The Role of First Responders 


in Child Maltreatment Cases: 


Disaster and Nondisaster Situations 


Richard Cage 


Marsha K. Salus 


2010 


U.S. Department of Health and Human Services 


Administration for Children and Families 


Administration on Children, Youth and Families 


Children’s Bureau 


Office on Child Abuse and Neglect 


Table of Contents 

PREFACE................................................................................................................................................ 1 


ACKNOWLEDGMENTS ....................................................................................................................... 3 


1. PURPOSE AND OVERVIEW....................................................................................................... 7 


2. RECOGNIZING CHILD MALTREATMENT .......................................................................... 11 


Types of Child Maltreatment ........................................................................................................12 


Child Fatalities ..............................................................................................................................19 


Domestic Violence and Child Maltreatment .................................................................................20 


Substance Abuse and Child Maltreatment .....................................................................................21 


3. INITIAL RESPONSE AND INVESTIGATION ......................................................................... 25 


Responsibilities of First Responders in Cases of Suspected Child Maltreatment ............................26 


Interviewing the Alleged Child Victim ..........................................................................................28 


Interviewing Adults ......................................................................................................................37 


Documenting Interviews ...............................................................................................................40 


Observing the Scene .....................................................................................................................41 


Collecting Physical Evidence .........................................................................................................43 


Assessing Safety and Developing a Safety Plan ..............................................................................45 


Understanding the Next Steps .......................................................................................................47 


4. TESTIFYING IN COURT .......................................................................................................... 53 


Preparation for Court ....................................................................................................................53 


During the Trial ............................................................................................................................53 


The Juvenile Court Process ............................................................................................................55 


The Criminal Court Process ..........................................................................................................58 


The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

i 
5. RESPONDING IN DISASTERS ..................................................................................................... 61 


Factors for First Responders ..........................................................................................................61 


Agency Preparations .....................................................................................................................66 


Agency Response...........................................................................................................................69 


Conclusion ...................................................................................................................................71 


ENDNOTES ......................................................................................................................................... 73 


APPENDICES: 


APPENDIX A—GLOSSARY OF TERMS................................................................................... 81 


APPENDIX B—RESOURCE LISTINGS OF SELECTED NATIONAL ORGANIZATIONS 


APPENDIX C—STATE TELEPHONE NUMBERS FOR REPORTING SUSPECTED CHILD 


APPENDIX D—REFERENCE GUIDE FOR RESPONDING TO CASES OF SUSPECTED 


APPENDIX F—DISTINGUISING PHYSICAL ABUSE FROM 


APPENDIX G—COMMON FOLK-MEDICINE PRACTICE INJURIES THAT MAY 


APPENDIX H—CRITERIA FOR DISTINGUISHING SIDS FROM FATAL CHILD 


APPENDIX N—ASSESSING DISASTER SURVIVOR IMMEDIATE 


CONCERNED WITH CHILD MALTREATMENT AND WITH FIRST RESPONDERS........ 87 


MALTREATMENT...................................................................................................................... 95 


CHILD MALTREATMENT ........................................................................................................ 97 


APPENDIX E—SIGNS OF POSSIBLE PHYSICAL ABUSE ................................................... 101 


NONINTENTIONAL INJURY................................................................................................. 105 


RESEMBLE ABUSE .................................................................................................................. 109 


MALTREATMENT ................................................................................................................... 111 


APPENDIX I—DOMESTIC VIOLENCE EXPOSURE ASSESSMENT.................................. 115 


APPENDIX J—INTERVIEWING NONOFFENDING ADULTS ........................................... 117 


APPENDIX K—MEMORANDUM OF UNDERSTANDING ................................................ 119 


APPENDIX L—HOME VISIT SAFETY TIPS.......................................................................... 121 


APPENDIX M—CASE STUDIES ............................................................................................ 123 


NEEDS WORKSHEET ............................................................................................................. 141 


APPENDIX O—CONTINUITY OF OPERATIONS PLAN (COOP) OUTLINE .................. 143 


ii Table of Contents 
 

Preface 

Each day, the safety and well-being of some 

children across the Nation are threatened by 

child abuse and neglect. Intervening eff ectively in 

the lives of these children and their families is not 

the responsibility of any single agency or professional 

group, but rather is a shared community concern. 

Since the late 1970s, the Child Abuse and Neglect 

User Manual Series has provided guidance on 

child protection to hundreds of thousands of 

multidisciplinary professionals and concerned 

community members. Th e User Manual Series off ers a 

foundation for understanding child maltreatment and 

the roles and responsibilities of various practitioners 

in its prevention, identification, investigation, and 

treatment. Through the years, the manuals have 

served as valuable resources for building knowledge, 

promoting effective practices, and enhancing 

community collaboration. 

Since the last update of the User Manual Series in 

the early 1990s, a number of changes have occurred 

that dramatically affect each community’s response to 

child maltreatment. The changing landscape refl ects 

increased recognition of the complexity of issues 

facing children and families, new legislation, practice 

innovations, and systems reform efforts. Signifi cant 

advances in research have helped shape new directions 

for interventions, while ongoing evaluations help 

determine “what works.” 

The Office on Child Abuse and Neglect within the 

Children’s Bureau of the Administration for Children 

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

Services, has developed this third edition of the User 

Manual Series to reflect the increased knowledge and 

the evolving state of practice on child protection. 

The updated and new manuals are comprehensive in 

scope while also succinct in presentation and easy to 

follow, and they address trends and concerns relevant 

to today’s professional. 

Th is manual, The Role of First Responders in Child 

Maltreatment Cases: Disaster and Nondisaster 

Situations, is for those professionals who have 

the primary responsibility for the initial on-scene 

response to situations in which child abuse or 

neglect may have occurred, even when the initial 

call may be for another situation, such as domestic 

violence or a drug offense. In most jurisdictions, 

emergency medical technicians, child protective 

services caseworkers, and law enforcement officers 

generally are considered the first responders for child 

maltreatment cases. This manual is designed to be a 

practical guide to help those in the fi eld and includes 

step-by-step guidelines for investigating possible child 

maltreatment. The manual also provides information 

for first responders when responding to cases of 

possible child maltreatment in disaster situations, 

including how fi rst responders and their agencies can 

prepare for disaster situations. While this manual will 

be useful to all first responders, some portions may be 

more relevant to particular types of first responders. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

1 
The Role of First Responders in Child Maltreatment 

Cases: Disaster and Nondisaster Situations builds upon 

the information presented in A Coordinated Response 

to Child Abuse and Neglect: The Foundation for 

Practice. Readers are encouraged to read that manual 

as it provides an understanding of what constitutes 

child maltreatment, its underlying causes, and how 

the child protection system works. Other manuals in 

the series that also may be of help are Child Protective 

Services: A Guide for Caseworkers and Child Protection 

in Families Experiencing Domestic Violence. 

User Manual Series 

This manual—along with the entire Child Abuse and Neglect User Manual Series—is available from Child 

Welfare Information Gateway. For a full list of available manuals and ordering information, contact: 

Child Welfare Information Gateway 

1250 Maryland Avenue, SW 

Eighth Floor 

Washington, DC 20024 

Phone: (800) 394-3366 

Fax: (703) 225-2357 

E-mail: info@childwelfare.gov 

The manuals also are available online at http://www.childwelfare.gov/pubs/usermanual.cfm. 

2 Preface 
ACKNOWLEDGMENTS 

AUTHORS 

Lieutenant Richard Cage, M.A., has been a police 

officer in the State of Maryland for more than 30 years. 

For 26 years, he was assigned to the Child Abuse/ 

Sexual Offense Unit of his department. Lieutenant 

Cage retired as the commander of the Pedophile 

Division in February 2003. He has conducted 

numerous training workshops on investigative 

techniques for child sexual abuse cases throughout the 

United States and abroad and is recognized nationally 

for his training expertise in the field. In 1988, he 

was a member of the Surgeon General’s Planning 

Committee for the Development of Protocol on 

Child Abuse. Lieutenant Cage is a past member of 

the board of the American Professional Society on the 

Abuse of Children. 

Marsha K. Salus, M.S.W., is a social work 

consultant. She has worked in the child welfare fi eld 

for more than 30 years. She began her career as a 

child protective services (CPS) caseworker and then 

became a CPS supervisor. She has developed several 

national curricula for child welfare workers and 

supervisors, including a number of preservice and 

inservice training programs for child welfare workers 

and supervisors in a variety of States. In addition, she 

has provided training on all aspects of family violence 

to multidisciplinary audiences around the country. 

Ms. Salus has assisted State and local CPS agencies 

in program development and evaluation, and she has 

worked with several States to establish standards of 

practice for child welfare supervision. She has also 

authored or co-authored numerous manuals in the 

Child Abuse and Neglect User Manual Series. 

CONTRIBUTING AUTHORS 

Jeannie Newman, M.I.B.S., M.S.W., formerly a 

consultant with ICF International, has held policy 

and direct practice positions in child welfare and 

family programs. She also has cultivated an extensive 

network in various related professional fi elds, 

including domestic violence and mental health. She 

was the Project Manager for the Child Abuse and 

Neglect User Manual Series. 

Matthew Shuman, M.S.W., a consultant with ICF 

International, has more than 11 years experience 

in the human services field. He previously worked 

as an analyst in the Office of the Secretary of the 

Department of Health and Human Services for a 

variety of child welfare issues, including foster care, 

adoption, and child care. He also has written and 

edited various child welfare publications, including 

other manuals in the User Manual Series. 

Lindsay Ritter Taylor, formerly a consultant with 

ICF International, worked on projects relating to 

various child welfare and juvenile justice issues. She 

helped write issue briefs highlighting fi ndings from 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

3 
the National Survey of Child and Adolescent Wellbeing, a national sample of children involved with the 

child welfare system. Additionally, she worked with 

the ICF technical assistance and evaluation teams on 

the Improving Child Welfare Through Systems of Care 

grant project. 

ACKNOWLEDGMENT OF PRIOR EDITIONS 

This manual is an update and expansion of the 

1992 publication The Role of Law Enforcement in the 

Response to Child Abuse and Neglect by Donna Pence 

and Charles Wilson. The first edition of the manual 

was published in 1979 as The Role of Law Enforcement 

in the Prevention and Treatment of Child Abuse and 

Neglect by Diane Broadhurst and James Knoeller. Th e 

prior work informed and contributed to the content 

of this publication. 

REVIEWERS 

Detective Frank Darley, Montgomery County Police, 

Pedophile Division, Rockville, MD 

Officer Kimberly Foster, Montgomery County Police 

Training Academy, Rockville, MD 

Kathy Pinto, Howard County, MD, Department 

of Social Services 

Sandra Slappey, Child Welfare Information Gateway 

Don Weber, Sussex County Emergency Medical 

Services, Georgetown, DE 

Sarah Webster, Texas Department of Protective and 

Regulatory Services (retired) 

TECHNICAL ADVISORY PANEL 

The following were members of the January 2001 

Technical Advisory Panel for the User Manual Series 

contract. The organizations identifi ed refl ect each 

member’s affiliation at that time. 

Carolyn Abdullah 

FRIENDS National Resource Center 

Washington, DC 

Lien Bragg 

American Public Human Services Association 

Washington, DC 

Sgt. Richard Cage 

Montgomery County Police Department 

Wheaton, MD 

Diane DePanfi lis, Ph.D. 

University of Maryland at Baltimore School 

of Social Work 

Baltimore, MD 

Pauline Grant 

Florida Department of Children and Families 

Jacksonville, FL 

Jodi Hill 

Connecticut Department of Children and Families 

Hartford, CT 

Robert Ortega, Ph.D. 

University of Michigan School of Social Work 

Ann Arbor, MI 

Nancy Rawlings 

Kentucky Cabinet for Families and Children 

Frankfort, KY 

4 Acknowledgments 
Barry Salovitz 

Child Welfare Institute/National Resource 

Center on Child Maltreatment 

Glenmont, NY 

Sarah Webster 

Texas Department of Protective and 

Regulatory Services 

Austin, TX 

Ron Zuskin 

University of Maryland at Baltimore School 

of Social Work 

Baltimore, MD 

ADDITIONAL ACKNOWLEDGMENTS 

Th e third edition of the User Manual Series was 

developed under the guidance and direction of Irene 

Bocella, Federal Task Order Offi cer, and Catherine 

Nolan, Director, Office on Child Abuse and Neglect. 

This manual was developed and produced by ICF International, Fairfax, VA, under Contract Number HHS282-98-0025. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

5 

CHAPTER 1 

Purpose and Overview 

In Th is Chapter 

• Child maltreatment statistics 

• Roles of fi rst responders 

• Purpose of manual 

Child abuse and neglect affect children, families, 

and communities throughout the United States. 

According to 2008 data from the National Child 

Abuse and Neglect Data System (NCANDS): 

• 	 An estimated 772,000 children were victims of 

abuse or neglect. 

• 	 An estimated 3.3 million referrals of abuse or 

neglect, concerning approximately 6 million 

children, were received by child protective services 

(CPS) agencies. Of those referrals, 62.5 percent 

were accepted for investigation or assessment. 

• 	 Nationally, 73.3 percent of child victims 

experienced neglect (including medical neglect), 

16.1 percent were physically abused, 9.1 percent 

were sexually abused, and 7.3 percent were 

psychologically maltreated. Additionally, 9 

percent of victims experienced “other” types 

of maltreatment, including abandonment and 

congenital drug addiction. A child could be 

identified as a victim of more than one type of 

maltreatment.1 

National Incidence Study of Child Abuse and Neglect (NIS) 

In addition to the NCANDS data, the U.S. Department of Health and Human Services also collects data 

through NIS. The most recent study, NIS-4, reviewed data collected from 2005–2006 and has shown an 

overall decrease in the incidence of child maltreatment since NIS-3, which used data from 1993. According 

to NIS-4, approximately 1.25 million children experienced neglect during the study year, as opposed to 

1.55 million children from NIS-3. NIS-4 also provides data about types of maltreatment; victim, family, 

and perpetrator characteristics; report sources; and investigations. NIS uses different methodologies than 

NCANDS to collect and assess data; NCANDS collects annual state-level administrative data on official 

reports of child maltreatment, while NIS estimates more broadly the incidence of child maltreatment in the 

United States by including both cases that are reported to the authorities and those that are not. 

To view the full NIS-4 report, visit http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/ 

index.html. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

7 
Many community professionals are involved in 

the identification, investigation, prevention, and 

treatment of child maltreatment. First responders, 

including emergency medical technicians (EMTs), 

law enforcement officers, and CPS workers, often are 

the first professionals to arrive at a scene where child 

maltreatment may have occurred or where children 

may be at risk for being abused or neglected. When 

first responders encounter a suspected case of child 

maltreatment, their initial objectives are to evaluate 

and address immediate medical and psychological 

needs, to assess and ensure the safety of victims, 

and to secure the scene in order to collect and 

preserve evidence. 

8 Purpose and Overview 
The Roles of First Responders 

The following are the general roles of fi rst responders: 

• EMTs. People’s lives may depend on the quick reactions and competent care of EMTs and paramedics, who 

often are the first to arrive at the scene of an incident. When dispatched to a scene, EMTs must determine 

the nature and the extent of the patient’s condition, give appropriate emergency care, and transport the 

patient to a medical facility, if necessary. Before arriving at the scene, EMTs might not be alerted to the 

possibility of child maltreatment.2 

• Law enforcement officers. Because of their presence in the community, law enforcement offi cers often 

encounter situations that involve child maltreatment. For example, they may be called to emergencies such 

as domestic violence, child fatalities, or incidents of serious physical harm to a child. Law enforcement 

officers also may see evidence of harm to a child during drug or other arrests. The role of law enforcement 

in child maltreatment cases is to determine if a violation of criminal law occurred, identify and apprehend 

the alleged offender, file appropriate criminal charges, and remove children from their families when 

their immediate safety is in jeopardy.3

 The patrol officer—and sometimes a law enforcement detective or 

investigator specializing in the investigation of child abuse and neglect—usually provides the initial law 

enforcement response. In some situations, law enforcement officers may conduct joint investigations of 

suspected child maltreatment with CPS caseworkers. 

• CPS caseworkers. CPS is the central agency in each community child welfare system and plays the lead 

role in coordinating communication and services among the various disciplines responsible for addressing 

child maltreatment. It is the agency legally mandated in most States to respond to reports of possible child 

abuse or neglect. CPS caseworkers conduct investigations or initial assessments regarding suspected child 

maltreatment, assess the risk to and safety of children, and develop individualized case plans. Th ey also 

provide or arrange for and coordinate services to achieve safe, permanent families for children who either 

have been maltreated or who are at risk of maltreatment. In most communities, CPS responds to reports of 

suspected child abuse or neglect 24 hours a day.4 

For more detailed descriptions of the roles and the responsibilities of all the professionals involved in a 

community’s response to child abuse and neglect, see A Coordinated Response to Child Abuse and Neglect: 

The Foundation for Practice, which is available at http://www.childwelfare.gov/pubs/usermanuals/ 

foundation/index.cfm. 

First responders should also be aware of their role as mandatory reporters. As of January 2008, 48 States, 

the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the 

U.S. Virgin Islands designate certain professions as being mandated to report suspected cases of child 

maltreatment. Eighteen States and Puerto Rico designate all persons as mandatory reporters, with 16 

States and Puerto Rico also specifying certain professions.5

 First responders should be aware of their 

State, local, agency, and professional responsibilities for reporting child abuse and neglect. To search State 

statutes regarding mandatory reporting and other child welfare issues, visit the Child Welfare Information 

Gateway website at http://www.childwelfare.gov/systemwide/laws_policies/state/. For information 

about State child maltreatment reporting hotlines, see Appendix C, State Telephone Numbers for Reporting 

Suspected Child Maltreatment. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

9 
This manual builds the foundation for successful 

outcomes when first responders encounter incidents, 

including disaster situations, in which child 

maltreatment might be suspected. Specifi cally, this 

manual: 

• 	 Helps first responders recognize the various types 

of child maltreatment and the signs that may 

indicate that maltreatment has occurred 

• 	 Provides an overview of the initial response and 

investigation in cases of suspected child abuse or 

neglect 

• 	 Explains how first responders should prepare for 

and provide testimony in court for child abuse 

and neglect cases 

• 	 Outlines how first responders and their agencies 

can respond to child maltreatment cases in 

emergencies and disasters, including how to 

prepare for such situations. 

First responders should recognize that not all the 

information in this manual necessarily pertains to their 

particular job duties or responsibilities. For instance, 

EMTs would not attempt to elicit a confession, nor 

would law enforcement or CPS perform a medical 

exam. Additionally, the scope of this manual does not 

cover actions to be taken either by law enforcement 

or by CPS caseworkers beyond their fi rst response 

(e.g., follow-up interviews). First responders should 

respond to cases of alleged child maltreatment and 

conduct investigations according to their agency and 

jurisdictional guidelines. Also note that presenting 

information and suggestions in this manual does not 

necessarily imply endorsement by the Offi ce on Child 

Abuse and Neglect or any other Federal agency, nor 

are they an official interpretation of Federal or other 

requirements. 

10 Purpose and Overview 
CHAPTER 2 

Recognizing Child 

Maltreatment 

In Th is Chapter 

• 	 Federal child welfare laws 

• 	 Recognizing the types and signs of child 

maltreatment 

– Physical abuse 

– Neglect 

– Psychological abuse 

– Sexual abuse 

• 	 Child fatalities 

• 	 Co-occurring issues 

– Domestic violence 

– Substance abuse 

First responders have various levels of experience 

and training regarding the detection of possible 

child abuse and neglect. While some effects of child 

maltreatment are easily observable, many require a 

more indepth assessment by first responders. Th e 

physical, emotional, and behavioral effects of child 

abuse or neglect are wide-ranging, but many of 

these also may be caused by something other than 

maltreatment. First responders should be able to 

recognize and to assess any possible maltreatment 

within the context of other problematic situations that 

may occur in the home, such as domestic violence or 

substance abuse. 

Federal Child Welfare Laws 

State laws, sound professional standards for practice, and strong philosophical underpinnings should guide 

any intervention into family life on behalf of children. The key principles guiding State child protection laws 

are based largely on Federal statutes, primarily the Child Abuse Prevention and Treatment Act (CAPTA), as 

amended by the Keeping Children and Families Safe Act of 2003 (P.L. 108-36), and the Adoption and Safe 

Families Act (ASFA) of 1997 (P.L. 105-89). CAPTA provides definitions and guidelines regarding child

maltreatment issues, and ASFA promotes three national goals for child protection: 

• Safety – All children have the right to live in an environment free from abuse and neglect. The safety of 

children is the paramount concern that must guide child protection eff orts. 

• Permanency – Children need a family and a permanent place to call home. A sense of continuity and 

connectedness is central to children’s healthy development. 

• Well-being – Children deserve nurturing families and environments in which their physical, emotional, 

educational, and social needs are met. Child protection practices must take into account each child’s needs 

and should promote the healthy development of family relationships. 

For additional information on Federal and State child welfare laws, visit the Child Welfare Information 

Gateway website at http://www.childwelfare.gov/systemwide/laws_policies/. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

11 
Appendix D, Reference Guide for Responding to Cases of Suspected Child Maltreatment, synthesizes key points

from this chapter and Chapter 3, Initial Response and Investigation, into a two-page handout. 

TYPES OF CHILD MALTREATMENT 

There are four commonly recognized forms of child 

maltreatment—physical abuse, neglect, psychological 

abuse, and sexual abuse. The definitions of these 

types of child maltreatment may vary depending on 

the State or the locality in which the fi rst responder 

works. First responders should become familiar with 

the definitions that apply in their jurisdictions. 

Additionally, the signs of child maltreatment listed 

in this manual, such as the behavioral clues listed 

in Exhibit 2-1, do not indicate absolutely that child 

maltreatment has occurred. They are meant to act as 

general guidelines for identifying the possibility of each 

type of maltreatment. Actual child maltreatment, as 

well as the perpetrator’s identity, can be determined 

only after a thorough response and investigation. 

Physical Abuse 


The physical abuse of children includes any 

nonaccidental physical injury caused by the child’s 

caretaker. Physical abuse can vary greatly in frequency 

and severity.6

 It may include injuries sustained from 

burning, beating, kicking, or punching. Although 

the injury is not an accident, neither is it necessarily 

the intent of the child’s caretaker to injure the child. 

Physical abuse may result from punishment that 

is inappropriate to the child’s age, developmental 

level, or condition. Additionally, it may be caused 

by a parent’s recurrent lapses in self-control that 

are brought on by immaturity, stress, or the use of 

alcohol or illicit drugs.7

 Caretakers may physically 

abuse children during discipline or as a way to “teach 

the child a lesson.” 

Exhibit 2-1 

Behavioral Clues That May Indicate Possible Child Maltreatment 

Children who possibly are maltreated may: 

• Be aggressive, oppositional, or defi ant 

• Cower or demonstrate a fear of adults 

• Act out, displaying aggressive or disruptive behavior 

• Be destructive to self or others 

• Come to school too early or not want to leave school, indicating a possible fear of being at home 

• Show fearlessness or extreme risk-taking 

• Be described as “accident prone” 

• Cheat, steal, or lie (may be related to too high expectations at home) 

• Be a low achiever 

• Be unable to form good peer relationships 

• Wear clothing that covers the body and may be inappropriate in warmer months, such as wearing a 

turtleneck sweater in the summer (Be aware that this may possibly be a cultural issue instead.) 

• Show regressive or less mature behavior 

• Dislike or shrink away from physical contact (e.g., may not tolerate physical praise, such as a pat on the 

back).8 

12 Recognizing Child Maltreatment 
Signs of possible physical abuse include: 

• 	 Fractures unexpectedly discovered in the course 

of an otherwise routine medical examination 

(e.g., discovering a broken rib while listening to 

the child’s heartbeat) 

• 	 Injuries that are inconsistent with, or out of 

proportion to, the history provided by the 

caretaker or with the child’s age or developmental 

stage (e.g., a 3-month old burning herself by 

crawling on top of the stove) 

• 	 Multiple fractures, often symmetrical (e.g., in 

both arms or legs), or fractures at diff erent stages 

of healing 

• 	 Fractures in children who are not able to walk 

• 	 Skeletal trauma (e.g., fractures) combined with 

other types of injuries, such as burns 

• 	 Subdural hematomas, which are hemorrhages 

between the brain and its outer lining that are 

caused by ruptured blood vessels 

• 	 Burns on the buttocks, around the anogenital 

region, on the backs of the hands, or on both 

hands, as well as those that are severe.9 

Some injuries that may have been caused by physical 

abuse have distinct marks. Exhibit 2-2 shows marks 

that may be indicative of physical abuse. Some 

Exhibit 2-2 

Marks from Burns or Instruments10 

Injuries from physical abuse may appear in distinct shapes, especially in cases involving an instrument

or burns. 

Marks from Instruments: 

Marks from Burns 

Reprinted from Pediatric Clinics of North America, volume 37, C.F. Johnson, Inflicted Injury Versus Accidenta

Injury, pp. 791–814, 1990, with permission from Elsevier. 

l 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

13 
injuries, however, may not be visible without a 

complete medical examination. For instance, injuries 

caused by abuse directed to the abdomen or to the 

head often are undetected because many of the 

injuries are internal. For a more complete list of the 

possible physical signs of child abuse, see Appendix E, 

Signs of Possible Physical Abuse. 

The first response in child physical abuse cases is 

handled predominately by social service agencies, such 

as child protective services (CPS). Many jurisdictions 

across the country have interagency agreements and 

protocols that define when a joint investigation by law 

enforcement and CPS will be conducted. Some have 

put guidelines in place for law enforcement to respond 

Distinguishing Physical Abuse from Nonintentional Injury 

Children may receive bruises during the course of play or while being active. The areas that are bruised 

most commonly during normal play include the leading or bony edges of the body, such as knees, elbows, 

forearms, or eyebrows. The soft tissue areas, such as cheeks, buttocks, and thighs, are not normally injured 

during play. Additionally, bruises received during the normal course of childhood activity rarely are in 

distinct shapes, such as a hand, a belt buckle, or adult teeth marks. Bruises in soft tissue areas or in distinct 

shapes may be indicative of physical abuse. 

Graphic reprinted from Reaching Out: Working Together in Identifying and Responding to Child Victims of 

Abuse by RIMER/PRAGER. 1998. Reprinted with permission of Nelson, a division of Th omson Learning: 

www.thomsonrights.com. Fax 800 730-2215. 

14 Recognizing Child Maltreatment 
For more information about how to distinguish

physical abuse from accidental injury, see Appendix 

F, Distinguishing Physical Abuse from Nonintentional 

Injury, or visit http://www.ncjrs.gov/pdffiles1/ 

ojjdp/160938.pdf. Additionally, some common 

folk-medicine practices may give the appearance of 

physical abuse. See Appendix G, Common FolkMedicine Practice Injuries That May Resemble Abuse, 

for an explanation of some of these practices. 

to all physical abuse cases involving young children, 

as well as to all cases of serious physical abuse. Serious 

physical abuse cases generally are defined as those 

requiring medical treatment or hospitalization. A 

response by law enforcement is also often required in 

cases involving any blows to the face or the head or 

the use of a particular instrument (e.g., clubs, bats, 

sticks, chains), which can indicate an attempt to do 

serious harm. 

Neglect 

Neglect involves a caregiver’s failure to meet the 

basic needs of a child, such as food, clothing, shelter, 

medical care, or supervision. Types of neglect include 

physical, environmental, emotional, and educational 

neglect, as well as inadequate supervision. Neglect 

follows a continuum from mild to severe and often 

is very diffi cult to defi ne.11 Most laws today include 

some mention of “failure or inability to provide” in 

their definitions. There is still a lack of consensus, 

however, as to what constitutes failure to provide 

adequate food, shelter, protection, or clothing. 

Some State definitions include “failure or inability 

to protect,” which refers to a situation in which a 

child is exposed to someone who may harm him, 

such as being left with a parent’s drug dealer or a 

known child molester.12 In addition, parents might 

be accused of failing to provide a safe environment by 

not protecting a child from unsanitary or hazardous 

living conditions. 

Caregivers may not provide proper care for a 

variety of reasons, including a lack of knowledge 

or understanding about meeting the child’s needs, 

inadequate bonding with the child, or impairment 

due to substance abuse or to mental illness. Although 

there are cases of co-occurring maltreatment and 

poverty, living in poverty, in and of itself, does not 

mean that a child is being neglected. 

Signs of Possible Neglect 

Children who possibly are neglected may: 

• Seem inadequately dressed for the weather (e.g., wearing shorts and sandals in freezing weather) 

• Appear excessively listless and tired (due to no routine or structure around bedtimes) 

• Report caring for younger siblings (when they themselves are underage or are developmentally not ready to 

do so) 

• Demonstrate poor hygiene or smell of urine or feces 

• Seem unusually small or thin or have a distended stomach (indicative of malnutrition) 

• Have unattended medical or dental problems, such as infected sores or badly decayed or abscessed teeth 

• Appear withdrawn 

• Crave unusual amounts of attention, even eliciting negative responses in order to obtain it 

• Be chronically truant.13 

Additionally, the first responder should check the home environment for signs of neglect, such as health or 

safety hazards, no heat, or unsanitary conditions. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

15 
For more information on neglect, refer to Child 

Neglect: A Guide for Prevention, Assessment, and

Intervention at http://www.childwelfare.gov/ 

pubs/usermanuals/neglect/index.cfm. 

Psychological Maltreatment 


Psychological maltreatment by a caretaker includes 

blaming, belittling, or rejecting a child; constantly 

treating siblings unequally; and demonstrating a 

persistent lack of concern for the child’s welfare.14 It 

often accompanies physical abuse. Th e fi ve categories 

of psychological maltreatment are: 

• 	 Spurning (e.g., belittling, ridiculing) 

• 	 Terrorizing (e.g., threatening) 

• 	 Isolating (e.g., confining the child from any 

family or friends) 

• 	 Exploiting or corrupting (e.g., encouraging or 

permitting prostitution or substance abuse) 

• 	 Denying emotional responsiveness (e.g., failing 

to express or to show aff ection).15 

Psychological maltreatment often causes behavior 

problems in children and, in some cases, may cause 

developmental lags, psychosomatic symptoms (i.e., 

bodily symptoms caused by a mental or emotional 

disturbance), and other effects, such as speech 

disorders. First responders may not detect the physical 

or behavioral signs of psychological maltreatment 

easily. 

Sexual Abuse 

Sexual abuse is defined as adult sexual behavior with 

a child. It can include fondling a child’s genitals, 

making the child fondle the adult’s genitals, digital 

penetration, intercourse, incest, rape, sodomy, 

exhibitionism, sexual exploitation, or exposure to 

pornography. Sexual abuse also may be committed by 

a person younger than age 18. This occurs when that 

person is signifi cantly older than the victim or is in a 

position of power or control over the child, such as 

an older youth babysitting a child or a sibling. Sexual 

abuse may take place within the family (referred to 

as incest), by a parent’s boyfriend or girlfriend, by 

a caretaker outside the family (e.g., family friend, 

babysitter), or by a stranger. Contrary to the myth of 

abuse by strangers, however, sexually abused children 

Signs of Possible Psychological Maltreatment 

Children who possibly are psychologically maltreated may exhibit: 

• Extremes in behavior (e.g., manically happy or very depressed) 

• Withdrawal (e.g., no verbal or physical communication with others) 

• Self-destructive behavior (e.g., cutting oneself) 

• General destructive behavior 

• Cruelty to others, including animals 

• Rocking, thumb-sucking that is developmentally inappropriate, or head-banging 

• Enuresis (i.e., wetting one’s pants) or soiling at an age or a developmental level when such behavior is 

inappropriate 

• Substance abuse 

• Physical manifestations, such as frequent stomachaches or headaches or an unexplained weight 

loss or gain.16 

16 Recognizing Child Maltreatment 
usually know their abusers and have some form of a 

relationship with them.17 

Child sexual abuse can come to the attention of 

authorities in a number of ways. The child might 

disclose the abuse to the authorities, to another 

adult, or to a child, or may display abnormal 

behaviors (e.g., inappropriate sexual behaviors, 

such as constantly rubbing the genital area). 

Additionally, the child may have unexplained 

injuries or other medical conditions that could 

be caused by sexual abuse.18 

Additional Information About Sexual Abuse 

The following information about sexual abuse may be helpful for fi rst responders: 

• The average age of sexual abuse victims is 9 years. 

• Boys tend to be older than girls when their sexual abuse starts. 

• Boys are more likely than girls to be abused by nonfamily members and women; girls are more likely than 

boys to be abused by family members and men. 

• Multiple episodes of sexual abuse happen in one-half to three-fourths of cases. 

• Girls are more likely to be abused sexually than boys are. 

• Sexual abuse is more common in families that lack cohesion, are more disorganized, and are more 

dysfunctional. 

• Children are at a higher risk for being sexually abused if they live with only one birth parent or do not have a 

strong relationship with their mother. 

• Children with a disability are at a greater risk of being sexually abused. 

• Sexual abuse does not appear to be related to socioeconomic status.19 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

17 
Signs of Possible Sexual Abuse 

Children may have been sexually abused if they: 

• Have bruises in the inner thigh or genital area 

• Have difficulty walking or sitting 

• Complain of genital or anal itching, pain, or bleeding 

• Frequently vomit 

• Become pregnant at a young age 

• Have any sexually transmitted diseases.20 

Additionally, children may have been sexually abused if they exhibit: 

• Exceptional secrecy 

• More sexual knowledge than is age appropriate, especially in younger children 

• Indepth sexual play with peers that is not developmentally appropriate 

• Extreme compliance or withdrawal 

• Overt aggression 

• An inordinate fear of males or females 

• Seductive behavior 

• Sleep problems or nightmares 

• Crying without provocation 

• A sudden onset of wetting or soiling of pants or bed 

• Suicide attempts or thoughts of wanting to kill themselves 

• Numerous attempts at running away from home 

• Cruelty to animals (especially those that would normally be pets) 

• Setting fires and enjoying watching them burn 

• Self-mutilation (e.g., cutting or scratching to draw blood).

21 

18 Recognizing Child Maltreatment 
The Internet and Child Sexual Abuse 

A relatively recent phenomenon is the sexual abuse of children via the Internet. Children of all ages now 

have access to computers at home and in schools and libraries. Computers are invaluable tools for learning, 

but there is a growing problem of children’s exposure (accidentally or intentionally) to pornography, as 

well as to online solicitations from sexual offenders. One study indicated that 49 percent of youths being 

solicited and 44 percent of those unintentionally exposed to pornography did not report the incidents.22 

The following information may be useful to first responders who encounter possible online sexual abuse: 

• Online offenders primarily target adolescents, not young children who often do not have the same type 

of access to the Internet and developmentally are not as interested in relationships, sex, or romance as 

adolescents. 

• One study found that only 5 percent of offenders pretended to be teens when they met their potential 

victims online, and many victims expressed love or close feelings for the off enders. 

• Girls are more likely to be online victims than boys, but boys who identify as gay or question their sexual 

orientation may be particularly susceptible as well. 

• Youth with histories of offline sexual or physical abuse seem to be considerably more likely to receive online 

aggressive sexual solicitations.23 

Internet crimes can be reported to the Cyber Tipline (http://www.cybertipline.org or 1-800-843-5678), 

which is a federally funded system operated by the National Center for Missing & Exploited Children. 

CHILD FATALITIES 

The ultimate tragedy in a child maltreatment case is 

the death of a child. In 2008, an estimated 1,740 

children died from abuse or neglect. This is a rate 

of 2.33 deaths per 100,000 children, which is 

comparable to the rate of 2.32 per 100,000 children 

in 2007.24 The rates for child fatalities are much 

higher for younger children. In 2008, 79.8 percent 

of child fatality victims were younger than 4 years.25 

It has been estimated that many child deaths that 

are determined to be accidental, caused by disease, 

or classified as having some other cause were actually 

the result of child maltreatment. For example, 

studies of child deaths in Colorado and North 

Carolina found that approximately 50 percent and 62 

percent, respectively, of child deaths caused by child 

maltreatment were not recorded as such.26 

Child fatalities from maltreatment usually result 

either from chronic neglect or abuse or from a 

single, severe incident of abuse or neglect. In 2008, 

39.7 percent of child fatalities were attributable to 

multiple types of maltreatment, 33.4 were caused by 

neglect only (including medical neglect), and 22.9 

were due to physical abuse only.27 When children 

die from neglect, it often is because they have been 

without proper nourishment, medical treatment, 

or supervision.28 Additionally, acute incidences of 

neglect, such as leaving a young child unsupervised in 

a bathtub, near a pool, in a room with a loaded gun, 

or in some other potentially dangerous environment, 

may lead to a child’s death.29 The most common 

injury that results in a child fatality is severe head 

trauma.30 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

19 
Child Death Review Teams 

Child death review teams (also known as child fatality review teams) examine the causes and circumstances 

of child maltreatment fatalities and other suspicious child deaths. Forty-nine States and the District of 

Columbia have child death review teams.31 Teams consist of multidisciplinary professionals, including 

CPS workers, coroners or medical examiners, prosecutors, law enforcement personnel, and others. Th e 

information gained through the reviews may be used to help family members receive services, correctly 

classify the causes of deaths, prosecute suspected perpetrators, and develop recommendations to prevent 

future deaths and improve child safety. 

For more information about child death review teams, visit the National Center for Child Death Review 

Policy and Practice website (http://www.childdeathreview.org/). 

Sudden Infant Death Syndrome (SIDS) 

SIDS is the “sudden death of an infant under one year of age which remains unexplained even after a 

thorough case investigation, including performance of a complete autopsy, an examination of the death 

scene, and a review of the clinical history.”32 SIDS is not child maltreatment. External suff ocation, 

vomiting and choking, minor illnesses, or vaccines or immunizations do not cause SIDS, and it is not 

contagious. In addition, SIDS is unexpected, usually occurring in apparently healthy infants aged 1 month 

to 1 year. Most deaths from SIDS occur by the end of the sixth month, with the greatest number taking 

place between ages 2 and 4 months. SIDS is the leading cause of death in the United States among infants 

between the ages of 1 month and 1 year.33 

In sudden, unexplained infant deaths, investigators, including medical examiners and coroners, use forensic 

medicine, which is the application of medical science for legal purposes, to arrive at a diagnosis. Often, 

the cause of an infant’s death only can be determined by carefully collecting and evaluating information 

from the death scene and by conducting forensic tests. The child and family’s history of previous illnesses, 

accidents, or behaviors also must be reviewed carefully. It is important to note that SIDS is not listed as 

the cause of every unexplained infant death. Basic steps that first responders can take when responding 

to the death of an infant are outlined in Chapter 3, Initial Response and Investigation, and criteria for 

distinguishing SIDS from death caused by child maltreatment are presented in Appendix H, Criteria for 

Distinguishing SIDS from Fatal Child Maltreatment. For additional information, visit http://www.sids 

center.org. 

