Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 300 - REPORTS OF CHILD ABUSE AND NEGLECT › Appendix B - Child Abuse and Neglect Allegations

Current through Register Vol. 48, No. 28, July 12, 2024
This Appendix describes the specific incidents of harm which
				must be alleged to have been caused by the acts or omissions of the persons
				identified in Section 3 of the Abused and Neglected Child Reporting Act before
				the Department will accept a report of child abuse or neglect. The allegation
				definitions focus upon the harm or the risk of harm to the child. Many of the
				allegations of harm can be categorized as resulting from either abuse or
				neglect. All abuse allegations of harm are coded with a one or two digit number
				under 50. All neglect allegations of harm are coded with a two digit number
				greater than 50. The allegations of harm are defined as follows:
ALLEGATION #
DEFINITION
1/51
Death
Death means the permanent cessation of all vital
						  functions.
The following definitions of death are also commonly
						  used:
* Total irreversible cessation of cerebral function,
						  spontaneous function of the respiratory system, and spontaneous function of the
						  circulatory system;
* The final and irreversible cessation of perceptible
						  heartbeat and respiration.
Verification of death must come from a physician or
						  coroner.
2/52
Head Injuries
As used in this Part, head injury means a serious head
						  injury causing skull fracture, brain damage or bleeding on the brain, such as
						  subdural hematoma. Brain damage, skull fractures, hematomas and subdural
						  hematomas are considered head injuries.
Brain Damage
Brain damage means injury to the brain contained within
						  the cranium skull.
Skull Fracture
Skull fracture means a broken bone of the skull.
Hematoma
Hematoma means a swelling or mass of blood (usually
						  clotted) confined to an organ, tissue or space and caused by a break in a blood
						  vessel.
Subdural Hematoma
Subdural means beneath the dura mater (the outer
						  membrane covering the spinal cord and brain).
A subdural hematoma is located beneath the membrane
						  covering the brain and is usually the result of head injuries or the shaking of
						  a small child or infant. It may result in the loss of consciousness, seizures,
						  mental or physical damage, or death.
Additional abusive head trauma includes subarachnoid
						  subgaleal and epidural hematomas.
Shaken Baby Syndrome
Abusive head trauma in infants and children is the
						  medical diagnosis and communication to describe the historical term shaken baby
						  syndrome.
Shaking of an infant causes stretching and tearing of
						  blood vessels in the brain causing subdural hematoma, bleeding in the brain and
						  retinal hemorrhage. These injuries may occur with or without obvious evidence
						  of impact.
Verification of head injuries and the presence or
						  absence of any predisposing medical condition that may have caused or
						  contributed to the injuries must come from a physician, preferably a
						  neurosurgeon or radiologist.
4/54
Internal Injuries
An internal injury is an injury which is not visible
						  from the outside, e.g., an injury to the organs occupying the thoracic or
						  abdominal cavities. Such injury may result from a direct blow or a penetrating
						  injury. A person so injured may be pale, cold, perspiring freely, have an
						  anxious expression, or may seem semicomatose. Pain is usually intense at first,
						  and may continue or gradually diminish as patient grows worse.
Verification of internal injuries must come from a
						  physician.
5/55
Burns
Burns
Burns are tissue injuries resulting from excessive
						  exposure to thermal, chemical, electrical or radioactive agents. The effects
						  vary according to the type, duration and intensity of the agent and the part of
						  the body involved. Burns are usually classified as first, second, third or
						  fourth degree.
* First Degree (Partial Thickness)
First degree burns are superficial burns in which
						  damage is limited to the outer layer of the epidermis (skin) and are
						  characterized by scorching or painful redness of the skin.
* Second Degree (Partial Thickness)
Second degree burns are burns in which the damage
						  extends through the outer layer of the skin into the inner layers (dermis).
						  Blistering will be present within 24 hours.
* Third Degree (Full Thickness)
Third degree burns are burns in which both layers of
						  the skin (epidermis and dermis) are destroyed with damage extending into
						  underlying tissues, which may be charred or coagulated.
* Fourth Degree (Full Thickness)
Fourth degree burns are burns that extend beyond skin
						  and underlying tissues into bone, joints and muscles.
Scalding
Scalding is a burn to the skin or flesh caused by moist
						  heat and hot vapors, as steam.
Verification must come from a physician.
6/56
Poison/Noxious
						  Substances
Poison
A poison is any substance, other than mood altering
						  chemicals or alcohol, taken into the body by ingestion, inhalation, injection,
						  or absorption that interferes with normal physiological functions. Virtually
						  any substance can be poisonous if consumed in sufficient quantity. Therefore,
						  the term poison more often implies an excessive amount rather than the
						  existence of a specific substance.
Noxious Substances
Any substance deemed to be harmful, injurious, not
						  wholesome.
Verification must come from a physician or by a direct
						  admission from the alleged perpetrator that the poison/noxious substance was
						  given to the minor by other than accidental means.
7/57
Wounds
A wound is a gunshot or stabbing injury.
Verification must come from a physician, a law
						  enforcement officer or by a direct admission from the alleged
						  perpetrator.
9/59
Bone Fractures
A fracture is a broken bone or certain cartilage
						  injuries such as a broken nose.
Metaphyseal/Epiphyseal
						  Fractures
Fractures located at the end of bones. They are
						  commonly described as corner fractures, chipped fractures or bucket-handle
						  fractures.
Diaphyseal Fractures
Diaphyseal fractures are located in the bone shaft.
						  Fractures in the shaft of long bones of the extremities are spiral (oblique) or
						  transverse. A spiral fracture is caused by twisting or rotational force.
