{"id":318,"date":"2019-07-30T20:05:33","date_gmt":"2019-07-30T20:05:33","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-mcc-childdevelopment\/?post_type=chapter&p=318"},"modified":"2019-08-19T15:23:33","modified_gmt":"2019-08-19T15:23:33","slug":"adverse-childhood-experiences-aces-and-child-maltreatment","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-mcc-childdevelopment\/chapter\/adverse-childhood-experiences-aces-and-child-maltreatment\/","title":{"raw":"Adverse Childhood Experiences (ACE's) and Child Maltreatment","rendered":"Adverse Childhood Experiences (ACE’s) and Child Maltreatment"},"content":{"raw":"Adverse Childhood Experiences (ACEs) and Child Maltreatment<\/strong>\r\n\r\nImportant:\u00a0 If you have been subjected to any type of abuse, going through this material may be challenging for you.\u00a0 There are some key points to remember.\u00a0 It can be helpful to work through past abuse and if you need assistance or a referral, do not hesitate to ask. What happened to you is not your fault.\u00a0 If you have been abused and decide to forgive the abuser it does not mean that what they did was okay, but that you are working to move forward. Each individual has a choice as to whether they continue the cycle of the behavior or make a decision to do things differently.<\/em>\r\n\r\nAdverse Childhood Experiences (ACEs)<\/strong> is the term used to describe all types of abuse, neglect, and other potentially traumatic experiences that occur to people under the age of 18.\r\n\r\nAdverse Childhood Experiences have been linked to\r\n
    \r\n \t
  • risky health behaviors,<\/li>\r\n \t
  • chronic health conditions,<\/li>\r\n \t
  • low life potential, and<\/li>\r\n \t
  • early death.<\/li>\r\n<\/ul>\r\nAs the number of ACEs increases, so does the risk for these outcomes.\r\n\r\n\"Types\r\n\r\nThe presence of ACEs does not mean that a child will experience poor outcomes. However, children\u2019s positive experiences or protective factors can prevent children from experiencing adversity and can protect against many of the negative health and life outcomes even after adversity has occurred.\r\n\r\n\"Adverse<\/strong><\/span>\r\n\r\nIt is important to address the conditions that put children and families at risk of ACEs so that we can prevent ACEs before they happen.\r\n\r\n\"Strategies\r\n\r\nChild maltreatment<\/strong> is a considerable social and public health problem in the United States. Unfortunately, data underestimates the number of children impacted by maltreatment due to underreporting and focus on a single data source. Research into the consequences of child maltreatment has identi\ufb01ed various acute and severe negative outcomes such as death, injury, and traumatic brain injury. Research has also uncovered many negative long-term developmental outcomes: academic problems, anxiety, conduct disorder, childhood aggression, delinquency, depression, increased risk for suicide, high-risk sexual behavior, interpersonal problems, poor physical health, posttraumatic stress disorder, risky health behaviors, substance abuse, and youth violence. These substantial short- and long-term consequences make prevention, early identi\ufb01cation, and intervention imperative. So many cases of child abuse go undetected or unreported. Again, when people do not speak up, other people get hurt \u2013 and sometimes even killed. Infants and children are at risk. In many cases, they do not know what constitutes inappropriate treatment and are powerless to do anything about it.\u00a0 Innocent children are dependent on others to protect them.\r\n\r\nDo I Have to Be a \u201cMandated Reporter\u201d in order to Report?<\/strong>\r\n\r\nNO, \u201cmandated reporters\u201d have a legal responsibility to report suspicion, but every citizen should be vigilant about looking for signs of possible abuse\/neglect.\u00a0 Children in these situations are often powerless to help themselves.\u00a0 Although it is not a legal responsibility for a non-mandated reporter, you would not feel good to hear that a child\u2019s situation that you were aware of ended in harm or even death when it might have been prevented.\u00a0 People often hesitate for various reasons that will be addressed in this chapter, however, remember that a report is not an accusation, but a request for an investigation to rule out abuse or neglect.\u00a0 Sometimes parents or caregivers are simply lacking resources or supports that would make the situation safe for a child.\r\n\r\nWho Are Mandated Reporters? Individuals in certain occupations are mandated by law to report situations where there is reasonable suspicion. If, for example, you are a teacher, a health care provider, a counselor, or a law enforcement officer and you see something suspicious, you are required by law to report it.\u00a0 You may have doubts or don't want to take the time to report. Later on, if the child is seriously hurt or killed and it comes out that you did not report your suspicions, you can be held legally liable. However, as noted above, anyone can report and should report when they see something that could help a child who may be in a harmful situation.\r\n\r\nChild Abuse and Neglect<\/strong>\r\n\r\nChildren under the age of 18 may be exposed to abuse and neglect by a parent, caregiver, or another person in a custodial role (e.g., clergy, coach, teacher). There are four common types of child abuse and neglect.\r\n
      \r\n \t
    • Physical abuse <\/strong>is the intentional use of physical force that can result in physical Examples include hitting, kicking, shaking, burning, or other shows of force against a child.<\/li>\r\n \t
    • Sexual abuse <\/strong>involves pressuring or forcing a child to engage in sexual acts. It includes behaviors such as fondling, penetration, and exposing a child to other sexual activity.<\/li>\r\n \t
    • Emotional\/Psychological abuse <\/strong>refers to behaviors that harm a child\u2019s self-worth or emotional well-being. Examples include name calling, shaming, rejection, manipulation, withholding love.<\/li>\r\n \t
    • Neglect <\/strong>is the failure to meet a child\u2019s basic physical and emotional needs such as housing, food, clothing, education, access to medical care, and failure to provide a safe and loving environment.<\/li>\r\n<\/ul>\r\nChild abuse and neglect result from the interaction of a number of individual, family, societal, and environmental factors. Child abuse and neglect are not inevitable\u2014safe, stable, and nurturing relationships and environments are key for prevention. Preventing child abuse and neglect can also prevent other forms of violence, as various types of violence are interrelated and share many risk and protective factors, consequences, and effective prevention tactics. Using a public health approach, we can prevent child maltreatment before it starts.\r\n