DOMESTIC VIOLENCE AND CHILD 

MALTREATMENT 

Over the past few decades, there has been a growing 

awareness of the co-occurrence of domestic violence 

and child maltreatment. Children who live in 

families experiencing domestic violence are at risk 

of exposure to traumatic events, neglect, and direct 

abuse. Research suggests that in an estimated 30 

to 60 percent of families where either domestic 

violence or child maltreatment is identifi ed, both 

may exist.34 A review of CPS cases in two States 

identifi ed domestic violence in more than 40 percent 

of cases in which there was the critical injury or death 

of a child.35 Research indicates, however, that child 

welfare workers are not identifying the occurrence 

of domestic violence in their cases.36 This also may 

be happening in other professions working with 

these families. One study found that although 31 

percent of female caregivers self-reported at least one 

incident of domestic violence in the past year, child 

20 Recognizing Child Maltreatment 
welfare workers only identified it in 12 percent of 

those cases.37 

Caregivers who are victims of domestic violence may 

be abused to the point of being unable or unwilling 

to keep their abusers from also abusing the children. 

This may be considered neglect in some States and is 

often referred to as “failure or inability to protect the 

child from harm.” In some cases, abused caregivers 

are afraid to defend the children in their care because 

doing so might put the caregiver’s or children’s lives 

in further danger or provoke more abuse. Whether 

caregivers are charged with “failure or inability to 

protect” often depends on whether the caregivers 

knew or should have known that their children were 

being abused.38 

Because of the coexistence of domestic violence 

and child maltreatment, first responders called to a 

domestic violence complaint should be alert to the 

possibility of child abuse or neglect, look for signs of 

possible child maltreatment, and assess the safety of 

the victim and the children. Children can be harmed 

in cases of domestic violence even if they are not the 

actual targets of the violence. For information about 

interviewing children in cases of domestic violence 

and factors to consider when assessing their safety, see 

Chapter 3, The Initial Response and Investigation. 

For more information on the co-occurrence of 

domestic violence and child maltreatment, see 

Child Protection in Families Experiencing Domestic 

Violence at http://www.childwelfare.gov/pubs/ 

usermanuals/domesticviolence/, the National 

Resource Center for Child Protective Services at 

http://www.nrccps.org/resources/domestic_ 

violence.php, and The Greenbook Initiative at 

http://www.thegreenbook.info/. 

SUBSTANCE ABUSE AND CHILD 


MALTREATMENT 


Even though it may be exacerbated by other problems, 

such as domestic violence or mental illness, there 

already is a strong relationship between substance 

abuse and child maltreatment. The 2007 National 

Survey on Drug Use and Health reports that 8.3 

million children live with at least one parent who 

abused or was dependent on alcohol or an illicit drug 

during the previous year. This includes 13.9 percent 

of children aged 2 years or younger, 13.6 percent of 

children aged 3 to 5 years, 12.0 percent of children 

aged 6 to 11 years, and 9.9 percent of youths aged 

12 to 17 years.40 These children face a heightened 

risk of maltreatment.41 One study, for example, 

showed that children of parents with a substance 

Risk Factors for Maltreatment 

Factors that may place a child at increased risk for being abused or neglected include: 

• Being born prematurely or having a low birth weight 

• Being perceived as unusual or different in terms of appearance or temperament 

• Being unhealthy or having congenital abnormalities 

• Having a physical, emotional, or developmental disability 

• Being irritable or displaying behaviors that are contrary to the expectations of the parents 

• Living in poverty 

• Living in an environment in which there is drug abuse, crime, or violence 

• Having young parents 

• Living in a single-family home 

• Having parents who lack education 

• Having parents who abuse substances. 

39 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

21 
use disorder are nearly three times more likely to be 

abused and more than four times more likely to be 

neglected than children of parents who do not abuse 

substances.42 Additionally, while estimates vary, most 

studies suggest that parental substance abuse is a 

contributing factor for between one-third and twothirds of children involved with CPS.43 

Methamphetamine Use and Its Impact on Children 

Methamphetamine is a powerfully addictive drug, and individuals who use it can experience serious 

health and psychiatric conditions, including memory loss, aggression, violence, psychotic behavior, and 

potential coronary and neurological damage.44 Methamphetamine is also known by ever-changing street 

names, such as speed, ice, crystal, crank, tweak, glass, bikers’ coffee, poor man’s cocaine, chicken feed, 

shabu, and yaba.45 Methamphetamine use in the United States has become an issue of great concern to 

professionals working with children and families. In 2007, there were an estimated 529,000 current users 

of methamphetamine aged 12 or older. Approximately, 5.3 percent of the population reported using this 

drug at least once in their lifetime.46 

Like children of parents with any substance use disorder, children whose parents use methamphetamine 

are at a particularly high risk for abuse and neglect. What compounds the problem for children of 

methamphetamine users is that the drug is relatively easy to make, and therefore, many of these children 

are exposed to the additional risks of living in or near a methamphetamine lab. During 2008, an estimated 

1,025 children were injured, killed at, or affected by methamphetamine labs.47 The manufacture of 

methamphetamine involves the use of highly flammable, corrosive, and poisonous materials that create 

serious health and safety hazards. Children affected by methamphetamine labs may exhibit symptoms such 

as chronic cough, skin rashes, red or itchy eyes, agitation, inconsolable crying, irritability, or vomiting.48 

Many communities have Drug Endangered Children (DEC) programs that assist CPS caseworkers, law 

enforcement, and medical services to coordinate services for children found living in environments where 

drugs are made. For more information on DEC programs, visit http://www.whitehousedrugpolicy.gov/ 

enforce/dr_endangered_child.html. 

For more information about methamphetamine, visit http://www.childwelfare.gov/systemwide/ 

substance/drug_specifi c/meth.cfm, http://www.methresources.gov/, or 

http://www.ncsacw.samhsa.gov/. 

For more information on child maltreatment in substance-abusing families, see Protecting Children 

in Families Aff ected by Substance Use Disorders at http://www.childwelfare.gov/pubs/usermanuals/ 

substanceuse/, or the National Center on Substance Abuse and Child Welfare at http://www.ncsacw. 

samhsa.gov/. 

22 Recognizing Child Maltreatment 
Signs of Methamphetamine Use and Manufacture49 

With the increased use of methamphetamine, first responders are now more likely to work with clients 

who are users or manufacturers of this drug. The following information can assist them in identifying 

methamphetamine use or manufacturing. 

Signs of possible methamphetamine use include: 

• Increased breathing and pulse rate 

• Sweating 

• Rapid/pressured speech 

• Euphoria (an exaggerated feeling of well-being) 

• Hyperactivity 

• Dry mouth 

• Tremors (shaking hands) 

• Dilated pupils 

• Lack of appetite 

• Insomnia or lack of sleep 

• Bruxism (teeth-grinding) 

• Depression 

• Irritability, suspiciousness, paranoia 

• Visual and auditory hallucinations 

• Formication (the sensation of bugs crawling on the skin) 

• The presence of white powder, straws, or injection equipment. 

Signs that methamphetamine is possibly being manufactured in a home include: 

• Laboratory equipment (e.g., flasks, rubber tubing, beakers, large amounts of coff ee fi lters) 

• Large quantities of pills containing ephedrine or pseudoephedrine (e.g., certain cold medicines) 

• A chemical odor 

• Chemicals not commonly found in a home (e.g., red phosphorous, acetone, liquid ephedrine, ether, iodine, 

phenylacetone [P2P]) 

• Unusually large quantities of household chemicals (e.g., lye, paint thinner) 

• Chemicals usually found on a farm (e.g., anhydrous ammonia) 

• Residue from the manufacture of methamphetamine (usually of a maroon color) in bathtubs, sinks, toilets, 

or on the walls 

• Containers used for purposes not originally intended (e.g., glass milk or beer bottles with unfamiliar liquids) 

• No visible means of income 

• Unusual security precautions (e.g., extra locks, barred or blacked-out windows, expensive alarm systems). 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

23 
Safety Issues When Encountering a Suspected Methamphetamine Lab 

First responders should use extreme caution and seek assistance from law enforcement, fi re/rescue 

personnel, hazardous materials crews, or other appropriate individuals or groups if they are visiting a home 

that has a suspected methamphetamine lab because these homes may have: 

• Individuals under the influence of methamphetamine or other drugs and/or who may be armed 

• Defense systems, including explosive devices and other booby traps 

• Vicious animals 

• Dangerous and volatile chemicals. 50 

First responders who enter a methamphetamine lab that has not been properly ventilated and cleaned—or 

who are not properly equipped to avoid exposure to chemicals (i.e., have respirators, protective clothing)— 

may experience shortness of breath, coughing, chest pain, dizziness, vomiting, lack of coordination, burns, 

and, in some cases, death. If first responders do come into contact with possibly dangerous chemicals, they 

should wash the exposed skin with liquid soap and water or, depending on the type of chemical exposure, a 

chemical solution. They also should remove contaminated shoes and clothing. First responders should also 

be knowledgeable about agency protocols for the evacuation, decontamination, and health screenings for 

children and others found at the home, including which, if any, of the child’s possessions (e.g., medications, 

eyeglasses) should be retrieved from the home and how they should be decontaminated. 

First responders who determine they are in a home that has a suspected methamphetamine lab should 

immediately leave the residence, taking care not to: 

• Touch anything in the lab 

• Turn on or off any electrical switches (e.g., lights) 

• Eat or drink anything 

• Open, move, or sniff containers with suspected chemicals 

• Smoke anywhere near the home 

• Alarm or act in a way that could be perceived as aggressive by others in the home (i.e., suddenly running 

from a room, pushing someone aside), especially suspected methamphetamine users, who may experience 

paranoia and extremely aggressive behavior.51 

24 Recognizing Child Maltreatment 
CHAPTER 3 

Initial Response 

and Investigation 

In Th is Chapter 

• 	 Responsibilities of first responders in cases of 

suspected child maltreatment 

• 	 Questions to be considered during an 

assessment or investigation 

• 	 Interviewing the alleged child victim 

• 	 Interviewing adults (alleged off enders and 

non-off enders) 

• 	 Documenting interviews 

• 	 Working in multidisciplinary teams 

• 	 Observing the scene 

• 	 Collecting physical evidence 

• 	 Assessing safety and developing a safety plan 

• 	 Next steps in the process 

• 	 First responders’ roles in child fatalities 

First responders who discover signs of possible 

child maltreatment, or who are in a situation in 

which child maltreatment may have occurred, should 

first ensure the safety of the child. Th ey immediately 

should assess whether there are any signifi cant and 

immediate threats to the child or others at the scene, 

including the first responders themselves. If there 

is any threat to safety, first responders should take 

immediate action to establish a safe environment. 

Once the scene is safe, first responders should begin 

an investigation and assess the future safety of the 

child and other family members. 

Response and Investigation During Disasters 

e response and investigation steps described in this chapter may not be wholly applicable during disaster 

r other emergency situations. During disasters, response and investigation protocols may be very diff erent 

han during “normal” circumstances. First responders should be familiar with their agencies’ protocols and 

se their own judgment regarding their safety and the safety of the families with which they are working. 

or more information, see Chapter 5, Responding in Disasters. 

Th

o

t

u

F

Appendix D, Reference Guide for Responding to Cases of Suspected Child Maltreatment, synthesizes key points 

from this chapter and Chapter 2, Recognizing Child Maltreatment, into a two-page handout. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

25 
Exhibit 3-1 

Responsibilities in Child Maltreatment Cases 

Emergency Medical 

Technicians (EMTs) Law Enforcement* Child Protective Services (CPS) 

• Ensure emergency medical needs • Receive reports of child abuse and • Receive reports of child abuse and 

are met neglect neglect 

• Identify and report possible child • Conduct investigations of reports • Determine whether the child is 

maltreatment of child maltreatment when there safe and, if not, develop a plan to 

• Preserve evidence is a suspicion that a crime has 

been committed 

ensure the child’s protection in the 

least intrusive manner 

• Testify in court. • 

• 

• 

• 

• 

• 

• 

Identify and report suspected 

child abuse and neglect 

Examine the crime scene 

Collect and preserve evidence 

Take statements and confessions 

Determine whether a crime 

occurred and if there is sufficient 

evidence to prosecute alleged 

off enders 

Assist in securing the protection 

of the child 

Testify in court. 

• 

• 

• 

• 

• 

• 

Conduct investigations and initial 

assessments regarding suspected 

child maltreatment 

Report maltreatment to law 

enforcement if there is a suspicion 

that a crime has been committed 

per State and local statutes 

Determine whether the child 

suffered maltreatment or is 

threatened with harm 

Determine if maltreatment is 

likely to occur in the near future 

and, if so, determine the level of 

risk 

Determine if the family has any 

emergency needs that must be met 

Testify in court. 

RESPONSIBILITIES OF FIRST RESPONDERS IN 

CASES OF SUSPECTED CHILD MALTREATMENT 

While the responsibilities and initial investigation 


methodologies of first responders often overlap, there 


are also important differences. Exhibit 3-1 outlines 


the responsibilities of each first responder when 

attending to a possible case of child maltreatment, 

and exhibit 3-2 summarizes the key questions each 

type of first responder should consider in these cases. 

*Some of the responsibilities listed for law enforcement may not be the responsibility of the first law enforcement 

officer at the scene. A detective or a specially trained investigator may be assigned the case later to complete 

the investigation. 

26 Initial Response and Investigation 
Exhibit 3-2 

Primary Questions That Should Be Considered 

During an Initial Assessment or Investigation52 

EMTs Law Enforcement CPS All 

• Does anyone need 

medical care or 

assistance? 

• Have the injuries been 

documented? How? 

• Should referrals be 

made to CPS or law 

enforcement? 

• Have any statements 

that were made by 

anyone at the scene been 

documented? How? 

Where? 

• Did a crime occur? 

• Who is the alleged 

off ender? 

• Is there evidence to 

arrest the alleged 

off ender? 

• Do sources of 

corroboration or 

witnesses exist? 

• Have all witnesses been 

interviewed? 

• Have signed witness 

statements been 

collected? 

• Did the child suff er 

maltreatment, or is the 

child threatened by 

harm as defined by the 

State reporting law? 

• Do sources of 

corroboration or 

witnesses exist? 

• Is maltreatment likely to 

occur in the near future? 

If so, what is the level 

of risk? 

• Are there emergency 

family needs that must 

be met? 

• Are agency services 

necessary to protect the 

child and to reduce the 

risk of maltreatment 

occurring in the future? 

• Is the child safe? If 

not, what measures are 

necessary to ensure the 

child’s safety? 

• Has all physical 

evidence been 

obtained, preserved, or 

photographed? 

• Are there any other 

possible victims (e.g., 

siblings)? 

• Should the child be 

taken into protective 

custody? (If yes, EMTs 

should refer the case 

to CPS or to law 

enforcement.) 

Objectivity of First Responders 

First responders should begin each case with objectivity. One of the biggest problems confronting many 

first responders is jumping to conclusions before all the facts have been presented and assessed. First 

responders can minimize this by initially developing several theories of what actually happened in each case. 

Examples of theories include: 

• The injuries occurred exactly as they were reported. 

• The reporter was confused or misunderstood. 

• This is an intentionally false report. 

First responders should explore each of their theories thoroughly through interviews and evidence 

collection. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

27 
INTERVIEWING THE ALLEGED CHILD VICTIM 

The child interview often is the focal point of the 

investigation. Many forms of child maltreatment 

leave few or no physical marks or evidence, and child 

interviews may be crucial to the case. Conducting 

these interviews can be challenging, but training and 

experience can assist first responders in gathering 

accurate, helpful information. What follows is 

information about the basics of conducting child 

interviews, developmental considerations, and tips on 

how to conduct culturally competent interviews. 

Interview Basics 

This section provides basic information about 

conducting an interview with an alleged victim 

of child maltreatment. It includes guidelines for 

the first responder to follow during the interview, 

as well as the types of questions that should 

be asked. 

Before the Interview 

The interview with the alleged victim should take 

place immediately after the allegations have been 

made, when possible.53 The first responder should 

prepare the child for the interview before it begins. 

Some techniques that may be used include: 

• 	 Having the first responder introduce herself and 

her role to the child 

• 	 Explaining the purpose of the interview in 

developmentally appropriate language 

• 	 Discussing confidentiality and its limits 

• 	 Explaining that it is okay for the child to say that 

he does not know the answer 

• 	 Communicating concern for the child’s safety 

• 	 Allowing the child to practice answering openended questions.54 

It is important to gain the trust of the child and 

establish a rapport prior to beginning the interview. 

The child may be more likely to share information if 

he trusts the first responder. To build trust, the fi rst 

responder can begin an interview by talking about 

general topics, such as the child’s favorite television 

show or a toy he likes.55 It also is a good idea to 

interview the child in a comfortable and secure 

environment, such as a child advocacy center or a 

private room at the child’s school. Ideally, the alleged 

child victim interview will be conducted without the 

child’s parent or other caretaker present in order to 

ensure that the child’s statement is his own and not 

infl uenced by others. It may be necessary to reassure 

the child that the parent or caretaker is nearby and 

available if necessary or appropriate. 

Confi dentiality 

Although the first responder needs to establish trust with the child, it is important that she does not mislead

the child about whether the information will be kept secret. The first responder should be open with the 

child about the limits of confidentiality so that the child does not feel betrayed later in the process.56 What 

this generally means is that anything the child tells the first responder that relates to an incident of alleged 

maltreatment must be disclosed to the proper authority. First responders should become familiar with 

confidentiality policies in their agencies and jurisdictions. 

28 Initial Response and Investigation 
 

Interview Guidelines 

Some basic guidelines for conducting interviews with 

children are to: 

• 	 Avoid jumping to conclusions 

• 	 Be at the child’s eye level (e.g., sitting on the fl oor 

with him), if possible 

• 	 Leave a comfortable space between the interviewer 

and the child 

• 	 Create a child-friendly environment (e.g., have 

toys available) 

• 	 Use body diagrams or dolls to help the child 

clarify body parts that are discussed 

• 	 Be mindful of responder’s facial expressions and 

body language 

• 	 Minimize the use of yes or no and multiplechoice questions 

• 	 Follow up all closed-ended questions with openended questions (types of questions are discussed 

later in this chapter) 

• 	 Listen carefully and completely (i.e., do not rush 

the child) 

• 	 Assess the child’s understanding of key concepts 

(e.g., being able to tell the truth, understanding 

timeframes), which will help to establish 

credibility as the interview proceeds into 

sensitive areas 

• 	 Reduce vocabulary problems by using the child’s 

vocabulary, when appropriate, and clarifying any 

areas of confusion 

• 	 Avoid using double negatives (e.g., “So your 

father didn’t not hit you with the belt?”) 

• 	 Observe the child’s nonverbal communication 

and body language 

• 	 Document the interviewer’s and child’s words 

carefully and completely, perhaps by audio- or 

videotaping the interview 

• 	 Be attuned to the developmental capabilities 

and limitations of the child as the interview 

progresses.57 

During the interview, first responders should assess 

the child’s statements for accuracy and for how they 

match other information or evidence that is collected. 

The accuracy of the interview may be infl uenced by: 

• 	 The child’s age and developmental stage 

• 	 The child’s understanding of events 

• 	 The child’s emotional state 

• 	 The first responder’s style and request for details 

• 	 The structure and nature of the questions.58 

To ensure that facts are gathered in a way that will 

be admissible in court, the first responder should 

carefully control the interview. This means that the 

first responder’s statements and body language should 

be neutral, alternative explanations for the child’s 

statements should be explored thoroughly, and the 

interview should be documented in such a way that it 

can bear scrutiny in court.59 

Types of Interview Questions 

The first responder should be aware of the types of 

questions used during the interview. Open-ended 

questions (e.g., “What happened to your arm?”), 

which allow the child to develop an answer that 

goes beyond yes or no, are often preferred during an 

interview. The goal of asking open-ended questions is 

to allow the child to tell the first responder, in his own 

words, what happened. The child’s response is more 

credible when the first responder asks him openended questions. The standard open-ended question 

for all first responders should be, “What can you tell 

me about what happened?” The first responder can 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

29 
Ways to Calm an Anxious Child 

A first responder can use the following techniques to try to calm an anxious child: 

• Respond as quickly as possible to the child’s signs of distress by approaching the child and by showing 

interest in what the child is feeling 

• Do not hug or touch the child unless he says it is okay to do so 

• “Listen” to what the child is saying with words and actions (e.g., nod, summarize what the child said when 

appropriate) 

• Take the child’s feelings—especially fear—seriously 

• Be as relaxed as possible when helping the child calm down 

• Restate to the child what he is saying to make sure he is understood 

• Provide appropriate outlets for strong emotions, including anger, frustration, sadness, and loneliness (e.g., 

letting the child use a punching bag, go to a quiet corner, play with a tape recorder, run in a special “running 

space,” paint) 

• Be there for the child; the first responder’s presence and care can be reassuring. 60 

follow that up with, “Can you tell me more about 

that?” 

Closed-ended questions (e.g., “Is your arm hurt?”) tend 

to restrict the information that the child provides to 

a fixed set of responses, such as yes or no. Multiplechoice questions (e.g., “Were you hit one, two, or three 

times?”) are a type of closed-ended question. Closedended questions can encourage young children to 

guess the answer even when they do not understand 

the question. They provide information to the child 

rather than the child providing the information. 

With multiple-choice questions in particular, none of 

the choices may be correct, but the child may choose 

one simply to please the fi rst responder.61 Th ough 

not as preferred as open-ended questions, close-ended 

questions can still be used appropriately during an 

interview (e.g., at the end of an interview to clarify 

information provided or omitted by the child). 

The first responder should not ask leading questions 

(e.g., “Did daddy hurt your arm?”). Direct questions 

or statements (e.g., “I see you have a mark on your 

arm.”) may, however, be necessary at times to direct 

the child to provide more information. Th e fi rst 

responder should follow every direct question or 

statement with open-ended probes, such as, “Tell 

me what happened,” or “Who hurt your arm?” If 

the child responds that it was “his daddy” who 

hurt him, then the open-ended probe would be, 

“Can you tell me more about how daddy hurt your 

arm?” Additionally, when the child fails to mention 

important information, prompts may be necessary. 

For example, if the child uses a “family word” for 

something, such as using “the bad boy room” to mean 

the hallway closet, the first responder may need to 

clarify the statement by asking a question such as, 

“Where is the bad boy room?”62 

End of the Interview 

At the end of the interview, the first responder should 

thank the child for his time and praise him for working 

hard. The praise should be for the eff ort and not for 

the content of what was said. If the child is upset, 

the first responder should offer support and empathy. 

She can ask the child what he thought of the interview 

and can attempt to dispel any misperceptions. Th e 

first responder also should make sure that the child 

does not feel that what happened was his fault. Even 

if the child did not struggle or try to keep the abuse or 

neglect from happening or, in cases of sexual abuse, if 

30 Initial Response and Investigation 
he enjoyed the sexual activity, the first responder still 

needs to reassure the child that he is not at fault.63 

In addition, the first responder should let the child 

know what the next steps will be.64 This will vary 

depending on the type of maltreatment and the 

particular child and family. Additionally, the fi rst 

responder should make sure that the child is safe if the 

disclosure of information puts the child in jeopardy 

(i.e., the alleged perpetrator would further harm the 

child because of the disclosure). 

Developmental Considerations 

Most children go through a series of normal 

developmental stages and changes. First responders 

should be aware of the developmental levels of 

children, particularly when conducting interviews, to 

ensure that they ask questions that can be understood 

by the children and have more context for the answers 

they receive. The developmental considerations that 

follow in this section for preschool-aged and young 

children and for older children and adolescents are 

based on the typical characteristics of children of 

those age ranges. Children, however, may move 

through developmental levels at different times. For 

example, a 14-year-old child, especially one who was 

maltreated, may be at a developmental level typically 

associated with a child who is 9 or 10 years old. 

Preschool-aged and young children. Th e following 

are important considerations for interviewing 

children in this age range: 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

31 
Investigating Sexual Abuse 

In 2008, 9.1 percent (69,184) of child maltreatment victims were sexually abused. Although sexual abuse 

victims may be of any age, older children are more likely to be victims. Additionally, almost two thirds 

of sexual abuse perpetrators were family members, with 27.1 percent being a parent, 8.8 percent being an 

unmarried partner of a parent, and 29.4 percent being another relative.65 

In order to work effectively on sexual abuse cases, first responders should: 

• Have a thorough understanding of child development and be able to communicate effectively with children 

of all ages 

• Understand that familial child sexual abuse does exist, as well as the dynamics associated with it 

• Be able to distinguish between true, confused, and false statements 

• Remain neutral and attempt to obtain as much factual information as possible.66 

Working on sexual abuse cases can be very emotionally trying for first responders. Common responses 

include anger, disgust, and denial. First responders should not let their emotions affect the way they 

handle a case. They should remain objective and follow up on several theories. If first responders are not 

able to control their emotions, they should not be assigned to conduct interviews during a sexual abuse 

investigation.67 

Investigating child sexual abuse cases presents extremely challenging circumstances for fi rst responders 

because: 

• Sexual abuse generally occurs in secret and with no witnesses. Child victims may be sworn to secrecy or the 

abuser may threaten to harm the child, his family, or his pet if he tells. 

• Child victims may care for their abusers and may not want to see any harm come to them. It takes a 

tremendous amount of courage for a child to come forward and to speak up against an adult abuser, 

especially if it is a loved family member or friend. 

• Sexual abuse rarely occurs only once. Generally, the grooming process (i.e., preparing the child for eventual 

sexual abuse by befriending them, giving them presents, etc.), which is sometimes called conditioning, and 

the sexual assaults occur on numerous occasions over a period of time. 

• The child victim often is confused by the circumstances and rarely can tell a coherent story about how the 

abuse began. What may have started as a backrub or a wrestling game can slowly progress over a period of 

time into sexual assault. 

First responders should try to determine the following information during the child interview in sexual 

abuse cases: 

• How and where the child was touched 

• If threats, promises, or requests were made 

• If other victims or offenders were involved 

• When and how often the abuse occurred 

• Where the abuse occurred.68 

Although a medical examination should be conducted later to look for signs of sexual abuse and to 

collect evidence, most child victims will not display physical signs of abuse. This may be due to delayed 

disclosure or because the nature of the abuse is not such that it would leave physical trauma (e.g., fondling, 

performing oral sex).69 

32 Initial Response and Investigation 
Secondary Traumatic Stress (STS) in First Responders 

First responders who work on child maltreatment cases may be at risk of developing STS, which is a 

condition caused by indirect exposure to trauma through a firsthand account of a traumatic event (e.g., 

interviewing or witnessing a child who has been severely abused).70 STS is also known as vicarious trauma 

or compassion fatigue. The symptoms of those experiencing STS may be similar to the stress symptoms 

experienced by the direct victim, such as increased fatigue or illness, social withdrawal, diffi culty sleeping, 

feelings of hopelessness, re-experiencing the event, anxiety, and sadness.71 Symptoms may be experienced in 

both their personal and professional lives. STS is different than what is commonly referred to as “burnout” 

as the latter is usually caused by work issues, such as long-term involvement in a nonsupportive work 

environment, large caseloads, and excessive paperwork.72 

First responders who believe they are experiencing STS should consult with a mental health professional 

and/or seek other support. They can help prevent STS by maintaining a personal/professional life balance, 

practicing stress management, spending time with family and friends, and taking personal time. Agencies 

can assist first responders experiencing STS by destigmatizing the condition (e.g., promoting openness and 

discussion about it) and encouraging affected workers to seek support.73 

• 	 Children’s thinking tends to be very concrete, 

and their ability to think abstractly is still 

developing. Irony, metaphor, and analogy are 

beyond their grasp. Th erefore, fi rst responders 

should not assume that children understand all 

the concepts presented to them. 

• 	 Children generally do not organize their 

thinking or speech logically. Instead, they say 

whatever enters their mind with little censoring 

or consideration. Therefore, their narratives tend 

to be disjointed and rambling, resulting in the 

need for first responders to sort out relevant from 

irrelevant data. It generally is beyond young 

children’s cognitive capacities to do this alone. 

First responders, however, should not ask them 

leading questions (e.g., “Isn’t it true that your 

uncle hit you with his belt?”). 

• 	 Children’s understanding of space, distance, 

and time generally may not be logical or linear. 

Since they probably have not learned units of 

time measurement, their memory may not work 

chronologically. To help them place the time of 

an incident, fi rst responders should use reference 

points, such as birthdays, holidays, summer, 

night, day, lunchtime, bedtime, television shows, 

and before and after school. 

• 	 Children generally are egocentric. Th ey think 

the world revolves around them and relate all that 

happens to personal issues. These children usually 

do not think about what effect their actions will 

have on others, or they may think everything, 

including the maltreatment, is their fault. 

• 	 The attention span of children is limited. Long 

interviews often are not possible because these 

children cannot concentrate or sit in one place 

for long periods of time. First responders should 

be flexible, conducting several short sessions over 

a brief period of time. 

• 	 Many children are afraid to talk with an 

unfamiliar person without a parent present. 

First responders should work slowly to help 

children separate from the parent, when possible. 

If this process is difficult, the interview may need 

to begin with a nonoffending parent present, 

when appropriate, and work toward separate 

interviews at a later time once the child feels 

more comfortable. First responders should be 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

33 
 

flexible and follow the children’s lead as long as it 

is within the protocol and the policies established 

by their agency. 

• 	 Children often are more compliant, suggestible, 

and easily confused than older children. First 

responders should be careful not to ask questions 

or to make statements that would infl uence the 

way children recount their situation.74 

Older children and adolescents. Children in this age 

range: 

• 	 Usually have a greater preference for a samegender interviewer 

• 	 May be awkward or embarrass easily 

• 	 Encompass a wide variety of physical and 

emotional developmental levels (e.g., some may 

look like adults, whereas others look more like 

children) 

• 	 May be in a stage where they are asserting their 

independence from adults and authority fi gures; 

they may not want to talk about the incidents or 

to tell the whole story.75 

Culturally Competent Child Interviews 

Children who have been abused or neglected may suff er 


from trauma, may have been threatened into keeping 


secrets, and may feel frightened and intimidated by
 

the entire interview process.76 When language and 

cultural differences enter the mix, achieving enough 

rapport to elicit full and accurate information may 

seem nearly impossible.77 The following are tips for 

conducting a culturally competent interview with a 

child: 

• 	 Gather information about the child’s 

background before conducting the interview, 

if possible. Answers to the following questions 

will help the first responder understand the extent 

to which the child is rooted in his culture and 

how much of an adjustment needs to be made in 

the standard interviewing process. 

– 	 What language or languages are spoken at 

home? 

– 	 What language does the child prefer to speak 

with siblings and friends? 

– 	 Is the child an immigrant or a child of an 

immigrant? If so, from where, and what 

were the circumstances of the immigration? 

– 	 Who lives at the home? Who else stays there? 

– 	 What is the child’s religion? How observant 

is the child’s family? 

– 	 Are the members of the family acculturating 

at different rates? If so, is it leading to 

confl ict? 

• 	 Select a neutral setting for the interview. 

Although this may not be possible for the fi rst 

responder, she should consider conducting the 

Truth and Lying in Preschool-aged Children 

Issues of truth and lying are particularly complex in the preschool years. Children in this age group 

may tell lies to avoid a problem or punishment, to impress adults, or to get attention. Research varies, 

however, on whether children can manufacture stories based on information that they have not learned 

or experienced. Despite their occasional tendency to tell false stories, children in the preschool years 

usually know the difference between fact and fantasy and between the truth and a lie. Gentle probing and 

nonleading questions from first responders usually will help children reveal what is true and what is false. 

First responders also should keep in mind that children can become easily confused about

 what happened.78 

34 Initial Response and Investigation 
Interviewing Children in Cases of Domestic Violence 

If child maltreatment and domestic violence may be co-occurring, first responders should incorporate 

questions about domestic violence into the interview and assessment. First responders should keep in 

mind that children receive messages, either directly or indirectly, that domestic violence is a “family 

secret.” Children often are uncomfortable and frightened of talking about it. Some children may be afraid 

that discussing the violence will create additional problems at home, such as additional violence or the 

separation of their parents. Other children may align with the abuser and attempt to provide protection 

by not discussing the violence or even by blaming the victim or themselves. It is critical to tell children 

that the violence is not their fault and that their feelings are normal. First responders should begin direct 

inquiry regarding domestic violence with a general statement, which may help the child feel more at ease. 

An example of this would be stating, “Sometimes when moms and dads (or boyfriends) fight, they get 

angry, sometimes even too angry. They may start to yell at each other or even hit each other. I know fi ghts 

can be scary. I want to ask you a few questions about whether your parents fight and what you think about 

it. Would that be OK?” 

First responders may want to consider asking alleged victims of domestic violence for suggestions on 

interviewing the children about it in order to have an initial understanding of the children’s likely attitude 

or behavior. They should keep in mind, however, that caretakers often underestimate the eff ects that 

domestic violence has on their children.79 First responders should assist the children and, whenever 

possible, the nonoffending parents in developing positive and effective methods to protect themselves. 

Where appropriate, safety plans need to include tips for children, such as what to do and who to contact 

for help in domestic violence situations. See Appendix I, Domestic Violence Exposure Assessment, for 

recommendations on interviewing children who may be affected by domestic violence. 

interview in a place of worship, a school, or some 

other place familiar to the child. If possible, law 

enforcement officers should be dressed in plain 

clothes because many members of immigrant 

groups do not see the police as their allies. 

• 	 Build rapport and establish trust. To gain 

trust, the first responder should explain her role, 

credentials, and experience carefully. Th e fi rst 

responder should be clear about the purpose of 

the conversation and explain it in simple terms 

and without professional jargon. Language 

confusion will be more acute and more frequent 

when the family’s native language is not English. 

In addition, depending on its culture, the family 

may trust certain professionals and not others 

(e.g., trust a doctor or nurse more than a social 

worker or law enforcement officer). 

• 	 Express empathy and warmth. Some Spanishspeaking cultures, for example, view professionals 

from the United States as cold, disinterested, and 

rejecting. The warmer the connection between 

the first responder and the child, the more 

comfortable the child will be in correcting the fi rst 

responder if the first responder makes a mistake, 

such as providing inaccurate information about 

the incident during the interview. Also, the child 

tends to be more forthcoming with information. 

• 	 Audiotape or videotape the interview. When an 

interpreter is used, an audiotape or videotape of 

the interview should be made. This record of the 

interview will be helpful should the translation of 

certain words be questioned in court.80 

The first responder should also keep in mind that even 

though she may expect the child to reveal sensitive 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

35 
 

information, personal matters may be discussed only 

indirectly, if at all, in the child’s culture. 

Interviewing Children with Disabilities 

Children with disabilities are more likely to be abused 

or neglected than children who do not have disabilities 

and are also less likely to report their maltreatment.81 

When interviewing children with disabilities, fi rst 

responders should recognize and understand the 

children’s unique characteristics, competencies, 

and limitations.82 As part of their normal training, 

first responders can familiarize themselves with 

various types of disabilities and how they may affect 

interviews and other areas of the response. If possible 

and if time permits, first responders should also 

gather information about the individual child prior to 

the interview. This information may include whether 

the child: 

• 	 Uses sign language, wears a hearing aid, or reads 

lips 

• 	 Is at a developmental level different from his age 

• 	 Has problems focusing or paying attention 

• 	 Uses a wheelchair or other adaptive equipment 

• 	 Has impaired or unusual speech 

• 	 Needs to be accompanied by a support person.83 

Although children with disabilities may have certain 

difficulties providing information about suspected 

maltreatment, they can provide valuable information. 

First responders can obtain useful and accurate 

information by keeping the following in mind during 

the interview: 

Factors to Consider When Interviewing Native American Children 

When working with Native American children and families about possible child maltreatment, CPS 

caseworkers should ensure that they understand and follow the regulations set forth in the Indian Child 

Welfare Act. Additionally, first responders should keep the following in mind: 

• Native American children may use their native language when describing people, body parts, or the situation 

in general. The first responder should implicitly or explicitly give children permission to communicate in 

whichever language they are most comfortable using and seek translating services when necessary. 

• Silence and pausing before responding are common among Native Americans. The first responder should 

allow the child to speak at his own pace. 

• Native American children may be particularly attuned to nonverbal communication (e.g., facial expressions), 

so the first responder should pay attention to how her nonverbal cues may be interpreted. 

• In Native American culture, not making eye contact may be an expression of respect. 

• Native American children may mark life events by seasons, ceremonies, and daily activities rather than by 

dates or days of the weeks. 

• The sense of community in his culture might cause a Native American child to not make allegations against 

or implicate an elder or other community member. 

• There may be a historical distrust of legal and social authorities that may discourage full participation in the 

interview process.84 

For additional information about working with Native American children and families, visit the National 

Indian Child Welfare Association website at http://www.nicwa.org, and Child Welfare Information 

Gateway at http://www.childwelfare.gov/systemwide/cultural/families/indian.cfm and http://www. 

childwelfare.gov/management/training/curricula/caseworkers/topical/amer_indian.cfm. 

36 Initial Response and Investigation 
• 	 Use simpler language and shorter sentences, 

but do not necessarily treat them like younger 

children or babies 

• 	 Recognize that children with disabilities may have 

various levels of capabilities across diff erent areas 

(e.g., they may be developmentally delayed with 

language but have age-typical cognitive abilities) 

• 	 Use mostly open-ended questions in the 

beginning, as is best with all child interviews 

• 	 Be especially careful about using yes/no questions 

or asking the same question repeatedly because 

children with disabilities may be less assertive or 

feel more of a need to be compliant or obedient.85

INTERVIEWING ADULTS 

After interviewing the alleged victim of child 

maltreatment, the first responder, when possible, 

should proceed to interview the adults in the home 

or wherever the alleged maltreatment occurred or was 

reported. (Throughout this section, the word adult is 

used to signify parents, caregivers, or other adults who 

may be of interest in the case.) Th e fi rst responder 

should begin by interviewing the nonoff ending adults 

and then the adults suspected of the maltreatment. 