						  Transverse fractures results from a direct blow or bending force.
Verification of the injury and the likely cause,
						  including presence or absence of any predisposing medical conditions that may
						  have caused or contributed to the injury, must come from a physician,
						  preferably an orthopedist or radiologist.
10/60
Substantial Risk of Physical
						  Injury (Abuse)/Environment
Injurious to Health and Welfare
						  (Neglect)
10 - Substantial Risk of Physical Injury
						  (Abuse)
Substantial risk of physical injury means that the
parent
, caregiver,
immediate family member
aged 16 or over, other person
residing in the home
aged 16 or
						  over, or the
parent's paramour
has created a real and
						  significant danger of
physical injury by other than accidental means
						  that would likely cause death, disfigurement, impairment of physical health or
						  loss or impairment of any body function
[
						  325 ILCS
						  5/3 ]. This allegation of harm is to be used when the
						  type or extent of harm is undefined but the total circumstances lead a
						  reasonable person to believe that the child is at substantial risk of physical
						  injury. This allegation of harm also includes incidents of violence or
						  intimidation directed toward the child that have not yet resulted in injury or
						  impairment but that clearly threaten injury or impairment.
Incidents
-
Examples of incidents that can cause a substantial risk
						  of physical injury include, but are not limited to:
* Choking the child;
* Smothering the child;
* Pulling the child's hair out;
* Violently pushing or shoving the child into fixed or
						  heavy objects;
* Throwing or shaking a smaller child;
* Subjecting the child to participation in or
						  witnessing the physical abuse or restraint of another person when it is used by
						  the perpetrator to intimidate the child (e.g., this could happen to you, this
						  will happen to you); or
* Other violent or intimidating acts directed toward
						  the child that cause excessive pain or fear.
Circumstances
-
Examples of circumstances that place the child in
						  substantial risk of physical injury include, but are not limited to:
* A perpetrator of child abuse who has been ordered by
						  a court to remain out of the home returns home and has access to the abused
						  child;
* Anyone living in the home has a documented history of
						  violence toward children or has been arrested for violence to a child;
* Domestic violence in the home when the child has been
						  threatened and the threat is believable, as evidenced by a past history of
						  violence or uncontrolled behavior on the part of the perpetrator;
* Allowing or encouraging a child to be involved in a
						  criminal activity; or
* The circumstances surrounding the death of one child
						  provides reason to believe that another child is at real and significant risk
						  of harm.
60 - Environment Injurious to Health and Welfare
						  (Neglect)
-
Environment injurious means that a
child's
						  environment creates a likelihood of harm to the child's health, physical
						  well-being or welfare and
that
the likely harm to the child is
						  the result of a blatant disregard of parent or caretaker
						  responsibilities
[
						  325 ILCS
						  5/3 ]. This allegation shall be used when the type or
						  extent of harm is undefined but the totality of circumstances, including
						  inculpatory and exculpatory evidence, leads a reasonable person to believe that
						  the child's environment may likely cause harm to the child's health, physical
						  well-being or welfare due to the parent's or caretaker's blatant disregard.
						  Blatant disregard is defined as
an incident where the real, significant
						  and imminent risk of harm would be so obvious to a reasonable parent or
						  caretaker that it is unlikely that a reasonable parent or caretaker would have
						  exposed the child to the danger without exercising precautionary measures to
						  protect the child from harm
[
						  325 ILCS
						  5/3 ]. This allegation of harm shall also be used when
						  there are conditions that create a real, significant and imminent likelihood of
						  harm to the child's health, well-being or welfare (i.e., domestic violence,
						  intimidation, or a child's participation in a criminal act) and the parent or
						  caretaker blatantly disregarded his/her parental responsibility by failing to
						  exercise reasonable precautionary measures to prevent or mitigate the imminent
						  risk of moderate to severe harm.
Circumstances
-
Examples of circumstances that may create real,
						  significant and imminent risk of moderate to severe harm include, but are not
						  limited to:
* exposure to toxic vapors resulting from flammable or
						  corrosive chemicals used in the manufacture of illicit drugs;
* the circumstances surrounding the death of one child
						  provides reason to believe that another child is at real, significant and
						  imminent risk of harm;
* exposing a child to an environment that significantly
						  affects the health and safety of the child, based on the sale or manufacture of
						  illegal drugs;
* a court has adjudicated a parent as unfit and the
						  parent has not completed services that would correct the conditions or behavior
						  leading to the court finding;
* situations that place a child at substantial risk of
						  harm due to the effects of being subjected to participation in or the
						  witnessing of the use of physical force or restraint of another.
Examples of circumstances that may, though not by
						  themselves, create a real, significant and imminent risk of moderate to severe
						  harm include, but are not limited to:
* Domestic Violence: The Illinois Domestic Violence Act
						  defines domestic violence as a crime in which
physical abuse,
						  harassment, intimidation of a dependent, interference with personal liberty or
						  willful deprivation
[
						  750 ILCS 60/103(1) and
						  (3) ] is perpetrated by one family or
						  household member against another.
Family or household members include
						  spouses, former spouses, parents, children, stepchildren and other persons
						  related by blood or by present or prior marriage, persons who share or formerly
						  shared a common dwelling, persons who have or allegedly have a child in common,
						  persons who shared or allegedly share a blood relationship through a child,
						  persons who have or have had a dating or engagement relationship, persons with
						  disabilities and their personal assistants and caregivers as defined
						  in
Section 12-4.4a of the Criminal Code of 2012 [
						  720
						  ILCS 5/12-4.4a ]. [ 720 ILCS 5/12-0.1]
* An incident of past or current domestic
						  violence may qualify for an allegation of environment injurious if the domestic
						  violence creates a real, significant and imminent risk of moderate to severe
						  harm to the child's health, physical well-being, or welfare, and the parent or
						  caregiver has failed to exercise reasonable precautionary measures to prevent
						  or mitigate the risk of harm to the child.
