 36-45. (Abstract)

Lindberg, D. M., Beaty, B., Juarez-Colunga, E., Wood, J. N., & Runyan, D. K. (2015). Testing for Abuse in Children With Sentinel Injuries. Pediatrics, 136(5), 0031-4005.

Loades, M., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., . . . Crawley, E. (2020). Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. Journal of the American Academy of Child and Adolescent Psychiatry, 59(11), 1218–1239.e3.

Ness, C. D. (2009). The Adverse Childhood Experiences (ACE) Study. Schuyler Center for Analysis and Advocacy, Research Briefing.

Notrica, D., Kirsch, L., Misra, S., Kelly, C., Greenberg, J., Bryce Ortiz, J., . . . Sayrs, L. W. (2021). Evaluating abusive head trauma in children < 5 years old: Risk factors and the importance of the social history. Journal of Pediatric Surgery, 56: 390-396.

Oregon Children’s Justice Act Taskforce, Oregon Department of Justice, Child Abuse Multidisciplinary Intervention (CAMI) Program, & Oregon Network of Child Abuse Intervention. (2017). Project Ability: A Reference Guide for Interviewing Children with Disabilities.

Orue, I., Bushman, B., Calvete, E., Thomaes, S., de Castro, B. O., & Hutteman, R. (2011). Monkey See, Monkey Do, Monkey Hurt: Longitudinal Effects of Exposure to Violence on Children’s Aggressive Behavior. Social Psychological and Personality Science, 2(4), 432–437. (Abstract)

Paine, C. W., & Wood, J. (2017). Skeletal Surveys in Young, Injured Children: A Systematic Review. Child Abuse and Negligence, 76: 237-249.

Paine, C. W., Oludolapo, F., Christian, C., Wood, J. (2019). Prevalence of Abuse Among Young Children With Rib Fractures: A Systematic Review. Pediatric Emergency Care, 35(2); 96-103.

Peterson, C., Florence, C., & Klevens, J. (2018). The Economic Burden of Child Maltreatment in the United States, 2015. Child Abuse & Neglect, 86:178-183.

Pereda, N., & Diaz-Faes, D. (2020). Family Violence Against Children in the Wake of COVID-19 Pandemic: A review of current perspectives and risk factors. Child and Adolescent Psychiatry and Mental Health, 14, 40.

Pierce, M. C., Kaczor, K., Lorenz, Bertocci, G., Fingarson, A. K., Makoroff, K., . . . Leventhal, J. M. (2021). Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Network Open, 4(4):e215832

Seay, D. M., Jahromi, L. B., Umaña-Taylor, A. J., & Updegraff, K. A. (2016). Intergenerational Transmission of Maladaptive Parenting Strategies in Families of Adolescent Mothers: Effects from Grandmothers to Young Children. Journal of Abnormal Child Psychology, 44(6), 1097-1109.

Sege, R. D; Amaya-Jackson L., American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, & National Center for Child Traumatic Stress. (2017). Clinical Report: Clinical Considerations Related to the Behavioral Manifestations of Child Maltreatment. Pediatrics, 139(4): e20170100.

Texas Department of Family and Protective Services. (n.d.). Texas Home Visiting.

Texas Department of Family and Protective Services. (n.d.). Recognize the Signs of Child Abuse.

Texas Department of Family and Protective Services. (n.d.). Reporting Abuse, Neglect, or Exploitation.

Texas State Legislature. 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.

Texas State Legislature. Texas Penal Code § 21.11. Title 5. Offenses against the person, Chapter 21. Sexual offenses.

The Commonwealth Fund. (2021). While Sick Visits to Pediatric Practices Decline, Mental Health Visits Rise.

U.S. Department of Health and Human Services, Children's Bureau. (2019). The Child Abuse Prevention and Treatment Act (CAPTA).

U.S. Department of Health and Human Services, Child Welfare Information Gateway. (2019). Fact Sheet: Long-Term Consequences of Child Abuse and Neglect.

U.S. Department of Health and Human Services, Child Welfare Information Gateway. (2013). What Is Child Abuse and Neglect? Recognizing the Signs and Symptoms. (Spanish version)

U.S. Department of Health and Human Services, Child Welfare Information Gateway. (2019). Strong & Thriving Families: 2019 Prevention Resource Guide.

U.S. Department of Health and Human Services, Child Welfare Information Gateway. (2018). The Risk and Prevention of Maltreatment of Children with Disabilities.

U.S. Department of Health and Human Services, Child Welfare Information Gateway. (n.d.). Protective Factors to Promote Well-Being and Prevent Child Abuse & Neglect.

U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention & Centers for Disease Control and Prevention. (2009). Children's Exposure to Violence: A Comprehensive National Survey. Juvenile Justice Bulletin.