Th e off ending or the nonoff ending adult may not be 

a parent, but a relative, friend, neighbor, boyfriend, 

or girlfriend. Additionally, an adult who initially is 

not suspected of being an off ender may be suspected 

at a later time. The first responder should keep in 

mind that approximately 80 percent of off enders 

are parents, but this should not preclude the fi rst 

responder from considering other adults in the 

investigations.86 Exhibit 3-3 provides statistics on the 

types of relationships child maltreatment off enders 

have to their victims. 

Interviewing Nonoff ending Adults 

In cases of alleged child maltreatment in which the 

maltreatment took place between one adult and the 

child without the knowledge or the participation of 

the other adults, the nonoffending adult may be a 

good source of information. The primary purpose of 

these interviews is to: 

• 	 Find out what, if anything, the adult knows 

about the alleged maltreatment 

Interviewing Siblings 

First responders should interview the alleged victims’ siblings in order to: 

• Determine whether the siblings have experienced maltreatment 

• Assess their levels of vulnerability 

• Gather corroborating information about the nature and the extent of any maltreatment of the identifi ed 

child 

• Gather further information about the family that may assist in assessing the risk to the identified child and 

the siblings. 

First responders should interview siblings using the same sensitivity and with similar styles of questions 

(mostly open-ended) as used in the interview of the alleged victim. First responders also should evaluate 

the objectivity of the siblings.87 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

37 
Exhibit 3-3 

Offenders by Relationship to Victims, 200889 

A. 

C. 

E. 

G. 

I. 

K. 

B 

E

D 

C 

F G H I J K 

A. Parent 

80.1%

 Parent 80.1% B. Other Relative 6.5% 

 Foster Parent 0.4% D. Residential Facility Staff 0.2%

 Child Daycare Provider 0.5% F. Unmarried Partner of Parent 4.4%

 Legal Guardian 0.2% H. Other Professionals 0.1% 

 Friends or Neighbors 0.5% J. Other 3.7% 

 Unknown or Missing 3.3% 

• 	 Gather information related to the risk of 

maltreatment and the safety of the child 

• 	 Gather information regarding family strengths or 

protective factors 

• 	 Determine the adult’s capacity to protect the 

child.88 

The first responder should interview the nonoff ending 

adult as soon as possible after the allegations 

have been made so that the statements will not be 

affected by contact with the alleged abuser. Th e 

first responder should provide the nonoff ending 

adult with basic information about the allegations 

without offering all the details. If there is evidence 

corroborating the child’s allegations, the fi rst 

responder should let the nonoffending adult know 

that she believes the child. The first responder should 

then explain to the nonoffending adult the process 

for the investigation and emphasize the importance of 

gathering information and evidence. Th roughout this 

discussion, the first responder should note whether 

the adult appears to believe the child and for whom 

38 Initial Response and Investigation 
the nonoffending adult expresses concern (the child 

or the alleged abuser).90 

The following are basic questions that the fi rst 

responder should ask nonoffending adults: 

• 	 What happened? 

• 	 How did the maltreatment happen? 

• 	 Who maltreated the child? 

• 	 Who was with the child? 

• 	 Who saw the maltreatment happen? 

• 	 Where did the maltreatment happen? 

• 	 Where were the other household members? 

• 	 When did the maltreatment occur? 

Appendix J, Interviewing Nonoffending Adults, 

provides additional questions that the fi rst responder 

can ask nonoffending adults in the home. 

Interviewing the Alleged Offender 

The primary goal of interviewing the alleged offender is 

to gather as much information as possible that verifi es, 

clarifies, or refutes the maltreatment allegations. The 

first responder should interview the alleged offender 

last. This allows the first responder to question the 

suspect with information gathered through interviews 

with the alleged victim and others.91 Before the 

interview, the first responder should gather additional 

information about the alleged offender and the family 

in relation to the risk to and the safety of the child. 

This information, coupled with the information 

collected during interviews with the alleged victim 

and nonoffending adults, will help the fi rst responder 

develop a more complete picture of the situation. 

During the interview, the alleged offender should 

be presented with the allegations and with specifi c 

information that was relayed during interviews with 

the victim and others. First responders use various 

methods to elicit a confession or gather additional 

information. For example, the fi rst responders could 

appeal to the suspect’s sense of loyalty to his family 

or to the suspect’s love for the child (e.g., “Telling 

us what happened that day is the best way to help 

your son.”).92 The first responder should evaluate 

the alleged perpetrator’s reaction to allegations of 

maltreatment, as well as to the child and the child’s 

condition. 

If the alleged offender is unable to provide information 

to refute the allegations, law enforcement or CPS will 

attempt to obtain a confession or an admission. If 

the alleged offender confesses, the law enforcement 

officer should follow the appropriate guidelines 

for documenting the confession and for arresting 

the suspect. If it is a CPS worker who obtains 

the admission, law enforcement may be called, 

depending on the severity of the maltreatment. If the 

suspect does not confess, it may be useful to offer him 

the chance to take a polygraph examination. Most 

importantly, the first responder should follow agency 

or department protocols and procedures when making 

these decisions.

93 Exhibit 3-4 presents a checklist for 

conducting interviews with alleged offenders. 

The first responder may need to ask follow-up 

questions to clarify what occurred if the alleged 

offender describes any of the following: 

• 	 A disclosure by the alleged offender that 

maltreatment did take place 

• 	 No explanation for an injury or suspect incident 

• 	 An explanation for an injury that is inconsistent 

with either the severity or the type of injury 

observed 

• 	 Different or changing explanations for an injury 

or incident 

• 	 A delay in obtaining medical treatment for an 

injury.94 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

39 
Exhibit 3-4 

Checklist for the Alleged Offender Interview for Law Enforcement and 

CPS Investigations 

During an alleged offender interview, the first responder should: 

• Maintain the element of surprise. This works to the advantage of the first responder. 

• Choose the location of the interview carefully. The location of the interview may enhance confession 

rates. The police station or the CPS office, for example, may be conducive to a confession or an admission. 

• Know the basic information about the maltreatment. The first responder should attempt to have 

knowledge of the modus operandi (a characteristic method of operation or procedure) of the suspect (e.g., 

usually says certain phrases during the maltreatment, uses a particular object to hit the child), as well as the 

who, what, when, where, and how of the maltreatment. The first responder should have already established a 

timeline for the maltreatment. 

• Be knowledgeable about the evidence and other information about the case. When possible, the fi rst 

responder should know about the available evidence and information about the case, including marks on the 

child, previous interviews with witnesses and victims, opportunity, and information about the scene of the 

maltreatment. 

• Make sure the alleged offender knows that the first responder believes the child, if appropriate. Th e 

first responder should confront denial gently, allow the suspect room to deny, listen carefully, test the denial, 

and strongly present the suspect with corroborative information, if pertinent and appropriate. 

• Be patient during the interview. The first responder should take the time to conduct a thorough and 

accurate interview. 

• Conduct the interview with a sensitive, empathetic style. This can create an environment conducive to a 

suspect’s confession or admission. 

• Obtain a signed, written statement or an audio- or videotaped statement. The first responder should be 

mindful of her agency’s policy on audio- or videotaping. 

DOCUMENTING INTERVIEWS 

Gathering and documenting accurate information 

from the alleged victim and from other family members 

and collateral sources are imperative to the success of a 

child abuse or neglect case. Inaccuracies in children’s 

statements, as recorded by the first responder, may be 

used to discredit the children later. Also, adult victims 

often are given time to review their statements before 

signing them to correct inaccuracies; child victims, 

however, usually are not given that opportunity. Th e 

first responder taking statements from an alleged child 

victim should attempt to clarify and understand the 

accuracy of the statements. Properly documenting 

the information, however, can sometimes be difficult. 

Conducting interviews and writing down questions 

and responses may be cumbersome and distracting 

to those being interviewed, as well as to the fi rst 

responder conducting the interviews. Additionally, 

child victims often communicate their maltreatment 

in fragmented and disjointed sentences. 

The following guidelines are recommended for 

documenting interviews: 

• Follow the agency’s or department’s protocols 

• Give the child permission to correct statements 

40 Initial Response and Investigation 
Miranda Rights 

Before questioning a suspect in custody, a law enforcement officer generally reads the suspect his Miranda 

rights, which state: 

You have the right to remain silent. If you give up the right to remain silent, anything you say can 

and will be used against you in a court of law. You have the right to an attorney. If you desire an 

attorney and cannot afford one, an attorney will be obtained for you before police questioning.95 

The purpose of the Miranda warning is to protect an individual’s Fifth Amendment right against selfincrimination. Information provided by a suspect is inadmissible at trial if those statements are made 

without a Miranda warning being provided before questioning or if the questioning continues after the 

suspect indicates that he wants an attorney present. A law enforcement officer does not have to read a 

suspect his Miranda rights, however, during “noncustodial” interviews (i.e., the suspect is not under arrest). 

If the law enforcement officer does not have to read the suspect his Miranda rights, the interview tends to 

be less hostile. Miranda rights only apply to statements made to law enforcement, not statements to CPS workers 

or EMTs. 

• 	 Document both the questions and answers, when 

possible 

• 	 Listen carefully to answers 

• 	 Read answers back to the child for clarifi cation, 

when appropriate 

• 	 Write notes clearly and concisely 

• 	 Quote direct statements, when possible 

• 	 Videotape or photograph the crime scene to 

confi rm accuracy 

• 	 Try to have an investigative team of one 

interviewer and one note taker. 

OBSERVING THE SCENE 

When gathering information for the case, the 

first responder should observe the identifi ed child 

victim, the other family members or adults, and 

the environment, including the scene of the alleged 

abuse. Everything that is viewed, heard, smelled, 

or otherwise observed at the scene is important 

information that must be documented. Specifi c areas 

for observation are: 

• 	 The physical condition of the child, including 

any observable effects of maltreatment 

• 	 The emotional status of the child, including 

mannerisms, signs of fear, and developmental 

status 

• 	 The reactions of the parents or caregivers to the 

first responder’s concerns 

• 	 The emotional and behavioral status of the 

parents or caregivers during the interview process 

• 	 The interactions between family members, 

including verbal and body language 

• 	 The physical status of the home or site of 

maltreatment, including cleanliness, structure, 

safety hazards, signs of excessive alcohol use, and 

signs of illicit drug use (e.g., drug paraphernalia, 

evidence of a methamphetamine lab) 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

41 
Multidisciplinary Teams 

If the goals of all first response agencies are to be achieved, EMTs, law enforcement offi cers, and CPS 

caseworkers should work with each other to eliminate any unnecessary duplication of effort, to promote 

proper and expeditious collection and preservation of evidence, and to develop a coordinated system 

for identifying and investigating reports of child maltreatment. This is best accomplished through a 

team approach in which professionals share information, assign investigative tasks, and participate in a 

collaborative decision-making process.96 The use of multidisciplinary teams for the investigation of child 

maltreatment has become an effective approach in various jurisdictions across the country. There are many 

benefits to this type of approach, including: 

• Increasing the early identification of child maltreatment 

• Reducing trauma to child victims by minimizing the number of interviews the child must experience 

• Preventing duplication and minimizing the number of interviews and court appearances by fi rst responders 

• Allowing first responders to provide necessary support to the alleged victim, as well as to one another 

• Helping provide a clearer picture of the situation 

• Allowing for more thorough investigations and for increasing the likelihood of achieving a positive case 

outcome 

• Preserving and enhancing the quality of the evidence needed for decision-making and successful 

prosecution.97 

To facilitate this process, the first responders’ agencies should develop protocols or memoranda of 

understanding (MOUs) that guide the investigative process and that specify timeframes and roles and 

responsibilities of the professionals involved in child protection. In jurisdictions where there is a lack 

of coordination among professionals involved in the child protection system, there often are confl icting 

opinions as to who should conduct the interview of the alleged offender during the investigation. For 

example, in cases of severe child physical abuse and sexual abuse, law enforcement may prefer that CPS not 

interview the alleged offender prior to law enforcement’s involvement. However, a CPS investigator may 

be the first and only responder to a case because the law enforcement agency cannot respond immediately 

or is not available to conduct the interview of the alleged offender for several days. MOUs can assist 

collaborating agencies in determining the roles and responsibilities of each. For more information on 

MOUs, refer to Appendix K, Memorandum of Understanding. 

First responders should be aware of the potential barriers to a multidisciplinary approach. A review of the 

literature on co-involvement of law enforcement and CPS in child welfare cases found that barriers include 

concerns about the other’s investigation techniques and protocols and about the privacy and confi dentiality 

of families.98 To help establish a team approach, first responders should have a clear understanding of each 

other’s roles, including the limitations of these roles, as well as the expertise that each profession can bring 

to the case.99 They also should trust and respect one another and understand that they are all working 

toward the common goal of keeping children and families safe. 

For more information about agencies and communities working together to prevent and respond to cases 

of child maltreatment, see Community Partnerships: Improving the Response to Child Maltreatment at http:// 

www.childwelfare.gov/pubs/usermanuals/partners/. 

42 Initial Response and Investigation 
• 	 The climate of the neighborhood, including 

the level of violence or drug use, and the 

accessibility of transportation, and methods of 

communication (e.g., cell phone coverage).100 

The first responder should note in her report any 

observations of these circumstances. 

COLLECTING PHYSICAL EVIDENCE 

The first responder also plays an important role in the 

collection and preservation of physical evidence. After 

ensuring that the child is protected from additional 

harm or injury, the first responder should ensure that 

the area in and around the scene is contained and that 

evidence is collected and documented according to 

agency and department protocols. Some evidence, 

such as semen, must be collected immediately and 

in a way that avoids contamination, destruction, or 

deterioration of quality. 

Obtaining as much physical evidence as possible 

is especially important if a case goes to trial. In 

maltreatment cases, there often may not be any 

witnesses, and the focus of the case may need to be 

on the testimonies of the alleged victim and alleged 

perpetrator and the available evidence. In cases of 

neglect, physical evidence may be especially difficult 

to collect. In these cases, the first responder should 

observe the scene for any unhealthy conditions in 

the home, a lack of food, or unclean or hazardous 

materials. Additionally, if enough evidence is 

collected, it may even eliminate the need for the child 

to testify, which can be a traumatic event. 

A lack of physical evidence does not mean that the 

allegation is necessarily false. However, physical 

evidence that corroborates a victim’s statement can 

enhance a case. The first responder is most likely to 

obtain physical evidence if she acts quickly and does 

not give the alleged offender a chance to destroy or 

tamper with the evidence. Even if the suspect is in 

custody, it is important to act quickly because he may 

be able to have someone else destroy the evidence.101 

Every incident of neglect, physical abuse, or sexual 

abuse of a child occurs at a specific location. Th e 

first responder must realize that she is standing 

in a potential crime scene and should obtain or 

make note of any evidence. The following may 

be useful evidence in the investigation of cases of 

suspected child maltreatment: 

• 	 Broken items or holes in the wall 

• 	 Stains from blood or semen (visible with a black 

light) 

• 	 Minute evidence, such as hair, fibers, blood, or 

semen 

• 	 Lures, such as toys or games 

• 	 Sexual aids, such as lubricants, dildos, and 

vibrators 

• 	 Drugs or alcohol 

• 	 Adult or child pornography or other sexually 

explicit material in print or on a computer (e.g., 

letters, diaries, books that discuss sexual activity 

with children) 

• 	 Cameras and film processing equipment 

• 	 An address book containing the alleged 

victim’s information 

• 	 Bedding 

• 	 Clothing 

• 	 Contents of trash cans 

• 	 Bills, bank records, and receipts, which may be 

used to show items that were purchased by the 

suspect for the victim 

• 	 Phone records 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

43 
Immersion Burns 


Immersion burns occur when a child is placed in extremely hot liquid. These burns have a “water line,” or 

sharp demarcation border. Symmetric burns with distinct edges (e.g., burns of the same height on both 

legs) are very suspicious. Doughnut-shaped burns can occur when a child is forced to sit in a bathtub of 

hot water. This causes parts of the body, usually the buttocks, to rest on the bottom of the tub, where they 

will not burn. The diagram illustrates the appearance and cause of doughnut-shaped burns. 

First responders who suspect a child has an immersion burn immediately should begin to gather 

information and evidence from the scene. First responders should take 360-degree (front, sides, and back) 

photographs of, or even videotape, the victim so the burn pattern can be documented and be evaluated 

by medical experts. They also should interview the caregiver suspected of immersing the child and ask 

questions such as: 

• How was the water turned on? 

• How long was it on? 

• How did the child come into contact with the water? 

If possible, first responders should videotape the scene of the immersion, preferably with the suspect 

showing his exact actions. If that is not possible, first responders still should videotape or photograph 

the scene. It also is important to document the hot water heater settings; the measurements of the tub, 

the sink, or any other water container in which the child was placed; and the temperature of the hot 

water when running. For more information on burns, see Appendix E, Signs of Possible Physical Abuse, 

and Appendix F, Distinguishing Physical Abuse from Nonintentional Injury, or visit http://www.ncjrs.org/ 

pdffiles/91190-6.pdf. 

 44 Initial Response and Investigation 
Types of Evidence 

Physical evidence, which is essentially an object or part of an object, is just one of several types. Other 

types include: 

• Direct evidence, which is based on personal knowledge, such as the testimony of an eyewitness 

• Demonstrative evidence, which is something that represents an object and includes items such as 

photographs, x-rays, and diagrams 

• Circumstantial evidence, which is indirect evidence from which an inference can be drawn (e.g., a child 

with a bruise on her back shaped like an adult handprint).102 

• 	 Weapons or other implements used to abuse 

a child (e.g., belts, cords, coat hangers, other 

instruments matching the injuries infl icted) 

• 	 Other items noted by the alleged victim 

or the witnesses during the interviews. 103 

ASSESSING SAFETY AND DEVELOPING 


A SAFETY PLAN 


When the first responder arrives at a scene of possible 

child maltreatment, her first responsibility is to 

ensure the safety of the alleged victim. She should 

only proceed once the child’s immediate safety is 

established. The first responder needs to make 

decisions throughout the response and investigation 

about whether the child is safe and what plans need 

to be made to ensure the child’s safety. If the child is 

at imminent risk of being harmed, the fi rst responder 

should develop, with the help of the child and family, 

if appropriate, a safety plan. For EMTs and law 

enforcement, this will mean involving CPS. 

Assessing Child Safety 

A child is considered unsafe when he is at imminent 

risk of serious harm. There are two key points during 

the initial assessment or investigation at which the fi rst 

responder should evaluate the child’s safety. Th e fi rst is 

during the initial contact with the child and family. At 

that point, the first responder should decide whether 

the child will be safe during the initial assessment or 

investigation by asking herself, “Is the child in danger 

right now?” The first responder should assess the 

family situation, the caregiver’s behavior or condition, 

and the child’s condition, including emotions and 

physical circumstances, for significant and immediate 

safety threats. Examples of these threats include 

currently hitting or otherwise hurting the child, 

head and face injuries, premeditated maltreatment, 

bizarre cruelty, young children left unsupervised, or 

the parent being intoxicated or unable to perform 

parental duties.104 If the child is at immediate risk, a 

non-CPS fi rst responder should contact CPS; all fi rst 

responders should follow applicable protocols for the 

removal of either the offender or the child from the 

home. 

The second point at which the fi rst responder should 

conduct a safety assessment is at the end of the 

interview process. At this point, the fi rst responder 

should evaluate the information and determine if the 

child is safe. When assessing the safety of the child, 

the first responder should: 

• 	 Identify the behaviors or conditions that increase 

concern for the child’s safety and consider how 

they affect each child in the family 

• 	 Identify the behaviors or conditions (e.g., 

strengths, resiliencies, support, resources) that 

may protect the child 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

45 
Search Warrants 

For many child maltreatment cases, interview testimony may be the only evidence available to the 

prosecution. Additional evidence may exist, but may be overlooked during the investigation. In child 

maltreatment cases, law enforcement often underutilizes search warrants as a means of obtaining additional 

evidence.105 When law enforcement officers obtain and execute search warrants properly, they can discover 

important evidence and improve the defensibility of the evidence in court. The primary use of search 

warrants is to obtain physical evidence from the crime scene or from a suspected offender’s house, vehicle, 

or other setting. Law enforcement also can use search warrants to obtain evidence from the body of 

the alleged perpetrator. For example, if a child noticed a mole, birthmark, or tattoo on the suspect, law 

enforcement can use a search warrant to photograph these marks. In addition, law enforcement can use 

search warrants to collect DNA evidence from the alleged perpetrator. A law enforcement offi cer may 

conduct a warrantless search, however, in certain circumstances, such as if he finds an injured or deceased 

child and is looking for other victims or the perpetrator, or if he is ensuring public and offi cer safety.106 

To gather enough information to establish probable cause to obtain a search warrant, the law enforcement 

officer may need to obtain consent to access the crime scene and collect “plain view” evidence. Th e plain 

view doctrine states that an officer may collect evidence when the officer has lawful access to the scene, 

the object is in plain view, and its incriminating nature is immediately apparent.107 The law enforcement 

officer should attempt to gain written consent from the appropriate person to view the area and, once 

received, ask family members or other witnesses to give a tour of the scene and provide information such as 

routines, sleeping arrangements, and disciplinary methods. If consent is not given or is withdrawn, the fi rst 

responder should discontinue the search.108 

The evidence seized through the use of search warrants can be essential for corroborating the victim’s 

statements. It also is advisable to photograph or to videotape the location of a search prior, during, and 

after the search is conducted. This is important for protecting investigators from later claims that they 

damaged property or planted evidence and for documenting where certain pieces of evidence were found.109 

Although CPS caseworkers are often key personnel in child maltreatment responses and investigations, 

they do not have the same authority as a law enforcement officer to enter a home or conduct a search. 

Caseworker authority varies by jurisdiction and agency, but the following are common elements: 

• Caseworkers can interview individuals involved in the case (e.g., the child, family members, the reporter, 

teachers, neighbors) and can interview the child without the parents being present. 

• In some cases, parents can refuse entry of the caseworker into their home. The caseworker, however, can 

request the assistance of the court or law enforcement to gain entry. 

• If the initial report or information gained during the CPS investigation indicates that there has been criminal 

conduct, the caseworker may need to file a cross-report to the appropriate law enforcement agency or 

prosecutor’s office to initiate a criminal investigation. 

• A child may not be removed from his home without a court order. To receive a court order, the agency 

must file a petition, and a hearing must be held. An exception is made, however, when CPS determines that 

the child’s living conditions place him in imminent threat of substantial physical harm. In those cases, the 

caseworker may proceed with an emergency removal and then schedule a court hearing as soon as possible 

(usually within 72 hours) to sustain the action. 

46 Initial Response and Investigation 
• 	 Examine the relationships among the risk factors 

and determine if, when combined, they increase 

safety concerns 

• 	 Determine whether family members or other 

community partners are able to address safety 

concerns without CPS intervention 

• 	 Consider the services required to address the 

specific behaviors or conditions for each risk 

factor directly affecting the child’s safety 

• 	 Identify who is available (e.g., CPS, other 

community partners) to provide the needed 

services or interventions in the frequency, 

timeframe, and duration required by the family 

to protect the child 

• 	 Evaluate the family’s willingness to accept—and 

its ability to use—the intervention or services at 

the level needed to protect the child.110 

Sometimes services or interventions are not available or 

accessible at the level needed or within the timeframe 

necessary to protect the child, or the caregivers are 

unable or unwilling to accept the services. In these 

cases, the first responder should consider whether the 

offending caregiver should be asked or be required 

to leave the home and if the nonoff ending caregiver 

can protect the child. If not, the fi rst responder 

should consider whether out-of-home care and 

court intervention are needed to ensure the child’s 

protection. In either case, the first responder should 

develop a safety plan for the child. 

Developing a Safety Plan 

When there is an imminent risk of moderate to serious 

harm to the child, the first responder should develop a 

safety plan with the child and, if appropriate, with the 

family. The plan should include interventions that: 

• 	 Have a direct and immediate impact on one or 

more of the risk factors determined during the 

assessment to cause the child to be unsafe, such as 

removal of the alleged perpetrator 

• 	 Are accessible to the family 

• 	 Are available in the frequency and for the 

duration with which they are needed to control 

the risk factors 

• 	 Fill the gaps in the caregiver’s protective factors 

and strengths in order to ensure the child’s 

protection.111 

When possible, the first responder should conduct 

the safety assessment jointly with the nonoff ending 

caregiver and the child, if age appropriate. By jointly 

developing a safety plan, the first responder and the 

caregiver can assess the feasibility of the caregiver 

carrying out the safety plan. 

UNDERSTANDING THE NEXT STEPS 

When a report of child maltreatment is fi led, possibly 

by a first responder, CPS makes several decisions. 

First, CPS must decide if the report meets the 

statutory criteria for child abuse or neglect, which 

may vary by jurisdiction. Then, it must investigate 

to ascertain if the maltreatment can be substantiated. 

CPS will interview the child if he is old enough 

to respond to questions, even if he had already 

been interviewed by another first responder. CPS 

will then contact the family and others who may 

have additional information about the incident. 

CPS typically will make one of two fi ndings— 

substantiated or unsubstantiated. A substantiated 

finding means that there is suffi cient evidence to 

prove that an incident of abuse or neglect occurred. 

A finding of unsubstantiated means that there is 

For more information on conducting assessments and investigations, see Child Protective Services: A Guide for 

Caseworkers at http://www.childwelfare.gov/pubs/usermanuals/cps/index.cfm. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

47 
insufficient evidence to conclude that a child was 

abused or neglected, but it does not always mean that 

maltreatment did not occur. Some States may have 

a third category—inconclusive, unable to determine, 

or unfounded. CPS also determines if the child is 

safe in the home and, if not, what the least intrusive 

interventions are to ensure the child’s safety. Finally, 

CPS determines if there is a risk of maltreatment 

occurring in the future. If a risk of abuse or neglect 

exists, CPS must offer or provide services to reduce 

the risk. Exhibit 3-5 provides an overview of the CPS 

process. 

In some States, the court system may become involved, 

particularly if the child is removed from the home. 

A juvenile or family court usually is responsible for 

cases involving child maltreatment. In cases of sexual 

abuse, extreme physical abuse, or death, however, 

complaints increasingly are filed in criminal court. In 

some instances, the first responder may be asked to 

appear in court as a witness. This is discussed in more 

depth in Chapter 4, Testifying in Court. 

Reasonable Efforts to Keep a Family Together 

When CPS workers identify safety interventions and develop safety plans, they are required to make 

“reasonable efforts” to keep families together, when safe and appropriate. This means that CPS workers 

must exhaust all the less intrusive methods of ensuring child safety before moving to more intrusive 

methods. The sequence of least intrusive safety interventions is: 

• In-home services, perhaps combined with partial out-of-home services (e.g., daycare services) 

• The removal of the off ending caregiver 

• Relative or kinship care 

• Out-of-home placement. 

Most States indicate that when certain factors are present in a case, they constitute enough of a threat to a 

child’s safety that reasonable efforts are not required to prevent placement. These factors may include: 

• Abandonment 

• Torture 

• Chronic abuse or neglect 

• Some forms of sexual abuse 

• Killing of another person or the child’s sibling 

• Having had parental rights terminated for another child. 

First responders should become familiar with the exceptions that apply in their jurisdictions. 

First responders must be aware of their surroundings when responding to possible cases of child maltreatment 

and ensure that they are safe. See Appendix L, Home Visit Safety Tips, for information about enhancing safety 

during response and investigation. 

48 Initial Response and Investigation 
Reporting 

• Contact designated agency (CPS or law enforcement) 

• Provide information on suspected maltreatment 

Intake 

• Determine whether report meets statutory and agency guidelines Screened • Decide whether to investigate 

• Assess urgency of response to request out 

Screened in 

Initial Assessment or Investigation 

• Contact child and family and gather information Ruled out • Determine whether maltreatment occurred or • Assess safety of child and need for emergency removal or services Unsubstantiated • Assess risk of future abuse or neglect 

Substantiated or indicated 

Referral 

Family Assessment 

• Identify family strengths and needs 

• Assess factors contributing to risk of maltreatment 

Planning 

• Specify outcomes and goals that will reflect reduction or elimination of risk 

of maltreatment 

• Identify strategies or services to achieve goals and outcomes 

• Develop case plans, permanency plans, and other plans 

• Set timeframes 

Service Provision 

• Provide in-home services (e.g., • Provide out-of-home services 

family preservation, parenting (e.g., foster care, reunification 

education) services) 

Evaluation of Family Progress 

• Assess safety of child and reduction of risks 

• Evaluate achievement of family outcomes, goals, and tasks 

• Review progress and need for continued services Continued 

Services 

Case Closure 

• Assess levels of safety and risk 

• Determine whether family can protect child without further CPS 

services 

 

 

 

Exhibit 3-5 

Overview of the CPS Process 

Identification 

• Recognize signs of child abuse or neglect 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

49 
The Role of First Responders in Investigating Child Fatalities 

When a child fatality occurs, the role of law enforcement is to investigate the cause of death, to determine 

if a crime took place and, if so, who is responsible. It is important that all sudden and unexplained deaths 

be investigated so that innocent people can be cleared of suspicion or any guilty individuals can be caught. 

CPS often is involved in child fatality investigations when a parent or other household member is a suspect. 

The role of CPS in child fatality cases is to help determine if child maltreatment was involved, to determine 

who was responsible for the maltreatment, and to ensure the safety of other children in the household. Law 

enforcement, however, should be the lead agency in child fatality investigations.112 

Medical personnel are required to contact law enforcement immediately if they suspect that a child fatality 

may have resulted from child maltreatment, but they should not let the parents know of their suspicions. 

(For more information about which individuals are required to report suspected child maltreatment, visit 

Child Welfare Information Gateway at http://www.childwelfare.gov/systemwide/laws_policies/state/.) 

Medical personnel also should take note of any statements made by the parents or other caretakers and pass 

these along to law enforcement officers. 

It is important that first responders be both thorough and sensitive when conducting investigations of child 

fatalities. The child may have died accidentally or as a result of a medical condition, and it is important not 

to traumatize the parents further. First responders should balance this sensitivity, however, with the need 

to conduct a thorough investigation. Law enforcement should approach every child fatality investigation 

with one of the hypotheses being that the child was the victim of maltreatment.113 This will help to ensure 

that evidence is collected properly and that a thorough investigation is conducted. First responders can 

explain to the parents that causes of death can only be determined through an investigation and that the 

investigation, including postmortem examination and clinical history reviews, will help them understand 

how their child died and how that may affect others in their family (e.g., if there is a genetic medical 

condition).114 

When investigating child fatalities, first responders should keep in mind several important issues, including: 

• There often is a delay between the incident of maltreatment and the death of the child. This may be even 

more likely if the child suffered from head trauma or internal injuries to the chest or abdomen. 

• Child fatalities often occur in the child’s home and have no witnesses. 

• The weapons used in child maltreatment fatalities usually are not traditional weapons, such as knives or 

firearms, but are more often hands, feet, household items, or scalding water. 

• Evidence in the house, such as fingerprints or DNA, is not always helpful if it was a household member who 

fatally maltreated the child. This is because that person normally would touch items in the house. 

• The victim may have suffered from internal injuries, which are not readily apparent upon initial 

investigation. Some injuries only can be determined by the use of x-rays, MRIs, and CT scans. 

• Suspicion of maltreatment initially should not be communicated to the family or to any witnesses, friends, or 

relatives.115 

50 Initial Response and Investigation 
The Role of First Responders in Investigating Child Fatalities (continued) 

In cases of an infant death, first responders should take note of the position of the infant, marks on the 

body, body temperature, the type of crib and any defects, the amount and placement of clothing and 

bedding, the room’s temperature, the type of ventilation and heating, and the reaction of the caregivers.116 

This information can help determine whether the infant death was caused by child maltreatment, a medical 

condition, an accident, or is unexplained (i.e., sudden infant death syndrome). 

For child fatalities that lack witnesses, it is important to establish that the suspect was the only person with 

the child at the time the injury occurred and that the injury was not accidental. Additionally, in cases in 

which a child may have died from lack of supervision, it is important to obtain evidence that establishes 

that the caretaker did not provide reasonable supervision and that this lack of supervision resulted in the 

death of the child.117 First responders also should take into account the possibility that another child in the 

house caused the victim’s death.118 

In addition to a criminal investigation into the child’s death, most States have some type of child fatality 

review team to examine deaths that occurred or may have occurred due to child maltreatment. Child 

deaths also may be reviewed by internal agency committees, coroners’ inquests, or the courts. Child 

welfare workers who have a case that is reviewed may experience increased stress caused by factors such as 

re-exposure to the traumatic event, the intensity of the review, and the critical nature of the inquiry (i.e., 

perceiving the agency or team as finding fault with how they responded to the case).119 

For additional information on investigating child fatalities, visit http://www.ncjrs.gov/pdffiles1/ 

ojjdp/209764.pdf. For more information about investigating the death of an infant, see Appendix H, 

Criteria for Distinguishing SIDS from Fatal Child Maltreatment. 

Appendix M, Case Studies, provides examples of how first responders can respond to cases of physical neglect, 

environmental neglect, physical abuse, and sexual abuse. Appendix D, Reference Guide for Responding to Cases 

of Suspected Child Maltreatment, is a handy format that highlights many of the topics covered in this manual. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

51 

CHAPTER 4 

Testifying In Court 

In Th is Chapter 

• Preparing for court 

• Guidelines for testifying 

• What to expect during the trial 

• The juvenile court process 

• The criminal court process 

First responders often are required to testify in court 

about cases of suspected child maltreatment. Th is 

provides them with an opportunity to present the 

information and evidence they have collected during 

their response and investigation. Testifying in court 

can be an intimidating experience for those who are 

new to it, as well as for those who have testifi ed many 

times. This chapter provides an overview of the court 

process. 

PREPARATION FOR COURT 

The most basic rule for testifying is to show up to court 

on time, well-groomed, and dressed appropriately. 

The first responder should wear clean and professional 

clothing. Prior to attending court, the fi rst responder 

should ensure that the case file is organized, complete, 

and current. This includes making certain that the 

evidence and interview logs are complete and include 

information on dates, times, and locations. Th e fi rst 

responder should thoroughly review and be familiar 

with the information in the case file. Prior to the trial, 

the prosecutor might meet with the first responder to 

discuss the case and prepare the first responder for 

possible questions. It is helpful to prosecutors to 

know the first responder’s answers to questions prior 

to asking them in court. 

DURING THE TRIAL 

The prosecuting party, which might be called the 

prosecutor, District Attorney, Commonwealth 

Attorney, Corporation Counsel, or State’s Attorney, 

may question first responders in several stages, 

including direct examination, cross-examination, 

and rebuttal examination. This questioning generally 

is open-ended. This allows the witness to explain 

the answers fully in order to present the court with 

evidence to support that party’s position. Direct 

examination usually includes the following: 

• 	 The witness’s name is called, and then she 

approaches the witness stand 

• 	 She takes an oath and swears to answer truthfully 

• 	 The attorney may ask for the following: 

–	 The witness’s name, occupation, and place of 

employment 

–	 The length of time at her current job, title, 

and type of work 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

53 
Guidelines for Testifying 

The following are guidelines to testifying in court: 

• Be prepared. Have a thorough knowledge of the case. This will help the first responder to be more 

confident and more persuasive. 

• Listen to each question and pause before answering. The first responder should not let the attorney rush 

her. 

• Ask for clarification if needed. If the first responder is asked a question she does not understand, she 

should have the attorney repeat, clarify, or rephrase it. 

• Answer only the question asked. The first responder should not volunteer additional information or 

discuss tangential subjects. 

• Do not be afraid to respond “I don’t know.” If the first responder does not know the answer to a question, 

she should not be afraid to say so. This may enhance the first responder’s credibility. 

• Do not give an opinion unless asked to do so. The first responder should only testify to the facts within 

her personal knowledge and experience. She should be specific and give exact times and dates. She should 

describe events step-by-step rather than narrate long stories. 

• Avoid taking sides. The first responder’s responsibility is to present the evidence truthfully and accurately. 

• Speak a little louder, slower, and more distinctly than normal. This helps the judge, attorneys, and others 

to understand the responses. The answer must be spoken; the first responder should not shrug her shoulders 

or nod her head. 

• Make eye contact. If a jury is present, the first responder should make eye contact with them while 

answering questions. 

• Use an open body posture. The first responder should keep her hands on the witness table for the jury to 

view. This gives an open, truthful, and confi dent appearance. 

• Use appropriate language. Never use professional jargon or slang. 

• Always tell the truth. The first responder should not compromise her credibility.120 

– Her job qualifi cations 

– How she knows the child or family 

– What happened at specific times and places 

– Any other pertinent information. 

During the direct examination, it is important that the 

first responder carefully listen to all questions that are 

asked and to request clarification if a question is not 

fully understood. The first responder should be polite 

and respectful to all court personnel. Additionally, 

the first responder should be aware that she is not 

expected to know the answers to every question. If 

the first responder does not know or remember the 

answer, she should state this. It is important to be 

honest. Mistakes may be made in any investigation, 

and the first responder should not attempt to cover 

up these mistakes.121 

After direct examination, the first responder is 

subjected to cross-examination, which usually is 

conducted by the alleged offender’s attorney. Th e 

purpose of cross-examination is to fi nd inconsistencies 

or fault in the first responder’s testimony and to expose 

54 Testifying in Court 
any weaknesses. The attorney typically uses closedended questions that require a yes or no response. 

If the first responder tries to give a more complete, 

explanatory answer, it usually is not allowed. Being 

cross-examined can be one of the most diffi cult parts 

of testifying. Typically, the attorney tries to cast doubt 

on the thoroughness of the investigation and the fi rst 

responder’s interpretation of the facts. Th e attorney 

also may allude to the possibility that the judgment 

and the actions of the first responder were clouded 

by her opinions about the alleged off ender. Th e fi rst 

responder should not become angered by statements 

made by the defense team and should stay in control 

of her emotions at all times. She should remember 

not to take the cross-examination personally; the 

defense attorney is doing his job.

 Defense attorneys use various techniques during 

cross-examination. If the first responder understands 

these techniques, it will be easier to keep her poise 

when answering questions. Exhibit 4-1 describes 

common techniques used during cross-examination. 

If the prosecutor believes that a rebuttal is needed 

after the cross-examination, he will conduct a redirect 

examination. The focus of the redirect examination 

is to address issues raised on cross-examination that 

need to be cleared up or answered more completely. 

