DFCS Online Policies & Procedures

  DFCS Online Policies & Procedures

   <<< Return to OPP Table of Contents
Handbook 3: Assessment Guides
3-4  Allegation Guide IV:  Health/Medical Maltreatment or Harm; Potential Maltreatment or Harm; and Child Coercion or Duress
Assessment Guides
3-4   Allegation Guide IV: Health/Medical Maltreatment or Harm; Potential Maltreatment of Harm; and Child Coercion or Duress
Reference Points
Malnutrition
Failure to Thrive (Non-organic)
Medical Neglect
Deadly Weapon
Violated Access Order
Family Violence Threatens Child
Parent/Guardian Afraid of Harming Child
Death of Another Child Due to Abuse/Neglect
Compelling Inappropriate Acts (non-sexual)


Reference Points
Effective Date: 03/01/06
Last Updated: 12/30/05


Health/Medical Maltreatment:  Malnutrition  

Malnutrition

  • Description
    Inadequate nutrition; poor nourishment resulting from insufficient food or poor diet.


  • Guidelines
    Some indicators, taken separately, are not necessarily symptomatic of abuse, neglect or exploitation. They must be examined within the context of other characteristics of the family to determine whether or not the child is at risk.

    Malnutrition is a medical condition which must be verified by a physician.


  • Factors to Consider  
    • Physical indicators of malnutrition include:
      • Decrease in lean body mass or fat; very prominent ribs ("skin and bones" look).
      • Hair is sparse, thin and dry and is easily pulled out or falls out spontaneously.
      • Skin is pale; child may be anemic.
      • Excessive perspiration, especially about the head.
      • Face looks lined and aged, often with a pinched or sharp appearance.
      • Skin has an old, wrinkled look with poor turgor. Skin folds hang loose on the inner thigh and buttock.
      • Abdomen is often protuberant.
      • Abnormal pulses, blood pressure, stool patterns, infections, abnormal sleep patterns, and decreased levels of physical and mental activity.
    • Parent Factors
      • Did this harm/injury/maltreatment occur as the result of an action or lack of action which:

        1) meets CDSS' definitions of abuse, neglect or exploitation and

        2) is directly attributable to the child's parent or legal guardian?

      • Did the parent or legal guardian:

        1) personally commit the harmful act,

        2) condone or permit a harmful act by other persons in circumstances in which it would be reasonably possible to prevent the harm, or

        3) force, allow or coerce the child to commit harmful acts?

  • Most Likely Classifications
    Did this condition occur as:
    • the result of the negligent failure of a parent/legal guardian to protect the child from severe malnutrition? - Neglect(Severe)
    • the result of a parent/legal guardian willfully causing or permitting the person or health of the child to be placed in a situation such that his/her person or health is endangered through the intentional failure to provide adequate food? - Neglect(Severe)
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Health/Medical Maltreatment:  Failure to Thrive (Non-organic)  

Failure-to Thrive (Non-Organic)

  • Description
    A serious medical condition in which the child's weight, height and motor development fall significantly below the average growth rates of normal children. Non-organic failure-to-thrive (i.e., not caused by an organic failure such as kidney, liver, heart or intestinal disease, a genetic metabolism problem or brain damage), is a result of a highly dysfunctional parent-child relationship manifested in severe physical and/or emotional neglect of the child.

  • Guidelines
    Some indicators, taken separately, are not necessarily symptomatic of abuse, neglect or exploitation. They must be examined within the context of other characteristics of the family to determine whether or not the child is at risk.

    Verification of failure-to-thrive must come from a physician.

  • Factors to Consider
    Organic failure-to-thrive must be ruled out before a parent is accused of abuse or neglect. Approximately 10% of all failure-to-thrive is organic.
    • Did this harm/injury/maltreatment occur as the result of an action or lack of action which:

      1) meets CDSS' definitions of abuse, neglect or exploitation and

      2) is directly attributable to the child's parent or legal guardian?

    • Did the parent or legal guardian:

      1) personally commit the harmful act,

      2) condone or permit a harmful act by other persons in circumstances in which it would be reasonably possible to prevent the harm, or

      3) force, allow or coerce the child to commit harmful acts?