      Acts of Commission (Child Abuse)<\/h3>\r\nWords or overt actions that cause harm, potential harm, or threat of harm<\/strong>\r\n\r\nActs of commission are deliberate and intentional; however, harm to a child might not be the intended consequence. Intention only applies to caregiver acts\u2014not the consequences of those acts. For example, a caregiver might intend to hit a child as punishment (i.e., hitting the child is not accidental or unintentional), but not intend to cause the child to have a concussion. The following types of maltreatment involve acts of commission:\r\n
        \r\n \t
      • Physical abuse<\/li>\r\n \t
      • Sexual abuse<\/li>\r\n \t
      • Psychological abuse<\/li>\r\n<\/ul>\r\n

        Acts of Omission (Child Neglect)<\/h3>\r\nFailure to provide needs or to protect from harm or potential harm<\/strong>\r\n\r\nActs of omission are the failure to provide for a child\u2019s basic physical, emotional, or educational needs or to protect a child from harm or potential harm. Like acts of commission, harm to a child might not be the intended consequence. The following types of maltreatment involve acts of omission:\r\n
          \r\n \t
        • Physical neglect<\/li>\r\n \t
        • Emotional neglect<\/li>\r\n \t
        • Medical and dental neglect<\/li>\r\n \t
        • Educational neglect<\/li>\r\n \t
        • Inadequate supervision<\/li>\r\n \t
        • Exposure to violent environments<\/li>\r\n<\/ul>\r\n