THE JUVENILE COURT PROCESS 

Juvenile courts typically hear cases of child 

maltreatment, delinquency, and status off enses 

(i.e., cases in which an action is a crime only if the 

offender is a minor, such as underage drinking), as 

well as those involving adoptions and terminations of 

parental rights (TPRs). In alleged child maltreatment 

Exhibit 4-1 

Types of Questions Used During Cross-Examination 

The following are types of questions that attorneys may use strategically during cross-examination: 

• Leading Questions. A leading question suggests by its wording that the answer should be either yes or no 

and has wording that attempts to guide the first responder’s answer. For example, in a neglect case where 

one of the allegations is that a baby was left at home without adult supervision, the defense attorney might 

ask, “Isn’t it true that the baby’s 14-year-old sister was in the home whenever the mother went out?” In 

this case, the answer may be yes, but the first responder may want to explain that the sister is not mature 

enough to care for the baby. The first responder usually will be allowed to explain an answer when only a 

yes or a no would be misleading. If this is the case, the first responder should begin her response by saying 

that the question requires an explanation rather than by answering yes or no and then trying to explain. If 

the attorney insists on a yes or no response, the first responder should turn to the judge and ask if she may 

continue. If the explanation is not permitted, the prosecutor can give the first responder an opportunity to 

give a complete answer during redirect testimony. 

• Rapid-fire questions. The defense attorney hopes to confuse or to upset the witness by asking a string of 

leading questions in rapid succession (e.g., “Isn’t it true that there were other adults in the house at the time 

of the maltreatment? Isn’t it true that they could have committed the abuse? Was it your bias toward my 

client that made him the primary suspect?”). Since each question requires an answer, the first responder has 

control over the pace of the response. The first responder should pause to think about each question before 

answering. The first responder should also ask for the question to be repeated or clarified if necessary. 

• Compound questions. The first responder may be asked a question that contains multiple parts. For 

example, “You saw the bruises on the child and the belt in the living room and assumed that the father 

caused the bruises, isn’t that true?” The prosecutor should object to the question. If the prosecutor 

does not object, the first responder should say that he does not understand the question and that it 

requires a two-part answer or request that the question be repeated. Witnesses do not have to answer 

compound questions. 122 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

55 
cases, the juvenile court determines whether there 

was maltreatment, orders any necessary services for 

children and families, and monitors the interventions. 

While not all first responders will be involved in all 

aspects of the juvenile court process, the following 

sections outline the key stages, which may vary across 

jurisdictions. 

Petition for Removal 

A child protection proceeding begins with the fi ling 

of a petition for removal, which contains the key facts 

of the child maltreatment case. In most States, only 

child protective services (CPS) can file the petition, 

but some also permit other public offi cials or private 

citizens to do so. Once the petition is filed, it must 

be served (presented) to the caretakers accused of 

maltreatment. Ideally, no child should be removed 

from a family until after a petition is filed and the 

court has conducted an initial hearing at which 

the parents were present and had an opportunity 

to be heard. In reality, however, most removals are 

authorized without the parents present, and the fi rst 

hearing is conducted after the removal has occurred. 

This may occur in emergency circumstances where 

the child should be immediately removed from the 

home for safety reasons. In this case, a petition 

would be filed after the removal. CPS workers and 

law enforcement officers should be familiar with the 

protocols in their jurisdiction. 

Initial Hearing 

Th e fi rst event in court after the fi ling of a petition is 

the initial hearing. Ideally, it should occur on the fi rst 

day following the filing of the petition, upon removal 

of the child, or as soon as possible thereafter. Th e 

main purpose of the initial hearing is to determine 

whether the child should be placed in substitute care 

or remain with or be returned to the parents pending 

further proceedings. The critical issue is whether 

services or other measures can be put in place to 

ensure the child’s safety. 

Pretrial Conferences 


Some courts use pretrial conferences, also known 

as settlement conferences, in child maltreatment 

cases. These are opportunities for the parents, their 

attorneys, and the child’s advocates to discuss a way to 

settle the case that would make a trial unnecessary. In 

courts where there are no formal pretrial conferences, 

these negotiations often occur among attorneys by 

phone or at the courtroom and as late as right before 

the scheduled adjudication. The judge may or may 

not participate, depending on the jurisdiction and 

the nature of the case, and some judges will initiate 

such negotiations themselves. It is important, 

however, that provable allegations of signifi cant child 

maltreatment not be negotiated away. 

Discovery 

Discovery is a pretrial process that allows each party 

to obtain information about the case from the other 

parties. It is intended to avoid “trial by ambush,” 

to narrow the contested issues, and to expedite 

settlement. Discovery in child maltreatment cases 

usually involves the parents’ and child’s attorneys 

asking CPS and other relevant agencies for their 

records. In most States, they are entitled to those 

records. While details of the initial and investigative 

reports are revealed, the name of the reporter is not. 

Adjudication Hearing 

If the case is not settled by agreement of the parties, 

it will go to adjudication, in which the court decides 

whether CPS can prove the maltreatment allegations 

in its petition. The CPS attorney will present evidence 

through the testimony of the first responders or 

other witnesses, including any experts. Documents 

such as medical records or photographs also may be 

entered into evidence. The attorneys for the parents 

and the child will have the right to question or crossexamine the witnesses and to present evidence. Th e 

parents may testify, as may other family members or 

neighbors who have knowledge of the facts alleged in 

56 Testifying in Court 
the petition or of the care the parents provided their 

children. 

Disposition Hearing 

At the disposition hearing, the court decides whether 

the child needs help from the court—and, if so, what 

services will be ordered—as well as whether the child 

should be: 

• 	 Left with or returned to the parents, usually 

under CPS supervision 

• 	 Kept in an existing placement 

• 	 Moved to a new placement 

• 	 Placed in substitute care for the first time if 

removal was not ordered previously. 

The court also may enter orders providing for 

visitation schedules or for controlling the conduct of 

the parent (e.g., having supervised visits, mandating 

counseling). It also can order CPS to conduct 

follow-up visits with the family to ensure the child’s 

protection. As a part of the preparation process for 

this hearing, CPS should talk with the parents and 

develop with them a case plan for the family. In some 

States, the court must approve the case plan. In all 

States, the plan must be discussed and refined at the 

disposition hearing, and any disagreements regarding 

its terms must be resolved. 

Review Hearing 

The review hearing is an opportunity to evaluate the 

progress that has been made toward completing the 

case plan and any court orders and to revise the plan 

as needed. If no progress has been made, and none 

seems likely, it is a chance to change the goal of the 

plan. For example, it may not be possible to reunite 

the child with his family because the parents have 

repeatedly not complied with their drug treatment 

requirements, which indicates that they would 

not safely be able to care for the child. Th erefore, 

alternative options must be explored. Review hearings 

should guide the case to permanency for the child. 

Unless a permanent placement is accomplished on or 

before the date of the permanency hearing, the court 

must continue to review the case periodically. 

Permanency Hearing 

The permanency hearing is the point at which 

a definitive decision is made about the child’s 

permanent placement. In making this determination, 

the court must weigh which option is in the child’s 

best interest.123 In some cases, concurrent planning 

may be pursued. Under concurrent planning, an 

alternative, permanent placement is developed at 

the same time as family reunification is attempted. 

With this approach, the child can be moved quickly 

to a stable home if reunification with the birth family 

cannot take place. 

Termination of Parental Rights 

Because the stakes are so high, TPR hearings are the 

most formal, longest, and frequently appealed of all 

child maltreatment proceedings. Biological parents 

whose parental rights are terminated as a result of 

child maltreatment have no right to have contact 

with the child, knowledge of the child’s whereabouts, 

pictures of the child, or information regarding the 

child. In addition to losing legal rights to the child, 

parents whose rights have been terminated generally 

have no further responsibilities to the child, except to 

pay child support that is past due. The grounds for 

TPR are specified in the statutes of each State, and 

CPS caseworkers are advised to familiarize themselves 

with these. Federal statutes also describe specifi c 

situations, such as when a parent has murdered a 

child’s sibling, in which CPS must file a TPR petition. 

Adoptions 

A child is eligible to be adopted once the TPR is 

granted by the courts. In most States, the case remains 

involved with the juvenile court during and after the 

adoption process to ensure that CPS is complying with 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

57 
the requirements of the Adoption and Safe Families 

Act, incorporating Federal adoption legislation into 

practice, and accessing a variety of adoption subsidies 

and post-adoption services for eligible children. 

Appeals 

Parents and CPS have the right to appeal some 

decisions of the juvenile court in child abuse and 

neglect and TPR cases. At the very least, they have the 

right to appeal at the conclusion of any adjudication, 

disposition, or TPR trial. Some States may allow 

appeals from other trial court orders or decisions, but 

generally, only final decisions are appealed or accepted 

for appellate review. 

THE CRIMINAL COURT PROCESS 

Some cases of child abuse or neglect may be heard 

in criminal courts because they constitute a crime, as 

defined by the State. Cases typically heard in criminal 

courts include sex offenses or those that result in the 

death of, or serious injury to, a child. However, 

not all cases that are considered criminal are tried 

in the criminal courts due to a number of reasons, 

such as whether the criminal case would interfere 

with rehabilitating the family or the possibility of 

traumatizing the child further by having him testify. 

As with the juvenile court process, fi rst responders 

may not be involved in all aspects of the criminal 

court process. Though the criminal court process 

may vary across jurisdictions, the following is an 

outline of the key stages. 

Arrest, Bail, and Other Conditions of Release 

Criminal prosecutions most commonly begin with 

an arrest. The defendant then is brought before a 

judicial officer (a judge, magistrate, or commissioner) 

who informs him of the charges against him and 

determines the conditions of his release pending trial. 

Th e defendant will be notified of the conditions 

that must be met to be released from police custody 

before the trial. A defendant with a stable residence 

and employment history and no signifi cant prior 

record often is released on his own recognizance or 

with a written promise to appear at subsequent court 

dates. For a defendant who seems less reliable, a 

cash bond may be required. The defendant can post 

the full amount of the bond in cash or property or 

secure a bondsman for a percentage of that amount. 

If the defendant flees, the bondsman is obligated to 

pay the full amount of the bond. The judge also has 

the discretion to impose other conditions of release, 

including the defendant having no contact with 

the child or other parent or not returning to the 

residence. In some cases, the judge may decide to 

hold the defendant without bail pending trial. 

Preliminary Hearings 

The purpose of a preliminary hearing is to determine 

whether there is probable cause to believe that the 

defendant committed the alleged offense and that 

he should be tried on that charge. If the judge fi nds 

no probable cause, the case will be dismissed. If the 

judge finds probable cause, the case will be transferred 

to the trial court for resolution. 

Witnesses, including first responders, sometimes are 

called to testify and are cross-examined at preliminary 

hearings. In some States, evidence of criminal conduct 

by the defendant is presented at a preliminary hearing 

to a grand jury instead of a judge. The grand jury 

then determines whether the evidence is suffi cient to 

constitute probable cause. If so, the grand jury will 

issue an indictment that puts the case before the trial 

court. Only the prosecutor and the State’s witnesses, 

usually the investigating law enforcement offi cer, 

appear before the grand jury. Neither the defendant 

nor the defense attorney has the right to be present at 

that proceeding. 

58 Testifying in Court 
Discovery
 

Discovery refers to the process of obtaining 

information about the charge from the opposing 

party and, at times, other sources. In some States, the 

defendant may be entitled to access fi rst responders’ 

records, particularly if they contain information or 

evidence that may be helpful to the defense. For 

the most part, the reporter’s identity is not released, 

but, in some jurisdictions, the reporter’s identity can 

be released to certain departments or under specifi c 

circumstances (e.g., the reporter made a knowingly 

false report).124 

Plea Bargaining 

Plea bargaining is a negotiated resolution that avoids 

trial and concludes the case. Without it, courts could 

not handle on a timely basis all the cases to be tried. 

Plea bargaining has the added benefit in child abuse 

and neglect cases of eliminating the need for the child 

to testify and of speeding the resolution of the case, 

both of which relieve the child’s anxiety. Nevertheless, 

there also may be negative consequences to a plea 

bargain. Depending on the sentence, the child victim 

may feel betrayed, disbelieved, or unsafe. In addition, 

the public may perceive that child maltreatment is 

not taken as seriously as other crimes. 

Trial 


If no plea bargain is reached, the case goes to trial. In a 

criminal trial, the rules of evidence are applied strictly, 

and the prosecutor has a greater burden of proof. In 

order to convict, the jurors must unanimously fi nd 

“beyond a reasonable doubt” that the defendant 

committed the alleged offense (i.e., there is no other 

logical explanation). This is a much higher burden 

of proof than the “clear and convincing evidence” 

standard (i.e., it is highly probable) in termination 

of parental rights trials in some States. It is higher 

still than the “preponderance or greater weight of 

the evidence” standard (i.e., there is more evidence 

supporting one side of the case) in civil cases generally 

and in child abuse and neglect cases in some States. 

The criminal court case may be concluded well 

after the disposition hearing in the child abuse and 

neglect case, in which the court decides if the child 

needs help from the court and, if so, what services 

will be provided. Additionally, the outcome of the 

criminal court case can be inconsistent with the case 

plan and the best resolution of the child abuse and 

neglect case. The opposite also can be true, and the 

criminal sentence can augment and enhance the case 

plan and the prospects for a positive outcome. In 

communities where the same prosecutor represents 

the public interest in both criminal and child abuse 

and neglect cases, there is greater likelihood of a 

coordinated approach to resolving both matters. 

The previous sections on the juvenile and criminal court processes were adapted from Chapter 4 of Working 

with the Courts in Child Protection, which can be found in its entirety at http://www.childwelfare.gov/ 

pubs/usermanuals/courts/. For additional information about legal issues related to child welfare, visit the 

website of the National Child Welfare Resource Center on Legal and Judicial Issues at http://www.abanet. 

org/child/rclji/courtimp.html, the website of the National Council of Juvenile and Family Court Judges 

at http://www.ncjfcj.org/, and Child Welfare Information Gateway at http://www.childwelfare.gov/ 

systemwide/courts/. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

59 

CHAPTER 5 

Responding in Disasters

In Th is Chapter 

• Factors for fi rst responders 

– Child responses to disasters or other 

trauma 

– Self-care 

• Agency preparation 

• Agency response 

Responding to a case of possible child maltreatment 

can be complex and stressful. Th e diffi culty of 

this situation can be compounded in the midst of or 

directly after an emergency, such as natural disasters 

(e.g., hurricanes, floods), manmade disasters (e.g., 

terrorist attacks, hazardous materials), or urgent 

medical emergencies (e.g., outbreaks of infectious 

disease). As communities try to cope during or in 

the aftermath of a disaster, some individuals may 

react in ways that could harm themselves and others. 

Some studies have shown increases in rates of child 

maltreatment and domestic violence after disasters. 

125 

Additionally, there may be a short-term increase in 

alcohol and drug abuse, which increases the risk for 

child maltreatment, among other social problems 

(e.g., domestic violence, driving under the infl uence). 

Although much of the information provided in this 

manual can be applicable in disasters, fi rst responders 

will have other factors to consider as they respond to 

possible cases of child maltreatment during disasters. 

These factors include more pronounced immediate 

safety concerns, being unable to communicate with 

their agency or other agencies or service providers, 

and additional emotional trauma, both for the alleged 

victim and the first responder. This chapter provides 

information about the additional factors that fi rst 

responders should consider, as well as ways fi rst 

responder agencies can better prepare for disasters. 

FACTORS FOR FIRST RESPONDERS 

Although no one can prepare for all the situations 

that may arise during a disaster, research and reports 

from the field can provide fi rst responders with 

information that may assist them if a disaster were 

to occur. This section highlights issues, such as 

child responses to trauma and disaster, self-care, and 

changes a community may experience post-disaster, 

to help first responders prepare for and respond to a 

disaster. 

Child Responses to Disasters or Other Trauma 

Children may react to trauma, such as disasters, 

immediately or days or even weeks later. Many 

children experience a loss of trust in adults or a 

fear that the event may occur again. Th e following 

describes reactions children and adolescents may 

have, according to their age, either immediately or 

some time after a traumatic event: 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

61 
Ages 5 years and younger. Reactions may include 

a fear of being separated from the parent, crying, 

whimpering, screaming, immobility or aimless 

motion, trembling, frightened facial expressions, 

excessive clinging, and regressive behaviors (e.g., 

thumb-sucking, bedwetting, fear of darkness). 

Children at this age tend to be strongly aff ected by 

their parents’ reactions to the traumatic event. 

Ages 6 to 11 years. Reactions may include extreme 

withdrawal, disruptive behavior, inability to pay 

attention, regressive behaviors, nightmares, sleep 

problems, irrational fears, irritability, problems in 

school, outbursts of anger and fi ghting, complaints 

of stomachaches or other bodily symptoms that have 

no medical basis, depression, anxiety, and feelings of 

guilt and emotional numbing or “fl atness.” 

Ages 12 to 17 years. Reactions may be similar to 

those of adults and include fl ashbacks, nightmares, 

emotional numbing, avoidance of any reminders of 

the traumatic event, depression, substance abuse, 

problems with peers, antisocial behavior, withdrawal 

and isolation, physical complaints, suicidal 

thoughts, school avoidance, academic decline, sleep 

disturbances, confusion, extreme guilt over perceived 

failure to prevent injury or loss of life, and revenge 

fantasies.126 

Children may react differently to disasters or other 

trauma based on the characteristics of the event, the 

child, and the child’s family and community. See 

Exhibit 5-1 for more details on these characteristics. 

The disaster may interfere with fi rst responders’ 

capacity to respond to the suspected child maltreatment 

in the manner described previously in this manual. 

They may need to adjust their response based on the 

particular circumstances of the maltreatment and 

disaster. Conducting a full investigation of possible 

child maltreatment may not be possible during a 

disaster, but the following are ways a fi rst responder 

can assist children during a disaster: 

• 	 Protect the children from 

– 	 Further harm 

– 	 Traumatic sites and sounds 

– 	 Onlookers and media 

• 	 Be kind, but firm, in directing them 

– 	 Away from the disaster site 

– 	 Away from injured survivors 

• 	 Keep children together with family and friends 

(when this will not compromise the safety of the 

child) 

• 	 Identify children in acute distress 

– 	 Stay with them until they are calm 

– 	 Recognize they may tremble, ramble, become 

mute, or exhibit erratic behavior, including 

rage, loud crying, or remaining completely 

still 

62 Responding in Disasters 
Exhibit 5-1 

Experiencing Disasters: The Risk of Trauma-related Problems127 

The following characteristics influence to what extent a child may experience problems after a disaster or 

other traumatic event: 

Characteristic of the Event Characteristic of the 

Individual 

Characteristic of the Family 

and Community 

Increase risk • Includes multiple or • Is female • Affected directly by the 

of traumarelated 

problems 

repeated events (e.g., 

numerous aftershocks, 

ongoing domestic violence 

or physical abuse) 

• Is a younger child (the 

younger the child, the more 

vulnerable) 

trauma 

• Are anxious (primary 

caregivers) 

• Causes physical injury to 

the child 

• Involves physical injury 

or death to a loved one, 

particularly the mother 

• Results in dismembered, 

dead, or disfi gured bodies 

• Destroys home, school, or 

community 

• Disrupts community 

infrastructure (e.g., a 

hurricane) 

• Is perpetrated by a family 

member 

• Has a long duration (e.g., 

fl ood). 

• Has a subjective perception 

of physical harm 

• Has a history of previous 

exposure to trauma 

• Has no cultural or religious 

anchors 

• Has no shared experience 

with peers (experiential 

isolation) 

• Has a low IQ 

• Has a pre-existing 

psychiatric disorder 

(especially anxiety related). 

• Are continually threatened 

and disrupted 

• Are chaotic or 

overwhelmed 

• Are physically isolated 

• Are distant or absent 

(caregivers). 

Decrease risk • Is a single event • Is cognitively capable of • Are intact and nurturing 

of traumarelated 

problems 

• Perpetrated by a stranger 

• Does not disrupt family or 

community structure 

understanding abstract 

concepts 

• Has healthy coping skills 

• Have not been traumatized 

(caregivers) 

• Are educated about 

• Has a short duration (e.g., 

tornado). 

• Is educated about 

normative posttraumatic 

responses 

• Receives immediate 

posttraumatic interventions 

• Has strong cultural or 

religious belief systems. 

normative posttraumatic 

responses 

• Have strong cultural and 

religious belief system 

• Possess mature and attuned 

parenting skills. 

• Be tolerant of difficult behavior and strong First responders also can help children or adults 

emotions 	 address immediate needs or concerns (e.g., obtaining 

food or shelter, finding a family member) by guiding 

• Act in a way that supports and reassures the them in: 

child.128 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

63 
• 	 Identifying the most immediate needs or concerns 

• 	 Discussing an action plan and setting reasonable 

goals 

• 	 Taking action to address the need. 

Aside from meeting immediate needs or concerns, 

this process can also help individuals, including fi rst 

responders, cope with feelings of loss of control or 

failure.129 

First responders who encounter a child who is 

emotionally overwhelmed (e.g., appears disoriented, 

is unresponsive, is uncontrollably shaking) can 

attempt to stabilize and orient the child. Being with 

a parent or other family member who is calm and 

coping well is an important way to help calm a child. 

If the child’s family is unavailable, or if they appear 

to be emotionally overwhelmed and not able to calm 

the child, first responders can try to stabilize them 

using a “grounding” technique (i.e., helping them 

focus on nondistressing thoughts or things outside of 

themselves). First responders should request that the 

distressed individual: 

• 	 Sit in a comfortable position 

• 	 Breathe in and out slowly and deeply throughout 

the process 

• 	 Name five nondistressing items he can see (e.g., 

a table, a cloud) 

• 	 Name five nondistressing sounds he can hear 

(e.g., his own breathing, the wind blowing) 

• 	 Name five nondistressing things he can feel (e.g., 

the blanket on his body, his feet against the 

fl oor).130 

If first responders are attempting to ground 

younger children, they can make alternative, more 

developmentally appropriate requests, such as 

naming five colors they can see or imagining a favorite 

playground or storybook character. If this process 

does not calm the individual, first responders should 

consult with medical or mental health professionals.131 

Psychological First Aid 

The National Child Traumatic Stress Network and the National Center for PTSD (Post-Traumatic Stress 

Disorder) developed the Psychological First Aid (PFA) Field Operations Guide to assist mental health and 

other disaster response workers who provide early assistance to children and adults affected by a disaster or 

other emergency. Basic objectives of PFA include: 

• Enhancing immediate and ongoing safety 

• Calming and emotionally orienting overwhelmed and distraught survivors 

• Offering practical information and assistance to meet survivors’ immediate needs and concerns 

• Connecting survivors as soon as possible with social support networks 

• Providing information that may help survivors cope effectively with the psychological impact of the 

disaster.132 

Appendix N features the Assessing Disaster Survivor Immediate Needs Worksheet from this guide. Th e 

complete guide can be found at http://www.nctsnet.org/nctsn_assets/pdfs/pfa/2/PsyFirstAid.pdf. 

For additional information about providing services to children affected by disasters, visit the Child Welfare 

Information Gateway website at http://www.childwelfare.gov/management/disaster_preparedness/. 

64 Responding in Disasters 
Self-care for First Responders 


In addition to ensuring the safety of children and 

families, first responders should ensure that they are 

taking care of their own mental and physical health 

and safety throughout and after their work during 

disasters, during which a “normal” case may be 

compounded by mass casualties, destruction, chaos, 

or other impending danger. (Note: Some of this 

information also will be applicable for nondisaster 

situations, when responding to possible cases of child 

maltreatment may also be stressful and emotional for 

the first responder.) Responding during a disaster 

can affect an individual’s mental and physical health 

immediately or days, weeks, or months after the event. 

The stress of working during a disaster takes a toll 

on first responders. Being involved in a disaster 

undoubtedly will affect an individual, and fi rst 

responders may exhibit normal feelings and reactions, 

such as: 

• 	 Being profoundly sad, grief stricken, and angry 

• 	 Not wanting to leave the scene until the work is 

fi nished 

• 	 Trying to override stress and fatigue with 

dedication and commitment 

• 	 Denying the need for rest and recovery time.133 

First responders also may exhibit stress symptoms 

during or after the disaster that disrupt their normal 

life and for which they should seek assistance. Exhibit 

5-2 lists some of these symptoms. 

While responding during a disaster, fi rst responders 

can take several steps to help them stay focused and 

manage their stress, including: 

• 	 Pacing themselves 

• 	 Taking frequent breaks, when appropriate 

Exhibit 5-2 

Stress Symptoms That May Be Experienced by First Responders in Disasters134 

Physical Cognitive Emotional Behavioral

• Chest pain* • Confusion • Anxiety • Intense anger 

• Diffi culty breathing* • Nightmares • Guilt • Withdrawal 

• Shock symptoms* • Disorientation • Grief • Emotional outburst 

• Fatigue • Heightened or lowered • Denial • Temporary loss or 

• Nausea/vomiting alertness • 	 Severe panic (rare) increase of appetite 

• Dizziness 

• Profuse sweating 

• 	 Rapid heart rate 

• Th irst 

• Headaches 

• Poor concentration 

• Memory problems 

• 	 Poor problem solving 

• Diffi culty identifying 

familiar objects or 

people 

• Fear 

• Irritability 

• 	 Loss of emotional 

control 

• Depression 

• Excessive alcohol 

consumption 

• 	 Inability to rest 

• 	 Change in sexual 

functioning 

• Visual difficulties • 	 Sense of failure 

• 	 Clenching of jaw • Feeling overwhelmed 

• 	 Nonspecific aches and • 	 Blaming others or self 

pains 

* Seek medical attention immediately if you experience these. Symptoms of shock include shallow breathing, 

rapid or weak pulse, nausea, shivering, pale and moist skin, mental confusion, and dilated pupils. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

65 
• 	 Taking care of each other 

• 	 Eating and drinking enough 

• 	 Communicating with loved ones 

• 	 Recognizing and accepting their limitations 

• 	 Limiting on-duty rotations to 12 hours per day, 

if possible 

• 	 Using counseling assistance programs, if available 

• 	 Participating in memorials, rituals, or other 

methods of expressing their feelings.135 

These steps may vary, of course, depending on the 

specifics of the disaster. 

First responders may have multiple roles during the 

course of a disaster. In addition to their professional 

or volunteer role as a first responder, they also may be 

victims. The first responder agency should recognize 

that some staff may not be physically or emotionally 

available to assist with the disaster response because 

they or their family have been affected and require 

immediate and long-term assistance.136 

AGENCY PREPARATIONS 

First responder agencies at the Federal, State, and 

local levels should have plans that outline how their 

operations will continue or be adapted during and 

after a disaster or other emergency. Th is section 

explores how agencies can prepare for disasters by 

developing Continuity of Operations Plans (COOPs), 

coordinating with key partners, and training staff 

about agency protocols and how to respond. 

Assessing Possible Disasters 

Before agencies can plan how they will react to a 


disaster or other emergency, they first must determine 


what types of events they might need to react to 

and how those events may affect their operations. 

Agency staff can develop a list of potential disasters 

for their area. For example, a large, urban area in 

the Northeast may want to consider the eff ects of 

blizzards, hurricanes, terrorist attacks, or an epidemic 

and a small, rural community in the Midwest that 

is adjacent to a chemical plant might be more prone 

to flooding, tornados, and chemical exposure. Th is 

does not mean that agencies should only plan for the 

most obvious types of disasters, but they may want to 

dedicate more planning time to disasters that are more 

likely in their area. Additionally, the agency should 

consider disasters of diff erent scopes (e.g., a localized 

fire at the child welfare agency versus widespread fi res 

throughout the community). When determining the 

possible effects of a disaster, the agency should also 

review how the disaster might aff ect partner agencies 

and how that might affect its own ability to provide 

services. 

Developing a Disaster Plan 

The disaster plan will assist the agency in continuing 

to provide services and respond to cases in the event 

of a disaster. The plan, at a minimum, should contain 

information about who has the authority to activate 

the plan, essential functions that should be performed 

and by whom, the members of the emergency 

management team, and the communication process.137 

This disaster plan may include a COOP, or the entire 

plan may be part of a COOP. A COOP outlines how 

an organization will maintain its essential functions 

in the event of a disruption or emergency. Appendix 

O, Continuity of Operations Plan (COOP) Outline, is 

a COOP guide developed by the Federal Emergency 

Management Agency (FEMA). 

An essential component of the planning process is 

determining how agency files and data can be securely 

stored and how they can be accessed during or after 

a disaster. In a review of the challenges encountered 

66 Responding in Disasters 
Federal Requirements Regarding Child Welfare Disaster Planning 

In 2006, the Child and Family Services Improvement Act (P.L. 109-288) mandated that in order to receive 

funding, States must describe in their Annual Progress and Services Reports how their child welfare systems 

would respond to a disaster. Specifically, States must outline how they will: 

• Identify, locate, and continue availability of services for children under State care or supervision who are 

displaced or adversely affected by a disaster 

• Respond to new child welfare cases in areas adversely affected by a disaster and provide services in those cases 

• Remain in communication with caseworkers and other essential child welfare personnel who are displaced 

because of a disaster 

• Preserve essential program records 

• Coordinate services and share information with other States.138 

and lessons learned about protecting and educating 

children during and after Hurricanes Katrina and Rita, 

the U.S. Government Accountability Offi ce (GAO) 

reported that data and record management was a key 

issue. Louisiana was in the process of developing a 

statewide child welfare information system, but it 

did not have extensive case information in a central 

database. Accordingly, child welfare agencies had 

difficulty contacting foster parents because their case 

records were limited and often inaccessible for weeks 

after the storm, and some court proceedings related 

to adoption and reunifications were delayed because 

records were inaccessible or had to be recreated by the 

caseworkers from memory.139 

To prepare for a disaster, agencies should store critical 

information in a statewide or other central database 

that is backed up and accessible in an emergency. 

Information that may need to be accessed in an 

emergency includes: 

• 	 Disaster plan details 

• 	 Case and client records 

• 	 Contact information for staff, families, providers, 

and youth 

• 	 Human resources information (e.g., employee 

information, payroll systems).140 

Agencies may want to assign and set aside time 

and resources for one person to oversee the 

development of the disaster plan. This person would 

be responsible for: 

• 	 Ensuring the plan is developed through a 

collaborative process 

• 	 Communicating the plan within the agency and 

community 

• 	 Coordinating the plan with any statewide or 

other local emergency management processes 

• 	 Ensuring agency involvement in any State or 

local practices or drills 

• 	 Reviewing and updating the plan periodically 

based on stakeholder feedback and changes in 

policies or circumstances.141 

Coordinating with Key Partners 

As first responders know, disasters rarely aff ect only 

one service provider or group within a community. 

A comprehensive response to a disaster usually 

will require the assistance of multiple agencies, 

organizations, and individuals at the local, State, and 

Federal levels. Working with partners at all levels will 

help the agency: 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

67 
Key Questions to Consider When Developing a Disaster Plan 

The following are some questions agencies should consider when developing a disaster plan: 

• When certifying and approving caregivers, do you ask where they will evacuate to in a disaster and collect 

that location’s contact information? 

• Do you know where your workforce will evacuate to during a disaster and collect that location’s contact 

information? 

• How often will the agency update the above information? 

• Is there a personnel requirement that the agency staff check in within a certain timeframe after a disaster? 

How would they contact the agency? 

• How will the agency transmit information to caregivers and staff (e.g., via a toll-free hotline, website)? 

• Can the agency issue paychecks during an emergency? How? 

• Are all critical documents in a centralized, accessible system, including documents that might not have 

originated in the agency but are critical to client well-being and services (e.g., court orders, birth certifi cates)? 

• How will the disaster affect funding levels for the agency? 

• How will the agency use the media in getting messages to the public? 

• What types of training do staff need? 

• How will the agency coordinate volunteers or other outside support? 

• What partners should the agency include in the development of its plan? 

• Will the disaster in the agency’s State or locality affect the service delivery system or assistance provided 

during and after the disaster by neighboring States and localities?142 

• 	 Be knowledgeable about emergency response 

plans at various levels 

• 	 Determine how the agency’s disaster plan or 

services may be incorporated into or complement 

partners’ plans 

• 	 Clarify the agency’s role in the response to a 

disaster 

• 	 Establish who has decision-making authority and 

in what circumstances 

• 	 Share information about who the liaisons 

between the partners are 

• 	 Determine where emergency services are located 

during a disaster, as well as if and how the agency 

can assist 

• 	 Advocate for the needs of agency clients, staff , 

and volunteers 

• 	 Seek agency participation in emergency response 

drills 

• 	 Establish data-sharing agreements to help locate 

displaced children and families after a disaster.143 

It is important that agencies know before a disaster 

occurs which partners they will need to work with 

and how they will work together. One of the lessons 

learned from the GAO’s review of the response to the 

Gulf Coast hurricanes was that standing agreements 

among State child welfare officials and the American 

Red Cross and FEMA regarding coordination and 

data sharing could have expedited recovery eff orts. 

For example, GAO reported that by the time 

Louisiana officials had developed a memorandum of 

understanding (MOU) with the Red Cross to search 

its shelters for foster children, the Red Cross had closed 

its shelters.144 (For more information about MOUs, 

see Appendix K, Memorandum of Understanding.) 

68 Responding in Disasters
Partnering with Community and Faith-Based Organizations 

A recent study about the role of community and faith-based organizations in the responses to Hurricanes 

Katrina and Rita indicates that it is important to include these organizations in the disaster planning 

process. Child welfare agencies can determine which community and faith-based organizations are in their 

area, the nature of their work, their capabilities, how they may fit into the agency disaster response, and 

prior experience, if any, in disaster planning or response.145 Then the agency can work with appropriate 

organizations to craft and revise the disaster response plan and train them in pertinent disaster response 

methods and issues. 

Training Staff 


First responder agencies should provide comprehensive 

training to staff about the agency’s response and 

operations during a disaster. Agencies can provide 

training to new staff during their orientation and 

provide ongoing training at regular intervals to 

existing staff. Additionally, agencies should include 

contracted staff in disaster preparedness and response 

training. The following are important topics to cover 

during these trainings: 

• 	 The agency’s disaster plan 

• 	 How the plan will be adapted to changing 

circumstances (e.g., in different types and scopes 

of disasters) 

• 	 The emergency management team and the 

delegation of authority 

• 	 The roles and expectations of various staff , 

including when and how they are to check in 

with the agency if a disaster occurs 

• 	 How to communicate with other staff and 

agencies during a disaster 

• 	 Critical personal and professional items they 

should have on hand in case a disaster occurs 

(e.g., flashlight, walking shoes, caseload list).146 

AGENCY RESPONSE 

During a disaster, first responder agencies need to 

recognize and assess the immediate needs of the 

community. It is essential that the agencies remain 

in contact and coordinate their eff orts, hopefully 

following the steps and protocols laid out in their 

disaster plans. Although much of this information 

Disaster Preparation for Children and Families 

In addition to ensuring their staff are properly trained for disasters, child welfare agencies should encourage 

children, youth, and families involved with their agency to develop their own disaster plans that include: 

• Where they would go in an evacuation 

• Contact information for themselves and an emergency contact 

• What they need to take with them (e.g., medication, documents) 

• How they will check in with the agency. 

Agencies should provide training and information to families about how to develop their plans, what to do 

in the event of a disaster, and how their children may react.147 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

69 
may already be outlined in their disaster plans, 

agencies should ensure they are taking the following 

steps during disasters, where appropriate: 

• 	 Establish contact with families, providers, 

children, and youth in the child welfare system 

by methods such as operating a call-in line or 

contacting or coordinating with other systems 

that may be in contact with them 

• 	 Maintain a database to track contact with 

clients, including whether their whereabouts or 

conditions are known 

• 	 Identify children who are separated from their 

families 

• 	 Conduct an initial assessment of the locations 

and needs of individuals involved with the child 

welfare system 

• 	 Provide information, support, and services 

for these families, including what services are 

available near their current location.148 

First responder agencies should recognize that their 

staff will have personal needs during and after a 

disaster. Agencies can assist their staff by providing 

additional support, such as flexible hours and making 

sure their basic needs are met (e.g., advocating 

for them having priority for emergency housing). 

Additionally, agencies may want to have counseling 

available for staff to help them to overcome the stress 

and emotional toll of the disaster and to process the 

situation. 

In the wake of a disaster, child welfare agencies may 

want to consider providing additional programs and 

services to children and families, including: 

• 	 Trauma services for children, youth, and families 

• 	 Assistance for medically fragile children and their 

caregivers 

• 	 Additional time for service visits 

• 	 Child care for families seeking help 

• 	 Extra assistance for foster families.149 

A critical component of an agency’s post-disaster 

plan is determining the strengths and weaknesses of 

its approach during the disaster. The agency should 

conduct debriefing sessions to capture information 

about how the agency responded and if it met the 

needs of children and families. Th e debriefi ng sessions 

should include managers, staff, clients, partnering 

agencies, and other stakeholders. Important areas to 

assess include: 

• 	 Service delivery 

• 	 Collaboration with partners 

• 	 Contracted services 

• 	 Communication 

• 	 Management of staff 

• 	 Information systems.150 

Reconnecting Families After an Emergency 

To assist States, Tribes, counties, and other child welfare agencies in helping families who have become 

separated during a disaster, the National Resource Center for Child Welfare Data and Technology 

(NRCCWDT) developed the Reconnect Families Database. This system, which was based on a database 

application developed in Louisiana after Hurricane Katrina, helps child welfare agencies track children’s 

whereabouts and well-being and identify those who have not yet been reunited with their families. It allows 

agencies to track children, adult family members, placement providers, and agency workers. Additional 

information about the Reconnect Families Database can be found on the NRCCWDT website at http:// 

www.nrccwdt.org/resources/disaster/disaster_db.html. 

70 Responding in Disasters 
The agency should analyze the information gathered 

during these sessions and use it to amend its disaster 

plan, as necessary. 

CONCLUSION 

First responders play an invaluable role in preventing, 


identifying, and responding to child maltreatment 


in both nondisaster and disaster situations. Th e 


ability of first responders to assess situations, provide 

immediate assistance to children and families, conduct 

interviews, and collect evidence is critical to the 

successful investigation and, if necessary, prosecution 

of suspected cases of child abuse and neglect. Since 

they often respond to and investigate the same 

cases, it is essential for each type of fi rst responder 

to understand the roles and responsibilities of the 

others. By working collaboratively, fi rst responders 

can enhance outcomes for children and families. 