  • Most Likely Classifications
    Did this condition occur as:
    • the result of the negligent failure of a parent/legal guardian to protect the child from medically diagnosed non-organic failure to thrive? - Neglect(Severe)
    • the result of a parent/legal guardian willfully causing or permitting the person or health of the child to be placed in a situation such that his/her person or health is endangered through the intentional failure to provide adequate medical care? - Neglect(Severe)
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Health/Medical Maltreatment:  Lack of Medical Care (Religious Reasons)  

Lack of Medical Care (Religious Reasons)

  • Description
    Refusal, based on religious beliefs, to obtain or allow medical or dental treatment for a child's health problem or condition which, if untreated, could constitute a serious or long-term harm to the child; refusal to follow-through on a prescribed treatment plan for a condition which could cause serious or long-term harm to the child if the plan is not implemented.

  • Guidelines
    Some indicators, taken separately, are not necessarily symptomatic of abuse, neglect or exploitation. They must be examined within the context of other characteristics of the family to determine whether or not the child is at risk.

    This category differs from G-73, Medical Neglect, below, in that the refusal to obtain or allow medical care is based on the legitimate practice of a religion. However, Penal Code (PC) Section 11165.2 clearly states that such religious practices do not constitute neglect; Welfare and Institutions Code (WIC) Section 300(b) states in part that a court may assume jurisdiction under specified conditions.

    PC 11165.2(b)

    ...For the purpose of this chapter, a child receiving treatment by spiritual means as provided in Section 16509.1 of the Welfare and Institutions Code or not receiving specified medical treatment for religious reasons, shall not for that reason alone be considered a neglected child. An informed and appropriate medical decision made by a parent or guardian after consultation with a physician or physicians who have examined the child does not constitute neglect.


    WIC 300(b)


    ...Whenever it is alleged that a minor comes within the jurisdiction of the court on the basis of the parent's or guardian's willful failure to provide adequate medical treatment or specific decision to provide spiritual treatment through prayer, the court shall give deference to the parent's or guardian's medical treatment, non-treatment, or spiritual treatment through prayer alone in accordance with the tenets and practices of a recognized church or religious denomination by an accredited practitioner thereof and shall not assume jurisdiction unless necessary to protect the minor from suffering serious physical harm or illness. In making its determination, the court shall consider (1) the nature of the treatment or non-treatment proposed by the parent or guardian (2) the risks to the minor posed by the treatment or non-treatment proposed by the parent or guardian (3) the risk, if any, of the course of treatment proposed by the petitioning agency, and (4) the likely success of the courses of treatment or non-treatment proposed by the parent or guardian and agency. The minor shall continue to be a dependent child pursuant to this subdivision only so long as is necessary to protect the minor from risk of suffering serious physical harm or illness.


    DCS may receive a request to obtain court authorization for medical treatment in these instances, but a child protective services case is not opened unless there are additional allegations of abuse, neglect, or exploitation.

  • Factors to Consider
    • Does the claim of religious belief as the foundation for refusing to obtain or allow medical or dental treatment follow the tenets and practices of a duly recognized church or religious denomination?
    • If the services of a spiritual practitioner are/were used in lieu of standard medical or dental care, is that person a duly accredited practitioner of that duly recognized church or religious denomination?
    • Was an informed and appropriate medical decision made after consultation with a physician or physicians who have examined the child?
     
  • Most Likely Classifications
    See Guidelines, above. Unless there are additional allegations of abuse, neglect, or exploitation, there is no neglect in these circumstances. However, as described in WIC 300(b), above, under specified conditions, a Medical Consent Only case may be opened at the Child Abuse Hot Line for the purpose of allowing the court to consider whether or not to assume jurisdiction over the child's medical treatment.

    If there are additional allegations of abuse, neglect, or exploitation, the referral shall be classified in accordance with those allegations, as specified in this Guide.
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Medical/Health Maltreatment:  Medical Neglect  

Medical Neglect

  • Description
    Refusal or failure to obtain or allow medical or dental treatment for a child's health problem or condition which, if untreated, could constitute a serious or long-term harm to the child; refusal or failure to follow-through on a prescribed treatment plan for a condition which could cause serious or long-term harm to the child if the plan is not implemented.