* Domestic violence is also referred to as
						  "intimate partner violence". The adult victim of domestic violence, who is the
						  non-offending parent or caregiver, is presumed to not be neglectful or to have
						  created an environment injurious to the child so long as he or she has
						  exercised precautionary measures to prevent or mitigate the real, significant
						  and imminent risk of moderate to severe harm to the child.
* Mental Health: A parent's or caregiver's mental
						  illness and behavior may qualify for an allegation of environment injurious if
						  an incident or behavior that is symptomatic of the mental illness creates a
						  real, significant and imminent risk of moderate to severe harm to the child's
						  health, physical well-being or welfare, and if the parent or caregiver has
						  failed to exercise reasonable precautionary measures to prevent or mitigate the
						  risk of harm to the child. To indicate an allegation based on this factor, the
						  Investigation Specialist must rule out dependency, as defined in the Juvenile
						  Court Act of 1987 [ 705 ILCS 405 ], as the presenting problem.
* Substance Abuse/Dependence: A parent's or caregiver's
						  substance abuse/dependence and behavior may qualify for an allegation of
						  environment injurious if an incident or behavior caused by the substance
						  abuse/dependence creates a real, significant and imminent risk of moderate to
						  severe harm to a child's health, physical well-being or welfare, and if the
						  parent or caregiver has failed to exercise reasonable precautionary measures to
						  prevent or mitigate the risk of harm to the child.
* Prior Harm to a Child: Prior harm to a child may
						  qualify for an allegation of environment injurious on behalf of another child
						  if the prior incidents of harm create a real, significant and imminent risk of
						  moderate to severe harm to the child's health, physical well-being or welfare
						  and if the parent or caregiver has failed to exercise reasonable precautionary
						  measures to prevent or mitigate the risk of harm to the child.
Factors To Be
						  Considered
Whether there is a real and significant danger to
						  justify taking a report is determined by the following factors. All factors
						  need not be present to justify taking the report. One factor alone may present
						  sufficient danger to justify taking the report. The list of factors does not
						  constitute child abuse or neglect in every instance. All factors must be given
						  consideration in order to identify potential aggravating or mitigating
						  circumstances.
* The child's age;
* The child's medical condition, behavioral, mental or
						  emotional problems, developmental disability or physical handicap, particularly
						  related to his or her ability to protect himself or herself;
* The severity of the occurrence;
* The frequency of the occurrence;
* The alleged perpetrator's physical, mental and
						  emotional abilities, particularly related to his or her ability to control his
						  or her actions;
* The dynamics of the relationship between the alleged
						  perpetrator and the child;
* The alleged perpetrator's access to the child;
* The previous history of indicated abuse or
						  neglect;
* The current stresses or crisis in the home;
* The presence of other supporting persons in the home;
						  or
* The precautionary measures exercised by a parent or
						  caregiver to protect the child from harm.
11/61
Cuts, Bruises, Welts, Abrasions
						  and Oral Injuries
Cut (Laceration)
A cut is an opening, incision or break in the skin made
						  by some external agent.
Bruise
A bruise is an injury that results in bleeding under
						  the skin, in which the skin is discolored but not broken. A bruise is also
						  referred to as a contusion.
Welt
A welt is an elevation on the skin produced by a lash,
						  blow, or allergic stimulus. The skin is not broken and the mark is
						  reversible.
Abrasion
An abrasion is the scraping away of the skin.
Oral Injuries
Oral injuries are injuries to the child's mouth,
						  including broken teeth.
Factors To Be
						  Considered
Not every cut, bruise, welt, abrasion, or oral injury
						  constitutes an allegation of harm. The following factors should be considered
						  when determining whether an injury that resulted in cuts, bruises, welts,
						  abrasions or oral injuries constitutes an allegation of abuse or
						  neglect:
* The child's age, mobility and developmental stage.
						  Bruises on children younger than 6 months are suspicious due to the limited
						  mobility often seen in children 0 to 6 months of age.
* The child's medical condition, behavioral, mental, or
						  emotional problems, developmental disability, or physical handicap,
						  particularly as they relate to the child's ability to seek help.
* A single incident or pattern or chronicity of similar
						  events.
* The severity/extent of the cuts, bruises, welts,
						  abrasions, or oral injuries (size, number, depth, extent of discoloration).
						  Some bruises may fade quickly, such as around a young child's mouth, but still
						  be considered serious if the type of bruise (e.g., fingerprint marks) suggest
						  intentionality.
* The location of the cuts, bruises, welts, abrasions,
						  or oral injuries. Accidental bruises are frequently seen over boney areas such
						  as knees, shins, the forehead, and other exposed bony surfaces. Bruises located
						  on padded areas such as the buttocks, cheeks, genitalia, or on relatively
						  protected areas like the ear lobes, neck or upper lip, or on soft areas such as
						  the stomach are highly suspicious.
* The pattern of the injury.
* Whether the injury was caused by an instrument used
						  on the child.
* Previous history of indicated abuse or neglect, or
						  history of previous injuries.
If the child has been treated by a physician,
						  verification of the injury and the likely cause, including the presence or
						  absence of any predisposing medical conditions that may have caused or
						  contributed to the injury, must come from the physician who treated the child.
						  Direct admission of the alleged perpetrator.
12/62
Human Bites
A human bite is a bruise, cut or indentation in the
						  skin caused by seizing, piercing, or cutting the skin with human teeth.