          Why Is a Consistent Definition Important?<\/h3>\r\nA consistent definition is needed to monitor the incidence of child abuse and neglect and to examine trends over time. In addition, a clear and consistent definition helps determine the magnitude of child abuse and neglect and allows comparison of the problem across jurisdictions.\r\n\r\nCaregiver<\/strong> - A caregiver is a person, or people, who at the time of the maltreatment is in a permanent (primary caregiver) or temporary (substitute caregiver) custodial role. In a custodial role, the person is responsible for care and control of the child and for the child\u2019s overall health and welfare.\r\n\r\nHarm<\/strong> - Any acute disruption caused by the threatened or actual acts of commission or omission to a child\u2019s physical or emotional health. Disruptions can a\ufb00ect the child\u2019s physical, cognitive, or emotional development.\r\n\r\nThreat of harm occurs when a parent or caregiver expresses an intention or gives signs or warnings through the use of words, gestures, or weapons to communicate the likelihood of in\ufb02icting harm to the child. Threat of harm can be explicit or implicit. Explicit threats would include such acts as pointing a gun at the child or raising a hand as if to strike the child. Implicit threats would include such acts as kicking holes in walls or breaking down doors.\r\n\r\nDisruption of physical health <\/strong>includes, but is not exclusive to, physical injuries, avoidable illnesses, and inadequate nutrition.\r\n\r\nPhysical injuries are physical harm, including death, occurring to the body from exposure to thermal, mechanical, electrical, or chemical energy interacting with the body in amounts or rates that exceed the threshold of physiological tolerance, or from the absence of such essentials as oxygen or heat. Physical injuries can include physical marks, burns, lacerations, contusions, abrasions, broken bones, internal injuries, organ damage, poisoning, asphyxiation, or death because of physical injuries sustained. Avoidable illnesses are those illnesses that are preventable or induced as a result of denial of medical care, withholding of medication, or failure to immunize against typical childhood diseases. Examples include sexually transmitted disease, Munchausen\u2019s Syndrome by Proxy, Pediatric Condition Falsi\ufb01cation, and deliberate failure to immunize against a vaccine-preventable disease. Inadequate nutrition is de\ufb01ned as a failure by the caregiver to provide nutrition that is adequate for growth and physical development. Examples include hunger, malnutrition, and failure to thrive due to poor nutrition. Note that discrepancies in the de\ufb01nition of caregiver often occur in state laws.\r\n\r\nDisruption of emotional health<\/strong> can include anxiety problems, disruption of social functioning, impaired relationships, depression and depressive symptoms, eating disorders, posttraumatic stress (including posttraumatic stress disorder [PTSD), externalizing behaviors (e.g., aggression), lack of education, school failure, delinquency, or substance abuse.\r\n\r\nHarm<\/strong> can be immediate (e.g., broken bones) or delayed (e.g., depression, PTSD).\r\n\r\nDEFINITIONS OF ACTS OF COMMISSION (CHILD ABUSE) <\/strong>\r\n\r\nPhysical Abuse<\/strong> - Physical abuse is de\ufb01ned as the intentional use of physical force against a child that results in, or has the potential to result in, physical injury. Physical abuse includes physical acts ranging from those which do not leave a physical mark on the child to physical acts which cause permanent disability, dis\ufb01gurement, or death. Physical abuse can result from discipline or physical punishment. Physical acts can include hitting, kicking, punching, beating, stabbing, biting, pushing, shoving, throwing, pulling, dragging, dropping, shaking, strangling\/choking, smothering, burning, scalding, and poisoning.\r\n\r\nSexual Abuse<\/strong> - Any completed or attempted (non-completed) sexual act, sexual contact with, or exploitation (i.e., noncontact sexual interaction) of a child by a caregiver. Sexual acts include contact involving penetration, however slight, between the mouth, penis, vulva, or anus of the child and another individual. Sexual acts also include penetration, however slight, of the anal or genital opening by a hand, \ufb01nger, or other object. Genital on genital contact includes:\u00a0 \u2022 Penis to vulva\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2022 Penis to anus\u00a0 \u2022 Penis to penis. Mouth on genital contact includes: \u2022 Mouth to penis \u2022 Mouth to anus \u2022 Mouth to vulva. Sexual acts can be performed by the caregiver on the child or by the child on the caregiver. A caregiver can also force or coerce a child to commit a sexual act on another individual (child or adult).\r\n\r\nAbusive sexual contact<\/strong> includes intentional touching, either directly or through the clothing, of the following:\u00a0 \u2022 Genitalia (penis or vulva)\u00a0 \u2022 Anus\u00a0 \u2022 Groin\u00a0 \u2022 Breast\u00a0 \u2022 Inner thigh\u00a0 \u2022 Buttocks.\r\n\r\nAbusive sexual contact does not have to involve penetration of any of the above. Abusive sexual contact can be performed by the caregiver on the child or by the child on the caregiver. Abusive sexual contact can also occur between the child and another individual (adult or child) through force or coercion by a caregiver. Abusive sexual contact does not include touching required for the normal care or attention to the child\u2019s daily needs.\r\n\r\nNoncontact Sexual Abuse<\/strong> does not include physical contact of a sexual nature between the caregiver and the child. Noncontact sexual abuse can include the following:\r\n
            \r\n \t
          1. Acts which expose a child to sexual activity (e.g., pornography; voyeurism of the child by an adult; intentional exposure of a child to exhibitionism);<\/li>\r\n \t
          2. Filming of a child in a sexual manner (e.g., depiction, either photographic or cinematic, of a child in a sexual act);<\/li>\r\n \t
          3. Sexual harassment of a child (e.g., quid pro quo; creating a hostile environment because of comments or attention of a sexual nature by a caregiver to a child);<\/li>\r\n \t
