Behavioral Health Protocol

Behavioral Health Service Providers, including behavioral health professionals, behavioral health technicians and behavioral health paraprofessionals, should be advocates for victims and children. As such, they may provide primary therapeutic intervention, support to families, information, and be a source of referral for child abuse allegations because of their contact with children and their families. A primary concern of the behavioral health providers is to prevent re-victimization of the child. The provider may hear the initial disclosure, either directly from the victim or indirectly from a third person. Since reporting of child abuse is mandatory for behavioral health service providers, it is incumbent upon the provider to be familiar with current theory and research on child physical and sexual abuse. The Arizona mandatory reporting Law, A.R.S. §13-3620 (see Appendix A), requires that behavioral health and social service professionals, providers and other persons having responsibility for the care or treatment of children who “reasonably believe” that a child has been abused or neglected, are mandated to report the matter immediately. "Reasonable Grounds" for reporting means if there are any facts from which one could reasonably conclude that a child has been abused or neglected, the person knowing those facts is required to immediately report those facts to the appropriate authorities. When in doubt, make the report. Abuse and neglect reports should be made to both the Child Abuse Hotline 1-888-SOS-CHILD and to local law enforcement by dialing 911. The statute also states that anyone who reports a case of suspected child abuse is immune from liability in any civil or criminal proceeding resulting from the report unless the reporter has been charged with or is suspected of committing the abuse, or is acting with malice. Behavioral health service providers are responsible for maintaining current awareness of any statutory changes that may occur in the reporting law. Every behavioral health service agency needs to establish a procedure for following the mandatory reporting law. Every behavioral health service provider should be familiar with the specific reporting requirements as defined by the professional standards of his/her governing board. This Protocol provides guidelines as to how behavioral health provider or other person responsible for the care or treatment of children can best fulfill their legal and professional mandates, while working in conjunction with the agencies responsible for the investigation of child abuse cases. I. Agency Responsibilities A. Behavioral health agencies should provide support and assistance to the person who received the initial disclosure through the child abuse reporting process. Please note that in all cases the person receiving the information will be solely responsible for all steps of reporting described herein, and in Section IV of this document, REPORTING AND TRAINING RESPONSIBILTIES, Mandatory Reporting Guidelines. October 2014 – Pima County Protocols for the Multidisciplinary Investigation of Child Abuse, page 26 B. Behavioral health service agencies should authorize yearly training on child abuse recognition and reporting for their entire staff. C. Behavioral health service agencies should adopt a standardized child abuse reporting form to be utilized for the mandatory written report (See Appendix N for exemplar). Agencies may adopt the sample provided or may create a form that provides the necessary information. II. Receiving the Initial Disclosure A. When it appears that a child is disclosing information about possible abuse, the person receiving such information should listen and ask no leading question. If the child does not spontaneously provide the information, only the following questions should be asked: What happened? Who did it? Where did it happen? B. The person receiving the information should ask no further questions. If the child has spontaneously answered any of the three questions, do not ask that question again. Record verbatim the statements made by the child or reporter in written form. Video/audio recording is not recommended. Any record you make including electronic, written, photo or video record must be preserved and may be subpoenaed. C. Once the initial disclosure has been made, only the forensic interviewer should conduct any further questioning or interviewing of the child. Further questioning may create additional trauma for the child. It may also impede, impair, hinder, interfere with or defeat future prosecution. There is a child advocacy center available where victim interview that meet the requirements of both criminal and DCS investigations are conducted by specially trained interviewers. (See Section III of this document). These interviews are video and/or audio recorded and become forensic evidence. This reduces the need for repeated interviews of the child victim. D. Inappropriate response to disclosure of abuse or neglect poses one of the greatest risks of trauma to the disclosing child. Do not make promises to the child or the nonoffending parent that cannot be guaranteed. For example, do not tell the child: "This does not have to be reported to the authorities"; "you won't have to testify"; "no one will go to jail"; etc. III. Reporting Child Abuse: When a behavioral health provider or other person required to report has reasonable grounds to believe that a minor has been the victim of abuse, he/she should: 1. If the non-offending parent or caretaker is aware of the disclosure and appears to be appropriately supportive, consideration should be given to encouraging the nonoffending parent or caretaker to immediately make the report to law enforcement and DCS while in the presence of the therapist. 1. The behavioral health service provider or other person required to report should request that he/she is identified in any report made by the reporting parent or caretaker. 