Previous history of indicated abuse or neglect or
						  history of previous injuries.
13/63
Sprains/Dislocations
Sprain
A sprain is a trauma to a joint that causes pain and
						  disability, depending upon the degree of injury to ligaments and/or surrounding
						  muscle tissue. In a severe sprain, ligaments and/or muscle tissue may be
						  completely torn. The signs are rapid swelling, heat and disability, often
						  discoloration and limitation of function.
Dislocation
A dislocation is the displacement of any part,
						  especially the temporary displacement of a bone from its normal position in a
						  joint. Types of dislocations include complicated, compound, closed and
						  complete.
* Complicated. A complicated dislocation is associated
						  with other major injuries.
* Compound. A compound dislocation is one in which the
						  joint is exposed to the external air.
* Closed. A closed dislocation is a simple
						  dislocation.
* Complete. A complete dislocation is a dislocation
						  that completely separates the surfaces of a joint.
The injury was inflicted or allowed to be inflicted
						  through other than accidental means or was a result of blatant disregard of
						  parental or caregiver responsibilities.
Verification of the injury and likely cause, including
						  the presence or absence of any predisposing medical condition that may have
						  caused or contributed to the injury, must come from a physician, preferably an
						  orthopedist or radiologist.
14
Tying/Close
						  Confinement
Tying/close confinement is the unreasonable restriction
						  of a child's mobility, actions, or physical functioning by tying the child to a
						  fixed (or heavy) object, tying limbs together or forcing the child to remain in
						  a closely confined area that restricts physical movement. Examples include, but
						  are not limited to:
* Locking a child in a closet or small room;
* Tying one or more limbs to a bed, chair, or other
						  object, except as authorized by a licensed physician;
* Tying a child's hand behind his or her back;
* Putting a child in a cage;
* Locking or blocking exits with the intention of
						  preventing the child's ability to escape in case of an emergency.
15/65
Substance Misuse
Option A
The consumption of a mood altering chemical capable of
						  intoxication to the extent that it harmfully affects the child's health,
						  behavior, motor coordination, judgment, or intellectual capability. Mood
						  altering chemicals include cannabis (marijuana), hallucinogens, stimulants
						  (including cocaine and methamphetamine), sedatives (including alcohol and
						  Valium), narcotics, or inhalants (abuse/neglect). Abuse occurs if the parent
						  provides the substance to the child. Neglect occurs if the parent allows the
						  use or fails to protect the child from consumption.
Option B
A diagnosis of fetal alcohol syndrome or drug
						  withdrawal at birth caused by the mother's addiction to drugs is included in
						  this definition and is considered child neglect (neglect).
Option C
Any amount of a controlled substance or a metabolite
						  thereof that is found in the blood, urine or meconium (newborn's first stool)
						  of a newborn infant. A controlled substance is defined in subsection (f) of
						  Section 102 of the Illinois Controlled Substances Act [
						  720 ILCS
						  570/102 ] (neglect). The presence of such substances
						  shall not be considered as child neglect if the presence is due to medical
						  treatment of the mother or infant.
NOTE: Methadone withdrawal or other withdrawal verified
						  as under the auspices of a drug treatment program is not included under drug
						  withdrawal at birth.
Examples
* Giving a minor (unless prescribed by a physician) any
						  amount of heroin, cocaine, morphine, peyote, LSD, PCP, pentazocine, or
						  methaqualone or encouraging, insisting, or permitting a minor's consumption of
						  the above substances.
* Giving any mood altering substance, including alcohol
						  or sedatives, unless prescribed by a physician, to an infant or toddler.
* Encouraging, insisting or permitting any minor to
						  become intoxicated by alcohol, drugs, or another mood altering substance even
						  if on an infrequent basis.
Parents supervising children permitted to drink a small
						  amount of alcohol as part of a religious or family celebration should not be
						  considered abusive/neglectful.
Factors To Be
						  Considered
* Age of the child;
* Frequency of substance misuse;
* Amount of substance consumption;
* Whether the substance is illegal for general
						  population use;
* Degree of behavioral dysfunction, or physical
						  impairment linked to substance misuse;
* The child's culture, particularly as it relates to
						  use of alcohol in religious ceremonies or on special occasions;
* Whether the parent or caregiver's attempts to control
						  an older child's substance misuse or to seek help for the child's substance
						  misuse were reasonable under the circumstances;
* Whether the parent or caregiver knew or should have
						  known of the child's substance misuse.
16
Torture
Torture means inflicting, or subjecting the child to,
						  intense physical and/or mental pain, suffering or agony that can be a one time
						  incident or is severe, repetitive, increased or prolonged. This definition
						  includes genital mutilation.
17/67
Mental and Emotional
						  Impairment
Mental and emotional impairment means injury to the
						  intellectual, emotional or psychological development of a child as evidenced by
						  observable and substantial impairment in the child's ability to function within
						  a normal range of performance and behavior, with due regard to his or her
						  culture.
Verification that a child has been mentally injured
						  must come from a medical doctor, psychiatrist, registered psychologist,
						  certified social worker, registered nurse or a therapist or counselor of a
						  community mental health agency or a licensed therapist in private
						  practice.