The following documents may be useful in helping child welfare and other agencies prepare for and respond 

to disasters: 

• 	 Coping with Disasters and Strengthening Systems: A Framework for Child Welfare Agencies (http://muskie.usm. 

maine.edu/helpkids/rcpdfs/copingwithdisasters.pdf) 

• 	 Disaster Preparedness Resource Guide for Child Welfare Agencies (http://www. 


caseyfoundation.com/~/media/Pubs/Topics/Child%20Welfare%20Permanence/Other/ 


DisasterPreparednessResourceGuideforChildWelf/DisasterPrep.pdf) 


• 	 Preventing Child Abuse and Neglect in Disaster Emergency Shelters (http://www.nrccps.org/resources/ 

disaster_emergency_shelters.php) 

• 	 Ready for Anything: A Disaster Planning Manual for Runaway and Homeless Youth Programs (http://www.ncfy. 

com/publications/pdf/ready_for_anything.pdf) 

The following organizations offer useful resources that address disaster preparedness and response: 

• 	 American Bar Association Center on Children and the Law (http://www.abanet.org/child/disater/disater_ 

materials.html) 

• 	 National Resource Center for Child Welfare Data and Technology (http://www.nrccwdt.org/resources/ 

disaster/disaster.html) 

• 	 National Resource Center for Permanency and Family Connections (http://www.hunter.cuny.edu/socwork/ 

nrcfcpp/disaster_relief.html). 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

71 

 

Endnotes 

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

Administration for Children and Families (ACF). 

(2010). Child maltreatment 2008. Available: 

http://www.acf.hhs.gov/programs/cb/pubs/ 

cm08/index.htm. 

2 	 U.S. Department of Transportation, National 

Highway Traffic Safety Commission. (1998). 

EMT-paramedic national standard curriculum. 

Available: http://www.nhtsa.dot.gov/people/ 

injury/ems/EMT-P/disk_1%5B1%5D/. 

3 	 Hammond, B., Lanning, K., Promisel, W., 

Shepherd, J., & Walsh, B. (2001). Law enforcement 

response to child abuse. Available: http://www. 

ncjrs.org/pdffi les/162425.pdf. 

4 	 Goldman, J., & Salus, M. K. (2003). A coordinated 

response to child abuse and neglect: Th e foundation 

for practice. Available: http://www.childwelfare. 

gov/pubs/usermanuals/foundation/index.cfm. 

5 	 Child Welfare Information Gateway. (2008a). 

Mandatory reporters of child abuse and neglect. 

Available: http://www.childwelfare.gov/ 

systemwide/laws_policies/statutes/manda.cfm. 

6 	 Goldman, J., & Salus, M. K. (2003). 

7 	 Crosson-Tower, C. (2003). 

8 	 Crosson-Tower, C. (2003). The role of educators 

in preventing and responding to child abuse and 

neglect. Available: http://www.childwelfare.gov/ 

pubs/usermanuals/educator/index.cfm; CrossonTower, C. (2002a). When children are abused: An 

educator’s guide to intervention. Boston: Allyn & 

Bacon. 

9 	 Loiselle, J. (2002). Physical abuse. In A. P. 

Giardino & E. R. Giardino (Eds.), Recognition of 

child abuse for the mandated reporter (3rd ed., pp. 

1–21). St. Louis, MO: G.W. Medical Publishing; 

Farley, R. H., & Reece, R. M. (2002). Recognizing 

when a child’s injury or illness is caused by abuse. 

Available: http://www.ncjrs.gov/pdffiles1/ojjdp/ 

160938.pdf; Children’s Hospital Boston, Child 

Protective Team. (2004). Injuries and behaviors 

indicative of abuse. Available: http://www.childprotection.org/CPTtext/tProviders/tInjuries. 

htm; Massachusetts Department of Social 

Services. (2002). Investigation training: Evidence 

and indicators of maltreatment. Boston: Author. 

10 	 Johnson, C. F. (2002). Physical abuse: Accidental 

versus intentional trauma in children. In J. E. B. 

Myers, L. Berliner, J. Briere, C. T. Hendrix, C. 

Jenny, & T. A. Reid (Eds.), The APSAC handbook 

on child maltreatment (2nd ed., pp. 249 –268). 

Thousand Oaks, CA: Sage; Johnson, C. F. (1990). 

Inflicted injury versus accidental injury. Pediatric 

Clinics of North America, 37, 791–814. 

11 	 Crosson-Tower, C. (2003). 

12 	 Dubowitz, H. (2000). What is child neglect? In 

H. Dubowitz & D. DePanfi lis (Eds.), Handbook 

for child protection practice (pp. 10–14). Th ousand 

Oaks, CA: Sage; DePanfilis, D. (2004). Child 

neglect: Working to increase safety and well-being. 

Presented at the Meeting of the Family Advocacy 

Training Section, Soldier & Family Support 

Branch, Department of Preventive Health 

Services, Army Medical Department Center & 

School, San Antonio, TX; Zuravin, S. (2001). 

Issues pertinent to defining child neglect. In T. 

D. Morton & B. Salovitz (Eds.), The CPS response 

to child neglect: An administrator’s guide to theory, 

policy, program design and case practice (pp. 2-1–2­

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

73 
22). Duluth, GA: National Resource Center on 

Child Maltreatment. 

13 	 Crosson-Tower, C. (2003); Crosson-Tower, C. 

(2002a); Dubowitz, H., Black, M., Starr, R. H., 

& Zuravin, S. (1993). A conceptual defi nition 

of child neglect. Criminal Justice and Behavior, 

20(1), 8–26. 

14 	 Crosson-Tower, C. (2003). 

15 	 Hart, S., & Brassard, M. (1991). Psychological 

maltreatment: Progress achieved. Development 

and Psychopathology, 3(1), 61–70; Hart, S., 

Brassard, M., & Karlson, H. (1996). Psychological 

maltreatment. In J. Briere, L. Berliner, J. Bulkley, 

C. Jenny, & T. A. Reid (Eds.), Th e APSAC 

handbook on child maltreatment (2nd ed., pp. 

72–89). Thousand Oaks, CA: Sage. 

16 	 Crosson-Tower, C. (2003); Hart, S., & Brassard, 

M. (1991). 

17 	 Goldman, J., & Salus, M. K. (2003). 

18 	 Christian, C. W., & Rubin, D. M. (2002). Sexual 

abuse. In A. P. Giardino & E. R. Giardino (Eds.), 

Recognition of child abuse for the mandated reporter 

(3rd ed., pp. 23–37). St. Louis, MO: G.W. 

Medical. 

19 	 Berliner, L., & Elliott, D. M. (2002). Sexual abuse 

of children. In J. E. B. Myers, L. Berliner, J. Briere, 

C. T. Hendrix, C. Jenny, & T. A. Reid (Eds.), Th e 

APSAC handbook on child maltreatment (2nd ed., 

pp. 55–78). Thousand Oaks, CA: Sage. 

20 	 Christian, C. W., & Rubin, D. M. (2002). 

21 	 Crosson-Tower, C. (2002a). 

22 	 Crosson-Tower, C. (2003); Crosson-Tower, C. 

(2002b). How has the Internet put children at 

risk for abuse? In When children are abused: An 

educator’s guide to intervention (p. 56). Boston: 

Allyn & Bacon. 

23 	 Wolak, J., Finkelhor, D., Mitchell, K. J., & Ybarra, 

M. L. (2008). Online “predators” and their victims: 

Myths, realities, and implications for prevention 

and treatment. American Psychologist, 63, 111– 

128; Wolak, J., Finkelhor, D., & Mitchell, K. J. 

(2004). Internet-based sex crimes against minors: 

Implications for prevention based on fi ndings 

from a national study. Journal of Adolescent 

Health, 35, 424.e11–424.e20; Mitchell, K. J., 

Finkelhor, D., & Wolak, J. (2001). Risk factors 

for and impact of online sexual solicitation of 

youth. Journal of American Medical Association, 

285, 3011–3014; DeLamater, J., & Friedrich, W. 

N. (2002). Human sexual development. Journal 

of Sex Research, 39, 10–14. 

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

ACF. (2010). 

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

ACF. (2010). 

26 	 Child Welfare Information Gateway. (2008b). 

Child abuse and neglect fatalities: Statistics 

and interventions. Available: http://www. 

childwelfare.gov/pubs/factsheets/fatality.cfm; 

Herman-Giddens, M., Brown, G., Verbiest, 

S., Carlson, P., Hooten, E., Howell, E., et al. 

(1999). Underascertainment of child abuse 

mortality in the United States. Journal of the 

American Medical Association. Available: http:// 

jama.ama-assn.org/cgi/content/full/282/ 

5/463#TABLEJOC80539T1; Crume, T., 

DiGuiseppi, C., Byers, T., Sirotnak, A., & 

Garrett, C. (2002). Underascertainment of child 

maltreatment fatalities by death certifi cates, 

1990–1998. Pediatrics. Available: http:// 

pediatrics.aappublications.org/cgi/reprint/110/2/ 

e18.pdf. 

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

ACF. (2010). 

28 	 Walsh, B. (1994). The role of law enforcement in 

fatal child abuse cases. The APSAC Advisor, 7(4), 

25–28. 

29 	 Walsh, B. (2005). Investigating child fatalities. 

Available: http://www.ncjrs.gov/pdffiles1/ojjdp/ 

209764.pdf. 

30 	 Walsh, B. (1994); Alexander, R. C., Levitt, C. J., 

& Smith, W. L. (2001). Abusive head trauma. 

In R. Reece & S. Ludwig (Eds.), Child abuse: 

Medical diagnosis and management (2nd ed., pp. 

47–80). Philadelphia: Lippincott, Williams, & 

Wilkins. 

31 	 Child Welfare Information Gateway. (2008b). 

32 	 Willinger, M., James, L. S., & Catz, C. (1991). 

Defining the sudden infant death syndrome 

(SIDS): Deliberations of an expert panel convened 

by the National Institute of Child Health and 

Human Development. Pediatric Pathology, 11, 

677–684, p. 681. 

33 	 U.S. Department of Health and Human 

Services, Centers for Disease Control and 

74 Endnotes
Prevention (CDC). (2005). Facts about SIDS. 

Available: http://www.hhs.gov/nvpo/factsheets/ 

fs_tableVII_doc5.htm. 

34 	 Appel, A. E., & Holden, G. W. (1998). Cooccurring spouse and child abuse: Implications 

for CPS practice. APSAC Advisor, 11(1), 11–14; 

Edleson, J. L. (1999). The overlap between child 

maltreatment and woman battering. Violence 

Against Women, 5(2), 134–154. 

35 	 Spears, L. (2000). Building bridges between 

domestic violence organizations and child protective 

services. Available: http://new.vawnet.org/Assoc_ 

Files_VAWnet/BCS7_cps.pdf. 

36 	 Kohl, P. L., Barth, R. P., Hazen, A. L., & 

Landsverk, J. A. (2005). Child welfare as a 

gateway to domestic violence services. Children 

and Youth Services Review, 27, 1203–1221. 

37 	 Kohl, P. L., et al. (2005). 

38 	 Lemon, N. K. D. (1999). The legal system’s response 

to children exposed to domestic violence. Future of 

Children, 9(3), 67–83. 

39 	 Farley, R. H., & Reece, R. M. (1996); Whitman, 

B. (2002). Psychological and psychiatric issues. 

In A. P. Giardino & E. R. Giardino (Eds.), 

Recognition of child abuse for the mandated reporter 

(3rd ed., pp. 137–156). St. Louis, MO: G.W. 

Medical. 

40 	 U.S. Department of Health and Human 

Services, Substance Abuse and Mental Health 

Services Administration (SAMHSA), Office of 

Applied Studies. (2009, April). Children living 

with substance-dependent or substance-abusing 

parents: 2002–2007. The NSDUH Report. 

Available: http://oas.samhsa.gov/2k9/SAparents/ 

SAparents.htm. 

41 	 DeBellis, M. D., Broussard, E. R., Herring, 

D. J., Wexler, S., Moritz, G., & Benitez, J. G. 

(2001). Psychiatric co-morbidity in caregivers 

and children involved in maltreatment: A pilot 

research study with policy implications. Child 

Abuse & Neglect, 25, 923–944; Dube, S. R., 

Anda, R. F., Felitti, V. J., Croft, J. B., Edwards, 

V. J., & Giles, W. H. (2001). Growing up with 

parental alcohol abuse: Exposure to childhood 

abuse, neglect, and household dysfunction. Child 

Abuse & Neglect, 25, 1627–1640; Chaffi n, M., 

Kelleher, K., & Hollenberg, J. (1996). Onset of 

physical abuse and neglect: Psychiatric, substance 

abuse, and social risk factors from prospective 

community data. Child Abuse & Neglect, 20, 

191–203. 

42 	 Kelleher, K., Chaffin, M., Hollenberg, J., & 

Fischer, E. (1994). Alcohol and drug disorders 

among physically abusive and neglectful parents 

in a community-based sample. American Journal 

of Public Health, 84, 1586–1590. 

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

ACF. (1999). Blending perspectives and building 

common ground. A report to Congress on substance 

abuse and child protection. Available: http://aspe. 

hhs.gov/hsp/subabuse99/subabuse.htm. 

44 	 Otero, C., Boles, S., Young, N. K., & Dennis, K. 

(2004). Methamphetamine: Addiction, treatment, 

outcomes and implications. Rockville, MD: U.S. 

Department of Health and Human Services, 

SAMHSA. 

45 	 U.S. Department of Justice, Drug Enforcement 

Administration. (n.d.). Methamphetamine. 

Available: http://www.usdoj.gov/dea/concern/ 

meth.html#3. 

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

SAMHSA. (2008). Results from the 2007 National 

Survey on Drug Use and Health: National 

fi ndings. Available: http://www.oas.samhsa.gov/ 

nsduh/2k7nsduh/2k7Results.cfm#TOC. 

47	 Office of National Drug Control Policy. 

(2010). Drug endangered children. Available: 

http://www.whitehousedrugpolicy.gov/enforce/ 

dr_endangered_child.html. 

48 	 Otero, C., et al. (2004). 

49 	 Illinois State University, School of Social Work. 

(2001). Signs of client methamphetamine use and 

caseworker safety procedures. Available: http://www. 

drugfreeinfo.org/PDFs/strengthensupervision. 

pdf. 

50 	 Society for Public Health Education, Th e 

American College of Medical Toxicology, & U.S. 

Department of Health and Human Services, 

Agency for Toxic Substances and Disease Registry 

(ATSDR). (2007). Helping communities combat 

clandestine methamphetamine laboratories. 

Available: http://www.acmt.net/cgi/page.cgi?_ 

id=136. 

51 	 Society for Public Health Education, Th e 

American College of Medical Toxicology, & U.S. 

Department of Health and Human Services, 

ATSDR. (2007). 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

75 
52 	 Goldman, J., & Salus, M. K. (2003). 

53 	 Cage, R. L., & Pence, D. M. (1997). Criminal 

investigation of child sexual abuse. Washington, 

DC: U.S. Department of Justice, Offi ce of Justice 

Programs (OJP), Office of Juvenile Justice and 

Delinquency Prevention (OJJDP). 

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

National Institutes of Health, National Institute 

of Child Health and Human Development 

(NICHD). (2000). NICHD researchers improve 

techniques for interviewing child abuse victims. 

Available: http://www.nichd.nih.gov/new/ 

releases/interviewing.cfm; Baker, L. L., Jaff e, P. 

G., Berkowitz, S. J., & Berkman, M. (2002). 

Children exposed to violence: A handbook for police 

trainers to increase understanding and improve 

community responses. Available: http://www.lfcc. 

on.ca/police-us.PDF. 

55 	 Saywitz, K. J., & Coulborn Faller, K. (2002). 

Interviewing child witnesses and victims of sexual 

abuse. Washington, DC: U.S. Department of 

Justice, OJP, OJJDP. 

56 	 Lanning, K. V. (2002). Criminal investigation 

of sexual victimization of children. In J. E. B. 

Meyers, L. Berliner, J. Briere, C. T. Hendrix, C. 

Jenny, & T. A. Reid (Eds.), The APSAC handbook 

on child maltreatment (2nd ed., pp. 329–347). 

Thousand Oaks, CA: Sage. 

57 	 U.S. Department of Health and Human 

Services, NIH, NICHD. (2000); Saywitz, K. J., 

& Coulborn Faller, K. (2002); Lanning, K. V. 

(2002); Baker, L. L., et al. (2002). 

58 	 Saywitz, K. J., & Goodman, G. S. (1996). 

Interviewing children in and out of court: Current 

research and practice implications. In J. Briere, L. 

Berliner, J. Bulkley, C. Jenny, & T. A. Reid (Eds.), 

The APSAC handbook on child maltreatment (2nd 

ed., pp. 297–318). Thousand Oaks, CA: Sage; 

Kolko, D., Brown, E., & Berliner, L. (2002). 

Children’s perceptions of their abusive experience: 

Measurement and preliminary fi ndings. Child 

Maltreatment, 7(1), 42–55. 

59 	 North Carolina Division of Social Services, 

& Family and Children’s Resource Program. 

(2002). Forensic interviewing and child welfare. 

Children’s Services Practice Notes. Available: http:// 

www.practicenotes.org/vol8_no1.htm. 

60 	 National Child Welfare Resource Center for 

Family-Centered Practice. (2002). Children, 

families, and workers: Facing trauma in child 

welfare. Available: http://www.hunter.cuny. 

edu/socwork/nrcfcpp/downloads/newsletter/ 

BPNPWinter02.pdf; Cohen, E., & Walthall, 

B. (2003). Silent realities: Supporting young 

children and their families who experience violence. 

Available: http://www.lfcc.on.ca/SilentRealities. 

pdf. 

61 	 Coulborn Faller, K. (1999). Questioning 

children who may have been sexually abused: 

An integration of research into practice. In K. 

Couldborn Faller (Ed.), Maltreatment in early 

childhood: Tools for research-based intervention (pp. 

37–58). New York: Hawthorn Press. 

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

NIH, NICHD. (2000). 

63 	 Lanning, K. V. (2002). 

64 	 Saywitz, K. J., & Coulborn Faller, K. (2002). 

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

ACF. (2010). 

66 	 Cage, R. L., & Pence, D. M. (1997). 

67 	 Lanning, K. V. (2002). 

68 	 Cage, R. L., & Pence, D. M. (1997). 

69 	 Heger, A. (2000). Making the diagnosis of sexual 

abuse: Ten years later. In A. Heger, S. J. Emans, 

& D. Muram (Eds.), Evaluation of the sexually 

abused child: A medical textbook and photographic 

atlas (2nd ed., pp. 1–10). New York: Oxford 

University Press. 

70 	 North Carolina Division of Social Services, & 

Family and Children’s Resource Program. (2005, 

June). Traumatic stress and child welfare workers. 

Children’s Services Practice Notes. Available: http:// 

ssw.unc.edu/fcrp/Cspn/vol10_n3/sts.htm. 

71 	 International Society for Traumatic Stress Studies. 

(2005). Indirect traumatization in professionals 

working with trauma survivors. Available: http:// 

www.istss.org/AM/Template.cfm?Section= 

ResourcesforProfessionals&Template=/CM/ 

ContentDisplay.cfm&ContentID=1625. 

72 	 Siegfried, C. B. (2008). Child welfare work and 

secondary traumatic stress. Available: http://www. 

nctsnet.org/nctsn_assets/pdfs/cwt3_sho_sts.pdf. 

73 	 Siegfried, C. B. (2008). 

74 	 Saywitz, K. J., & Goodman, G. S. (1996); 

Kolko, D., et al. (2002); DePanfilis, D., & 

76 Endnotes
Salus, M. (2003). Child protective services: A 

guide for caseworkers. Available: http://www. 

childwelfare.gov/pubs/usermanuals/cps/cps. 

pdf.; U.S. Department of Health and Human 

Services, NIH, NICHD. (2000); Saywitz, K. J., 

& Coulborn Faller, K. (2002); Lanning, K. V. 

(2002). 

75 	 Berliner, L. (2000). How do I interview older 

children and adolescents about sexual abuse? In 

H. Dubowitz & D. DePanfi lis (Eds.), Handbook 

for child protection practice (pp. 65–69). Th ousand 

Oaks, CA: Sage. 

76 	 Sattler, J. (1998). Clinical and forensic interviewing 

of children and families. San Diego, CA: Sattler, 

Inc. 

77 	 Fontes, L. A. (2000). Interviewing children from 

immigrant families about maltreatment. Newbury 

Park, CA: Sage; Fontes, L. A. (2005a). Interviewing 

diverse children about maltreatment. Child abuse 

and culture: Working with diverse families. New 

York: Guilford Press. 

78 	 Saywitz, K. J., & Goodman, G. S. (1996); Kolko, 

D., et al. (2002); DePanfilis, D., & Salus, M. K. 

(2003). 

79 	 Bragg, H. L. (2003). Child protection in families 

experiencing domestic violence. Available: http:// 

www.childwelfare.gov/pubs/usermanuals/ 

domesticviolence/. 

80 	 Fontes, L. A. (2005b). Interviewing immigrant 

children and families about child maltreatment: 

Setting the stage. Protecting Children, 20(1), 

37–46; U.S. Department of Health and Human 

Services, NIH, NICHD. (2000); Veith, V. (2002). 

Cultural sensitivity in the forensic interview process. 

American Prosecutors Research Institute [Online]. 

Available: http://www.ndaa-apri.org/publications/ 

newsletters/update_volume_15_number_1_2002. 

html. 

81 	 Lamb, M. E., Hershkowitz, I., Orbach, Y., & 

Esplin, P. W. (2008). Interviewing children with 

intellectual and communicative diffi culties. In 

Tell me what happened: Structured investigative 

interviews of child victims and witnesses. West 

Sussex, England: John Wiley & Sons; Westcott, 

H. L., & Jones, D. P. H. (1999). Annotation: 

The abuse of disabled children. Journal of Child 

Psychology and Psychiatry, 40, 497–506. 

82 	 Lamb, M. E., et al. (2008). 

83 	 Anderson, J., & Heath, R. T. (2006a). Forensic 

interviews with children who have developmental 

disabilities: Part 1 of 2. American Prosecutors 

Research Institute Update. Available: http://ndaa. 

org/pdf/update_vol_19_number_1_2006.pdf. 

84 	 Blahauvietz, S. (2005). Key factors in forensic 

interviews with Native American children. 

National Center for Prosecution of Child Abuse 

Update. Available: http://ndaa.org/pdf/update_ 

vol_18_number_6_2005.pdf. 

85 	 Anderson, J., & Heath, R. T. (2006b). Forensic 

interviews with children who have developmental 

disabilities: Part 2 of 2. American Prosecutors 

Research Institute Update. Available: http://ndaa. 

org/pdf/update_vol_19_number_2_2006.pdf; 

Lamb, M. E., et al. (2008). 

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

ACF. (2010). 

87	 DePanfilis, D., & Salus, M. K. (2003); Cage, R. 

L., & Pence, D. M. (1997). 

88 	 DePanfilis, D., & Salus, M. K. (2003). 

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

ACF. (2010). 

90 	 Cage, R. L., & Pence, D. M. (1997). 

91 	 Cage, R. L., & Pence, D. M. (2001). Criminal 

investigation of child sexual abuse. Washington, 

DC: U.S. Department of Justice, OJP, OJJDP. 

92 	 Cage, R. L., & Pence, D. M. (1997). 

93 	 Cage, R. L., & Pence, D. M. (1997). 

94 	 Loiselle, J. (2002). 

95 	 American Bar Association. (n.d.). Criminal law: 

The police & your rights. Available: http://www. 

abanet.org/publiced/practical/criminal/miranda_ 

rights.html. 

96 	 U.S. Department of Justice, Attorney General’s 

Task Force on Family Violence. (1984). Attorney 

General’s Task Force on Family Violence Final 

report. Available: http://www.eric.ed.gov/PDFS/ 

ED251762.pdf. 

97 	 Lanning, K. V. (2002); Baker, L. L., et al. (2002). 

98 	 Cross, T. P., Finkelhor, D., & Ormrod, R. (2005). 

Police involvement in child protective services 

investigations: Literature review and secondary 

analysis. Child Maltreatment, 10, 224–244. 

99 	 Lanning, K. V. (2002). 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

77 
100 	 DePanfilis, D., & Salus, M. K. (2003). 

101 	 Walsh, B. (1995). Law enforcement: The use of 

search warrants in cases of crimes against children. 

The APSAC Advisor, 8(1), 3–7. 

102 	 Jones, W. G. (2006). Working with the courts 

in child protection. Available: http://www. 

childwelfare.gov/pubs/usermanuals/courts/. 

103 	 Cage, R. L., & Pence, D. M. (1997); KosidUthe, J. (1992). Appendix I: Considerations in 

obtaining and using expertise search warrants 

in cases of preferential child molesters. In K. 

V. Lanning (Ed.), Child molesters: A behavioral 

analysis for law enforcement offi cers investigating 

cases of child sexual exploitation. Washington, 

DC: National Center for Missing and Exploited 

Children. 

104 	 Holder, W. (2000). How do I assess risk and 

safety? In H. Dubowitz & D. DePanfi lis (Eds.), 

Handbook for child protection practice (pp. 227– 

232). Thousand Oaks, CA: Sage. 

105 	 Walsh, B. (1995). 

106 	 U.S. Department of Justice, OJP, OJJDP, & 

University of Southern Maine, Edmund S. 

Muskie Institute of Public Aff airs. (1996). 

Child maltreatment & abuse investigation for law 

enforcement officers. Available: http://muskie.usm. 

maine.edu/helpkids/rcpdfs/COPS.pdf. 

107 	 U.S. Department of Justice. (2002). Searching and 

seizing computers and obtaining electronic evidence 

in criminal investigations. Available: http://www. 

usdoj.gov/criminal/cybercrime/s&smanual2002. 

htm. 

108 	 U.S. Department of Justice, OJP, OJJDP, & 

University of Southern Maine, Edmund S. 

Muskie Institute of Public Aff airs. (1996). 

109 	 Walsh, B. (1995). 

110 	 DePanfilis, D., & Salus, M. K. (2003). 

111 	 DePanfilis, D., & Salus, M. K. (2003). 

112 	 Walsh, B. (2005). 

113 	 Walsh, B. (2005). 

114 American Academy of Pediatrics Committee on 

Child Abuse and Neglect. (2006). Distinguishing 

sudden infant death syndrome from child abuse 

fatalities. Pediatrics, 107, 437–441. 

115 	 Walsh, B. (2005). 

116 American Academy of Pediatrics Committee on 

Child Abuse and Neglect. (2006). 

117 	 Walsh, B. (2005). 

118 	 Walsh, B. (2005). 

119 	 Regehr, C., Chau, S., Leslie, B., & Howe, P. 

(2002). Inquiries into deaths of children in care: 

The impact on child welfare workers and their 

organization. Child and Youth Services Review, 24, 

885–902. 

120 	 American Association for Protecting Children. 

(1998). Child sexual abuse curriculum for social 

workers. Denver, CO: Author; American Bar 

Association, National Legal Resource Center 

for Child Advocacy and Protection. (1989). 

Resource guide to legal practice in dependency cases. 

Washington, DC: Author. 

121 	 Nusbaum-Feller, J., Davidson, H., Hardin, 

M., & Horowitz, R. (1992). Working with the 

courts in child protection. Available: http://www. 

childwelfare.gov/pubs/usermanuals/courts_92/ 

index.cfm. 

122 	 Nusbaum-Feller, J., et al. (1992). 

123 	 Child Welfare Information Gateway. (2003). 

Determining the best interests of the child: Summary 

of state laws. Available: http://www.childwelfare. 

gov/systemwide/laws_policies/statutes/best_ 

interestall.pdf. 

124 	 Child Welfare Information Gateway. (2008a). 

125 	 World Health Organization, Department of 

Injuries and Violence Prevention. (2005). 

Violence and disasters. Available: http://www.who. 

int/violence_injury_prevention/publications/ 

violence/violence_disasters.pdf; Curtis, T., 

Miller, B. C., & Berry, E. H. (2000). Changes 

in reports and incidence of child abuse following 

natural disasters. Child Abuse and Neglect, 24, 

1151–1162. 

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

NIH, National Institute of Mental Health 

(NIMH). (2001). Helping children and adolescents 

cope with violence and disasters. Available: http:// 

www.nimh.nih.gov/publicat/violence.cfm; 

Osofsky, J. D. (1995). The effects of exposure to 

violence on young children. American Psychologist, 

50, 782–788; Pynoos, R. S., Steinberg, A. M., 

& Goenjian, A. K. (1996). Traumatic stress in 

childhood and adolescence: Recent developments 

and current controversies. In B. A. Van der Kolk, 

78 Endnotes
A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic 

stress: The effects of overwhelming experience on mind, 

body, and society (pp. 331 –358). New York: Guilford 

Press; Marans, S., & Adelman, A. (1997). 

Experiencing violence in a developmental context. 

In J. D. Osofsky (Ed.), Children in a violent society 

(pp. 202–222). New York: Guilford Press; Vogel, J. 

M., & Vernberg, E. M. (1993). Part 1: Children’s 

psychological responses to disasters. Journal of 

Clinical Child Psychology, 22, 464–484; Garbarino, 

J., Kostelny, K., & Dubrow, N. (1991). What 

children can tell us about living in danger. 

American Psychologist, 46, 376–383; Duncan, R. D., 

Saunders, B. E., Kilpatrick, D. G., Hanson, R. 

F., & Resnick, H. S. (1996). Childhood physical 

assault as a risk factor for PTSD, depression, and 

substance abuse: Findings from a national survey. 

American Journal of Orthopsychiatry, 66, 437–448; 

Boney-McCoy, S., & Finkelhor, D. (1995). 

Prior victimization: A risk factor for child sexual 

abuse and for PTSD-related symptomatology 

among sexually abused youth. Child Abuse & 

Neglect, 19,1401–1421; Roth, S. H., Newman, 

E., Pelcovitz, D., Van der Kolk, B. A., & Mandel, 

F. S. (1997). Complex PTSD in victims exposed 

to sexual and physical abuse: Results from the 

DSM-IV Field Trial for Posttraumatic Stress 

Disorder. Journal of Traumatic Stress, 10, 539– 

555; Morrison, J. A. (2000). Protective factors 

associated with children’s emotional responses to 

chronic community violence exposure. Trauma, 

Violence, and Abuse: A Review Journal, 1, 299–320. 

127 	 Dobson, C., & Perry, B. D. (n.d.). Th e impact 

of Katrina on children: Special comments for fi rst 

responders and helping professionals. Available: 

http://www.childtrauma.org/CTAMATERIALS/ 

SecondaryTrauma_Katrina.pdf. 

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

NIH, NIMH. (2006). Helping children and 

adolescents cope with violence and disasters: What 

rescue workers can do. Available: http://www. 

nimh.nih.gov/health/publications/helpingchildren-and-adolescents-cope-with-violenceand-disasters-rescue-workers/index.shtml. 

129 	 National Child Traumatic Stress Network, & 

National Center for PTSD. (2006). Psychological 

first aid: Field operations guide (2nd ed.). Available: 

http://www.nctsnet.org/nctsn_assets/pdfs/pfa/2/ 

PsyFirstAid.pdf. 

130 	 National Child Traumatic Stress Network, & 

National Center for PTSD. (2006). 

131 	 National Child Traumatic Stress Network, & 

National Center for PTSD. (2006). 

132 	 National Child Traumatic Stress Network, & 

National Center for PTSD. (2006). 

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

SAMHSA. (2005). Tips for managing and 

preventing stress: A guide for emergency and disaster 

response workers. Available: http://mentalhealth. 

samhsa.gov/publications/allpubs/tips/disaster. 

pdf. 

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

CDC, National Institute for Occupational Safety 

and Health (NIOSH). (2001). Traumatic incident 

stress: Information for emergency response workers. 

Available: http://www.cdc.gov/niosh/docs/2002­

107/. 

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

SAMHSA. (2005); U.S. Department of Health 

and Human Services, CDC, NIOSH. (2001). 

136 	 O’Brien, M., Webster, S., & Herrick, A. (2007). 

Coping with disasters and strengthening systems: 

A framework for child welfare agencies. Available: 

http://muskie.usm.maine.edu/helpkids/rcpdfs/ 

copingwithdisasters.pdf. 

137 	 O’Brien, M., Webster, S., & Herrick, A. (2007). 

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

ACF. (2006). New legislation: The Child and 

Family Services Improvement Act of 2006 (Public 

Law 109-288) (ACYF-CB-IM-06-05). Available: 

http://www.acf.hhs.gov/programs/cb/laws_ 

policies/policy/im/2006/im0605.htm. 

139 	 U.S. Government Accountability Offi ce. (2006). 

Lessons learned for protecting and educating 

children after the Gulf Coast hurricanes (GAO06-680R). Available: http://www.gao.gov/new. 

items/d06680r.pdf. 

140 	 O’Brien, M., Webster, S., & Herrick, A. (2007). 

141 	 O’Brien, M., Webster, S., & Herrick, A. (2007). 

142 	 Weisner, C. D. (2005). Former child 

welfare leader offers insights on lessons 

learned from Hurricane Katrina at COA’s 

Public Agency Roundtable. Available:

http://www.coanet.org/Files/Roundtable 

Luncheon.pdf. 

143 	 O’Brien, M., Webster, S., & Herrick, A. (2007). 

144 	 U.S. Government Accountability Offi ce. (2006). 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

79 
145 	 De Vita, C. J., Kramer, F. D., Eyster, L., Hall, 

S., Kehayova, P., & Triplett, T. (2008). The role of 

faith-based and community organizations in posthurricane human service relief eff orts. Available: 

http://aspe.hhs.gov/hsp/08/PostHurricaneRelief/ 

report.pdf. 

146 	 Lind, C. (2005). Managing in emergencies: 

Enhancing collaboration for human services. 

Available: http://76.12.61.196/publications/ 

feskatrina1.pdf; O’Brien, M., Webster, S., & 

Herrick, A. (2007). 

147 O’Brien, M., Webster, S., & Herrick, A. (2007). 

148 O’Brien, M., Webster, S., & Herrick, A. (2007). 

149 O’Brien, M., Webster, S., & Herrick, A. (2007). 

150 O’Brien, M., Webster, S., & Herrick, A. (2007). 

80 Endnotes 
APPENDIX A 

Glossary of Terms 

Adjudicatory Hearings – held by the juvenile and 

family court to determine whether a child has been 

maltreated or whether another legal basis exists for 

the State to intervene to protect the child. 

Adoption and Safe Families Act (ASFA) – signed 

into law November 1997 and designed to improve 

the safety of children, to promote adoption and other 

permanent homes for children who need them, and 

to support families. Th e law requires CPS agencies 

to provide more timely and focused assessment and 

intervention services to the children and families that 

are served within the CPS system. 

CASA – court-appointed special advocates (usually 

volunteers) who serve to ensure that the needs 

and interests of a child in child protection judicial 

proceedings are fully protected. 

Case Closure – the process of ending the relationship 

between the CPS worker and the family that often 

involves a mutual assessment of progress. Optimally, 

cases are closed when families have achieved their 

goals and the risk of maltreatment has been reduced 

or eliminated. 

Case Plan – the casework document that outlines the 

outcomes, goals, and tasks necessary to be achieved in 

order to reduce the risk of maltreatment. 

Caseworker – see Child Protective Services 

Caseworker. 

Central Registry – a centralized database containing 

information on all substantiated/founded reports of 

child maltreatment in a selected area (typically a State). 

Child Abuse Prevention and Treatment Act 

(CAPTA) – see Keeping Children and Families Safe 

Act. 

Child Protective Services (CPS) – the designated 

social services agency (in most States) to receive 

reports, investigate, and provide intervention and 

treatment services to children and families in which 

child maltreatment has occurred. Frequently, this 

agency is located within larger public social service 

agencies, such as departments of social services. 

Child Protective Services (CPS) Caseworker – an 

individual employed by a CPS agency to receive 

reports, investigate, and/or provide intervention and 

treatment services to children and families in which 

child maltreatment has occurred. 

Concurrent Planning – identifies alternative forms 

of permanency by addressing both reunifi cation or 

legal permanency with a new parent or caregiver if 

reunifi cation eff orts fail. 

Cultural Competence – a set of attitudes, behaviors, 

and policies that integrates knowledge about groups 

of people into practices and standards to enhance the 

quality of services to all cultural groups being served. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

81 
Differential Response – an area of CPS reform that 

offers greater flexibility in responding to allegations 

of abuse and neglect. Also referred to as “dual track” 

or “multi-track” response, it permits CPS agencies to 

respond differentially to children’s needs for safety, 

the degree of risk present, and the family’s needs for 

services and support. See Dual Track. 

Dispositional Hearings – held by the juvenile and 

family court to determine the legal resolution of 

cases after adjudication, such as whether placement 

of the child in out-of-home care is necessary, and the 

services the children and family will need to reduce 

the risk of maltreatment and to address the eff ects of 

maltreatment. 

Dual Track – term reflecting new CPS response 

systems that typically combine a nonadversarial, 

service-based assessment track for cases in which 

children are not at immediate risk with a traditional 

CPS investigative track for cases where children 

are unsafe or at greater risk for maltreatment. See 

Diff erential Response. 

Emergency Medical Technician (EMT) – a fi rst 

responder who has been trained and certifi ed in 

providing certain medical care to patients in need of 

immediate medical attention before and, if needed, 

during transport to a health care facility. 

Emotional Maltreatment – see Psychological 

Maltreatment. 

Evidence – information or items, such as testimony, 

written documents, and physical items, that are 

presented to prove or to disprove an allegation. 

Family Assessment – the stage of the child protection 

process during which the CPS caseworker, the 

community treatment provider, and the family reach 

a mutual understanding regarding the behaviors and 

conditions that must change to reduce or eliminate 

the risk of maltreatment, the most critical treatment 

needs that must be addressed, and the strengths on 

which to build. 

Family Group Conferencing – a family meeting 

model used by CPS agencies to optimize family 

strengths in the planning process. This model brings 

the family, extended family, and others important 

in the family’s life (e.g., friends, clergy, neighbors) 

together to make decisions regarding how best to 

ensure the safety of the family members. 

Family Unity Model – a family meeting model used 

by CPS agencies to optimize family strengths in the 

planning process. This model is similar to the Family 

Group Conferencing model. 

First Responder – a professional whose responsibilities 

include the initial response to the scene of child 

maltreatment. Types of professionals who are fi rst 

responders include child protective services (CPS) 

caseworkers, law enforcement offi cers, and emergency 

medical technicians (EMTs). 

Guardian ad Litem – a lawyer or lay person who 

represents a child in juvenile or family court. Usually 

this person considers the best interest of the child 

and may perform a variety of roles, including those 

of independent investigator, advocate, advisor, and 

guardian for the child. A lay person who serves in this 

role is sometimes known as a court-appointed special 

advocate or CASA. 