          4. Prostitution of a child (e.g., employing, using, persuading, inducing, enticing, encouraging, allowing, or permitting a child to engage in or assist any other person to engage in, prostitution, or sexual tra\ufb03cking. Sexual tra\ufb03cking is de\ufb01ned as the act of transporting children for forced sexual activity such as prostitution or sexual slavery.<\/li>\r\n<\/ol>\r\nPsychological (Emotional) Abuse <\/strong>\r\n\r\nIntentional caregiver behavior (i.e., act of commission) that conveys to a child that he\/she is worthless, \ufb02awed, unloved, unwanted, endangered, or valued only in meeting another\u2019s needs.<\/em> Psychological abuse can be continual (e.g., chronic and pervasive) or episodic (e.g., triggered by a speci\ufb01c context or situation: caregiver substance use\/abuse).\r\n\r\nPsychologically abusive behaviors may include blaming, belittling, degrading, intimidating, terrorizing, isolating, restraining, con\ufb01ning, corrupting, exploiting, spurning (rejecting), or otherwise behaving in a manner that is harmful, potentially harmful, or insensitive to the child\u2019s developmental needs, or can potentially damage the child psychologically or emotionally. Terrorizing includes caregiver behavior that is life-threatening; makes a child feel unsafe (e.g., situations that are likely to physically hurt, kill, or abandon the child); sets unrealistic expectations of the child with threat of loss, harm, or danger if expectations are not met; and threatens or perpetrates violence against a child or a child\u2019s loved ones or objects (including toys, pets, or other\r\n\r\npossessions). For example, placing a child in unpredictable or chaotic circumstances would be considered terrorizing as would be placing a child in a situation reasonably considered dangerous by either the child or another adult. Psychological isolation occurs when a caregiver forbids, prevents, or minimizes a child\u2019s contact with others.\r\n\r\nDEFINITIONS OF ACTS OF OMISSION (CHILD NEGLECT) <\/strong>\r\n\r\nFailure to Provide<\/strong> - Failure by a caregiver to meet a child\u2019s basic physical, emotional, medical\/dental, or educational needs\u2014or combination thereof. Failure to provide includes the following:\r\n\r\nPhysical Neglect<\/strong> - Caregiver fails to provide adequate nutrition, hygiene, or shelter; or, caregiver fails to provide clothing that is adequately clean, appropriate size, or adequate for the weather. Several examples follow:\r\n
              \r\n \t
            • Nutrition: A 9-year-old child makes dinner several times per week because the caregiver(s) are sleeping, away, or otherwise unavailable; a child misses or is denied meals on numerous occasions over time; a child is diagnosed as being severely malnourished.<\/li>\r\n \t
            • Hygiene: Child is dirty, smells bad, or has unwashed hair. Child\u2019s living situation is unsanitary; dirty dishes and spoiled food are left on the kitchen table and counter.<\/li>\r\n \t
            • Shelter: Living arrangements for the child and family are unstable for two weeks or more; the residence is infested with roaches or vermin; residence in unheated or inadequately heated because caregivers have failed to ensure heat available.<\/li>\r\n \t
            • Clothing: The child always wears clothing that is too small; the child is not given a warm coat and gloves when the weather is cold.<\/li>\r\n<\/ul>\r\nEmotional Neglect <\/strong>\r\n\r\nCaregiver ignores the child, or denies emotional responsiveness or adequate access to mental health care (e.g., caregiver does not respond to infant cries or older child\u2019s attempt to interact).\r\n\r\nMedical\/Dental Neglect <\/strong>\r\n\r\nCaregiver fails to provide adequate access to medical, vision, or dental care for the child. Examples include the following: \u2022 Caregiver does not administer prescribed medications; \u2022 Caregiver refuses to take the child for needed medical attention or seek timely medical attention.\r\n\r\nEducational Neglect <\/strong>\r\n\r\nCaregiver fails to provide access to adequate education. Examples include:\r\n
                \r\n \t
              • Caregiver allows child to miss 25 or more school days in one academic year without excuse;<\/li>\r\n \t
              • Caregiver does not enroll the child in school (if not home schooled); caregiver encourages a child (under 16 years of age) to drop out of school.<\/li>\r\n<\/ul>\r\nFailure to Supervise <\/strong>- Failure by the caregiver to ensure a child\u2019s safety within and outside the home given the child\u2019s emotional and developmental needs.\r\n\r\nInadequate Supervision\u00a0 \u00a0<\/strong>\r\n\r\nFailure by the caregiver to ensure that the child engages in safe activities and uses appropriate safety devices, to ensure that the child is not exposed to unnecessary hazards; or to ensure appropriate supervision by an adequate substitute caregiver. Inadequate supervision (sometimes called \u201csupervisional neglect\u201d) includes occasions when a caregiver knowingly fails to protect a child from\r\n\r\nmaltreatment perpetrated by a substitute caregiver. Under such conditions, the primary caregiver\u2019s behavior would be considered neglectful only if the maltreatment was recognized and allowed to occur. Regardless of the primary caregiver\u2019s knowledge of the maltreatment, the substitute caregiver\u2019s behavior would be considered maltreatment.\r\n\r\nExposure to Violent Environments\u00a0 <\/strong>\r\n\r\nCaregiver intentionally fails to take available measures to protect the child from pervasive violence within the home, neighborhood, or community. For example, a caregiver who sells illicit drugs out of the child\u2019s home exposes the child to a violent environment; or, a school bus driver (temporary caregiver) who allows a student to be routinely victimized by another student while riding the bus without taking steps to intervene (e.g., notifying school administrators) also exposes a child to a violent environment. Exposure of a child to violence between caregivers in the home may also qualify as exposure to a violent environment, particularly if the caregivers do not take available measures to protect the child from exposure. But, in instances where the caregiver is being victimized by a partner, and alternatives to protect the child are not available, or the caregiver is unaware of alternatives, the caregiver is not maltreating the child.1\r\n
                \r\n\r\nPossible Indicators or Signs of Abuse\/Maltreatment \u2013 What to look for\u2026.<\/strong>\r\n\r\n<\/div>\r\n
                  \r\n \t
                • Sudden change in behavior<\/li>\r\n \t
                • Withdrawn, signs of depression, anxiety<\/li>\r\n \t
                • Learning difficulties with no known cause<\/li>\r\n \t
                • Not wanting to go home<\/li>\r\n \t
                • Not wanting to be around parent, guardian, sibling<\/li>\r\n \t
                • Attempts to run away<\/li>\r\n \t
                • Parents may keep child overly neat and clean to cover abuse<\/li>\r\n \t
                • Not allowed to have friends over<\/li>\r\n<\/ul>\r\n