18
Sexually Transmitted
						  Diseases
A sexually transmitted disease is a disease that was
						  acquired originally as a result of sexual penetration or sexual conduct with an
						  individual who is afflicted with the disease. The diseases may include, but are
						  not limited to:
* Acquired Immune Deficiency Syndrome (AIDS)
* AIDS Related Complex (ARC)
* Chancroid
* Chlamydia Trachomatis
* Genital Herpes
* Genital Warts
* Gonorrhea
* Granuloma Inquinale
* HIV Infection
* Lymphogranuloma Venereum
* Neisseria Gonorrhea
* Proctitis
* Syphilis
* Trichomonas Vaginalis (Symptomatic)
Sexual penetration is defined in the Illinois Criminal
						  Sexual Assault Act as "any contact, however slight, between the sex organ or
						  anus of one person by an object, the sex organ, mouth or anus of another
						  person, or any intrusion, however slight, of any part of the body of one person
						  or any animal or object into the sex organ or anus of another person, including
						  but not limited to cunnilingus, fellatio or anal penetration."
Sexual conduct is defined in the Act as "any
						  intentional or knowing touching or fondling of the victim or the perpetrator,
						  either directly or through clothing of the sex organs, anus or breast of the
						  victim or the accused, or any part of the body of a child...for the purpose of
						  sexual gratification or arousal of the victim or the accused."
Verification of sexually transmitted diseases must come
						  from a medical source.
19
Sexual Penetration
Sexual penetration is any contact, however slight,
						  between the sex organ or anus of one person by an object, the sex organ, mouth
						  or anus of another person, or any intrusion, however slight, of any part of the
						  body of one person or any animal or object into the sex organ or anus of
						  another person. This includes acts commonly known as oral sex (cunnilingus,
						  fellatio), anal penetration, coition, coitus, and copulation.
In order to indicate this allegation, benign touching
						  for the purpose of rendering normal, routine and reasonable care must be ruled
						  out.
20
Sexual Exploitation
Sexual exploitation is the use of a child for sexual
						  arousal, gratification, advantage, or profit. This includes, but is not limited
						  to:
*
Indecent solicitation of a child/explicit verbal
						  enticement;
*
Child pornography;
*
Intentionally exposing a child to sexually explicit
						  material in any form;
* Exposing sexual organs to a child for the purpose of
						  sexual arousal or gratification;
* Forcing the child to watch sexual acts;
* Self-masturbation in the child's presence;
* Other behavior by an eligible perpetrator that, when
						  considered in the context of the circumstances, would lead a reasonable person
						  to conclude that sexual exploitation of a child has occurred.
NOTE: Sexual penetration and molestation are excluded
						  from this allegation. They are listed as separate allegations.
21
Sexual Molestation
Sexual molestation is sexual conduct with a child when
						  the contact, touching or interaction is used for arousal or gratification of
						  sexual needs or desires. Parts of the body, as used in the examples below,
						  refer to the parts of the body described in the definition of sexual conduct
						  found in the Illinois Criminal Sexual Assault Act [
						  720 ILCS 5/12-12 ] as
						  quoted above under Allegation 18, Sexually Transmitted Diseases. Examples
						  include, but are not limited to:
* Fondling;
* The alleged perpetrator inappropriately touching or
						  pinching parts of the child's body generally associated with sexual
						  activity;
* Encouraging, forcing, or permitting the child to
						  touch parts of the alleged perpetrator's body normally associated with sexual
						  activity.
22
Substantial Risk of Sexual
						  Injury
Substantial risk of sexual injury means that the
						  parent, caregiver, immediate family member, other person residing in the home,
						  or the parent's paramour has created a real and significant danger of sexual
						  abuse as explained in the following options.
Option A
An indicated, registered, or convicted sex perpetrator
						  has significant access to children, and the extent/quality of supervision
						  during contact is unknown or suspected to be deficient.
Option B
There are siblings or other children in the same
						  household as the alleged perpetrator of a current allegation of sexual abuse.
						  There is credible information/evidence of a current or previous incident of
						  child sexual abuse that did not meet Department eligibility requirements for a
						  report to be taken (e.g., an ineligible victim or the victim discloses after
						  attaining the age of 18) and the alleged perpetrator has current access to
						  children.
Option C
Persistent, highly sexualized behavior or knowledge in
						  a very young child (e.g., under the age of 5 chronologically or
						  developmentally) that is grossly age inappropriate, and there is reasonable
						  cause to believe that the most likely manner in which this behavior or
						  knowledge was learned is in having been sexually abused.
Reports of risk of sexual harm are not to be taken
						  solely on the inappropriate or suggestive behavior of the alleged offender or
						  because there is insufficient information for an allegation of specific sexual
						  abuse.
If, during the course of the investigation, a specific
						  allegation of harm is identified, the appropriate allegation must be added and
						  a determination made on all the allegations. If another allegation is
						  determined to be more appropriate, that allegation should be utilized and the
						  substantial risk of sexual injury allegation unfounded.
Option D
A member of the household is suspected of, or known to
						  possess or engage in, the making and/or distribution of child pornography and
						  has significant access to the children and the extent/quality of the
						  supervision is unknown or suspected to be deficient.
A member of the household has engaged in child
						  pornography activities outside and/or inside the residence and has significant
						  access to the child and the extent/quality of the supervision is unknown or
						  suspected to be deficient.
40/90
Human Trafficking of
						  Children
Federal law defines severe forms of trafficking of
						  persons as: sex trafficking in which a commercial sex act is induced by force,
						  fraud, or coercion, or in which the person induced to perform such act has not
						  attained 18 years of age; or the recruitment, harboring, transportation,
						  provision, or obtaining of a person for labor or services through the use of
						  force, fraud, or coercion for the purpose of subjection to involuntary
						  servitude, peonage, debt bondage or slavery. (
						  22
						  USC 7102(8) )
Incidents of
						  Maltreatment
* Coerced labor exploitation (abuse);
* Domestic servitude (abuse);
* Commercial sexual exploitation (i.e., prostitution)
						  (abuse);
* Anyone in the home exposes the child to an
						  environment that significantly influences the child's health and safety
						  (neglect).