    Allegations of withholding appropriate nutrition, hydration, medication or other medically indicated treatment from viable but severely handicapped infants (i.e., the so-called "Baby Doe" cases) are included in this category. Allegations of lack of medical care based on religious beliefs are not included in this category - see G-72.

  • Guidelines
    Some indicators, taken separately, are not necessarily symptomatic of abuse, neglect or exploitation. They must be examined within the context of other characteristics of the family to determine whether or not the child is at risk.

    It must be verified that a child has or had an untreated health problem or condition or that a prescribed treatment plan was not implemented. Such verification must come from a physician, registered nurse or dentist, or by direct admission from the alleged perpetrator. It must further be verified by a physician, registered nurse or dentist that the problem or condition, if untreated, could result in serious or long-term harm to the child.

  • Factors to Consider
    • Child's age, particularly as it relates to the ability to obtain treatment.
    • Child's developmental stage.
    • Child's physical condition.
    • Seriousness of the current health problem or condition.
    • Probable outcome if the current problem or condition is not treated and the seriousness of that outcome.
    • Generally accepted medical benefits of the prescribed treatment.
    • Generally recognized side effects or harms associated with the prescribed treatment.
    • Did this harm/injury/maltreatment occur as the result of an action or lack of action which:

      1) meets CDSS' definitions of abuse, neglect or exploitation and

      2) is directly attributable to the child's parent or legal guardian?

    • Did the parent or legal guardian:

      1) personally commit the harmful act,

      2) condone or permit a harmful act by other persons in circumstances in which it would be reasonably possible to prevent the harm, or

      3) force, allow or coerce the child to commit harmful acts?

  • Most Likely Classifications
    Did this medical neglect occur as:
      • the result of the negligent failure of a parent/legal guardian to provide adequate medical care where no physical injury has occurred? - Neglect(General)
      • the result of a parent/legal guardian willfully causing or permitting the person or health of the child to be placed in a situation such that his/her person or health is endangered through the intentional failure to provide adequate medical care? - Neglect(Severe)
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Potential Harm:  Deadly Weapon  

Deadly Weapon

  • Description
    Threatening a child with a deadly weapon such as a knife or gun.

  • Factors to Consider
    • Did this harm/injury/maltreatment occur as the result of an action or lack of action which:

      1) meets CDSS' definitions of abuse, neglect or exploitation and

      2) is directly attributable to the child's parent or legal guardian?

    • Did the parent or legal guardian:

      1) personally commit the harmful act,

      2) condone or permit a harmful act by other persons in circumstances in which it would be reasonably possible to prevent the harm, or

      3) force, allow or coerce the child to commit harmful acts?

  • Most Likely Classifications

Did this situation occur as:

  • the result of a parent/legal guardian inflicting nonphysical mistreatment which may be characterized by disturbed behavior by the child?- Abuse(Emotional)
  • the result of the negligent failure of a parent/legal guardian to provide adequate supervision where no physical injury has occurred? - Neglect(General)
  • the result of a parent/legal guardian negligently or willfully causing or permitting the person or health of the child to be placed in a situation such that his/her person or health is endangered through the failure to provide adequate supervision where physical injury has occurred? - Neglect(Severe)
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Potential Maltreatment or Harm:  Violated Access Order  

Violated Access Order

  • Description
    A perpetrator or suspected perpetrator of child abuse, neglect, or exploitation who has been ordered by the court to remain out of the household, to not see/communicate with the child, etc., has violated the order and has access to the child victim.


  • Factors to Consider
    • Did this harm/injury/maltreatment occur as the result of an action or lack of action which:

      1) meets CDSS' definitions of abuse, neglect or exploitation and

      2) is directly attributable to the child's parent or legal guardian?

    • Did the parent or legal guardian:

      1) personally commit the harmful act,

      2) condone or permit a harmful act by other persons in circumstances in which it would be reasonably possible to prevent the harm, or

      3) force, allow or coerce the child to commit harmful acts?