2. If a behavioral health service provider or other person required to report believes the victim or other children in the home continue to be at risk, he/she should make October 2014 – Pima County Protocols for the Multidisciplinary Investigation of Child Abuse, page 27 a second report to DCS. 3. Regardless of the non-offending parent or caretaker’s willingness or ability to report, the behavioral health provider still has the responsibility of making the reports to the appropriate law enforcement agency and to DCS immediately. B. Report the suspected abuse immediately to the Child Abuse Hotline and the law enforcement agency in the jurisdiction where the offense took place. C. Document the report information on a state/and or agency approved reporting form. Per A.R.S. §13-3620 (See Appendix A), a copy of the reporting form should be transmitted to DCS within 72 hours of making the initial report. If available, the forms should be faxed to DCS. The fax number for reporting to DCS should be requested from the Hotline Worker to whom the report is made. If fax is not immediately available, the reporting form should be mailed to Department of Child Safety, P.O. Box 44240, Phoenix, AZ 85064-4240. D. The behavioral health service provider and/or Agency should maintain the original copy of the written report and records regularly maintained, which should be kept in the client's file, in accordance with the requirements for preservation of a minor’s records as provided by Arizona regulations. E. Notify an Agency Supervisor, if applicable and immediately available, of the disclosure. Never delay making a report pending discussion with or approval of a Supervisor or other Agency resource. If there are questions as to whether information received constitutes abuse and should be reported, or whether the report should be made to DCS and/or law enforcement in the jurisdiction where the suspected abuse took place, contact the Child Abuse Hotline at 1-888-SOS-CHILD (or 1-888-767- 2445) and they may provide advice. The person receiving the information is solely responsible for reporting to DCS and the appropriate law enforcement agency. IV. Behavioral Health Service Provider's Responsibilities: The behavioral health service provider's primary goal is to facilitate healing in the child who has been victimized. This may include working with family members to negotiate changes in the child's environment, and assisting the family in aligning with the victim to provide emotional support and protection, and assisting in minimizing secondary trauma during the legal process. A. In this role, the behavioral health service provider should delay primary trauma intervention until after the forensic interview and investigation has been completed by the appropriate agency. In the interim, supportive therapy should be provided. Examples of supportive therapy include: 1. Encouraging the child's parent or caretaker not to allow contact between the victim and alleged offender. 2. Taking appropriate steps to ensure the safety of other children in the home. 3. Stabilizing the victim's environment by supporting removal of the alleged offender. B. Behavioral health service providers, who prefer not to work with child abuse victims, or lack expertise in this area, may also contact the Pima County Attorney's Victim Services Division to seek referrals to behavioral health professionals who specialize in working with child abuse victims. October 2014 – Pima County Protocols for the Multidisciplinary Investigation of Child Abuse, page 28 C. During treatment, if the child or other person discloses further information regarding the abuse, the behavioral health service provider should document the information in direct quotes and promptly report this information to law enforcement and DCS. D. In accordance with A.R. S. §13-3620 (See Appendix A), mandated reporters, including behavioral health service provider, may be requested to release records to DCS and/or law enforcement. Offender treatment records may also be obtained pursuant to A.R.S. §13¬3620 in any civil, criminal, or administrative proceeding or investigation conducted by DCS or law enforcement in which a child's neglect, dependency, abuse or abandonment is an issue. Thus, written records should be complete, concise, clear and factual. A behavioral health service provider who has any questions regarding the release, or requested release, of records should contact the Special Victims Unit of the Pima County Attorney's office. E. Behavioral health service providers should not disclose facts regarding the allegations to the offender, victim, non-offending parent, caretakers or family members prior to the forensic investigation. Explain to the non-offending parent, caretaker or other family members that the facts of the alleged abuse should not be discussed until after the investigative interview is completed by law enforcement/ DCS. Behavioral health service providers should educate the parent/caretaker that the child may need to talk. Parent/caretakers should listen, be supportive of the child, and seek support from the treatment provider during this time. F. Behavioral health service providers involved in the treatment of various parties (i.e., victim, offender, non-offending parents and siblings) should collaborate with each other to support effective treatment. G. Behavioral health service providers should maintain appropriate boundaries in their work with the child and family members. 1. The victim should have a separate behavioral health service provider from the alleged offender. 2. The "no contact" rules between offender and victim should be followed consistently. 3. The victim's behavioral health service provider should not have direct contact with the alleged offender. Communication should be limited to communication between the victim's and the alleged offender's respective behavioral health service providers. 4. The victim's behavioral health service provider should familiarize her/himself with the Adult and Juvenile Probation Department's special conditions of probation for sex offenders. H. Behavioral health service providers should provide support to the child victim through the legal process, as appropriate. In cases where prosecution occurs, a Victim Services Advocate may be assigned. The role of the Advocate includes providing information about the criminal justice system and victim's rights; notification of court dates; visiting a courtroom with the victim; and being a support person during interviews, depositions, and/or court sessions. The behavioral health service provider should provide emotional support to the victim during this process in conjunction with the preparation done by the Victim Services Advocate. October 2014 – Pima County Protocols for the Multidisciplinary Investigation of Child Abuse, page 29 I. The behavioral health service provider or other person required to report should be prepared to be called as a witness, although this will not always be necessary. This may be done by interview, deposition and/or appearance in court. These persons should be aware that there may be legal limitations regarding the content and scope of their testimony, and should contact the assigned County Attorney concerning any questions regarding requests for interviews, depositions or court appearances. V. Behavioral Health Information Sharing Disclosures may be made to law enforcement, DES and other authorities during the course of an investigation as required or permitted by law.

https://www.pcao.pima.gov/documents/2014_Child_Abuse_Protocol%20Final.pdf