Factors To Be
						  Considered
All factors need not be present to justify taking a
						  report. One factor alone may present sufficient danger to justify taking a
						  report.
* The child's age.
* The child's inability to attend school on a regular
						  basis due to actions of the perpetrator.
* A child who is a chronic runaway has been recruited,
						  enticed, harbored and transported for the purpose of forced labor and/or
						  commercial sexual exploitation.
* The child makes references to frequent travel to
						  other cities.
* The child makes reference to having a pimp.
* The child makes reference to being coerced into
						  performing illegal activities.
* The child exhibits bruises or other physical trauma,
						  withdrawn behavior, depression or fear.
* The child lacks control over his or her
						  identification documents.
* The child shows signs of exposure to drug
						  manufacturing.
Additional factors that may indicate sex-related
						  trafficking include the following:
* The child has a sudden change in attire, behavior or
						  material possessions (e.g., expensive items).
* The child makes references to sexual situations that
						  are beyond age-specific norms.
* The child has a "boyfriend/girlfriend" who is
						  noticeably older (10+ years).
* The child makes references to terminology of the
						  commercial sex industry that are beyond age-specific norms or engages in
						  promiscuous behavior and may be labeled "fast" by peers.
74
Inadequate
						  Supervision
Inadequate supervision occurs when a child is placed at
						  a real, significant and imminent risk of likely harm due to a parent's or
						  caregiver's blatant disregard of parental or caregiver responsibilities of care
						  and support, including supervision.
"Blatant disregard" means an incident where the
						  real, significant, and imminent risk of harm would be so obvious to a
						  reasonable parent or caretaker that it is unlikely that a reasonable parent or
						  caretaker would have exposed the child to the danger without exercising
						  precautionary measures to protect the child from harm.
[
						  325 ILCS
						  5/3 ]
Option A - Children Left Home Alone, Outside or in the
						  Community
This option may be used when a child has been placed at
						  a real, significant and imminent risk of likely harm by being left alone at
						  home, outside or in the community due to a parent's or caregiver's blatant
						  disregard of his or her duty of care.
Option B - Children Left in Vehicles
This option may be used when a child has been placed at
						  a real, significant and imminent risk of likely harm by being left alone inside
						  a vehicle due to a parent's or caregiver's blatant disregard of his or her duty
						  of care.
Option C - Children Left in the Care of an Inadequate
						  Caregiver
This option may be used when a child has been placed at
						  a real, significant and imminent risk of likely harm by being left in the care
						  of an individual whose age, impairment, lack of qualifications or insufficient
						  capabilities posed an obvious risk of likely harm to the child due to a
						  parent's or caretaker's blatant disregard of his or her duty of
						  care.
Option D - General Category
This option may be used when a child has been placed at
						  a real, significant and imminent risk of likely harm when the child is not
						  receiving proper care or support, including supervision due to a parent's or
						  caregiver's blatant disregard of his or her duty of care.
Factors to Be Considered
To determine if the child is placed at a real,
						  significant and imminent risk of likely harm due to a parent's or caregiver's
						  blatant disregard of parental or caregiver responsibilities, the following
						  factors should be considered. The list of factors does not constitute child
						  neglect in every instance and all factors need not be present when making a
						  final finding determination.
* Age of the child;
* Special needs of the child;
* Maturity level of the child;
* The duration of time and frequency of occurrence the
						  child was left without care and support, including supervision;
* The time of day or night the child was left without
						  care and support, including supervision;
* Weather conditions, including whether the child was
						  left in a location with adequate protection from the natural elements, such as
						  adequate heat, light or shelter;
* Condition or location of the place where the child
						  was left without care and support, including supervision;
* The location and accessibility of the parent or
						  guardian to the child;
* The physical distance the child was from the parent
						  or guardian at the time the child was without care and support, including
						  supervision;
* Whether the child was given a phone number of a
						  person or location to call in the event of an emergency and whether the child
						  was capable of making an emergency call;
* Whether the child's movement was restricted;
* The child's access to or ability to access provisions
						  necessary for his or her physical well-being, such as food, water, necessary
						  medication or medical treatments;
* The age and physical and mental capabilities of the
						  caregiver;
* The number and ages of the children left at the
						  location;
* Other factors that may endanger the health and safety
						  of the child;
* Other factors that demonstrate that the parent or
						  caregiver took other precautionary measures to prevent or mitigate the risk of
						  any harm to the child.
75
Abandonment/Desertion
Abandonment
Abandonment is parental/legal guardian conduct that
						  demonstrates the purpose of relinquishing all parental/legal rights and claims
						  to the child. Abandonment is also defined as any parental or caregiver conduct
						  that evinces a settled purpose to forego all parental/legal claims to the
						  child.
Desertion
Desertion is any conduct on the part of a parent or
						  legal guardian that indicates that the parent or legal guardian has no
						  intention, now or in the future, to maintain any degree of interest, concern or
						  responsibility for the child. Desertion includes leaving a child with no
						  apparent intention to return unless the child has been left in the care of a
						  relative.
Examples
* Leave a baby on a doorstep;
* Leave a baby in a garbage can;
* Leave a child with no apparent intention to
						  return;
* Leave a child with an appropriate caregiver without a
						  proper plan of care.
76
Inadequate Food
Inadequate food means that there is a lack of food
						  adequate to sustain normal functioning. It is not as severe as malnutrition or
						  failure to thrive, both of which require a medical diagnosis.
