Myth #1: County Children and Youth caseworkers question medical information.

Myth #2: County Children and Youth caseworkers have all previous information involving the family.

Myth #3: Physicians never receive follow-up information regarding the disposition of the report.

Myth #4: County Children and Youth caseworkers never remove children from the home or County Children and Youth caseworkers always remove children first and ask questions later.

Myth #5: Physicians make referrals to County Children and Youth Agencies all the time.

Myth #6: If I make a referral to the County Children and Youth Agency, I will automatically have to testify in court.

Myth #1: County Children and Youth caseworkers question medical information.
Physicians play a vital role in the reporting and investigation of child abuse. Beyond the fact that they are a crucial link to the identification of child maltreatment, physician expertise in diagnosing abusive injuries is an important part of the child welfare investigation. The actual reporting of child abuse is usually not the physician's last step in this process. County Children and Youth Agency (CCYA) caseworkers are not medical experts. The CCYA will rely on the opinion of the physician to assist in establishing that an abusive act occurred. Many physicians have confused a CCYA caseworker's need for clarification about a diagnosis of abuse as questioning his/her medical expertise. Physicians need to understand that part of an investigation involves ruling out other explanations for an injury given to the caseworker by the child's parent or caretaker.

In situations involving sexual abuse of young children, questions will also be asked about the events that led up to the disclosure of abuse. Given the suggestibility of young children, it is important for the caseworker to establish the credibility of the child's statements. Knowing the specific questions that led up to the disclosure of abuse or questions asked after medical evidence has been discovered is an important aspect of establishing credibility. It is important to note that informing parents of a suspicion of interfamilial sexual abuse prior to making a report may prevent the CCYA caseworker and law enforcement officer from interviewing the child before an alleged perpetrator can attempt to suppress information the child may be willing to tell. This is especially true in situations where the medical evidence is not strong and the investigation rests on the interview with the child.

The Child Protective Services Law requires that all children who appear to have injuries that meet the legal test of abuse be seen by a physician to document the injury. Without this documentation, many cases cannot be indicated and will not stand up to the test of an appeal hearing in the court of common pleas or the DPW administrative appeal hearings, which are often granted to parents or caretakers accused of abuse. In many situations, the child welfare system is powerless without the assistance of health care providers and their willingness to intervene on behalf of their patients.

Myth #2: County Children and Youth caseworkers have all previous information involving the family.
When making a report of suspected abuse or neglect to the CCYA, the physician may be asked a number of questions relating to the experience they have had with a family. Other previous concerns they may have had in regards to a specific child, that may not have reached the threshold of suspected abuse, should be conveyed to the CCYA. If this is not the first referral in regards to a specific family, the physician may assume the agency has retained a record of the last report. This may not be accurate.

On average, 70% of the investigations of child abuse are unfounded in Pennsylvania. Unfounded reports are maintained for one year after the date the report was received and are expunged (destroyed) no later than 120 days following the one-year period. This requirement was put into effect in 1999, at which time previous unfounded reports were expunged within 120 days of the oral report. No record, except for the memory of the CCYA caseworker, may exist for prior reports of abuse. Physicians should always reference prior concerns they have had about the safety of their patients and reports that they have made to Children and Youth. Many of the families who make up the 70% of cases that are unfounded receive CCYA services despite the fact that abuse could not be substantiated. The CCYA retains unfounded reports that have been accepted for service. These reports are expunged within 120 days following one year after the case was closed.

Myth #3: Physicians never receive follow-up information regarding the disposition of the report.
All mandated reporters, including physicians, have the legal right to receive information regarding the results of an investigation they initiated and which services will be provided to the referred family. Generally, the physician needs to request this information. In many instances, the physician will be aware of agency decisions through the ongoing contacts with the worker involved with the child. While the physician is certainly deserving of a call from the agency with the results of an investigation that he/she initiated, the caseworker is often in the midst of several investigations and will not make this call until they have completed their work with the family. Some CCYA will notify the physician or mandated reporter in writing regarding the disposition of the case.

Myth #4: County Children and Youth caseworkers never remove children from the home or County Children and Youth caseworkers always remove children first and ask questions later.
The CCYA that receives the report of abuse from a physician is first responsible to assure the safety of the child in question and establish risk of further harm or injury. Placement out of the home will occur only in those situations where the child's safety cannot be assured. In many situations, the alleged perpetrator is asked to leave the family residence while the investigation is being conducted. The severity of the abusive or neglectful incident, parents’ cooperation, presence of an adult ally, and vulnerability of the child will impact on the decision to remove a child from his/her home.

Myth #5: Physicians make referrals to County Children and Youth Agencies all the time.
Referrals from mandated reporters in the health care field represent almost 20% of all abuse reports. Less than 3% of these reports are from private physicians or health care providers.

Myth #6: If I make a referral to the County Children and Youth Agency, I will automatically have to testify in court.
The majority of CCYA interventions do not require involvement with the courts. There are a few contested abuse findings that do require a court hearing and testimony from the physician who made the report of abuse or who diagnosed abuse after having a child brought to their attention. The Bureau of Hearings and Appeals, which is located in Harrisburg, may not require the physician's physical presence at the hearing. Telephone testimony may be arranged.

In many jurisdictions, the Juvenile Court or Family Court can also make arrangements to have a physician testify by phone, which will minimize the time spent away from the office. As stated earlier, testimony from the physician is frequently pivotal in allowing the court to mandate the provision of child welfare services and monitoring.

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