  • Most Likely Classifications
    Did this situation occur as:
    • the result of a parent/legal guardian inflicting nonphysical mistreatment which may be characterized by disturbed behavior by the child?- Abuse(Emotional)
    • the result of the negligent failure of a parent/legal guardian to provide adequate supervision where no physical injury has occurred? - Neglect(General)
    • the result of a parent/legal guardian negligently or willfully causing or permitting the person or health of the child to be placed in a situation such that his/her person or health is endangered through the failure to provide adequate supervision where physical injury has occurred? - Neglect(Severe)
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Potential Maltreatment or Harm:  Family Violence Threatens Child  

Family Violence Threatens Child

  • Description
    Family violence in the household when the child has been or is being threatened (verbally or via acts of omission) and the threat is believable, as evidenced by a history of past violence or uncontrolled behavior.

    Family violence is any behavior which would constitute assault or attempted assault under the criminal statute, including the destruction of property or throwing of objects in a manner which could result in serious physical or emotional harm to the child.
  • Guidelines
    Some indicators, taken separately, are not necessarily symptomatic of abuse, neglect or exploitation. They must be examined within the context of other characteristics of the family to determine whether or not the child is at risk.

    This category should be used to specify family violence which occurred in the presence of the child and which threatened serious physical or emotional harm to the child.

  • Factors to Consider
    • Did this harm/injury/maltreatment occur as the result of an action or lack of action which:

      1) meets CDSS' definitions of abuse, neglect or exploitation and

      2) is directly attributable to the child's parent or legal guardian?

  • Did the parent or legal guardian:

    1) personally commit the harmful act,

    2) condone or permit a harmful act by other persons in circumstances in which it would be reasonably possible to prevent the harm, or

    3) force, allow or coerce the child to commit harmful acts?

  • Most Likely Classifications
    Did this situation occur as:
    • the result of a parent/legal guardian inflicting nonphysical mistreatment which may be characterized by disturbed behavior by the child?- Abuse(Emotional)
    • the result of the negligent failure of a parent/legal guardian to provide adequate supervision where no physical injury has occurred? - Neglect(General)
    • the result of a parent/legal guardian negligently or willfully causing or permitting the person or health of the child to be placed in a situation such that his/her person or health is endangered through the failure to provide adequate supervision where physical injury has occurred? - Neglect(Severe)
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Potential Maltreatment or Harm:  Parent/Guardian Afraid of Harming Child  

Parent/Guardian Afraid of Harming Child

  • Description
    A referral regarding a parent/legal guardian who has stated that (s)he is having difficulty caring for his/her child and fears that (s)he is on the verge of becoming abusive, neglectful or exploitative. This referral may come directly from the parent/legal guardian or from a third party to whom the parent/legal guardian made these statements.

  • Guidelines
    Verification of this allegation is not needed when the parent/legal guardian is self-referring and the situation described would constitute abuse, neglect or exploitation. If the referral is from a third party, it may be beneficial to contact the parent/legal guardian to verify the situation and determine the immediacy and scope of the problem.

  • Factors to Consider
    • Child's age and developmental state.
    • Child's physical condition, particularly as related to the child's ability for self-care and self-protection.
    • Child's mental abilities, particularly as related to the ability to comprehend his/her situation.
    • Is there a family history of abuse, neglect or exploitation?
    • Is there a substitute caregiver who could provide respite care?
    • Did this harm/injury/maltreatment occur as the result of an action or lack of action which:

      1) meets CDSS' definitions of abuse, neglect or exploitation and

      2) is directly attributable to the child's parent or legal guardian?

    • Did the parent or legal guardian:

      1) personally commit the harmful act,

      2) condone or permit a harmful act by other persons in circumstances in which it would be reasonably possible to prevent the harm, or

      3) force, allow or coerce the child to commit harmful acts?

  • Most Likely Classifications
    The classification depends on what risk to the child is alleged in the referral. Any classification is potentially possible in this situation.
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Potential Maltreatment or Harm:  Death of Another Child Due to Abuse/Neglect  

Death of Another Child Due to Abuse/Neglect

  • Description
    The non-accidental death of one child provides reason to believe that another child is at risk.