Examples
* The child frequently and repeatedly misses meals or
						  is frequently and repeatedly fed insufficient amounts of food;
* The child frequently and repeatedly asks neighbors
						  for food and other information substantiates that the child is not being
						  fed;
* The child is frequently and repeatedly fed
						  unwholesome foods when his or her age, developmental stage and physical
						  condition are considered.
Factors To Be
						  Considered
Child Factors
* The child's age;
* The child's developmental
						  stage;
* The child's physical condition,
						  particularly related to the need for a special diet;
* The child's mental abilities, particularly
						  related to his or her ability to obtain and prepare his or her own
						  food.
Incident Factors
* The frequency of the
						  occurrence;
* The duration of the
						  occurrence;
* The pattern or chronicity of
						  occurrence;
* Previous history of
						  occurrences;
* The availability of adequate
						  food.
Investigative decisions must never be influenced in any
						  way by the family's economic status. The fact that a family is poor should play
						  no part in the decision to indicate or unfound the report. In order to indicate
						  a report for this allegation, the investigator must determine that the
						  allegation is due to some reason other than financial circumstances
						  alone.
77
Inadequate Shelter
Inadequate shelter means there is a lack of shelter
						  that is safe and that protects the children from the elements.
Examples
* No housing or shelter;
* Condemned housing;
* Housing with exposed, frayed wiring;
* Housing with structural defects that endanger the
						  health or safety of a child;
* Housing with indoor temperatures consistently below
						  50°F;
* Housing with broken windows in sub-zero
						  weather;
* Housing that is an obvious fire hazard to a
						  reasonable person;
* Housing with an unsafe heat source that poses a fire
						  hazard or threat of asphyxiation.
Factors To Be
						  Considered
Child Factors
* The child's age;
* The child's developmental stage;
* The child's physical condition,
						  particularly when it may be aggravated by the inadequate shelter;
* The child's mental abilities, particularly
						  related to the child's ability to comprehend the dangers posed by the
						  inadequate shelter.
Shelter Factors
* Seriousness of the problem;
* Frequency of the problem;
* Duration of the problem;
* Pattern or chronicity of the
						  problem;
* Previous history of shelter-related
						  problems.
Investigative decisions must never be influenced in any
						  way by the family's economic status. The fact that a family is poor should play
						  no part in the decision to indicate or unfound the report. In order to indicate
						  a report for this allegation, the investigator must determine that the
						  allegation is due to some reason other than financial circumstances
						  alone.
78
Inadequate Clothing
Inadequate clothing means a lack of appropriate
						  clothing to protect the child from the elements.
Factors To Be
						  Considered
Child Factors
* The child's age;
* The child's developmental stage;
* The child's physical condition,
						  particularly related to conditions that may be aggravated by exposure to the
						  elements;
* The child's mental abilities, particularly
						  related to his or her ability to obtain appropriate clothing.
Incident Factors
* Frequency of the incident;
* Duration of the incident;
* Chronicity or pattern of similar
						  incidents;
* Weather conditions such as extreme heat or
						  extreme cold.
Investigative decisions must never be influenced in any
						  way by the family's economic status. The fact that a family is poor should play
						  no part in the decision to indicate or unfound the report. In order to indicate
						  a report for this allegation, the investigator must determine that the
						  allegation is due to some reason other than financial circumstances
						  alone.
79
Medical Neglect
Medical or Dental Treatment
Lack of medical or dental treatment for a health
						  problem or condition that, if untreated or not treated as prescribed, could
						  become severe enough to constitute serious or long-term harm to the child; lack
						  of follow-through on a reasonable prescribed medical or dental treatment plan
						  for a condition that could become serious enough to constitute serious or
						  long-term harm to the child if the treatment or treatment plan goes
						  unimplemented.
Treatment is the administration of a remedy to cure a
						  health condition.
Management is the practice of providing care of a
						  chronic medical condition.
Lack of medical or dental management for a health
						  problem or condition that, if unmanaged or not managed as prescribed, could
						  become severe enough to constitute serious or long-term harm to the
						  child.
Lack of proper or necessary health care recognized
						  under State law as necessary for the child's well-being.
Proper and necessary preventive health care to include
						  preventive health care, such as HIV and newborn screening tests that place
						  children at serious risk of illness due to lack of early detection and
						  treatment.
Health care professionals include physicians, nurse
						  practitioners, nurses, dentists, physical therapists, infant development
						  specialists and nutritionists.
Factors To Be
						  Considered
* The child's age, particularly as it relates to the
						  child's ability to obtain and implement a treatment/management plan;
* The child's developmental stage;
* The child's physical condition;
* The seriousness of the current health problem;
* The probable outcome if the current health problem is
						  not treated and the seriousness of that outcome;
* The generally accepted health benefits of the
						  prescribed treatment;
* The generally recognized side effects/harms
						  associated with the prescribed treatment;
* Whether the parent has been informed about the
						  availability of preventive health care services and how services can be
						  obtained.
It must be verified that the child has/had an untreated
						  health problem, or that a prescribed treatment plan was implemented. The
						  verification must come from a physician, registered nurse, dentist, or by a
						  direct admission from the alleged perpetrator. It must further be verified by a
						  physician, registered nurse or dentist that the problem or condition, if
						  untreated, could result in serious or long-term harm to the child.
81
Failure to Thrive
						  (Non-Organic)
Failure to thrive is a serious medical condition most
						  often seen in children under one year of age. The child's weight, height and
						  motor development fall significantly short of the average growth rates of
						  normal children (i.e., below the fifth percentile). In a small percentage of
						  these cases, there is an organic cause such as a serious kidney, heart or
						  intestinal disease, a genetic error of metabolism or brain damage. Usually in
						  non-organic failure to thrive cases there is a disturbed parent/child
						  relationship that manifests itself as physical and emotional neglect of the
						  child. Diseases that may prevent growth and psychosocial reasons that cause
						  growth failure are not mutually exclusive. They are often found together.