                  1. Signs and Symptoms of Physical Abuse<\/h3>\r\n
                    \r\n \t
                  • Injuries that do not match explanation<\/li>\r\n \t
                  • Marks that appear to be from a hand or an object<\/li>\r\n \t
                  • Injuries that are healing at different times<\/li>\r\n \t
                  • Untreated medical issues<\/li>\r\n \t
                  • Fear of adults, a parent or guardian<\/li>\r\n \t
                  • Abuse of animals or pets<\/li>\r\n \t
                  • Wearing long clothing inappropriate for weather<\/li>\r\n \t
                  • Avoidance of physical contact<\/li>\r\n \t
                  • Withdrawing from friends and family<\/li>\r\n \t
                  • Parent describes child in a negative way<\/li>\r\n \t
                  • History of abuse in family<\/li>\r\n \t
                  • Use of physical punishment<\/li>\r\n<\/ul>\r\n

                    2. Signs and Symptoms of Neglect<\/h3>\r\n
                      \r\n \t
                    • Poor hygiene<\/li>\r\n \t
                    • Lack of medical, mental or dental care<\/li>\r\n \t
                    • Frequently miss school<\/li>\r\n \t
                    • Steal money or food<\/li>\r\n \t
                    • Eat an unusual amount or hide food<\/li>\r\n \t
                    • Need new or weather-appropriate clothing<\/li>\r\n \t
                    • Say they are home alone a lot<\/li>\r\n<\/ul>\r\n