Home Visitation Programs – prevention programs 

that offer a variety of family-focused services to 

pregnant mothers and families with new babies. 

Activities frequently encompass structured visits to 

the family’s home and may address positive parenting 

practices, nonviolent discipline techniques, child 

development, maternal and child health, available 

services, and advocacy. 

Immersion Burn – a type of burn whereby an 

individual is forced into extremely hot liquid. Th ese 

burns have a “water line” or sharp demarcation border. 

Immunity – established in all child abuse laws to 

protect reporters from civil law suits and criminal 

prosecution resulting from filing a report of child 

abuse and neglect. 

82 Appendix A—Glossary of Terms 
 

Initial Assessment or Investigation – the stage of the 

CPS case process during which the CPS caseworker 

determines the validity of the child maltreatment 

report, assesses the risk of maltreatment, determines 

if the child is safe, develops a safety plan if needed to 

ensure the child’s protection, and determines services 

needed. 

Intake – the stage of the CPS case process where the 

CPS caseworker screens and accepts reports of child 

maltreatment. 

Interview Protocol – a structured format to ensure 

that all family members are seen in a planned strategy, 

that community providers collaborate, and that 

information gathering is thorough. 

Keeping Children and Families Safe Act – the 

Keeping Children and Families Safe Act of 2003 (P.L. 

108-36) included the reauthorization of CAPTA in 

its Title I, Sec. 111. CAPTA provides minimum 

standards for defining child physical abuse and neglect 

and sexual abuse that States must incorporate into 

their statutory definitions in order to receive Federal 

funds. CAPTA defines child abuse and neglect as “at 

a minimum, any recent act or failure to act on the 

part of a parent or caretaker, which results in death, 

serious physical or emotional harm, sexual abuse or 

exploitation, or an act or failure to act which presents 

an imminent risk of serious harm.” 

Kinship Care – formal or informal child placement 

by the juvenile court and child welfare agency in the 

home of a child’s relative. 

Law Enforcement Officer – an individual who is 

given the authority to uphold Federal, State, and/ 

or local laws, which may include responding to 

and investigating possible crimes, pursuing and 

apprehending individuals who break laws, and issuing 

citations. Law enforcement officers may include 

police officers, sheriffs and deputies, detectives, and 

State and Federal agents. 

Liaison – a person within an organization who 

has responsibility for facilitating communication, 

collaboration, and coordination between agencies 

involved in the child protection system. 

Mandated Reporter – individuals required by 

State statutes to report suspected child abuse and 

neglect to the proper authorities (usually CPS or law 

enforcement agencies). Mandated reporters typically 

include professionals, such as educators and other 

school personnel, health care and mental health 

professionals, social workers, childcare providers, and 

law enforcement officers. Some States identify all 

citizens as mandated reporters. 

Miranda Rights – read by law enforcement officers 

upon the arrest of a suspect and state that a suspect 

does not have to speak to police and that the suspect 

can request an attorney. These rights are designed to 

protect the Fifth Amendment rights of individuals to 

not self-incriminate. 

Modus Operandi – a habitual method of procedure 

or operation, often in reference to how an individual 

commits a crime. 

Multidisciplinary Team – established between 

agencies and professionals within the child protection 

system to discuss cases of child abuse and neglect 

and to aid in decisions at various stages of the CPS 

case process. These terms may also be designated by 

different names, including child protection teams, 

interdisciplinary teams, or case consultation teams. 

Neglect – the failure to provide for the child’s 

basic needs, including physical, educational, or 

emotional. Physical neglect can include not providing 

adequate food or clothing, appropriate medical care, 

supervision, or proper weather protection (heat or 

coats). Educational neglect includes failing to provide 

appropriate schooling, failure to address special 

educational needs, or allowing excessive truancies. 

Psychological neglect includes the lack of any emotional 

support and love, chronic inattention to the child, 

exposure to spouse abuse, or drug or alcohol abuse. 

Open-Ended Question – a type of question used 

during an interview that allows the respondent to 

express what is most relevant and important to him, 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

83 
as opposed to a question that directs the respondent 

(e.g., What did you do to your daughter’s arm when 

you entered the room?). An example of an openended question is “What happened this afternoon?” 

Out-of-Home Care – child care, foster care, or 

residential care provided by persons, organizations, 

and institutions to children who are placed outside 

their families, usually under the jurisdiction of 

juvenile or family court. 

Parent or Caretaker – person responsible for the care 

of the child. 

Physical Abuse – the inflicting of a nonaccidental 

physical injury. This may include burning, hitting, 

punching, shaking, kicking, beating, or otherwise 

harming a child. It may, however, have been the 

result of over-discipline or physical punishment that 

is inappropriate to the child’s age. 

Primary Prevention – activities geared to a sample 

of the general population to prevent child abuse and 

neglect from occurring. Also referred to as “universal 

prevention.” 

Protective Factors – strengths and resources that 

appear to mediate or serve as a buff er against 

risk factors that contribute to vulnerability to 

maltreatment or against the negative eff ects of 

maltreatment experiences. 

Protocol – an interagency agreement that delineates 

joint roles and responsibilities by establishing criteria 

and procedures for working together on cases of child 

abuse and neglect. 

Psychological Maltreatment – a pattern of caregiver 

behavior or extreme incidents that convey to children 

that they are worthless, flawed, unloved, unwanted, 

endangered, or only of value to meeting another’s 

needs. This can include parents or caretakers using 

extreme or bizarre forms of punishment or threatening 

or terrorizing a child. Psychological maltreatment 

is also known as emotional abuse or neglect, verbal 

abuse, or mental abuse. 

Response Time – a determination made by CPS 

and law enforcement regarding the immediacy of the 

response needed to a report of child abuse or neglect. 

Review Hearings – held by the juvenile and family 

court to review dispositions (usually every 6 months) 

and to determine the need to maintain placement in 

out-of-home care or court jurisdiction of a child. 

Risk – the likelihood that a child will be maltreated 

in the future. 

Risk Assessment – the measurement of the likelihood 

that a child will be maltreated in the future; frequently 

carried out through the use of checklists, matrices, 

scales, and other methods. 

Risk Factors – behaviors and conditions present in 

the child, parent, or family that will likely contribute 

to child maltreatment occurring in the future. 

Safety – absence of an imminent or immediate threat 

of moderate to serious harm to the child. 

Safety Assessment – a part of the CPS case process 

in which available information is analyzed to identify 

whether a child is in immediate danger of moderate 

or serious harm. 

Safety Plan – a casework document developed 

when it is determined that the child is in imminent 

danger or at risk of serious harm. In the safety plan, 

the caseworker targets the factors that are causing or 

contributing to the risk of imminent serious harm to 

the child, and identifies, along with the family, the 

interventions that will control the safety factors and 

ensure the child’s protection. 

Secondary Prevention – activities targeted to prevent 

breakdowns and dysfunction within families that have 

been identified as being at risk for abuse and neglect. 

Service Agreement – the casework document 

developed between the CPS caseworker and the 

family that outlines the tasks necessary to achieve risk 

reduction goals and outcomes. 

84 Appendix A—Glossary of Terms 
Service Provision – the stage of the CPS casework 

process when CPS and other providers deliver 

specific services geared toward reducing the risk of 

maltreatment. 

Sexual Abuse – inappropriate adolescent or adult 

sexual behavior with a child. It includes fondling 

a child’s genitals, making the child fondle the 

adult’s genitals, intercourse, incest, rape, sodomy, 

exhibitionism, sexual exploitation, or exposure to 

pornography. To be considered child abuse, these 

acts have to be committed by a person responsible for 

the care of a child (for example a babysitter, a parent, 

or a daycare provider) or related to the child. If a 

stranger commits these acts, it would be considered 

sexual assault and handled solely by the police and 

criminal courts. 

Substantiated – an investigation disposition 

concluding that the allegation of maltreatment or risk 

of maltreatment was supported or founded by State 

law or State policy. A CPS determination means that 

credible evidence exists that child abuse or neglect has 

occurred. 

Sudden Infant Death Syndrome (SIDS) – the 

sudden death of an infant younger than one year of 

age that remains unexplained after a thorough case 

investigation, including performance of a complete 

autopsy, examination of the death scene, and review 

of the clinical history. 

Tertiary Prevention – treatment eff orts geared 

to address situations where child maltreatment 

has already occurred, with the goals of preventing 

additional maltreatment and its harmful eff ects. 

Testify – to provide testimony in court. See 

Testimony. 

Testimony – the statement made by a witness in 

court. For example, a CPS caseworker may provide 

testimony in court about what she saw when she 

entered a house due to a report of child abuse. 

Treatment – the stage of the child protection case 

process when specific services are provided by CPS 

and other providers to reduce the risk of maltreatment, 

support families in meeting case goals, and address 

the effects of maltreatment. 

Unsubstantiated (not substantiated) – an 

investigation disposition that determines that there is 

not sufficient evidence under State law or policy to 

conclude that the child has been maltreated or is at 

risk of maltreatment. A CPS determination means 

that credible evidence does not exist that child abuse 

or neglect has occurred. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

85 

APPENDIX B 

Resource Listings of Selected 

National Organizations Concerned 

with Child Maltreatment and with 

First Responders 

Listed here are several representatives of the many 

national organizations and groups dealing with 

various aspects of child maltreatment. First are several 

representatives of the many national organizations 

and groups that may act as first responders to 

child abuse and neglect cases. Visit http://www. 

childwelfare.gov/pubs/usermanual.cfm to view a 

more comprehensive list of resources and visit http:// 

www.childwelfare.gov/organizations/index.cfm to 

view an organization database. Inclusion on this list 

is for information purposes and does not constitute 

an endorsement by the Office on Child Abuse and 

Neglect nor the Children’s Bureau. 

EMS/EMT/MEDICAL EXAMINERS 


ORGANIZATIONS 


Emergency Medical Services for Children National 

Resource Center 

address: 8737 Colesville Road, Suite 400 

Silver Spring, MD 20910 

phone: (202) 476-4927 

fax: (202) 476-6845 

e-mail: emscinformation@cnmc.org 

website: http://www.childrensnational.org/EMSC/ 

Works with State health departments, medicalbased universities, and stakeholder organizations to 

improve the pediatric emergency care infrastructure 

throughout the United States and its territories. 

EMS Village 

website: http://www.emsvillage.com/ 

An interactive community with information relevant 

to EMS providers. 

National Association of EMTs 

address: P.O. Box 1400 

Clinton, MS 39060-1400 

phone: (601) 924-7744

 (800) 34-NAEMT 

fax: (601) 924-7325 

e-mail: info@naemt.org 

website: http://www.naemt.org/ 

Represents and serves emergency medical services 

personnel through advocacy, educational programs, 

and research. 

National Association of Medical Examiners 

address: 430 Pryor Street, SW 

Atlanta, GA 30312 

phone: (404) 730-4781 

website: http://www.thename.org/ 

Fosters the professional growth of physician death 

investigators and disseminates professional and 

technical information on the medical investigation of 

violent, suspicious, and unusual deaths. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

87 
National Registry of Emergency Medical 

Technicians 

address: Rocco V. Morando Building 

6610 Busch Boulevard 

P.O. Box 29233 

Columbus, OH 43229 

phone: (614) 888-4484 

fax: (614) 888-8920 

website: http://www.nremt.org

 National certification agency that establishes uniform 

standards for training and examination of personnel 

active in the delivery of emergency ambulance service. 

LAW ENFORCEMENT ORGANIZATIONS 

International Association of Chiefs of Police 


address: 515 North Washington Street

 Alexandria, VA  22314 

phone: (703) 836-6767     

(800) THE IACP 

fax: (703) 836-4543 

e-mail: information@theiacp.org 

website: http://www.theiacp.org/ 

Develops and disseminates information on 

administrative, technical, and operational practices 

for use in police work as well as fostering police 

cooperation and the exhange of information among 

police officers. 

International Crime Scene Investigators 

Association 

address: PMB 385 

15774 S. LaGrange Road 

Orland Park, IL  60462 

phone: (708) 460-8082 

e-mail: info@icsia.org 

website: http://icsia.org/ 

Provides information to assist law enforcement 

personnel who are involved in the processing of crime 

scenes and provides public forums for crime scene 

investigators to communicate with one another. 

National Association of Police Organizations 

address: 317 South Patrick Street 

Alexandria, VA 22314 

phone: (703) 549-0775 

fax: (703) 684-0515 

e-mail: info@napo.org 

website: http://www.napo.org/ 


Promotes the interests of America’s law enforcement 


officers through legislative and legal advocacy, political 


action, and education. 


National Center for Community Policing 

phone: (800) 892-9051 

website: http://www.cj.msu.edu/~people/cp/ 

Facilitates organizational change within police 

agencies and the development of community 

partnerships to institutionalize community policing. 

88 Appendix B—Resource Listings of Selected National Organizations Concerned 

with Child Maltreatment and with First Responders 
National Center for Prosecution of Child Abuse 


address: American Prosecutors Research Institute 

44 Canal Center Plaza, Suite 110 

Alexandria, VA 22314 

phone: (703) 549-9222 

fax: (703) 836-3195 

e-mail: ncpca@ndaa.org 

website: http://www.ndaa.org/ncpca_home.html 

Serves as a central resource for training, expert legal 

assistance, court reform, and information on criminal 

child abuse investigations and prosecutions. 

National Criminal Justice Reference Service 

address: P.O. Box 6000 

Rockville, MD 20849-6000 

phone: (800) 851-3420

 (877) 712-9279 (TTY) 

fax: (301) 519-5212 

website: http://ncjrs.gov/ 

Provides justice and substance abuse information to 

support research, policy, and program development 

for various groups, including law enforcement. 

National Sheriff s’ Association 

address: 1450 Duke Street 

Alexandria, VA 22314-3490 

phone: (703) 836-7827 

fax: (703) 836-6541 

website: http://www.sheriff s.org/ 

Provides programs to enable sheriffs, their deputies, 

chiefs of police, and others in the field of criminal 

justice to perform their jobs in the best possible 

manner and to better serve the people of their 

jurisdictions. 

EMERGENCY RESPONSE ORGANIZATIONS 

Federal Emergency Management Agency 


address: 500 C Street, SW 

Washington, DC 20472 

phone: (800) 621-FEMA (3362)

 (800) 462-7585 (TTY) 

fax: (800) 827-8112 

e-mail: FEMA-Correspondence-Unit@dhs.gov 

website: http://www.fema.gov/ 

Seeks to reduce the loss of life and property and 

protect the United States from all hazards, including 

natural disasters, acts of terrorism, and other 

manmade disasters, by leading and supporting the 

Nation in a risk-based, comprehensive emergency 

management system of preparedness, protection, 

response, recovery, and mitigation. 

CHILD WELFARE ORGANIZATIONS 

American Humane Association 

Children’s Division 

address: 63 Inverness Drive, East 

Englewood, CO 80112-5117 

phone: (303) 792-9900 

fax: (303) 792-5333 

email: info@americanhumane.org 

website: www.americanhumane.org/protectingchildren/ 

Conducts research, analysis, and training to help 

public and private agencies respond to child 

maltreatment. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

89 
American Professional Society on the Abuse 

of Children 

address: P. O. Box 30669 

Charleston, SC 29417 

phone: (843) 764-2905 

(877) 40A-PSAC 

fax: (803) 753-9823 

e-mail: apsac@comcast.net 

website: www.apsac.org 

Provides professional education, promotes research to 

inform eff ective practice, and addresses public policy 

issues. Professional membership organization. 

American Public Human Services Association 

address: 810 First Street, NE, Suite 500 

Washington, DC 20002-4267 

phone: (202) 682-0100 

fax: (202) 289-6555 

website: www.aphsa.org 

Addresses program and policy issues related to the 

administration and delivery of publicly funded human 

services. Professional membership organization. 

AVANCE Family Support and Education Program 

address: 118 N. Medina 

San Antonio, TX 78207 

phone: (210) 270-4630 

fax: (210) 270-4612 

website: www.avance.org 

Operates a national training center to share and 

disseminate information, material, and curricula 

to service providers and policy-makers interested in 

supporting high-risk Hispanic families. 

Chadwick Center for Children and Families 

address: 3020 Children’s Way 

MC 5016 

San Diego, CA 92123 

phone: (858) 966-5814 

fax: (858) 966-8535 

e-mail: chadwickcenter@chsd.org 

website: http://www.chadwickcenter.org/ 

Strives to protect children and strengthen families 

through excellence in prevention, treatment, 

education, public policy, advocacy, and research. 

Child Welfare League of America 

address: 2345 Crystal Drive, Suite 250 

Arlington, VA 22202 

phone: (703) 412-2400 

fax: (703) 412-2401 

website: http://www.cwla.org 

Provides training, consultation, and technical 

assistance to child welfare professionals and agencies 

while educating the public about emerging issues 

aff ecting children. 

National Black Child Development Institute 

address: 1313 L Street, NW, Suite 110 

Washington, DC  20005-4110 

phone: (202) 833-2220 

fax: (202) 833-8222 

e-mail: moreinfo@nbcdi.org 

website: http://www.nbcdi.org 

Operates programs and sponsors a national training 

conference through Howard University to improve 

and protect the well-being of African-American 

children. 

90 Appendix B—Resource Listings of Selected National Organizations Concerned 

with Child Maltreatment and with First Responders 
National Center on Substance Abuse and 

Child Welfare 

address: 4940 Irvine Boulevard, Suite 202 

Irvine, CA 92620 

phone: (866) 493-2758 

fax: (714) 505-3626 

e-mail: ncsacw@cff utures.org 

website: http://www.ncsacw.samhsa.gov 

Assists local, State, and Tribal agencies in improving 

systems and practice for families with substance use 

disorders who are involved in the child welfare and 

family judicial systems. 

National Children’s Advocacy Center 

address: 210 Pratt Avenue 

Huntsville, AL 35801 

phone: (256) 533-5437 

fax: (256) 534-6883 

website: www.nationalcac.org 

Provides prevention, intervention, and treatment 

services to physically and sexually abused children and 

their families within a child-focused team approach. 

National Child Welfare Resource Center for 

Organizational Improvement 

address: Edmund S. Muskie School of 

Public Service 

P.O. Box 9300, 34 Bedford Street 

Portland, ME 04104-9300 

phone: (800) HELPKID (435-7543)

 (207) 780-5646 (TTY) 

fax: (207) 780-5817 

website http://muskie.usm.maine.edu/helpkids/ 

Helps child welfare agencies improve management 

and operations, expand organizational capacity, 

and promote service integration through training, 

technical assistance, research, and evaluation. 

National Indian Child Welfare Association 

address: 5100 SW Macadam Avenue, Suite 300 

Portland, OR 97239 

phone: (503) 222-4044 

fax: (503) 222-4007 

website: www.nicwa.org 

Disseminates information and provides technical 

assistance on Indian child welfare issues. Supports 

community development and advocacy eff orts to 

facilitate tribal responses to the needs of families and 

children. 

National Resource Center for Child 

Protective Services 

address: 925 #4 Sixth Street, NW 

Albuquerque, NM 87102 

phone: (505) 345-2444 

fax: (505) 345-2626 

website: http://www.nrccps.org/ 

Assists jurisdictions with system and practice 

issues that help improve the prevention, reporting, 

assessment, and treatment of child abuse and neglect. 

Provides consultation, technical assistance, and 

training in all areas of child protective services. 

Prevent Child Abuse America 

address: 500 N. Michigan Avenue, 

Suite 200 

Chicago, IL 60611 

phone: (312) 663-3520 

fax: (312) 939-8962 

e-mail: mailbox@preventchildabuse.org 

website: http://www.preventchildabuse.org 

Conducts prevention activities such as public 

awareness campaigns, advocacy, networking, 

research, and publishing. Also provides information 

and statistics on child abuse. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

91 
Shaken Baby Syndrome Prevention Plus 


address: P.O. Box 205 

Groveport, OH 43125 

phone: (800) 858-5222 

fax: (614) 836-8359 

e-mail: sbspp@aol.com 

Develops, studies, and disseminates information and 

materials designed to prevent shaken baby syndrome 

and other forms of physical child abuse and to increase 

positive parenting and child care. 

FOR MORE INFORMATION 

Child Welfare Information Gateway 


address: 1250 Maryland Avenue, SW 

Eighth Floor 

Washington, DC 20024 

phone: (800) 394-3366 

(703) 385-7565 

fax: (703) 385-3206 

e-mail: info@childwelfare.gov 

website: http://www.childwelfare.gov/ 

Collects, stores, catalogs, and disseminates information 

on all aspects of child maltreatment and child welfare 

to help build the capacity of professionals in the fi eld. 

A service of the Children’s Bureau. 

FOR THE GENERAL PUBLIC 

Childhelp 

address: 15757 North 78th Street 

Scottsdale, AZ 85260 

phone: (800) 4-A-CHILD (child abuse hotline) 

(800) 2-A-CHILD (TDD child abuse 

hotline) 

(480) 922-8212 

fax: (480) 922-7061 

website: http://www.childhelp.org 

Provides crisis counseling to adult survivors and child 

victims of child abuse, offenders, and parents, and 

operates a national hotline. 

National Center for Missing and 

Exploited Children 

address: Charles B. Wang International 

Children’s Building 

699 Prince Street 

Alexandria, VA 22314-3175 

phone: (800) 843-5678 (24-hour hotline)

 (703) 274-3900 

fax: (703) 274-2220 

website: www.missingkids.com 

Provides assistance to parents, children, law

enforcement, schools, and the community in

recovering missing children and raising public 

awareness about ways to help prevent child abduction, 

molestation, and sexual exploitation. 

92 Appendix B—Resource Listings of Selected National Organizations Concerned 

with Child Maltreatment and with First Responders 
Parents Anonymous 


address: 675 West Foothill Boulevard, 

Suite 220 

Claremont, CA 91711 

phone: (909) 621-6184 

fax: (909) 625-6304 

e-mail: parentsanonymous@parents 

anonymous.org 

website: www.parentsanonymous.org 

Leads mutual support groups to help parents provide 

nurturing environments for their families. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

93 

APPENDIX C 

State Telephone Numbers

for Reporting Suspected 

Child Maltreatment 

Each State designates specific agencies to receive and investigate reports of suspected child abuse and neglect. 

Typically, this responsibility is carried out by child protective services (CPS) within a Department of Social 

Services, Department of Human Resources, or Division of Family and Children Services. In some States, police 

departments also may receive reports of child abuse or neglect. 

Many States have local or toll-free telephone numbers, listed here, for reporting suspected maltreatment. Th e 

reporting party must be calling from the same State where the child allegedly is being maltreated for most 

of the following numbers to be valid. 

For States not listed, or when the reporting party resides in a different State from the child, please call Childhelp, 

800-4-A-Child (800-422-4453), or your local CPS agency. States occasionally change the telephone numbers; 

to view the most current contact information, including State Web addresses, visit http://www.childwelfare. 

gov/pubs/reslist/rl_dsp.cfm?rs_id=5&rate_chno=11-11172. 

Alabama (AL) 

334-242-9500 

Alaska (AK) 

800-478-4444 

Arizona (AZ) 

888-SOS-CHILD 

(888-767-2445) 

Arkansas (AR) 

800-482-5964 

Colorado (CO) 

303-866-5932 

Connecticut (CT) 

800-842-2288 

800-624-5518 (TDD) 

Delaware (DE) 

800-292-9582 

District of Columbia (DC) 

202-671-SAFE (7233) 

Florida (FL) 

800-96-ABUSE 

(800-962-2873) 

Hawaii (HI) 

808-832-5300 

Idaho (ID) 

800-926-2588 

208-332-7205 (TDD) 

Illinois (IL) 

800-252-2873 

217-524-2606 

Indiana (IN) 

800-800-5556 

Iowa (IA) 

800-362-2178 

Kansas (KS) 

800-922-5330 

Kentucky (KY) 

800-752-6200 

Maine (ME) 

800-452-1999 

800-963-9490 (TTY) 

Massachusetts (MA) 

800-792-5200 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

95 
Michigan (MI) 

800-942-4357 

Mississippi (MS) 

800-222-8000 

601-359-4991 

Missouri (MO) 

800-392-3738 

573-751-3448 

Montana (MT) 

866-820-5437 

Nebraska (NE) 

800-652-1999 

Nevada (NV) 

800-992-5757 

New Hampshire (NH) 

800-894-5533 

603-271-6556 

New Jersey (NJ) 

877-652-2873 

800-835-5510 (TDD/TTY) 

New Mexico (NM) 

800-797-3260

505-841-6100 

New York (NY) 

800-342-3720 

518-474-8740 

800-369-2437 (TDD) 

Oklahoma (OK) 

800-522-3511

Pennsylvania (PA) 

800-932-0313

Puerto Rico (PR) 

800-981-8333 

787-749-1333

Rhode Island (RI) 

800-RI-CHILD

(800-742-4453) 

South Carolina (SC) 

803-898-7318 

Tennessee (TN) 

877-237-0004

Texas (TX) 

800-252-5400 

Utah (UT) 

800-678-9399 

Vermont (VT) 

800-649-5285

Virginia (VA) 

800-552-7096

804-786-8536 

Washington (WA) 

866-END-HARM

(866-363-4276) 

800-562-5624 

800-624-6186 (TTY) 

West Virginia (WV) 

800-352-6513 

96 Appendix C—State Telephone Numbers for Reporting Child Maltreatment 
APPENDIX D 

Reference Guide for 

Responding to Cases of 

Suspected Child Maltreatment 

The following handy reference guide for first responders in cases of suspected child maltreatment contains 

highlights of the information provided throughout this manual and addresses signs of possible abuse, interviewing 

the alleged victim and perpetrator, assessing for risk, and testifying in court. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

97 

Signs of possible physical abuse 

(Chapter 2) 

• Fractures unexpectedly discovered in the 

course of an otherwise routine medical 

examination (e.g., discovering a broken rib 

while listening to the child’s heartbeat) 

• Injuries that are inconsistent with, or out of 

proportion to, the history provided by the

caretaker or 

proportion to, 

w

the 

ith the child’s 

history provided 

age or 

by the 

developmental stage (e.g., a 3-month old 

burning herself by crawling on top of the 

stove) 

• Multiple fractures, often symmetrical (e.g., 

in both arms or legs), or fractures at different 

stages of healing 

• Fractures in children who are not able to 

walk 

• Skeletal trauma (e.g., fractures) combined 

with other types of injuries, such as burns 

• Subdural hematomas, which are 

hemorrhages between the brain and its 

outer lining that are caused by ruptured 

blood vessels 

• Burns on the buttocks, around the 

anogenital region, on the backs of the 

hands, or on both hands, as well as those 

that are severe that are severe 

Signs of possible psychological 

maltreatment (Chapter 2) 

• Extremes in behavior (e.g., manically 

happy or very depressed) 

• Withdraw

i 

al 

i 

(e.g., 

commun cation wi

no verbal or physical 

i ithothers) 

• Self-destructive behavior (e.g., cutting 

oneself) 

• General destructive behavior (e.g., setting 

fires) 

• Cruelty to others, including animals 

• Rocking, thumb-sucking that is 

developmentally inappropriate, or headbanging 

• Enuresis (i Enuresis (i.e., wetting wetting one ’s pants) or pants) or 

soiling at an age or a developmental level 

when such behavior is inappropriate 

• Substance abuse 

• Physical manifestations, such as frequent 

stomachaches or headaches or an 

unexplained weight loss or gain 

Signs of possible sexual abuse (Chapter 

2) 

Children may have been sexually abused if 

they: 

• Have bruises in the inner thigh or genital 

area 

• Have difficulty walking or sitting 

• Complain of genital or anal itching, pain,

or bleedin

Complain 

g 

of genital or anal itching, pain, 

• Frequently vomit 

• Become pregnant at a young age 

• Have any sexually transmitted diseases 

Additionally, children may have been 

sexually abused if they exhibit: 

• Exceptional secrecy 

• More sexual knowledge than is age 

appropriate, especially in younger children 

• Indepth sexual play with peers that is not 

developmentally appropriate 

• Extreme compliance or withdrawal 

• Overt aggression 

• An inordinate fear of males or females 

• Seductive behavior 

• Sleep problems or nightmares 

• Crying without provocation 

• A sudden onset of wetting or soiling of 

pants or bed pants or bed 

• Suicide attempts or thoughts of wanting to 

kill themselves 

• Numerous attempts at running away from 

home 

• Cruelty to animals (especially those that 

would normally be pets) 

• Setting fires and enjoying watching them 

burn 

• Self-mutilation (g e.., cutting or scratching

to draw blood) 

g 

Behavioral clues that may indicate 

possible child maltreatment (Chapter 2) 

• Be aggressive, oppositional, or defiant 

• Cower or demonstrate a fear of adults 

• Act out, displaying aggressive or 

disrup tive behavior

• Be destructive to self or others 

• Come to school too early or not want to 

leave school—indicating a possible fear of 

being at home 

• Show fearlessness or extreme risk-taking 

• Be described as “accident prone” 

• Cheat, steal, or lie (may be related to too 

high expectations at home) 

• Be a low achiever 

• B e unabl e to f orm good peer rel ati onshi ps 

• Wear clothing that covers the body and 

that may be inappropriate in warmer 

months, such as wearing a turtleneck 

sweater in the summer (Be aware that this 

may possibly be a cultural issue instead.) 

• Show regressive or less mature behavior 

• Dislike or shrink away from physical 

contact (e.g., may not tolerate physical 

praise such as a pat on the back) praise, such as a pat on the back) 

Signs of possible neglect (Chapter 

2) 

• Seem inadequately dressed for the 

weather (e.g., wearing shorts and 

sandals in freezing weather) 

• Appear excessively listless and 

tired (due to no routine or structure 

around bedtimes) around 

• Report caring 

bedtimes) 

for younger siblings 

(when they themselves are underage 

or are developmentally not ready to 

do so) 

• Demonstrate poor hygiene or smell 

of urine or feces 

• Seem unusually small or thin or 

have a distended stomach (indicative 

of malnutrition) 

• Have unattended medical or dental 

problems, such as infected sores or 

badly decayed or abscessed teeth 

• Appear withdrawn 

• Crave unusual amounts of 

attention, even eliciting negative 

responses in order to obtain it 

Ri k f f l Risk factors for maltreatment 

(Chapter 2) 

• Born prematurely or low birth 

weight 

• Perceived as unusual or different in 

terms of appearance or temperament 

• Be unhealthy or with congenital 

abnormalities 

• Have a physical, emotional, or 

developmental developmental disability disability 

• Be irritable or display behaviors that 

are contrary to the expectations of the 

parents 

• Live in poverty 

• Live in an environment in which 

there is drug abuse, crime, or 

violence 

• Live in a single-family home 

• Have parents who lack education 

• Have parents who abuse 

substances 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

99 
Child interview guidelines (Chapter 3) 

• Avoid jumping to conclusions 

• Be at the child’s eye level, if possible 

• Leave a comfortable space between

the interviewer and the child 

• Create a child-friendly environment 

(e.g., have toys available) 

• Use body diagrams or dolls to help the 

child 

Use 

clarify 

body diagrams 

body parts that are 

or dolls to 

discussed 

help the 

• Be mindful of responder’s facial 

expressions and body language

• Minimize the use of yes or no and 

multiple-choice questions 

• Follow up all closed-ended questions 

with open-ended questions (types of 

questions are discussed later in this 

chapter)

• Listen carefully and completely (e.g., 

do not rush the child) 

• Assess the child’s understanding of 

key concepts (e.g., being able to tell the 

truth, understanding timeframes), which 

will help to establish credibility as the 

interview proceeds into sensitive areas 

• Reduce vocabulary problems by using 

the 

and clarify

child's 

ing 

vocabulary, w

any areas of 

hen appro

confusion 

priate, 

and clarifying any areas of confusion 

• Avoid using double negatives (e.g., “So 

your father didn’t not hit you with the 

belt?”)

• Observe the child’s nonverbal 

communication and body language

• Document the interviewer’s and child’s 

words carefully and completely, perhaps 

by audio- or videotaping the interview 

• Be attuned to the developmental 

capabilities and limitations of the child as 

the interview progresses 

What to observe at the scene (Chapter 

3)

• The physical condition of the child, 

including any observable 

The physical condition of 

effects 

the child, 

of 

maltreatment 

• The emotional status of the child, 

including mannerisms, signs of fear, and 

developmental status 

• The reactions of the parents or 

caregivers to the first responder’s 

concerns 

• The emotional and behavioral status of 

the parents or caregivers during the 

interview process 

• The interactions between family 

members, including verbal and body 

language 

• The physical status of the home or site 

of maltreatment, including cleanliness, 

structure, safety hazards, signs of 

ex

drug use (e 

cessive alcohol 

g drug 

use, 

parap

and 

. ., he

signs of 

rnalia 

illicit 

drug use (e g drug paraphernalia, 

evidence of a methamphetamine lab) 

• The climate of the neighborhood, 

including the level of violence or drug 

use, and the accessibility of 

transportation, telephones, or other

methods of communication 

What to be aware of during alleged 

offender interview (Chapter 3) 

• A disclosure by the alleged offender that 

maltreatment did take place 

• No explanation for an injury or suspect 

incident 

• An explanation for an injury that is 

inconsistent with either the severity or the 

ty

inconsistent 

pe of injury

w

 observed 

ith either the severity or the 

• Different or changing explanations for an 

injury or incident 

• A delay in obtaining medical treatment for 

an injury 

Guidelines for documenting interviews 

(Chapter 3)

• Follow the agency’s or department’s 

protocols

• Give the child permission to correct 

statements 

• Document both the questions and 

answers, when possible 

• Listen carefully to answers 

• Read answers back to the 

cl ifi ar cation, when appropri

child for 

iate 

• Write notes clearly and concisely 

• Quote direct statements, when possible 

• Videotape or photograph the crime scene 

for accuracy

• Try to have an investigative team that 

consists of one interviewer and one note 

taker 

What to obtain or make note of (Chapter 

3)

• Broken items or holes in the wall 

• Stains from blood or semen (visible with a 

black light and/or luminol) 

• Minute evidence, such as hair, fibers, or 

semen 

• 

items f 

“Souvenirs” of 

child’s 

the alleged 

clothing pict 

abuser, such 

of the 

as 

items of a child’s clothing or pictures of the 

child 

• Lures, such as toys or games 

• Sexual aids, such as lubricants, dildos, 

and vibrators 

• Drugs or alcohol 

• Adult or child pornography, in print or on 

computer

• Cameras and film processing equipment 

• An address book containing the victim’s

information 

An address book containing the victim s 

• Bedding 

• Clothing

• Contents of trash cans 

• Bills, banks records, and receipts, which 

may be used to show items that were 

purchased by the suspect for the victim 

• Phone records 

• Work records showing if the suspect was 

available to spend time with the child at the 

time of the maltreatment 

• Weapons or other implements used to 

abuse a child (e.g., belts, cords, coat 

hangers, other instruments matching the 

injuries inflicted)

• Other items noted by the victim or the 

witnesses during the interviews 

Questions to ask nonoffending adults 

(Chapter 3)

• What happened?

• How did the injury happen? 

• Who injured the child? 

• Who was with the child? 

• Who saw the injury happen? 

• Where did the injury happen? 

• 

Where 

Where w

did 

ere the other 

the injury happen? 

household 

members? 

• When did the injury happen? 

Conducting a safety assessment 

(Chapter 3)

• Identify the behaviors or conditions that 

increase concern for the child's safety and 

consider how they affect each child in the consider how they affect each child in the 

family

• Identify the behaviors or conditions (e.g., 

strengths, resiliencies, support, resources) 

that may protect the child 

• Examine the relationships among the 

risk factors and determine if, when 

combined, they increase safety concerns

• Determine whether family members or 

other community partners are able to 

address safety concerns without CPS 

intervention 

• Consider the services required to 

address the specific behaviors or 

conditions for each risk factor directly 

affecting the child's safety 

• Identify who is available (e.g., CPS, 

other community partners) to provide the 

neede

freq timeframe 

d services or interventio

u y, , and d uration

ns in the 

freq enc timeframe and d ration 

required by the family to protect the child 

• Evaluate the family's willingness to 

accept—and its ability to use—the 

intervention or services at the level needed 

to protect the child 

Elements of a safety plan (Chapter 3) 

• Direct and immediate impact on one or 

more of the risk factors determined during 

the assessment to cause the child to be 

unsafe 

• Accessible to the family 

• Available in the frequency and for the 

duration with which they are needed to 

control the risk factors 

• Fills the gaps in the caregiver’s 

protective 

ensure the child

factors and strengths in order to 

ensure the child s protection ’s protection

Guidelines for testifying (Chapter 4) 

• Be prepared

• Listen to each question and pause 

before answering 

• Ask for clarification if needed 

• Answer only the question asked 

• Do not be afraid to respond “I don’t 

know” 

• Do not give an opinion unless asked to 

do so 

• Avoid taking sides 

• Speak a little louder, slower, and more 

distinctly than normal 

• Make eye contact 

• Use an open body posture 

100 Appendix D—Reference Guide for Responding to 

Cases of Suspected Child Maltreatment 
APPENDIX E 

Signs of Possible Physical 

Abuse1 

Th e following discusses signs of possible physical 

abuse. While much of this information can be 

valuable to all first responders, some of it may be 

beyond the experience of first responders who do not 

have an extensive medical background. 

Bruises 

• 	 Color 

– 	 Bruises go through a cycle of color. Th ey 

initially are red, violet, black, or blue and 

later turn brown, green, or yellow. Th e color 

is affected by the depth and the placement of 

the bruise, as well as by the skin color and the 

quality of the light at the location where the 

bruise is being viewed. 

– 	 Estimating the age of a bruise by its color 

cannot be done with much precision, but in 

general: 

• 	 A bruise with any yellow is usually older 

than 18 hours. 

• 	 Red, blue, purple, or black colors in a 

bruise may occur anytime from within 1 

hour of bruising to resolution (i.e., when 

the bruise coloration disappears). 

• 	 A red color may be present at any stage 

of the bruise. 

• 	 Bruises of identical age and cause on the 

same person may not appear with the 

same coloration and may not change 

color in the same manner. 

• 	 Site 

– 	 Ears and buttocks usually are not injured 

accidentally. 

– 	 Knees, shins, foreheads, and elbows are 

normal bruising areas, particularly for 

toddlers. 

• 	 Shape 

– 	 Bruises caused by pinching often have a 

symmetrical pattern. 

– 	Loop-shaped marks can be caused by 

whipping a child with a cord or belt; there is 

no disease or accident that looks like a loop 

or belt mark. 

– 	 Cords or ropes tied around a child’s ankles or 

neck may result in a bruise or a rope burn. 