Vachon, D. D., Krueger, R. F., Rogosch, F. A., & Cicchetti, D. (2015). Assessment of the Harmful Psychiatric and Behavioral Effects of Different Forms of Child Maltreatment. JAMA Psychiatry, 72(11):1135-1142.

Van Horne, B. S., Caughy, M. O., Canfield, M., Case, A. P., Greeley, C. S., Morgan, R., & Mitchell, L. E. (2018). First-time maltreatment in children ages 2-10 with and without specific birth defects: A population-based study. Child Abuse & Neglect, 84:53-63.

Van Horne, B. S., Moffitt, K. B., Canfield, M. A., Case, A. P., Greeley, C. S., Morgan, R., & Mitchel, L. E. (2015). Maltreatment of Children Under Age 2 With Specific Birth Defects: A Population-Based Study. Pediatrics, 136(6):e1504-12. (Abstract)

World Health Organization. (2021). Social Determinants of Health.

Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis, 8th Edition. (Fee)

Medical Definitions

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

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.

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.

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.

Texas Council on Family Violence. Works to end family violence through partnerships; advocacy; and direct services for women, children and men. Offers support of domestic violence shelters; child abuse intervention and prevention programs; domestic violence-related resources library; and public awareness efforts about domestic violence in Texas and beyond.

Texas Department of Family and Protective Services. Help for Parents, Hope for Kids offers local resources to help parents, caregivers, child-care providers, community members, companies and organizations give children hope for a brighter future.

Texas Health and Human Services Commission. Supplemental Nutrition Assistance Program (SNAP) provides food assistance for eligible families.

Texas Health and Human Services Commission, Take Time Texas. A 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 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.

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.

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.

The SAFE Alliance. An Austin nonprofit alliance that works 24/7 to stop child abuse and neglect through an array of programs including housing, counseling, education and advocacy.

U.S. Department of Health and Human Services, 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.

Women, Infants, and Children (WIC), a nutrition program for pregnant women, breastfeeding women and families with children 4 years of age or younger.

Medical Definitions

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, Mayo Clinic, Mosby's Medical Dictionary 8th edition, National Institute on Alcohol Abuse and Alcoholism, Psychology Dictionary, Stanford University, U.S. Department of Health and Human Services and U.S. National Library of Medicine.

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians. 

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of Nursing Continuing Professional Development by the American Nurses Credentialing Center’s Commission on Accreditation.

Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hours of Nursing Continuing Professional Development.

Licensed Professional Counselors

Up to 1.25 LPC hours may be earned at this event.

Licensed Psychologists

The Texas Department of State Health Services, Continuing Education Service is approved as a provider of professional development hours for licensed psychologists, per the Texas Administrative Code Rule §463.35 (f)(1). The Texas Department of State Health Services, Continuing Education Service has awarded  1.25 professional development hours.

Social Workers

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.

Certified Community Health Worker

The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.25 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

  1. Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
    • Create a Texas Health Steps account.
    • Complete on-line registration process.
    • Thoroughly read the content of the module.
    • Complete the on-line examination.
    • Complete the evaluation.
  2. Commercial Support.
    The THSTEPS Web-based Continuing Education Series has received no commercial support.
  3. Disclosure of Relevant Financial Relationships.
    The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
  4. Non-Endorsement Statement.
    Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
  5. Off-Label Use.
    Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.

Health-Care Providers

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.

American Academy of Pediatrics, healthychildren.org. (2021). Childhood Exposure to Violence.

American Academy of Pediatrics. (2018). Policy Statement: Effective Discipline to Raise Healthy Children. Provides guidance to pediatricians and other primary health-care providers for educating parents about positive and effective parenting strategies for child discipline at each stage of development as well as references to educational materials.

American Academy of Pediatrics. (2016). Policy Statement: Maltreatment of Children With Disabilities, focuses on 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 help prevent child maltreatment with early detection.

American Academy of Pediatrics. (2015). Clinical Report: The Evaluation of Suspected Child Physical Abuse. Outlines the role of the physician, which may include identifying and reporting child abuse, supporting families 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.

Center for the Study of Social Policy, Strengthening Families. About Strengthening Families and the Protective Factors Framework. Explains the five key protective factors that together create the framework.

Centers for Disease Control and Prevention. Preventing Abusive Head Trauma. Definitions, consequences, awareness and prevention tips.

Centers for Disease Control and Prevention. Sex Trafficking. Information on the risks, signs and consequences of sex trafficking, and a list of resources.  https://www.cdc.gov/violenceprevention/sexualviolence/trafficking.html functional 4/16/22

Centers for Disease Control and Prevention (2021). Social Determinants of Health: Know What Affects Health. Research, tools and resources related to people’s living, working, social and health conditions.