                      3. Signs and Symptoms of Sexual Abuse<\/h3>\r\n
                        \r\n \t
                      • Note - Sexual abuse can be very difficult to detect<\/li>\r\n \t
                      • Have trouble sitting or walking<\/li>\r\n \t
                      • Overly modest or overly open about nudity\/sexuality<\/li>\r\n \t
                      • Nightmares<\/li>\r\n \t
                      • Bed wetting<\/li>\r\n \t
                      • Lack of appetite<\/li>\r\n \t
                      • Demonstrates inappropriate knowledge of sex<\/li>\r\n \t
                      • Fear or hesitation around parent, guardian or sibling<\/li>\r\n \t
                      • Get attached to strangers quickly<\/li>\r\n \t
                      • Discomfort or markings around the genitals<\/li>\r\n \t
                      • Sexually abuses other children<\/li>\r\n \t
                      • Pregnancy or STI<\/li>\r\n \t
                      • Tries to run away<\/li>\r\n \t
                      • May try to tell indirectly<\/li>\r\n<\/ul>\r\n

                        4. Signs and Symptoms of Emotional Abuse<\/h3>\r\n
                          \r\n \t
                        • Constantly worry they are doing something wrong<\/li>\r\n \t
                        • Distant from parent or caregiver<\/li>\r\n \t
                        • Delays in learning, emotional development or speech<\/li>\r\n \t
                        • Poor academic performance<\/li>\r\n \t
                        • Attention seeking<\/li>\r\n \t
                        • Behavior inappropriate for age<\/li>\r\n \t
                        • Depression<\/li>\r\n \t
                        • Low self-esteem<\/li>\r\n \t
                        • Headaches or stomach issues with no known causes<\/li>\r\n \t
                        • Lack interest in activities or friends<\/li>\r\n<\/ul>","rendered":"