– 	 If a child is slapped or hit, a mark in the shape 

of the offender’s fingers or hand may be left. 

1 Children’s Hospital Boston, Child Protective Team. (2004). Injuries and behaviors indicative of abuse. Available: http://www.childprotection.org/CPTtext/tProviders/tInjuries.htm; Massachusetts Department of Social Services. (2002, March). Investigation training: 

Evidence and indicators of maltreatment. Boston, MA: Author. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

101 
• 	 Placement 

– 	 Loose tissues, with little bony structure 

underneath (e.g., eyelids, genitals), bruise 

most easily and retain bruises longest; injuries 

at those locations often are not accidental. 

– The first responder should be suspicious if a 

caretaker delays seeking treatment for a child 

with a genital injury. For example, the injury 

may have been caused by pinching a boy’s 

penis to punish him for touching himself or 

by using a string or rubber band around the 

penis (causing grooves) to prevent the child 

from wetting the bed. 

– 	 Some individuals mistake the presence of 

Mongolian spots (birthmarks) as an indicator 

of abuse. These spots usually are grayishblue, clearly defined spots on the buttocks, 

back, or extremities. They are most common 

in African-American and American Indian 

babies. 

Lacerations 

• 	 Lacerations are tears or cuts in the skin. 

• 	 In cases of abuse, they often occur on soft tissue 

areas, such as the abdomen, the throat, the 

buttocks, and the thighs. 

• 	 Some areas of the body are normally protected 

from lacerations by being inside or covered by 

other body parts (e.g., the side of the arm that 

normally lies against the body when in a standing 

position). It is difficult to fall and injure these 

areas. 

• 	 Lacerations of the ear, the nose, or the throat do 

not tend to occur accidentally. 

• 	 A torn frenulum of the upper lip (the tissue that 

connects the upper lip to the upper gum) may 

be an indicator of abuse if there is no reasonable 

explanation, especially in the case of infants. 

Bites 


• 	 Human bites appear as oval or horseshoe-shaped 

marks in which tooth impressions look like 

bruises facing each other. 

• 	 If the distance between the canines (the third 

tooth on each side) is greater than 3 centimeters, 

the bite is most likely from an adult. Adult bite 

marks are a sign of serious danger to a child. 

• 	 Depending on the location of the bite, the 

victim’s teeth should be examined and measured 

to exclude the possibility of a self-infl icted bite. 

• 	 A forensic odontologist or pathologist should 

evaluate the size, contour, and color of the bite 

marks, as well as make molds of the suspected 

abuser’s teeth and of the bite itself, if possible. 

Each individual has a characteristic bite pattern. 

Burns/Scalds 

• 	 Immersion burns occur when a child is placed in 

extremely hot liquid. These burns have a “water 

line” or sharp demarcation border. Symmetrical 

burns with sharp edges (e.g., sock-shaped burns of 

the same height on each leg) are very suspicious. 

The first responder should document if there is 

an absence of splash marks, which may indicate 

that the child did not fall into the liquid and try 

to get out. 

• 	 Doughnut-shaped burns can occur when a child 

is forced into a bathtub. This causes parts of the 

body, usually the buttocks, to rest on the bottom 

of the tub, where they will not burn. 

• 	 Splash burns can occur when the off ender throws 

hot liquid at the child. Unintentional splash 

burns are usually on the head or top of the chest 

and run downward and may be caused by a child 

reaching upward to grab a pot handle. Liquids 

that are thrown at a child hit at a horizontal 

angle, causing the burns to be concentrated on 

the child’s face or chest and run toward the back 

102 Appendix E—Signs of Possible Physical Abuse 
 

of the body. Splash burns on the back or buttocks 

are highly suspicious. 

• 	 Cigarette burns usually appear on the trunk, 

external genitalia, or extremities. They also often 

appear on the palms of the hands or soles of the 

feet. Cigarette burns usually are symmetrical in 

shape. Impetigo blisters (caused by a bacterial 

infection) are irregular and can be ruled out 

by testing for signs of strep. When there are 

intentional cigarette burns on a child, there often 

are multiple burns in various stages of healing 

(i.e., indicating that the burns occurred at various 

times). 

spiral fractures are not always indicative of 

abuse. 

– 	 Periosteal elevation occurs when an infant’s 

extremities are twisted or shaken, causing the 

periosteum (a type of connective tissue) to be 

separated from the bone and blood to collect 

in the new space. 

– 	 Rib fractures can be caused by a caretaker 

forcefully squeezing the baby. Victims may 

present with signs of respiratory distress, but 

they are usually asymptomatic. 

Internal Injuries 

• 	 Chemical burns are caused by household products. • 	 Might be indicated by: Some parents or caretakers force children to drink 

lye derivatives (toilet bowl cleaner, detergents, or – Abdominal, chest, flank, or back pain; 

oils), which causes chemical burns of the mouth – 	 Visible bruising of the chest or abdomen; and throat, vomiting, and esophageal damage. – 	Distended, swollen abdomen or tense 

abdominal muscles;

Fractures and Dislocations – 	 Dyspnea (labored breathing); 

– 	 Pleuritic pain (a type of chest pain); • 	 Fractures usually are inflicted by an abuser on 

nonambulatory children (i.e., those who are not – Nausea or vomiting. 

able to walk). 

Neurological Damage (Skull Fracture, Brain • 	 Ninety percent of all abusive fractures in children or Spinal Cord Damage, and Intracranial 2 years of age or younger include the ribs. Hemorrhage) 

• 	 The following are types of fractures and 

dislocations that may be indicative of abuse: 

– 	 Metaphyseal fractures, in which a chip of the 

metaphysis (a piece of bone that grows during 

childhood) is pulled off by a ligament, can 

only occur when a jerking force is applied to 

the extremities (e.g., by shaking or swinging 

a child by the arms or legs). 

– 	 Spiral fractures, which are diagonal fractures 

usually caused by the twisting of an extremity, 

are common in children because they have 

more pliant bones. Spiral fractures can occur 

in small children by twisting their own leg 

or ankle in an accidental injury (e.g., getting 

their feet caught in the slats of a crib). Th us, 

• 	 Serious life-threatening skull injuries, with the 

exception of epidural hematomas (a type of brain 

hemorrhage), do not result from a child falling 

from a short height, such as a bed or crib. 

• 	 Skull fractures are more likely in young children. 

Any pressure from cerebritis (infl ammation of 

the brain) or hemorrhage can separate fontanelles 

(one of two soft spots on an infant’s skull). 

• 	 Brain injury in young children is more likely due 

to their having an increased subarachnoid space 

(the space between the middle and innermost 

membranes covering the brain). 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

103 
• Subgaleal hematoma (bleeding beneath the scalp 

caused when the scalp separates from the skull) is 

often a sign of skull fracture. Diagnostic images 

of the skull should be taken. It may be caused 

by jerking or twisting a child’s hair —especially 

in girls with pigtails—and may be indicated by 

a bald spot. 

• Alopecia (a partial or complete loss of hair) may 

be caused by neglect if the child lies on his back 

for long periods of time. 

Shaken Baby Syndrome 

• This occurs when a child has been held around 

the upper thorax (under the arms) and shaken 

back and forth with great force. It also occurs 

when the child is held upside down by the feet 

and is shaken up and down. 

• 	 Many infants die from shaken baby syndrome, 

especially if there is a delay in getting treatment. 

Those who survive often have permanent brain 

damage and may be paralyzed, be developmentally 

delayed, or develop cerebral palsy. 

• 	 There is often an absence of externally visible 

injuries, but retinal bleeding may occur. Subdural 

hematoma (a hemorrhage between the brain and 

its outer lining that is caused by ruptured blood 

vessels) and metaphyseal lesions (when a piece of 

a bone that grows during childhood chips off ) are 

common effects of shaken baby syndrome. 

104 Appendix E—Signs of Possible Physical Abuse 
APPENDIX F 

Distinguishing Physical 

Abuse From Nonintentional 

Injury1 

The following table outlines methods to determine if a child’s injury may be nonintentional or caused by 

maltreatment. While much of this information can be applied by all first responders, some of it may be beyond 

the experience of first responders who do not have an extensive medical background. 

Injury Possible Nonintentional Cause Steps to Confi rm 

Bruise Accidental fall • Check the location of the bruises; bruises on knees, shins, 

forehead, or elbows are usually unintentional. 

• In the case of black eyes, check for bruises on the forehead; 

bruises to the forehead often drain through soft tissues to give 

appearance of black eyes 24–72 hours afterward. 

• Check to see whether the bruises on a single surface are 

clustered (e.g., multiple bruises on the right arm); one bruise 

on a single surface is usually accidental. 

• Consider whether the explanation for the injury correlates with 

the developmental age and motor skills of the child (e.g., could 

a 1-month-old child crawl to the edge of the stairs and fall?) 

• Check for discrepancies between the bruise and the explanation 

provided by the caretaker and others. 

Bite Mark Bitten by an animal or a child • Check to see whether the flesh is torn or just compressed; torn 

flesh is usually an animal bite, and compressed flesh is usually a 

human bite. 

• Measure the distance between the center of the canines (the 

third tooth on each side); if it is greater than 3 centimeters, the 

bite is most likely from an adult. 

• Check for discrepancies between the injury and the history 

provided by the caretaker and others. 

1

 Children’s Hospital Boston, Child Protective Team. (2004). Injuries and behaviors indicative of abuse. Available: http://www.childprotection.org/CPTtext/tProviders/tInjuries.htm; Massachusetts Department of Social Services. (2002, March). Investigation training: 

Evidence and indicators of maltreatment. Boston, MA: Author. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

105 
Injury Possible Nonintentional Cause Steps to Confi rm 

Burn Accidental spilling of hot liquid • Check the location of the splash burns; unintentional burns 

are most likely to occur on the front of the head, neck, trunk, 

and arms. It is usually possible to estimate the direction from 

which the liquid came and the position of the body. 

• Check for discrepancies between the burn and the history 

provided by the caretaker and others. 

Brushing against a cigarette • Check the location of the burns; they are usually unintentional 

if found on the child’s face and arms. 

• Check the shape of the burn; it is usually unintentional if it is 

more elongated than round and has a higher degree of intensity 

on one side. 

• Check for discrepancies between the burn and the history 

provided by the caretaker and others. 

Accidentally falling into a hot bath • Check for clear lines of demarcation on the skin and those that 

are parallel (e.g., the same height on both legs); unintentional 

burns have no clear, straight line demarcating the burned and 

unburned skin (e.g., a sock-like burn on a child’s leg may 

indicate an intentional burn). 

• Check the depth of the burn through the skin; unintentional 

burns are not as deep as forced burns because an unrestrained 

child generally can remove himself from the burning 

environment (i.e., the child would try to get out of the hot 

water quickly). 

• Check to see whether the buttocks and feet are burned, but not 

the hands; it is impossible for a child to unintentionally fall 

into a tub without his hands going into the water. 

• Doughnut-shaped burns may indicate abuse. Th ese burns 

occur when parts of the body, usually the buttocks, rest on 

the bottom of the tub and thus will not burn. A patch of 

unburned skin is created in the center of the burn (like the hole 

in a doughnut) and may be a sign that the child was forced to 

sit in the tub. 

• Check for signs of burns from splashing; an unrestrained child 

will splash when in water that is too hot. 

• Check for discrepancies between the burn and the history 

provided by the caretaker and others. 

Accidentally coming into contact • Check the location of the burn; some areas of the body, such as with a burning object the buttocks or the back, are more difficult for a child to selfinflict a burn. 

• Check the depth of the burn; unintentional burns are usually 

deep on one edge of the burn. 

• Check the pattern margins of the burn; unintentional burns 

usually do not have crisp margins or defi ned shapes. 

• Check for discrepancies between the burn and the history 

provided by the caretaker and others. 

106 Appendix F—Distinguising Physical Abuse from Nonintentional Injury 
Injury Possible Nonintentional Cause Steps to Confi rm 

Fracture • Birthing trauma (fractured 

collarbones are most common) 

• Little league elbow (pain in the 

elbow due to excessive throwing) 

• Fractures from passive exercises 

for therapeutic reasons (e.g., the 

caregiver is manipulating the 

child’s legs as part of a physical 

therapy regimen) 

• Other accidental trauma, such as 

a fall 

• Ensure the explanation of the injury matches the injury and 

the developmental level of the child. 

• Check for discrepancies between the fracture and the history 

provided by the caretaker and others. 

Head Injury • Birth trauma causing eff usion (the 

accumulation of fluid in a body 

space) 

• Posttraumatic hypopituitaris 

(the deficiency of one or more 

hormones of the pituitary gland) 

• Insect bite on head (usually 

forehead) 

• Check the onset of the injury; injuries from birth traumas 

should become apparent shortly after birth. 

• Check for discrepancies between the injury and the history 

provided by the caretaker and others. Note: Subdural 

hematomas (hemorrhages between the brain and its outer 

lining that are caused by ruptured blood vessels) found in an 

infant or toddler without adequate explanation may indicate 

abuse. 

Eye Injury • Chemical burns 

• Object accidentally hitting the eye 

• Check for signs of the child having been slapped around the 

ear, during which the adult’s fingers also may have struck the 

child’s eye. 

• Check for discrepancies between the injury and the history 

provided by the caretaker and others. 

Ear Injury • Accidental injury from inserting a 

cotton swab 

• Check whether the laceration is of the external auditory meatus 

(the outer opening of the ear canal); this injury can only occur 

by inserting a pointed object into the ear. 

• Check for discrepancies between the injury and the history 

provided by the caretaker and others. Nasal Injury • Accidental injury from inserting 

an object into the nose 

• Check whether the objects are found in more than one site 

(e.g., in the ears as well); if found only in the nose, this is 

common for a normally developing child. 

• Check for discrepancies between the injury and the history 

provided by the caretaker and others. 

Tooth Injury • Accidentally falling or striking the 

mouth with a hard object 

• Check for discrepancies between the injury and the history 

provided by the caretaker and others. 

Poisoning • Accidentally giving toxic doses of 

vitamins and minerals to cure an 

illness 

• Unintentionally feeding a baby 

improperly diluted formula 

• Accidental ingestion of medicines, 

household cleaners, etc. 

• Check with the caretaker about the cause of the poisoning; 

unintentional poisoning may be a form of neglect that can be 

treated with education and support. 

• Check for discrepancies between the condition and the history 

provided by the caretaker and others. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

107 

APPENDIX G 

Common Folk-Medicine 

Practice Injuries That May 

Resemble Abuse1 

Injury Ritual Country/Region/ 

Ethnic Group 

Circular burns, about 6–8cm Can result from “cupping,” in which a cup of ignited Mexico 

in diameter; often multiple alcohol is placed over a part of the body. As the heated 

area cools, the skin is sucked into the cup, producing 

redness and burns. 

Subdural hematomas 

(hemorrhages between the 

brain and its outer lining 

that are caused by ruptured 

blood vessels) 

Remedies for caida de mollera, or “fallen fontanelle,” can 

cause subdural hematomas. The fontanelle is one of two 

soft spots on an infant’s skull, and some believe that it 

can become depressed if an infant is pulled away from a 

nipple (breast or bottle) too quickly. The most dangerous 

folk remedy for fallen fontanelle is hanging the child over 

a basin of hot water and tapping the child’s feet. 

Mexico 

Light, linear bruising with 

petechiae (pinpoint-sized red 

spots on the skin), usually 

between the ribs on both the 

front and back; also may be 

seen on the neck, both sides 

of the spine, or along the 

inner arms 

Although they resemble strap marks, these linear bruises 

may actually be the result of the folk-medicine practice 

of Cao Gio (coining). This practice is used to relieve 

symptoms such as fever, chills, headaches, and vomiting 

and includes massaging the skin with oil and stroking 

it with the edge of a coin until bruising occurs. It is 

believed that coining forces the “bad wind,” or noxious 

substances, from the body. Normally, this practice should 

not cause undue concern about child abuse. 

Vietnam 

Cambodia 

China 

Hmong people 

1 Massachusetts Department of Social Services. (2002, March). Investigation training: Evidence and indicators of maltreatment. Boston, 

MA: Author. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

109 
Injury Ritual Country/Region/ 

Ethnic Group 

Light bruising, petechiae 

(pinpoint-sized red spots 

on the skin), or abrasions 

on both sides of the spine, 

behind both knees, in the 

bend of both arms, and on 

the chest from just above the 

nipple to the clavicle 

These bruises may be the result of the folk-medicine 

practice of Tzowsa (spooning). This employs a similar 

method to coining, but a spoon is used. If a raised area 

appears, cupping treatment has probably also been used. 

This treatment is believed to alleviate pain. 

Hmong people 

Intense, isolated, 

nonsymmetrical bruises 

anywhere on the body, but 

often found between the 

eyes on the forehead, along 

the trachea, in a necklace 

pattern around the base 

of the neck, bilaterally on 

the upper chest or arms, or 

along the spine 

These bruises may be the result of the folk-medicine 

practice of Bat Gio (pinching) in which Pinching Tiger 

Balm, a mentholated ointment, may be massaged into 

the area before it is pinched. It is very commonly used to 

exude the “bad wind” for localized pain, lack of appetite, 

heat exhaustion, dizziness, fainting, blurred vision, cough, 

fever, or any other minor illness. 

Southeast Asia 

Second- and third-degree In this practice, an analgesic balm, such as Icy Hot, Latin America 

burns on the foot and ankle may be applied to a child’s foot, which is then held 

under running water. This home treatment is based on 

a hot-cold theory of disease that is held in many Latin 

American cultures, and it is performed in an effort to cure 

a child’s sprained ankle. Because there is a clear line of 

demarcation, it may resemble an immersion burn. 

Burns or scars, usually 

0.5–1cm in diameter 

(like cigarette burns), 

located randomly around 

the lower rib cage or in a 

definite pattern around the 

umbilicus (belly button) 

These burns may be part of a folk medicine therapy in 

which pieces of burning string are lowered onto the child’s 

skin in order to cure abdominal pain or fever. 

Southeast Asia 

110 Appendix G—Common Folk-Medicine Practice Injuries That May Resemble Abuse 
APPENDIX H 

Criteria for Distinguishing 

SIDS from Fatal Child 

Maltreatment1 

The following table outlines methods to determine if a child’s death may be caused by SIDS. While some of this 

information can be applied by all first responders, some of it may be beyond the experience of first responders who 

do not have an extensive medical background. 

Consistent with SIDS Less Consistent 

with SIDS 

Concern for Child 

Maltreatment 

Circumstances 

Surrounding 

Death 

• An apparently healthy infant 

who was fed and put to bed 

is later found lifeless (silent 

death). 

• EMS resuscitation eff orts are 

unsuccessful. 

• The infant is found not 

breathing, but after EMS 

transports the infant to the 

hospital, the infant lives for 

hours or days. 

• There is a family history of 

illness or substance abuse. 

• The family’s and child’s 

histories are not typical of 

SIDS, have discrepancies, 

or are unclear. 

Age of Child • The infant is 0–7 months 

of age. (Most SIDS deaths 

occur between 2 and 4 

months of age, and 90 

percent occur before 7 

months of age.) 

• The infant is 8–12 months 

of age. 

• The infant is more than 

12 months of age. 

1 U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention. (2002, December). Recognizing when a child’s 

injury or illness is caused by abuse. Available: http://www.ncjrs.gov/pdffi les1/ojjdp/160938.pdf. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

111 
Consistent with SIDS Less Consistent 

with SIDS 

Concern for Child 

Maltreatment 

Physical • The infant has bloody, • The infant has • The infant has skin 

Examination watery, frothy, or mucous­ organomegaly of the viscera injuries or traumatic 

and Lab Studies filled nasal discharge. (abnormal enlargement injuries to body parts 

at Time of 

Death 

• The infant has postmortem 

lividity in dependent areas 

(i.e., blood settles in portions 

of the body that are lower, 

causing a purplish red 

of certain internal organs) 

or diagnostic signs of a 

disease process (by physical 

examination, laboratory 

tests, imaging studies). 

(e.g., mucous membranes 

of the eyelids, scalp, 

inside of the mouth, 

ears, neck, trunk, anus or 

genitals, extremities). 

discoloration). • There is evidence of 

• There are marks on pressure 

points (places where a blood 

malnutrition, neglect, or 

fractures. 

vessel runs near a bone). • The infant has a closed 

• There is no skin trauma. head wound or a 

subdural hematoma (a 

• The baby appears well cared hemorrhage between 

for. the brain and its outer 

lining that is caused by 

ruptured blood vessels). 

History of • There was prenatal care. • There was prenatal care. • There was little or no 

Pregnancy, • The mother used cigarettes • The child has a history prenatal care. 

Delivery, and during pregnancy. of recurrent illnesses or • The mother arrived 

Infancy • The infant was premature or 

had a low birth weight. 

multiple hospitalizations 

(i.e., a “sickly” or “weak” 

baby). 

late at the hospital for 

delivery, or the birth 

occurred outside of the 

• The infant showed minor 

defects with regard to feeding 

and general temperament. 

• There is a previous, specifi c 

diagnosis of organ system 

disease. 

hospital. 

• The child received 

little or no well­

• The infant has less height and baby care, including 

weight gain after birth than immunizations. 

normal. • The mother used 

• The infant is a multiple (e.g., cigarettes, drugs, or 

twin, triplet). alcohol during and after 

• History of spitting, the pregnancy. 

gastrointestinal refl ux, • The child was described 

thrush, pneumonia, illnesses as hard to care for or 

requiring hospitalization, discipline. 

tachypnea (rapid breathing), 

tachycardia (rapid heart rate), 

or cyanosis (a blue coloration 

of the skin and mucous 

membranes). 

• There are no signs of 

problems or diffi culty before 

the death. 

112 Appendix H—Criteria for Distinguishing SIDS from Fatal Child Maltreatment 
Consistent with SIDS Less Consistent 

with SIDS 

Concern for Child 

Maltreatment 

Death Scene • The crib or bed is in good • The crib or bed is defective, • The living conditions 

Investigation condition. or there are inappropriate either are chaotic, 

• There are no dangerous 

bedclothes, toys, plastic 

sheets, pacifi er strings, 

pillows stuff ed with 

sheets, pillows, or sleeping 

clothes. 

• Dangerous toys, plastic 

sheets, pacifier cords, or 

unsanitary, or crowded or 

are extremely orderly (to 

a compulsive degree of 

neatness). 

pellets, cords, bands, or pellet-stuffed pillows are • There is evidence of drug 

other possible means of present. or alcohol use by the 

entanglement or suff ocation. • It is evident that the child caretakers. 

• The caregiver provides an did not sleep alone. • There are signs of a 

accurate description of the 

child’s position, including 

whether there is head or neck 

entrapment. 

• The room is a normal 

temperature. 

• No toxins or insecticides are 

• The room has poor 

ventilation or heat control. 

• Toxins or insecticides are 

present. 

• The conditions are 

unsanitary. 

struggle in the crib or 

other equipment. 

• The bedclothes are 

bloodstained. 

• There is evidence of 

hostility, discord, or 

violence between the 

present. caretakers. 

• The room has good • The caretaker admits 

ventilation. harm or accuses another 

caretaker of harming the 

child. 

Previous Infant 

Death in 

Family 

• There are no previous 

unexplained or unexpected 

infant deaths. 

• There are one or more 

previous unexplained or 

unexpected infant deaths. 

• There are one or more 

previous unexplained or 

unexpected infant deaths. 

Autopsy • No adequate cause of death • Subtle changes in the liver, • The death is caused by a 

Findings is determined during the the adrenal glands, or the trauma. 

exam. 

• The results of the skeletal 

myocardium (the heart 

muscle). • There are external 

bruises, abrasions, or 

survey, toxicological burns. 

findings, chemistry studies, 

microscopic examination, 

and metabolic screen are 

normal. 

• There is evidence of 

malnutrition and 

fractures. 

• There are changes in certain 

organs that are thought to 

• There are abnormal body 

chemistry values. 

be more commonly seen • There are abnormal 

in SIDS than in non-SIDS toxicological fi ndings. 

deaths (e.g., subtle changes 

in the liver, such as blood 

forming in the liver). 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

113 
Consistent with SIDS Less Consistent 

with SIDS 

Concern for Child 

Maltreatment 

Previous 

Involvement 

of Department 

of Social 

Services or Law 

Enforcement 

• No • Yes • Yes 

114 Appendix H—Criteria for Distinguishing SIDS from Fatal Child Maltreatment 
APPENDIX I 

Domestic Violence 

Exposure Assessment1 

First responders can use the following assessment questions when interviewing children who may have been 

exposed to domestic violence. 

Type and Frequency of Exposure 

• 	 What kinds of things do your mom and dad (or his/her girlfriend or boyfriend) fi ght about? 

• 	 What happens when they argue? 

• 	 Do they yell at each other or call each other bad names? 

• 	 Does anyone break or smash things when they get angry? Who? 

• 	 Do they hit one another? What do they hit each other with? 

• 	 How does the hitting usually start? 

• 	 How often do your mom and dad argue or hit? 

• 	 Have the police ever come to your home? Why? 

• 	 Have you ever seen your mom or dad get hurt? What happened? 

Risks Posed by the Exposure 

• 	 Have you ever been hit or hurt when your mom and dad (or his/her girlfriend or boyfriend) are fi ghting? 

• 	 Has your brother or sister ever been hit or hurt during a fight between your mom and dad (or his/her 

boyfriend or girlfriend)? 

1

 Ganley, A. L., & Schechter, S. (1996). Domestic violence: A national curriculum for child protective services. San Francisco, CA: Family 


Violence Prevention Fund; Children’s Hospital Boston, Child Protective Team. (2004). Injuries and behaviors indicative of abuse. 


Available: http://www.child-protection.org/CPTtext/tProviders/tInjuries.htm; Massachusetts Department of Social Services. (2002, 


March). Investigation training: Evidence and indicators of maltreatment. Boston, MA: Author; Bragg. L. (1998). Domestic violence 


protocol for child protective services intervention. Charlotte, NC: Mecklenburg County Department of 


Social Services. 


The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

115 
• What do you do when they start arguing or when someone starts hitting? 

• Has either your mom or dad hurt your pet? 

Impact of the Exposure 

• Do you think about your mom and dad (or his/her girlfriend or boyfriend) fighting a lot? 

• Do you think about the fighting when you are at school? While you are playing? When you are by yourself? 

• How does the fighting make you feel? 

• Do you ever have trouble sleeping at night? Why? Do you have nightmares? If so, what are they about? 

• Why do you think they fight so much? 

• What would you like them to do to make it better? 

• Are you afraid to be at home? To leave home? 

• What or who makes you afraid? 

• Do you think it is okay to hit when you are angry? When is it okay to hit someone? 

• How would you describe your mom? How would you describe your dad? 

Protective Factors 

• What do you do when your mom and dad (or his/her girlfriend or boyfriend) fi ght? 

– If the child has diffi culty responding to this question, the fi rst responder can ask if the child has: 

• Stayed in the room 

• Left the room or hidden 

• Gotten help 

• Gone to an older sibling 

• Asked his parents to stop 

• Tried to stop the fi ghting. 

• Have you ever called the police when your parents are fighting? What did the police say? 

• Have you ever talked to anyone about your parents’ fighting? Who? What did that person say? 

• Is there an adult you can talk to about what is happening at home? Who? 

• What makes you feel better when you think about your parents’ fi ghting? 

116 Appendix I—Domestic Violence Exposure Assessment 
APPENDIX J 

Interviewing Nonoffending 

Adults1 

Questions about the child: 

• 	 What did the child say about the maltreatment? 

• 	 Has the child exhibited any unusual behaviors before or after the disclosure of maltreatment? If yes, please 

describe the unusual behaviors. 

• 	 Has the child been abused or neglected previously or had allegations of abuse been reported to child 

protective services before? If yes, what happened before, or what did the child say previously? 

• 	 What else is going on in the child’s life? 

• 	 (If sexual abuse) What type of exposure has the child had to sexual material (e.g., movies, television, 

magazines, computer images)? 

• 	 What is the child’s medical history? 

The first responder also should note: 

• 	 How the nonoffending parent describes the child’s feelings and behaviors 

• 	 If the nonoffending parent demonstrates empathy for the child’s condition and experience 

• 	 If the nonoffending parent has the capacity to protect the child 

• 	 The nonoffending parent’s opinion about the vulnerability of the child. 

Questions about the alleged off ender: 

• 	 What was the alleged offender’s reaction to the allegations? 

• 	 Has the alleged offender made any statements about the allegations? 

1

 Cage, R. L., & Pence, D. M. (1997). Criminal investigation of child sexual assault. Portable guide to investigating child abuse. 

Washington, DC: Office of Juvenile Justice and Delinquency Prevention. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

117 
• 	 Does the alleged offender have a history of drug or alcohol abuse? 

• 	 (If sexual abuse) Does the alleged offender have scars, tattoos, or birthmarks? (This can help corroborate 

the victim’s statement.) 

• 	 (If sexual abuse) Has the alleged offender ever had a sexually transmitted disease? 

• 	 What is the alleged offender’s medical history? 

• 	 (If sexual abuse) Does the alleged offender use pornography, sexual aids or implements, or birth control 

devices, or engage in unusual sexual practices? 

• Have prior accusations been made against the alleged off ender? 


Questions about the relationship between the child and the alleged off ender: 


• 	 Can you describe the relationship between the child and the alleged offender? Are there any problems 

between them? 

• 	 Can you think of any reason why the child would lie about the alleged off ender? 

• 	 How much time does the alleged off ender spend alone with the child? When has he spent time with the 

child? Can anyone else verify this? 

• 	 What types of discipline do you and the alleged offender consider appropriate? 

• 	 Who in the family has child care responsibilities? 

• 	 What are the alleged offender’s child care responsibilities? 

• 	 How are cultural beliefs incorporated in family functioning? 

• 	 What role does religion play in the family? How does it affect child-rearing practices? 

• 	 What are the sleeping arrangements in the home? 

• 	 How are decisions made in the family? Who usually makes decisions about the children? 

• 	 How does the family communicate? How is aff ection expressed? 

118 Appendix J—Interviewing Nonoffending Adults 
APPENDIX K 

Memorandum of 

Understanding1 

What is a memorandum of understanding? 

A memorandum of understanding (MOU) is a written agreement that clarifies the relationships and the 


responsibilities between two or more organizations that share services, clients, and resources. 


Why is it important to have an MOU? 


MOUs help strengthen partnerships by delineating roles of individuals, agencies, and other groups. 


What is actually included in an MOU? 

MOUs can address a variety of issues and topics. Content areas to consider including in an MOU are: 

• Purpose statement 

• Clarification of agency roles 

• Referrals across agencies 

• Assessment protocols 

• Parameters of confi dentiality 

• Case management intervention 

• Interagency training of staff 

• Agency liaison/coordination 

• Process for resolving interagency confl icts 

• Periodic reviews of the MOU. 

1

 Bragg, H. L. (2003). Child protection in families experiencing domestic violence. Available: http://www.childwelfare.gov/pubs/

usermanuals/domesticviolence/. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

119 
How do we know our agency is ready to develop an MOU? 


Agencies that work together (or should work together) to reduce child maltreatment are excellent candidates 

for creating an MOU. In agencies that are experiencing strained relationships between potential partners, the 

process of writing an MOU provides a unique opportunity to address misperceptions and differences and to 

work jointly to resolve gaps in service delivery. 

What strategies should we undertake as we begin the MOU development process? 

Depending on existing relationships between agencies, one strategy may include inviting key supporters to 

meetings to explore the feasibility of MOU development. An additional strategy may include inviting an outside 

consultant to facilitate a mutual partnership that leads to the development of an MOU. 

What are the potential problems that arise during the MOU development process? 

Problems may arise concerning misperceptions about each other’s goals, missions, and philosophies. Professionals 

from child welfare agencies often report that the MOU meetings helped them understand the other organizations’ 

language and history and provided a context to consider other philosophies and missions. Additional problems 

may include differing confidentiality policies, assessment decisions, and levels of intervention. 

120 Appendix K—Memorandum of Understanding 
APPENDIX L 

Home Visit 

Safety Tips1 

Families experiencing multiple issues (e.g., substance abuse, mental health problems, domestic violence, 

criminal behavior) can pose dangers for first responders going into homes to respond to cases that may involve 

child maltreatment. While on a home visit, first responders—particularly those who are not law enforcement 

officers—should remember the following safety tips: 

• 	 Ensure that the CPS supervisor know s the time and place of the appointment and the expected time of 

return. 

• 	 Dress appropriately and in a manner that blends into the community. 

• 	 Walk close to buildings or close to the curb in an effort to have at least one safe side. Stay away from bushes, 

alleys, and dark corners, if possible. 

• 	 Know the route in and out of the area by examining a map or by talking with others beforehand. Do not 

wander or appear lost or confused. 

• 	 Park as close to the home as possible and in a way that helps ensure an easy exit. Keep the car keys in hand 

while entering and exiting the home so they are easily available. 

• 	 Be aware of your surroundings at all times. Enter and leave homes carefully, noticing doors, windows, 

neighbors, loiterers, and anything or anyone that may be a risk to safety. 

• 	 If unsure of the safety or surroundings of the location, move to another spot by suggesting taking a break 

or getting a cup of coffee and finish talking there. 

• 	 Attempt to keep a clear path to an exit. 

• 	 Be aware of dogs that may pose a threat. 

• 	 Follow intuition and take action if feeling afraid or threatened. Leave the home or call 911 if necessary. 

• 	 Have access, if possible, to technology that may assist with safety issues (e.g., GPS systems, cell phones). 

1 California Attorney General’s Office, Crime and Violence Prevention Center. (n.d.). Recognizing clandestine meth labs. Available: 

http://www.stopdrugs.org/recognizinglabs.html; KCI The Anti-Meth Site. (n.d.). Is there a meth lab cookin’ in your neighborhood?. 

Available: http://www.kci.org/meth_info/neighborhood_lab.htm; Salus, M. K. (2004). Supervising child protective services caseworkers. 

Available: http://www.childwelfare.gov/pubs/usermanuals/supercps/supercps.pdf. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

121 
In cases where drugs and alcohol may be an issue in the family or the surrounding community: 

• 	 Go to the home with another caseworker or law enforcement officer, particularly in an area known for drug 

dealing. 

• 	 Know the local signs that indicate a drug deal is occurring. In such situations, do not enter the home 

without law enforcement personnel. 

• 	 Be aware of homes or other living environments that may be used as a clandestine drug factory. Do not 

attempt to investigate such places alone, and immediately contact law enforcement if such a lab is suspected. 

Anyone without proper training and protective gear should stay at least 500 feet away from any suspected 

laboratory. The following are signs of a possible lab: 

– 	 Strong or unusual chemical odors 

– 	 Laboratory equipment, such as glass tubes, beakers, funnels, and Bunsen burners 

– 	 Chemical drums or cans in the yard 

– 	 A high volume of automobile or foot traffic, particularly at odd hours 

– 	 New, high fences with no visible livestock or other animals. 

• 	 If one or both parents appear to be intoxicated, high, incoherent, or passed out, ensure the safety and 

supervision of the children, which may require their immediate removal from the home. Once that has 

been accomplished, it is appropriate to reschedule the appointment. It may be appropriate to call the 

supervisor for guidance. 

122 Appendix L—Home Visit Safety Tips 
APPENDIX M 

Case Studies 

The following are four examples of scenarios—one each for physical neglect, environmental neglect, physical 

abuse, and sexual abuse—that first responders may face. These case studies include general guidelines for 

responding to each situation. The cases are intended to provide a framework for first responders and do not 

represent all of the steps a first responder should take. It is important to note that these examples were written 

by and for law enforcement professionals, but may be helpful to other types of professionals. 

The inclusion of these guidelines and methodologies does not necessarily imply endorsement by the U.S. 

Department of Health and Human Services. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

123 
Physical Neglect Case 


Synopsis A 911 call is placed to the local police department at 10:00 p.m. by a concerned neighbor 

alleging that a mother left her 4-year-old daughter and 5-year-old son home alone. Th e 

neighbor describes the mother’s vehicle and reports that it is not in front of the apartment 

complex. The neighbor overheard the children crying, which prompted her to call the 

police. A patrol car is dispatched to the address. Upon arriving on the scene, the officer 

finds the children home alone. 

Initial • Conduct a quick background check to see if any previous charges have been filed or if child 

Response protective services (CPS) has had previous involvement with this family. 

• Try to coordinate the response with any other first responders, if needed, in order to arrive at 

the home simultaneously. 

• The safety of the children is the first priority. Check the environment for potentially harmful 

objects, such as poisons or electrical hazards. 

• If the children are verbal and can communicate information, conduct a basic interview to 

obtain the parent’s location. Ask questions about what and when the children last ate. Th is 

may provide information on potential maltreatment, as well as help to begin a timeline for how 

long the parent has been gone. 

Theories • Develop multiple theories of the neglect situation, such as: 

– The complaint is true as alleged 

– The parent is injured and unable to respond 

– The parent is temporarily detained, (e.g., is taking laundry out of the dryer downstairs). 

• Follow up on each theory: 

– Confirm that the vehicle is not in the parking lot 

– Check with the neighbors or any relatives who may be nearby 

– Consider possible vehicle breakdown 

– Look for evidence of a laundry basket and soap 

– Have someone check the apartment laundry room 

– Check the parent’s name through the local emergency call system (accidents, ambulance) 

– Contact the property manager for emergency contact information 

– Check for evidence of when the parent may have last been in the apartment (food warm or 

cooking, cigarette warm, oven warm, bathtub wet) 

– Consider the possibility of foul play 

– Document any drugs or alcohol or related paraphernalia in plain view. 

• Check for a phone in the residence and look for contact information, such as outgoing or 

incoming calls on the caller ID. 

• If the phone has redial buttons, they should be utilized to ascertain who was called last (cab, 

relative, work). 

• Begin calling contact numbers. Neighbors are excellent resources for contact information. 

• Have local department personnel run names and addresses through the Haines Directory,

which provides addresses and phone numbers for every residence in a jurisdiction and under 

whose name the property is listed. Other police patrol units often can drive by addresses where 

telephone contact cannot be made. 

• Contact the local CPS agency: 

– Advise and standby 

– The family history may be known to CPS caseworkers 

– Coordinate with the on-call CPS caseworker to determine a placement for the children if 

no family members can be located. 

• After waiting an appropriate time for parents to return to the home, remove the children as the 

last resort. Leave an identification card and emergency number for the parent to contact 

upon return. 

124 Appendix M—Case Studies 
Interview Parent interview: 

• When and if the parent returns, conduct an interview: 

– Listen for an explanation. 