  • Factors to Consider
    Whether there is a real and significant danger is determined by the following factors:
    • The child's age (children age 6 years and younger are at a much greater risk of harm).
    • The child's medical condition, behavioral, mental or emotional problems, developmental disability, or physical handicap, particularly related to the child's capability for self-protection.
    • The nature of the abuse or neglect which caused the other child's death.
    • The alleged perpetrator's access to the child.
    • The alleged perpetrator's physical, mental and emotional abilities, particularly related to ability to control actions.
    • The dynamics of the relationship between the alleged perpetrator and the child.
    • The history of suspected or confirmed abuse or neglect by the alleged perpetrator or within this family or to this child.
    • The current stresses or crises in the home.
    • The presence in the home of a person who could protect the child.
    • Did this harm/injury/maltreatment occur as the result of an action or lack of action which:

      1) meets CDSS' definitions of abuse, neglect or exploitation and

      2) is directly attributable to the child's parent or legal guardian?

    • Did the parent or legal guardian:

      1) personally commit the harmful act,

      2) condone or permit a harmful act by other persons in circumstances in which it would be reasonably possible to prevent the harm, or

      3) force, allow or coerce the child to commit harmful acts?

  • Most Likely Classifications
    The classification depends on what risk to the surviving child is alleged in the referral. Any classification is potentially possible in this situation.
    < Return to OPP Table of Contents | ^ Back to Top of Page
   
Child Coercion or Duress:  Compelling Inappropriate Acts (non-sexual)  

Compelling Inappropriate Acts (Non-Sexual)

  • Description
    Forcing or coercing a child into performing acts which are beyond his/her capabilities, or into illegal or degrading (non-sexual) acts.

    Examples of non-sexual inappropriate, illegal or degrading acts include, but are not limited to:
    • Unrealistic expectations of child.
    • Requiring child to supervise siblings for an unreasonable extent of time, particularly if it prevents child from attending school.
    • Requiring child to bathe, feed, dress or otherwise care for siblings when the tasks are inappropriate.
    • Requiring child to assume housekeeping duties/meal preparation.
    • Forcing or coercing child to commit non-sexual crimes, e.g., stealing to obtain drug money for a parent.
    • Humiliating the child in front of others, not for disciplinary reasons (see Harassment/Ridicule) but for the parent's amusement.
    • Forcing a child to be employed for long hours and/or in a job which is dangerous or beyond his/her capabilities.

      Note that sexual exploitation is listed as a separate category in Sexual Maltreatment or Harm. See B-21.

  • Guidelines
    Some indicators, taken separately, are not necessarily symptomatic of abuse, neglect or exploitation. They must be examined within the context of other characteristics of the family to determine whether or not the child is at risk.
    Verification of this allegation may come from any or all of the following, depending on the conduct alleged: a medical, psychiatric or psychological opinion; statements of law enforcement officer, CSW, witness(es) or the child; or, direct admission of alleged perpetrator.

  • Factors to Consider
    • Child's age.
    • Child's developmental stage.
    • Medical conditions, behavioral, mental or emotional problems, developmental disabilities or physical handicaps of all children in the home.
    • Pattern or chronicity of similar incidents.
    • Family's cultural background, particularly as it relates to expectations about child care by siblings and working.
    • Family's support systems and financial situation.
    • Do the actions required of the child prevent him/her from attending school?
    • Do the actions required of the child preclude him/her from participation in normal childhood activities?
    • Is the child and/or any of the other children endangered by the actions required of the child?
    • Did this harm/injury/maltreatment occur as the result of an action or lack of action which:

      1) meets CDSS' definitions of abuse, neglect or exploitation and

      2) is directly attributable to the child's parent or legal guardian?

    • Did the parent or legal guardian:

      1) personally commit the harmful act,

      2) condone or permit a harmful act by other persons in circumstances in which it would be reasonably possible to prevent the harm, or

      3) force, allow or coerce the child to commit harmful acts?

  • Most Likely Classifications
    Did the inappropriate (non-sexual) acts occur as:
      • the result of a parent/legal guardian forcing or coercing a child into performing functions which are beyond child's capabilities or capacities? - Exploitation
      • the result of a parent/legal guardian forcing or coercing a child into performing illegal or degrading acts? - Exploitation

        Note: While the child who is the subject of this allegation is the victim of exploitation, other children in the home may be victims of neglect or abuse.
    < Return to OPP Table of Contents | ^ Back to Top of Page