Social Determinants of Health (SDOH) Screening Tools:

  • Kaiser Permanente, Your Current Life Situation Survey
  • National Association of Community Health Centers, Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) 

Child Abuse Prevention and Treatment Act (CAPTA). U.S. Department of Health and Human Services.

Child and Family Research Partnership, The University of Texas at Austin. (2019). The Evidence Base: Child Maltreatment Risk Factors.

Child Protector mobile app, developed by the University of Texas Health Science Center in San Antonio and Children’s Mercy Hospital in Kansas City. Designed to help Child Protective Services, law enforcement and medical personnel when evaluating possible physical abuse.

Children’s Advocacy Centers of Texas. A membership association representing the 70 local children’s advocacy centers in Texas and offering statistics about child abuse cases.

Children’s Safety Network. A national resource center for injury and violence prevention that provides technical assistance for 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 that encourages doctors to fulfill their important role as active advocates for infants, toddlers and preschoolers on the national, state and local levels.

Essentials for Childhood: Steps to Create Safe, Stable, Nurturing Relationships and Environments, 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 who can, in turn, build stronger and safer families and communities for their children.

Literacy Promotion. Participation in Reach Out and Read nonprofit program that champions the positive effect of daily reading to children 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 young children from families with low income and using a robust spectrum of options to support and promote these efforts.

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 Center on Shaken Baby Syndrome. Facts and information as well as research about children who suffer from shaken baby syndrome.

National Human Trafficking Hotline. 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. It also provides tools and strategies to integrate the protective factors into existing programs and systems.

Prevention is Possible. This 3-minute video, part of a video gallery provided by the Centers for Disease Control and Prevention, shows Shairi Turner, MD and former Florida Deputy Secretary for Health discussing child abuse and neglect prevention.

Recognizing, Reporting, and Preventing Child Abuse and Neglect. A Texas Health Steps video about the extent of child neglect and abuse in Texas, signs and symptoms that can be identified during a preventive 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 Abuse Hotline, including online reporting. A secure website for the reporting of suspicions of child maltreatment – abuse, neglect or exploitation of children – in situations that are not urgent or emergency situations.

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.

Texas Department of Family and Protective Services. Recognize the Signs of Child Abuse. What to look for to detect possible physical, sexual or emotional abuse, and neglect.

Texas Department of Family and Protective Services. Child Maltreatment Fatalities and Near Fatalities Annual Report, Fiscal Year 2020.

Texas Family Code in its entirety. Includes Title 2, Child in Relation to the Family; Title 3, Juvenile Justice Code; Title 4, Protective Orders and Family Violence; Title 5, The Parent-Child Relationship and the Suit Affecting the Parent-Child Relationship; Subtitle E., Protection of the Child. See Page 1247 for “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 Department of Family and Protective Services. DFPS Data Card, Fiscal Year 2021.

Texas Health Steps Periodicity Schedule. Download copies in a large color format, pocket-size or laminated.

Texas Health Steps Anticipatory Guidance Provider Guide. Age-appropriate guidance on children from birth through age 20.

Texas Home Visiting. This Texas Department of Family and Protective Services includes two primary components: 1) provision of evidence-based home visiting services for pregnant women and parents or caregivers of children ages birth through 6 years, and 2) development and enhancement of early childhood coalitions that coordinate services and address broad, community-level issues that impact young children and families. For direct service delivery, Texas Home Visiting uses three evidence-based home visiting programs: Nurse-Family Partnership, Parents as Teachers, and Home Instruction for Parents of Preschool Youngsters.

Texas Department of State Health Services. Medical Child Abuse Resources and Education System Biennial Report 2019-2020, includes a list of child abuse pediatricians and specialist/subspecialist contacts in Texas.

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 as well as youth and direct outreach programs to combat human trafficking.

U.S. Department of Health and Human Services. (2021). Tools to Help Healthcare Organizations Address SDOH.

U.S. Department of Health and Human Services. 2020 Child Maltreatment Report.

U.S. Department of Health and Human Services, Child Welfare Information Gateway. (2019). Strong & Thriving Families: 2019 Prevention Resource Guide.

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.

U.S. Department of Health and Human Services, Child Welfare Information Gateway, What is Child Abuse and Neglect? Recognizing the Signs and Symptoms. Includes information on federal law, when to report, and resources.

U.S. Department of Health and Human Services, Child Welfare Information Gateway: Cultural Responsiveness, Abuse and Neglect web page.

U.S. Department of Health and Human Services, Child Welfare Information Gateway. The Risk and Prevention of Maltreatment of Children with Disabilities.

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. 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.