– Allow time to assess the information and to give thought to the theories developed. 

– Gently probe the parent based on her statements. For example, “You said your car broke 

down. Tell me more about that?” or “You said you went to the store and left the children 

sleeping. Tell me more about that?” 

Action • Determine how the case will be handled (e.g., referral to CPS, temporary removal of children, 

charges fi led). 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

125 
Environmental Neglect Case 


Synopsis An anonymous call is received via the CPS hotline alleging that there are three children younger 

than age 4 who are living in what the caller describes as “a house with a known meth lab inside.” 

The anonymous caller alleges that numerous individuals are observed trafficking in and out of the 

residence at all hours of the day and night. The caller rarely observes the children outside and can 

only report the approximate ages of the children. The caller describes the children as an infant, a 

2-year-old, and a 4-year-old. No further information is available. 

If true, the environmental conditions could be hazardous to the well-being of the children. Th e 

facts, as presented, also constitute the serious crime of narcotics distribution. A coordinated 

response is absolutely essential to the safety and well-being of all professionals involved, as well 

as to reduce the potential for injury to the children upon entry into the residence. A cautious 

approach to this investigation is recommended. (See Appendix L, Home Visit Safety Tips, for more 

information about safely approaching and entering a home.) 

Initial 

Response 

• Prior to any response to the residence, perform the following enquiries: 

– The local police and CPS should check their records for available information on the 

suspect residence, including prior involvement in the system. 

– Police should check the computer system for “caution flags” on the residence. All available 

police reports written on occupants can be queried. 

– Arrest records and criminal histories should be obtained on all known occupants of the 

residence. 

– The Motor Vehicle Administration can be queried for identifying information on vehicle 

ownership. 

– Police should check the undercover narcotics divisions for available information on the 

residence. 

– Undercover officers can check with known informants for additional information. 

– Local land tax records can be queried for property ownership. 

– Police and CPS agencies can make a coordinated decision as to the level of the emergency 

and the appropriate response. 

• Police may want to send an undercover officer to the home for a drug purchase and 

assessment prior to any CPS intervention. 

• Local uniform beat officers can be queried for knowledge of the neighborhood. 

Theories • Develop multiple theories of the neglect situation, such as: 

– The complaint is true as alleged 

– The anonymous caller mistakenly provided wrong information 

– The complaint is deliberately false. 

• Follow up on each theory. 

126 Appendix M—Case Studies 
Action • Analyze all the available data collected prior to entry into the residence. 

• Consider a neighborhood canvass to obtain additional information. 

• Obtain police surveillance. 

• Plan the police and CPS response: 

– A coordinated plan is essential 

– The police will generally provide personnel and legal authority for entry into the residence 

(e.g., a search warrant) in cases where probable cause of a crime exists 

– Pre-raid checklists and personnel should be on hand 

– Police personnel will make entry into the residence 

– Evidence will be seized and necessary arrests will be made. 

• The children will need to be protected and turned over to the local CPS agency standing by. 

At no time should the CPS worker be placed in jeopardy during a controlled drug raid and 

search. 

• In those instances where the first responders lack the sufficient information to substantiate 

drug involvement, a subsequent safety plan must be developed. 

• Always approach the residence with a cautious safety plan. Plain clothes or uniformed police 

officers should approach the residence and make the initial contact. CPS personnel should be 

located nearby to respond when entry safety has been assessed. 

Entering a Home Suspected to Be Involved with 

Drug Distribution or Manufacture 

CPS caseworkers who do not have police backup and support are advised to wait until local law 

enforcement agencies are available before entering a residence suspected of being involved in the 

distribution or manufacture of drugs. Entry without sufficient support could put the personal safety of the 

CPS caseworker and the children at risk. 

For more information on meth labs and substance use disorder, refer to Protecting Children in Families 

Aff ected by Substance Abuse or Addiction at http://childwelfare.gov/pubs/usermanual.cfm. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

127 
Physical Abuse Case: Hitting 


Synopsis A fourth grade teacher at the local elementary school contacts the CPS hotline and 

reports that a 9-year-old male student in her class came to school this morning with a 

large red mark on his face. When asked by the teacher what had happened to his face, 

the student responded that he fell off his bicycle. The teacher explained to the intake 

worker that the red mark looks very similar to a handprint. The student is normally very 

talkative, but seems withdrawn and fearful of talking more about the red mark. 

Initial • Check to see if there is an open CPS case on the child or family or if there are any prior 

Response referrals to CPS. 

• Meet with the principal or other authorized school personnel to gain access to a quiet, private 

interview room. 

• If available, the teacher who made the report should be interviewed. 

Theories • Develop multiple theories of how the injury occurred: 

– The complaint is true as alleged 

– The injury was sustained in a fall 

– The injury was inflicted by a sibling, other family member, or a classmate 

– The injury claim is deliberately false. 

• Follow up on each theory: 

– Visually examine the red mark on the child 

– Conduct a child interview 

– Interview the siblings, parents, classmates, or others, where appropriate. 

128 Appendix M—Case Studies 
Interview Child interview: 

Look at the injury on the child’s face. Attempt to determine if the mark resembles a handprint. 

Take photographs. 

• Ask open-ended questions. Note both the verbal response and the child’s body language. 

Sibling interview (for siblings who are not suspects): 

• Siblings should be interviewed separately. 

• Provide privacy for the interviews. 

• Separate rooms and vehicles may provide the only privacy available at the school. 

Alleged suspect interview: 

• The element of surprise should be utilized. 

• The location of the interview (e.g., school, home) should be determined. 

• Allow the alleged suspect to give an explanation. 

• Gently probe the suspect about how the injury occurred. 

• Determine whether the injury as viewed fits the explanation provided. 

• If another explanation is given for the cause of the injury, follow up on this explanation by 

visually examining the alleged site of the injury (if possible) and taking photographs. 

• An abusive parent or sibling will usually blame the injured child for causing the situation. 

• If the suspect denies causing the injury, present him with the information that has already been 

obtained (e.g., hand measurements, witness information, time, location, opportunity). 

• Most guilty suspects will admit to the temporary loss of control and slapping the child in 

anger. State that you understand his loss of control, thank him for sharing the information, 

and tell him that it was helpful. This may help him to share additional information. 

• While taking statements or admissions: 

– Allow the parent or sibling to provide details of the incident 

– Compare the explanation to the injury 

– Follow department procedures for taking statements (initialed, signed). 

• If possible or necessary, obtain a medical history of the child to rule out medical causes for 

the injury. (See Appendix F, Distinguishing Physical Abuse from Nonintentional Injury, for 

more information.) 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

129 
Action • Determine what actions should be taken by CPS or law enforcement agencies: 

– CPS may decide that the situation can be handled best with family counseling and followup services 

– Law enforcement may elect to close its investigation with the recommendation that CPS 

works with the family 

– Arrest may be considered depending on the family history and the risk of potential injury 

to other family members. 

– Local prosecutors should be consulted to ensure that the injuries sustained meet the State or 

local statute’s definition of child maltreatment. 

• Medical exam of the child often is legally mandated for any arrest for child physical abuse: 

– First responders should check their agency’s and State’s regulations 

– Even if an exam is not mandated, the first responder should consult with medical staff 

about what additional treatment, if any, is recommended. 

• Photographs and measurements should be taken and documented appropriately. 

• Follow-up photographs should be taken to document the approximate age of bruises, should 

they develop. 

• Determine if arrangements need to be made for the child. Arrangements for the child should 

be made prior to leaving the school. Possible arrangements include: 

– The child remains in school and follows his normal schedule. 

– The child goes to a friend’s house after school. 

– The child is temporarily cared for by others. 

130 Appendix M—Case Studies 
Sexual Abuse Case: Incest 


Synopsis A local middle school counselor contacts the child abuse hotline and reports that a 

12-year-old female student from her seventh grade class reported that her father sexually 

abused her. The abuse allegedly started at age 9 and continued until the present. Th e 

last incident involved sexual intercourse and occurred 2 days ago. The child is fearful of 

telling her mother and is worried about her family. 

Initial • Establish the required response time and arrange for any other first responders to arrive 

Response simultaneously. 

• Meet with the principal or other authorized school personnel to gain access to a quiet, private 

interview room. 

• As the reporter, the school counselor should be interviewed: 

– Discuss the method of disclosure 

– Obtain the questions asked and responses given 

– Obtain a written statement from the counselor (signed, initialed, and dated) 

– Direct the counselor not to discuss the interview with the other parties at this time. 

Theories • Develop multiple theories of the sexual abuse: 

– The complaint is true as alleged 

– The counselor misunderstood the information 

– The child is making a false complaint. 

• Follow up on the theories developed: 

– Interview the child 

– Locate witnesses 

– Corroborate information 

– Locate and collect evidence from the crime scene. 

Interview In general: 

• The details of each incident of sexual abuse can provide corroboration of facts and are 

important for establishing credibility for the victim. Attempt to establish a timeline for 

separate incidents, including: 

– The last incident 

– The time before the last incident 

– Other remembered incidents 

– The location of any other household members during each assault (mother working late, 

mother at store, brother playing outside). 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

131 
Interview Child interview: 

• Locate a private place in the school to conduct the interview. 

• A joint interview with CPS and law enforcement is recommended to minimize the number of 

times the child is interviewed. 

• Explain to school personnel that they should not be present during the interview because they 

may be subpoenaed for court and the details could be embarrassing for the child. 

• Conduct a forensically sound interview: 

– Follow agency guidelines for establishing interview rules. 

– Skilled interviewers try to obtain as much narrative from the child as possible. Begin with 

basic probes, such as: 

• Do you know why we came to talk with you? 

• Please tell me what you told your counselor. 

• Please tell me what happened with your father. 

• Most children older than age 5 can provide narrative responses to open-ended questions (e.g., 

“Tell me everything that happened in the bedroom, from the beginning to the middle to the 

end.”). However, children may be embarrassed, ashamed, or scared of providing many intricate 

details about sexual foreplay and acts. It therefore may be necessary to ask more direct or 

focused questions. Remember that direct and focused questions should always be followed by 

open-ended probes (e.g., “Tell me more about the room.” or “Tell me more about the touch.”). 

Exhibit M-1 provides examples of detailed questions to ask the victim. 

Nonoffending parent interview: 

• Make contact with the nonoffending parent prior to leaving the school. A nonoff ending 

parent who is at work can be contacted at work and asked to meet the first responders at the 

parent’s residence. 

• Tell the nonoff ending parent: 

– “We are at your child’s school, and your child is physically fi ne.” 

– “We are looking into a matter that we cannot discuss over the telephone.” 

• Most nonoffending parents will respond immediately when a serious matter is raised about 

their child. 

• A very small percentage will call the other parent and have him or her respond as well. 

However, because the nonoffending parent has no information, he or she usually assumes it is 

something about school and will not call the other parent. 

• If the parent is not able to return to the home, arrange for an immediate meeting place. 

• Assess the nonoffending parent’s abilities to believe the child and to protect the child from 

further abuse. 

• Prevent the destruction of evidence. 

132 Appendix M—Case Studies 
Interview • Attempt to obtain the following information from the nonoff ending parent: 

– Observations of the situation 

– Knowledge of the relationship between the father and daughter (e.g., attitude or behavioral 

changes such as the daughter not wanting to stay home alone with the father) 

– Timeline information, such as the nonoffending parent’s work schedule (any late hours), 

which can be compared to the timeline given by the child 

– Relationship with spouse (e.g., domestic violence, fear, sexual problems). 

• Assess the reaction of the nonoffending parent. The nonoffending parent usually will be 

understandably in denial. She may accuse the first responders of making up the allegations or 

of misunderstanding the information. 

– Do not overreact to anger or to initial disbelief on the part of the nonoffending parent. 

First responders want and need information. Every word from the nonoff ending parent 

can be critical to the case. 

– Allow the initial denial, and then proceed with questions. Examples of questions that may 

be asked include: 

• “Can you tell us about your spouse?” 

• “Does your spouse get up in the night?” Possible responses may include, “Yes, he gets up 

to smoke a cigarette” or “He goes to the bathroom.” 

– Questions also may need to be asked regarding domestic violence, fear, and sexual 

problems. 

– If the alleged victim provided a description of the alleged perpetrator’s underclothing (e.g., 

boxer shorts with hearts, green shirt), have the nonoffending parent corroborate these facts. 

Items will be seized and collected from the residence. 

– If the victim provided a description of the father’s anatomy (e.g., penis, moles, tattoo, 

shaved pubic hair), have the nonoffending parent confi rm. 

– Use your skill and knowledge to keep an open mind, and do not overwhelm the 

nonoffending parent with information: 

• Do not let prior experience or current knowledge of the case immediately lead you to 

preconvict the suspect. For example, do not say to the nonoffending parent, “We know 

he did this. We know he is a child molester. We know this happened.” 

• Nonoffending parents have many initial reactions, but they usually want to provide 

helpful information during the initial interview to determine the truth. First responders 

want this information and must maintain rapport. 

– Allow time for the nonoffending parent to begin to acknowledge that the incident might be 

true. 

– Nonoffending parents will often unknowingly provide corroborative information (e.g., “I 

took my son shopping last weekend,” “I worked late on Thursday,” “He has two pairs of 

boxer shorts with hearts on them,” or “He gets up to smoke a cigarette at about 2:00 in the 

morning.”). 

– Explain in a diplomatic manner that you would like to conduct a search of the residence 

for evidence. Law enforcement can have the nonoffending parent sign a consent-to-search 

form. (Follow department guidelines for consent to search legal issues.) This generally is 

not difficult at this stage of the investigation. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

133 
Interview – If the nonoffending parent refuses to allow the first responders to conduct a search, law 

enforcement should obtain a search warrant. (Follow department guidelines for search 

warrant applications.) 

– Understand that this is a serious crime and that all evidence should be seized from the 

crime scene. The nonoffending parent should not be allowed to interfere with or to destroy 

evidence. CPS and law enforcement may have someone stand by at the residence to 

prevent evidence destruction while time is taken to obtain a search warrant. 

Alleged suspect interview: 

• Evaluate the information previously reported and collected for: 

– Corroboration or noncorroboration of the alleged victim’s statement 

– Clarification of previously reported information that may have been misunderstood 

– Indication of false statements 

– Crime scene evidence. 

– Obtain the suspect’s work schedule. 

• Plan when and where the suspect will be interviewed. 

• The element of surprise is critical. Do not warn the suspect by contacting him prior to the 

interview, thus giving him time to delay. 

• The suspect may live with the victim, and so the interview should be conducted on the same 

day that the accusations are made in order to: 

– Protect the victim and other household members 

– Prevent further criminal behavior in the community 

– Prevent threats and intimidation of the victim and the witnesses 

– Prevent the destruction of evidence 

– Prevent a false alibi from being established 

– Prevent the suspect and the nonoffending parent from pressuring the victim to retract or 

recant the statement. 

• Maintain a professional demeanor. A calm and systematic approach should be used to establish 

factual information. 

• Follow department guidelines for Miranda rights issues. 

134 Appendix M—Case Studies 
Interview • The following statements may be helpful when interviewing the suspect: 

– “Sir, we are conducting a sensitive investigation. Is there someplace we can talk privately?” 

(Suspects will find a private place to talk if they are confronted at work.) 

– “Sir, we were at your daughter’s school today, and she reported a problem.” 

– “Sir, she told us that there had been some inappropriate contact.” (Most guilty suspects will 

not ask for the details of what is meant by inappropriate contact because they already know 

the answer.) 

– “Sir, we have interviewed your wife, and we know that she was at work late on Th ursday” 

or “We know what happened at home.” 

– “Sir, we have conducted an investigation, and we have corroborative evidence from your 

home and the beach house.” 

• During the interview, alleged suspects may respond with one or more of the following 

statements: 

– “I don’t know what to say.” 

– “I may have gone into her room one time.” 

– “Could I have done this and not remember?” 

– “Could I have been drinking and not remember?” 

– “I don’t recall ever touching her.” 

– “Could I have done this accidentally?” 

• Be patient and let the suspect know that you believe the victim. The following statements may 

be used: 

– “Sir, we know this happened. We just want to know how it got started.” 

– “Sir, we know that you would never deliberately hurt your daughter.” 

– “Sir, you have a problem, and we need to talk about what happened.” 

– “Sir, we have evidence to match to your DNA. We collected the sheets, pants, 

underwear..” 

– “Sir, I know you don’t feel good about what happened. I think you would agree that you 

owe this to your family.” 

• Expect denial and numerous stalling techniques: 

– “Why would I do that?” 

– “I don’t know why she is saying that.” 

– “I love my daughter and would not hurt her.” 

– “I don’t know what to say.” 

• Note the behavior and body language of the suspect during the interview. Most guilty suspects 

make little eye contact and generally look down during direct assertions of guilt. Innocent 

individuals often are highly insulted at the insinuation that they molested a child. 

• Do not rush the interview. Plan on spending a minimum of 2 hours with the suspect. Possible 

child molesters must be interviewed thoroughly and completely. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

135 
Interview • Remember to use silence as a tool during the interview. There is no need to fi re repetitive 

questions one after another during an interview: 

– Looking up at the suspect and writing down notes also provides time to think of additional 

questions 

– Remember, suspects have no idea what information the first responder knows or what she is 

thinking. 

• Do not lose patience and assume the suspect is not going to provide a confession or admission. 

Most suspects want to unburden themselves by admitting their guilt. Several approaches can 

be used: 

– Ask the suspect what he thinks should happen to someone who touches a child. Th e 

answer is usually a projection of what he would like to see happen to himself. For example, 

the suspect may say, “They should probably get some psychological counseling” or “Th ey 

need help.” 

– Provide the suspect with a “bridge to cross,” which can allow the suspect the ability to 

confess while still saving face. For example, ask the suspect if this could have happened by 

accident. Examples of suspect statements that indicate a desire to confess include: 

• “I may have touched her by accident while wrestling.” 

• “I may have accidentally gone into the wrong bedroom.” 

• “I was drinking alcohol and thought it was my wife.” 

• “I was drinking alcohol and don’t remember.” 

• “I don’t recall ever doing this.” 

• “Could I have done this and not remember?” 

• “I was just rubbing her back and my hand slipped down.” 

• “I accidentally fell and my mouth landed on her privates.” 

• “I wanted to teach her about sex.” 

• “I would never deliberately hurt my child.” 

• “If you want me to say I did this, then I did.” 

• “She wanted me to touch her.” 

• “She put her body on me.” 

– Recognize the above statements as a desire to confess, and follow up with open-ended 

probes. For example, use the following probes in response to the above statements: 

• “Tell me more about the wrestling.” 

• “Tell me more about the time you accidentally went into the wrong bedroom.” 

• “Tell me more about the time you were drinking.” 

• “Tell me more about rubbing her back.” 

• “Tell me more about your hand accidentally slipping down.” 

• “Tell me more about the time you accidentally fell onto her body.” 

• “Tell me more about how she wanted you to touch her.” 

• “Tell me more about how you wanted to teach her.” 

136 Appendix M—Case Studies 
Interview – Allow the confession to contain excuses and minimization during the initial statement. 

Details can be obtained later in the written documentation. 

• Maintain a professional tone and demeanor throughout this interview process. Child molesters 

may be more willing to confess to those who listen and do not make personal judgments. 

• Try to obtain a confession because: 

– It may be the only available evidence. 

– It may lead to other physical evidence. 

– It may corroborate the statements of the victim. 

– It relieves the child of the burden of carrying the entire case in court. 

– It may lead to the discovery of other victims. 

– It generally will convince the nonoffending parent of the suspect’s guilt. 

– It may prevent the child from needing to testify. 

– It may prevent further child abuse. 

– It may prevent recantation pressure on the child. 

– It provides the prosecutor with evidence needed to go forward with the court case. 

Action • If appropriate, take the child to a local hospital to be examined for: 

– Genital trauma 

– Forensic evidence 

• Semen (within 72 hours of assault) 

• Saliva 

• Hair transfer from suspect to victim 

• Trace evidence (e.g., fibers, material found under fi ngernails) 

• Bite marks or scratches 

• Bruises and blood. 

• Investigate the crime scene: 

– Photograph the entire crime scene. 

– Sketch the crime scene, including measurements. 

– Locate items to be seized, such as the victim’s clothing. 

– Using an evidence vacuum with filters, vacuum the areas in the room for the suspect’s hair 

or other evidence. 

– Utilize forensic illumination (such as luminol) for detecting semen or blood. 

– Number and photograph items in the location where they were found. 

– Collect all bed sheets, covers, and pillow cases and fold them inward to prevent hair and 

fibers from falling off . 

– Locate, photograph, and collect the suspect’s clothing. 

– Take any computers to check for further evidence, such as child pornography. 

– Identify sounds, lights, odors, and other corroborative information provided by the victim 

(e.g., door squeaks, fl oor creaks). 

– All separate crime scenes must be identified and included in processing (e.g., basements, 

vehicles). 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

137 
– 	 Forensic evidence can be located many days, weeks, or months after the alleged incident. 

Many cases have been solved by locating forensic evidence, such as blood or semen on 

carpets, rugs, wooden floors, mattresses, and bedcovers, months or years after the crime 

took place. Evidence may be where it is not expected. For example, victims often pull 

covers over themselves after the assault. Therefore, saliva and semen may be present on the 

underside of bed covers. 

– 	 Attempt to reconstruct the crime for the purposes of locating forensic evidence, as is done 

in other serious crime scenes (e.g., the suspect knelt on the floor beside the bed while 

touching the child; suspects often will masturbate in this position.). 

– 	 Maintain the chain of custody of seized evidence. Dates, times, locations, and persons who 

collected the evidence must be recorded for all items seized. Follow department protocols 

for this. There also should be an evidence inventory list, which is an itemized list of the 

evidence that was seized. Maintain a separate log for the chain of custody of all seized 

evidence. 

– 	 Be prepared for a delay in receiving the evaluation results of the forensic evidence. Have a 

general knowledge of what was identified and collected from the crime scene (e.g., possible 

semen, hair, clothing, pajamas, underwear). This information will be benefi cial when 

interviewing the suspect. 

• 	 Determine what the next steps should be: 

– 	 Decide if the child is safe in her home or if she should be placed with a relative or in 


another out-of-home setting. 


• 	 If a confession is obtained, the suspect should be arrested and placed in custody, unless 

the law enforcement officer is conducting a noncustodial interview and the suspect 

was not Mirandized. In this case, the suspect should be allowed to leave, even for a 

short time (e.g., 1 hour) to show the court that he was not arrested. An arrest warrant 

or physical arrest could occur shortly after the suspect or the first responder leaves the 

interview scene. 

• At some point, law enforcement may want to use a polygraph as a part of the interview. 

(The use of polygraphs is beyond the scope of this manual.) 

138 Appendix M—Case Studies 
Exhibit M-1 

Alleged Sexual Abuse Victim Interview Dialog 

The following are portions of a typical interview of an alleged sexual abuse victim. Please note that because 

of the nature of the alleged abuse, the interview questions and answers are graphic. 

Interviewer: Tell me everything that happened the last time. Start at the beginning and tell me what 

happened. 

Child: I was sleeping and heard the bedroom door open. The floor makes noise when you walk on it. 

Interviewer: Tell me more about the noise. 

Child: The door creaks a little. The floor makes a squeaking noise. 

Interviewer: Tell me more about what happens after you hear the fl oor creak or Then what happens? 

Child: He touched me. 

Interviewer: Tell me what happens right before he touches you. 

Child: He pulls my covers down. 

Interviewer: What happens right after he pulls your covers down? 

Child: Then he touches my privates. 

Interviewer: What clothes are you wearing? 

Child: Pajamas. 

Interviewer: Tell me what happens with the pajamas or Tell me what happens after he pulls your pajamas 

down or What else are you wearing? 

Child: Underwear. 

Interviewer: Tell me what happens with the underwear or What happens after he pulls down your 

underwear? 

Child: He touches me. 

Interviewer: Where does he touch you? (Note: the child may have a personal name for that part of her 

body. Examples include vagina, vulva, private, thing. The first responder may want to use anatomical 

drawings for clarifi cation.) or What does he touch you with? 

Child: His fi ngers. 

Interviewer: Where is your father while this is taking place? 

Child: He’s on the bed. 

Interviewer: Tell me what happened before he got on the bed. 

Child: He took his pants off . 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

139 
Interviewer: Tell me about his clothes (outer and under) or Tell me what happens when he gets on the bed 


or Tell me what happens right before the touch or Tell me what happens right after the touch. 


Child: He put it in. 


Interviewer: He put what in? 


Child: His thing (penis, pee pee, dick). (Note: if the child is young and saw the penis, have her draw 


it on paper prior to using an anatomical drawing for body part identifications. It may be helpful to use 


anatomical drawings for clarifi cation.) 


Interviewer: Tell me what happens right before he put it in or What is he wearing? or Th en what 


happened? or Where is his body? or Where is your body? or Tell me what happened after he put it in? or 


Then what happened? 


Child: He licked my neck and breasts. 


Interviewer: Then what happened? 


Child: He just made a noise and stopped. 


Interviewer: Tell me more about the noise or Tell me what you heard, tasted, or smelled or Th en what 


happened? 


Child: He got off and left. 


Interviewer: What about the clothes? 


Child: He put them back on. 


Interviewer: Then what happened? 


Child: I went to sleep. 


Interviewer: What about your clothes? 


Child: I pulled them back up. 


Interviewer: Did he say anything? or Who was home when this happened? 


Child: My brother. 


Interviewer: Where was your mother (and any other household members)? 


Child: Mom was working late; my brother was sleeping. 


Interviewer: Did this ever happen any other time or any other place? 


Child: Last week on vacation. 


Interviewer: Let’s talk about last week or Tell me more about that time or Tell me what you were wearing 


or Tell me what he was wearing or Tell me what you heard, smelled, tasted or Where was the rest of your 


family? 


140 Appendix M—Case Studies 
APPENDIX N 

Assessing Disaster 

Survivor Immediate 

Needs Worksheet1 

Instructions: Use this form to document what the survivor needs most at this time. This form can be used to 


communicate with referral agencies to help promote continuity of care. 


Date: ___________ Responder: _______________________________ 


Survivor Name(s): ____________________________________ 


Location: _________________________________________ 


This session was conducted with (check all that apply): 


 Child  Adolescent  Adult  Family  Group 

1. Check the boxes corresponding to difficulties the survivor is experiencing. 

Behavioral Emotional Physical Cognitive 

 Extreme  Acute stress  Headaches  Inability to accept disorientation reactions 

 Stomachaches or cope with death

of loved one(s)  Excessive drug,  Acute grief reactions alcohol, or  Sleep difficulties  Distressing dreams prescription drug use  Sadness or 

tearfulness  Diffi culty eating or nightmares 

 Isolation or 

withdrawal  Irritability or anger  Worsening of health 

conditions 

 Intrusive thoughts 

or images 

 High-risk behavior 

 Regressive behavior 

 Anxiety or fear 

 Despair or 

 Fatigue or 

exhaustion 

 Difficulty

concentrating 

 Separation anxiety hopelessness 

 Feelings of guilt or 

 Chronic agitation  Difficulty

remembering 

 Violent behavior shame  Other _________  Diffi culty making 

 Maladaptive coping  Feeling emotionally decisions 

 Other _________ 

numb or 

disconnected 

 Preoccupation with 

death or destruction 

 Other _________  Other _________ 

1 National Child Traumatic Stress Network, & National Center for PTSD. (2006). Psychological fi rst aid: Field operations guide (2nd

ed.). Available: http://www.nctsnet.org/nctsn_assets/pdfs/pfa/2/PsyFirstAid.pdf. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

141 
______________________________________________________________________ 

______________________________________________________________________ 

2. Check the boxes corresponding to other difficulties the survivor is experiencing. 

 Past or preexisting trauma/psychological problems/substance abuse problems 

 Injured as a result of the disaster 

 Loved one(s) missing or dead 

 Financial concerns 

 Displaced from home 

 Living arrangements 

 Lost job or school 

 Assisted with rescue/recovery 

 Has physical/emotional disability 

 Medication stabilization 

 Concerns about child/adolescent 

 Spiritual concerns 

 Other: _____________________________________________________ 

3. Please make note of any other information that might be helpful in making a referral. 

4. Referral 

 Within project (specify) _________________ 

 Other disaster agencies 

 Professional mental health services 

 Medical treatment 

 Substance abuse treatment 

 Other community services 

 Clergy 

 Other: ___________________ 

5. Was the referral accepted by the individual? 

 Yes 

 No 

142 Appendix N—Assessing Disaster Survivor Immediate Needs Worksheet 
 

APPENDIX O 

Continuity of Operations 

Plan (COOP) Outline1 

I. 	 Executive Summary 

• 	 Briefly outlines the organization and content of the COOP 

• 	 Describes what it is, whom it affects, and the circumstances under which it should be executed 

• 	 Discusses the key elements of COOP planning 

• 	 Explains the organization’s implementation strategies. 

II. Introduction 

• 	 Explains the importance of COOP planning to the organization 

• 	 Discusses the background for planning 

• 	 References recent events that have led to the increased emphasis on the importance of a COOP capability for the 

organization. 

III. Purpose 

• 	 Explains why the organization is developing a COOP 

• 	 Briefly discusses applicable Federal/State/local guidance 

• 	 Explains that the COOP is intended to ensure the continuity of functions essential to the mission and duties of 

the organization. 

IV. Applicability and Scope 

• 	 Describes the applicability of the plan to the organization as a whole (i.e., management, staff, clients, other 

stakeholders) 

• 	 Outlines the scope of the plan (i.e., the spectrum of potential disasters it covers). 

V. Essential functions 

Essential functions are those organizational functions and activities that must be continued under any and all 

circumstances (e.g., provide safe foster homes for children, investigate cases of potential child maltreatment). 

1 Adapted from Federal Emergency Management Agency. (2004). Continuity of operations plan (COOP) template. Available: http:// 

www.fema.gov/doc/government/coop/coop_plan_template_instructions.doc. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

143 
This section should: 

• 	 Identify and prioritize all essential functions 

• 	 Establish staffing and resource requirements for each 

• 	 Integrate supporting activities from other agencies or departments. 

VI. Authorities and References 

• 	 Provides a brief overview of the supporting authorities and references that have assisted in the development of 

this COOP. This may include relevant Federal, State, or local regulations or policies, as well as outside sources 

(e.g., articles, books) that affect or shape the development and implementation of the COOP. 

• 	 References the COOP appendix that provides a full listing of authorities and references. 

VII. Concept of Operations 

• 	 Explains how the organization will implement its COOP and how it plans to address each critical COOP 

element 

• 	 Should be separated into three phases: activation and relocation, alternate facility operations, and reconstitution. 

A. 	Phase I: Activation And Relocation 

• 	 Explains COOP activation procedures and relocation procedures from the primary facility to the alternate 

facility, if necessary 

• 	 Addresses procedures and guidance for personnel who will not be relocating to the alternate facility. 

1. Decision Process 

• 	 Explains the logical steps associated with implementing a COOP and the circumstances under which a plan may 

be activated (both with and without warning) 

• 	 Identifies who has the authority to activate the COOP. 

2. Alert, Notification, and Implementation Process 

• 	 Explains the events that should occur after a decision to activate the COOP, including employee alert and 

notification procedures and the COOP implementation process. 

3. Leadership 

a. Orders of Succession 

• 	 Identifies the orders of succession to key positions within the organization to ensure the organization’s ability to 

manage and direct its essential functions and operations 

• 	 Outlines the conditions under which succession will take place, the method of notification, and any temporal, 

geographical, or organizational limitations of authority. 

b. Delegations of Authority 

• 	 Identifies, by position, the authorities for making policy determinations and decisions at the agency level, on the 

front line, and at other organizational locations and levels, as appropriate. Generally, predetermined delegations 

of authority will take effect when normal channels of direction are disrupted and terminate when these channels 

have resumed. Such delegations may also be used to address specific competency requirements related to one or 

more essential functions that are not otherwise satisfied by the order of succession. 

• 	 Documents the legal authority for making key decisions 

• 	 Identifies the programs and administrative authorities needed for eff ective operations 

144 Appendix O—Continuity of Operations Plan (COOP) Outline 
• 	 Establishes capabilities to restore authorities upon termination of the event. 

c.	 Devolution/Worst-case Scenario 

• 	 Addresses how an organization will identify and conduct its essential functions in the aftermath of a worst-case 

scenario—one in which the leadership is incapacitated. The organization should be prepared to transfer all of 

its essential functions and responsibilities to personnel at a diff erent offi ce or location. 

B. 	Phase II: Alternate Facility Operations 

• 	 Identifies initial arrival procedures 

• 	 Establishes operational procedures for the continuation of essential functions. 

1. Mission Critical Systems 

• 	 Addresses the organization’s mission critical systems necessary to perform essential functions and activities 

• 	 Defines these systems and addresses the method of transferring/replicating them at an alternate site. 

SAMPLE 

The following table shows examples of mission critical systems for a child welfare agency: 

System Name Current Location Other Locations 

Child Abuse and Neglect Hotline Agency HQ Building X, which is equipped for call 

forwarding from Agency HQ 

Investigations Agency HQ Individual caseworkers’ homes, if possible, 

or Building X 

2. Vital Files, Records, and Databases 

• 	 Addresses the organization’s vital files, records, and databases that are necessary to perform essential 

functions and activities and to reconstitute normal operations after the emergency ceases. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

145 
SAMPLE 

The following table shows examples of vital files, records, and databases for a child welfare agency, their format, 

and how they may be able to be accessed during and after an emergency: 

Vital File, Record, or 

Database 

Form of Record 

(e.g., hardcopy, 

electronic) 

Pre-positioned at 

Alternate Facility 

Hand Carried to 

Alternate Facility 

Backed up at 

Th ird Location 

Locations of families 

served 

Electronic X X 

Child maltreatment 

report records 

Hardcopy X X 

Subsequent 

investigations 

Hardcopy and 

electronic X X X 

Out-of-home 

placements 

Electronic X X 

COOP Hardcopy and 

electronic X X X 

C. Phase III: Reconstitution 

• 	 Explains the procedures for returning to normal operations, including procedures for returning to the primary 

facility, if available, or procedures for acquiring a new facility 

• 	 Addresses notification procedures for all employees returning to work 

• 	 Outlines when and how normal lines of communication and leadership will be resumed 

• 	 Describes when and how an after action report can be developed to determine the effectiveness of the COOP 

and what changes may need to be made to it. 

VIII. COOP Planning Responsibilities 

• 	 Includes COOP maintenance responsibilities. 

146 Appendix O—Continuity of Operations Plan (COOP) Outline 
SAMPLE 

The following table shows examples of COOP maintenance responsibilities: 

Task Assigned Staff

Update COOP annually or after emergency Agency Director, Emergency Response Committee 

Update telephone rosters monthly Director, Human Resources 

Review status of vital files, records, and databases Director, Data Systems 

Develop and lead COOP training Deputy Director 

Plan COOP exercises Interagency Liaison 

IX. Logistics 

A. 	Alternate Location 

• 	 Explains the significance of identifying an alternate facility (including staff homes), the requirements for 

determining an alternate facility, and the advantages and disadvantages of each location. 

Alternate facilities should provide: 

(1) Sufficient space and equipment 

(2) Capability to perform essential functions within 12 hours, up to 30 days 

(3) Reliable logistical support, services, and infrastructure systems 

(4) Consideration for health, safety, and emotional well-being of personnel 

(5) Interoperable communications 

(6) Computer equipment and software 

B. 	Interoperable Communications 

• 	 Identifies communication systems that are located at the alternate facility. These systems should provide the 

ability to communicate within the organization and outside the organization. 

Interoperable communications should provide: 

(1) Capability commensurate with an agency’s essential functions 

(2) Ability to communicate with essential personnel 

(3) Ability to communicate with other agencies, organizations, and customers 

(4) Access to data and systems 

(5) Communications systems for use in situations with and without warning 

(6) Ability to support COOP operational requirements 

(7) Ability to operate at the alternate facility within 12 hours and for up to 30 days 

(8) Interoperability with existing fi eld infrastructures 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

147 
X. Test, Training, and Exercises 

• 	 Addresses the organization’s test, training, and exercise (TT&E) plan: 

– 	 TT&E familiarizes staff members with their roles and responsibilities during an emergency, ensures that 

systems and equipment are in a constant state of readiness, and validates certain aspects of the COOP 

– 	 Managers may be creative when it comes to COOP readiness and include snow days, power outages, server 

crashes, and other ad hoc opportunities to assess preparedness. 

COOP TT&E plans should provide: 

(1) Individual and team training of agency personnel 

(2) Internal agency testing and exercising of COOP policies and procedures 

(3) Testing of alert and notifi cation procedures 

(4) Annual refresher orientation for COOP personnel 

(5) Joint interagency exercising of COOPs, if appropriate 

XI. Multi-Year Strategy and program Management Plan 

• 	 Discusses how the organization will develop its multi-year strategy and program management plan: 

–	 The plan should address short- and long-term COOP goals, objectives, and timelines; budgetary 

requirements; preparedness considerations; and milestones or tracking systems to monitor accomplishments 

– 	 It should be developed as a separate document. 

148 Appendix O—Continuity of Operations Plan (COOP) Outline 
XII. COOP Maintenance 


• 	 Addresses how the organization plans to update the COOP regularly 

• 	 Includes current key evacuation routes, roster and telephone information, and maps and room/building 


designations of alternate locations. 


Appendix A: Authorities and References 

• 	 Cites a list of authorities and references that mandate the development of the COOP and helped to develop the 

COOP. 

Appendix B: Operational Checklists 

• 	 Contains operational checklists for use during a COOP event. Checklists may be designed to list the 


responsibilities of a specific position or the steps or equipment required to complete a specifi c task. 


Appendix C: Alternate Location/Facility Information 

• 	 Includes general information about the alternate location/facility, such as the address, points of contact, and 

available resources. 

Appendix D: Maps and Evacuation Routes 

• 	 Provides maps, driving directions, and available modes of transportation from the primary facility to the alternate 

location 

• 	 Includes evacuation routes from the primary facility. 

Appendix E: Definitions and Acronyms 

• 	 Provides definitions of key words, phrases, and acronyms used throughout the COOP and within the COOP 

community. 

Appendix F: Agency Contact Information 

• 	 Includes the names and contact information, as well as emergency contact information, for all staff . 

Appendix G: Partner Contact Information 

• 	 Includes the name, contact information, and liaison for all partner agencies or other organizations or individuals 

that the agency may need to contact during or after an emergency. 

The Role of First Responders in Child Maltreatment Cases: 

Disaster and Nondisaster Situations 

149