                          Adverse Childhood Experiences (ACEs) and Child Maltreatment<\/strong><\/p>\n

                          Important:\u00a0 If you have been subjected to any type of abuse, going through this material may be challenging for you.\u00a0 There are some key points to remember.\u00a0 It can be helpful to work through past abuse and if you need assistance or a referral, do not hesitate to ask. What happened to you is not your fault.\u00a0 If you have been abused and decide to forgive the abuser it does not mean that what they did was okay, but that you are working to move forward. Each individual has a choice as to whether they continue the cycle of the behavior or make a decision to do things differently.<\/em><\/p>\n

                          Adverse Childhood Experiences (ACEs)<\/strong> is the term used to describe all types of abuse, neglect, and other potentially traumatic experiences that occur to people under the age of 18.<\/p>\n

                          Adverse Childhood Experiences have been linked to<\/p>\n

                            \n
                          • risky health behaviors,<\/li>\n
                          • chronic health conditions,<\/li>\n
                          • low life potential, and<\/li>\n
                          • early death.<\/li>\n<\/ul>\n

                            As the number of ACEs increases, so does the risk for these outcomes.<\/p>\n

                            \"Types<\/p>\n

                            The presence of ACEs does not mean that a child will experience poor outcomes. However, children\u2019s positive experiences or protective factors can prevent children from experiencing adversity and can protect against many of the negative health and life outcomes even after adversity has occurred.<\/p>\n

                            \"Adverse<\/strong><\/span><\/p>\n

                            It is important to address the conditions that put children and families at risk of ACEs so that we can prevent ACEs before they happen.<\/p>\n

                            \"Strategies<\/p>\n

                            Child maltreatment<\/strong> is a considerable social and public health problem in the United States. Unfortunately, data underestimates the number of children impacted by maltreatment due to underreporting and focus on a single data source. Research into the consequences of child maltreatment has identi\ufb01ed various acute and severe negative outcomes such as death, injury, and traumatic brain injury. Research has also uncovered many negative long-term developmental outcomes: academic problems, anxiety, conduct disorder, childhood aggression, delinquency, depression, increased risk for suicide, high-risk sexual behavior, interpersonal problems, poor physical health, posttraumatic stress disorder, risky health behaviors, substance abuse, and youth violence. These substantial short- and long-term consequences make prevention, early identi\ufb01cation, and intervention imperative. So many cases of child abuse go undetected or unreported. Again, when people do not speak up, other people get hurt \u2013 and sometimes even killed. Infants and children are at risk. In many cases, they do not know what constitutes inappropriate treatment and are powerless to do anything about it.\u00a0 Innocent children are dependent on others to protect them.<\/p>\n

                            Do I Have to Be a \u201cMandated Reporter\u201d in order to Report?<\/strong><\/p>\n

                            NO, \u201cmandated reporters\u201d have a legal responsibility to report suspicion, but every citizen should be vigilant about looking for signs of possible abuse\/neglect.\u00a0 Children in these situations are often powerless to help themselves.\u00a0 Although it is not a legal responsibility for a non-mandated reporter, you would not feel good to hear that a child\u2019s situation that you were aware of ended in harm or even death when it might have been prevented.\u00a0 People often hesitate for various reasons that will be addressed in this chapter, however, remember that a report is not an accusation, but a request for an investigation to rule out abuse or neglect.\u00a0 Sometimes parents or caregivers are simply lacking resources or supports that would make the situation safe for a child.<\/p>\n

                            Who Are Mandated Reporters? Individuals in certain occupations are mandated by law to report situations where there is reasonable suspicion. If, for example, you are a teacher, a health care provider, a counselor, or a law enforcement officer and you see something suspicious, you are required by law to report it.\u00a0 You may have doubts or don’t want to take the time to report. Later on, if the child is seriously hurt or killed and it comes out that you did not report your suspicions, you can be held legally liable. However, as noted above, anyone can report and should report when they see something that could help a child who may be in a harmful situation.<\/p>\n

                            Child Abuse and Neglect<\/strong><\/p>\n

                            Children under the age of 18 may be exposed to abuse and neglect by a parent, caregiver, or another person in a custodial role (e.g., clergy, coach, teacher). There are four common types of child abuse and neglect.<\/p>\n