						  Non-organic failure to thrive requires a medical diagnosis before it may be
						  indicated.
Verification of failure to thrive must come from a
						  physician who has the relevant information to make a diagnosis.
Factors That Must Be
						  Present
* The infant or child's weight and head circumference
						  do not match standard growth charts. The person's weight falls lower than
						  3rd percentile (as outlined in standard growth
						  charts) or 20% below the ideal weight for his or her height.
* There is emotional deprivation as a result of
						  parental withdrawal, rejection or hostility.
* The physician has made a diagnosis of failure to
						  thrive after eliminating medical causes such as Down syndrome and Turner
						  syndrome or diseases involving major organs (e.g., heart, kidney,
						  intestinal).
82
Environmental
						  Neglect
The child's person, clothing, or living conditions are
						  unsanitary to the point that the child's health may be impaired. This may
						  include infestations of rodents, spiders, insects, snakes, etc., human or
						  animal feces, rotten or spoiled food or rotten or spoiled garbage that the
						  child can reach.
Factors To Be
						  Considered
Special attention should be paid to the child's
						  physical condition and the living conditions in the home in order to determine
						  whether the report constitutes an allegation of harm. In addition, the
						  following factors should be considered.
Child Factors
* The child's age (children aged 6 and under
						  are more likely to be harmed);
* The child's developmental stage;
* The child's physical condition;
* The child's mental abilities.
Incident Factors
* The severity of the conditions;
* The frequency of the conditions;
* The duration of the conditions;
* The chronicity or pattern of similar
						  conditions.
83
Malnutrition
						  (Non-Organic)
Malnutrition is the lack of necessary or proper food
						  substances in the body caused by inadequate food, lack of food, or insufficient
						  amounts of vitamin or minerals. This is also known as marasmus or kwashiorkor.
						  Non-organic malnutrition requires a medical diagnosis before it may be
						  indicated. There are various physical signs of malnutrition:
* A decrease in lean body mass or fat; very prominent
						  ribs; the child may often be referred to as skin and bones;
* Hair is often sparse, thin, dry, and is easily pulled
						  out or falls out spontaneously;
* The child is often pale and suffers from
						  anemia;
* Excessive perspiration, especially about the
						  head;
* The face appears lined and aged, often with a pinched
						  and sharp appearance;
* The skin has an old, wrinkled look with poor turgor
						  and typically skin folds hang loose on the inner thigh and buttock;
* The abdomen is often protuberant;
* There are abnormal pulses, blood pressure, stool
						  patterns, intercurrent infections, abnormal sleep patterns and a decreased
						  level of physical and mental activity.
Verification of malnutrition must come from a
						  physician.
84
Lock-Out
The parent or caregiver has denied the child access to
						  the home and has refused or failed to make provisions for another living
						  arrangement for the child.
85
Medical Neglect of Disabled
						  Infants
Medical neglect of a disabled infant is the withholding
						  of appropriate nutrition, hydration, medication or other medically indicated
						  treatment from a disabled infant with a life-threatening condition. Medically
						  indicated treatment includes medical care that is most likely to relieve or
						  correct all life-threatening conditions and evaluations or consultations
						  necessary to assure that sufficient information has been gathered to make
						  informed medical decisions. Nutrition, hydration and medication, as appropriate
						  for the infant's needs, are medically indicated for all disabled infants. Other
						  types of treatment are not medically indicated when:
* The infant is chronically and irreversibly
						  comatose;
* The provision of the treatment would be futile and
						  would merely prolong dying;
* The provision of the treatment would be virtually
						  futile and the treatment itself would be inhumane under the
						  circumstances.
In determining whether treatment will be medically
						  indicated, reasonable medical judgments, such as those made by a prudent
						  physician knowledgeable about the case and its treatment possibilities, will be
						  respected. However, opinions about the infant's future "quality of life" are
						  not to bear on whether a treatment is judged to be medically indicated.
Factors To Be
						  Considered
* The infant's physical condition;
* The seriousness of the current health problem;
* The probable medical outcome if the current health
						  problem is not treated and the seriousness of that outcome;
* The generally accepted medical benefits of the
						  prescribed treatment;
* The generally recognized side effects associated with
						  the prescribed treatment;
* The opinions of the Infant Care Review Committee
						  (ICRC), if the hospital has an ICRC;
* The judgment of the Perinatal Coordinator regarding
						  whether treatment is medically indicated and whether there is credible evidence
						  of medical neglect;
* The parent's knowledge and understanding of the
						  treatment and the probable medical outcome.
Verification that treatment was medically indicated
						  must come from a physician and may come from experts in the field of neonatal
						  pediatrics.
86
Neglect by Agency
Neglect by Agency means children or adult residents are
						  exposed to harm, risk of harm or a lack of other necessary care that includes,
						  but is not limited to:
* failure to provide adequate supervision;
* failure to provide food, clothing and shelter;
						  or
* subjecting a child or adult resident to an
						  environment that is injurious, as a result of the failure of an agency to
						  implement practices that ensure the health, physical well-being, or welfare of
						  the children or adult residents residing in the facility.
This neglect exists when there are conditions at the
						  agency, such as inadequate staffing, lack of management training or lack of
						  supervision of staff, that are to such an extent that staff culpability for
						  abuse or neglect is mitigated by systemic problems. This neglect also includes
						  instances in which an incident of abuse or neglect occurs against a child or
						  adult resident and the perpetrator of such harm cannot be identified.