Maltreatment Safety Risk Information                                                

1. Emotional Abuse
2. Emotional Neglect
3. Neglect of Medically Handicapped infant
4. Physical Abuse

5. Physical Neglect – Denial of Essential Services

   Food/nutrition

   Clothing/hygiene

   Shelter/utilities

   Medical care/behavioral

   Supervision

6. Abandonment
7. Sexual Abuse
8. Substance Abuse
9. Domestic Violence
10. Dependency
11. Exploitation

1.  EMOTIONAL ABUSE (CPS only)

Parent/caregiver demonstrates pattern of criticizing, rejecting, insulting, isolating, terrorizing or humiliating the child resulting in serious emotional/behavioral issues.  Child is perceived in extremely negative terms.

1. What do the parents/caregivers do that causes emotional or behavioral problems for the child?
2. What symptoms does the child have that would indicate psychological, emotional or social impairment?  How does the child react to what the parents/caregivers do?
3. Have there been any formal psychological or psychiatric evaluations of the child?
4. Is the child failing to thrive or developmentally delayed?
5. How do the parents/caregivers talk about the child?
6. How long has this been going on?
7. Are there any indications of cruel or unusual punishment?

2.  EMOTIONAL NEGLECT  (CPS only)

Parent/caregivers pattern of failure to seek emergency mental health services for children who have suicidal, homicidal or severe self harming behaviors.

Parent’s active, untreated and uncontrolled serious mental illness which prevents him/her from fulfilling parental responsibilities or when there is indication the parent may harm the child.  In situations where there are allegations of abuse/neglect or bizarre parental behaviors that are likely to result in harm to children, an APS intake will also be taken on the mentally ill adult.  

1. Describe the child’s suicidal attempts/gestures.  
2. Acts or statements about hurting him/herself in other ways?  
3. Acts or statements about hurting others?  
4. How do the parents/caregivers respond?  How have they tried to help the child?

3.  NEGLECT OF MEDICALLY HANDICAPPED INFANT (CPS only)

Does the child have a life-threatening condition?  What is it?

Are medical personnel recommending treatment that the parents do not want to provide?

What will happen if the child has or does not have the recommended treatment?  

4.  PHYSICAL ABUSE

Physical injury means damage to bodily tissue caused by non-therapeutic conduct, including, but not limited to, fractures, bruises, lacerations, internal injuries, or dislocations, and includes, but is not limited to, physical pain, illness, or impairment of physical function.

Neb. Rev. Stat. § 28-363 (For APS, Entered into the information system as Physical abuse)

Unreasonable Use of Confinement/Restraints will be added to physical abuse to include:

Physical abuse will also include the use of restraints without a physician’s order; the withholding or forcing a child/vulnerable adult to consume excess food/water/harmful substances; the parent/caregiver using confinement to a chair, bed, corner or similar environment for extended periods of time as the primary tool to modify behaviors of a vulnerable adult/child; or a parent/caregiver’s use of sadistic measures or weapons to modify behavior of a vulnerable adult or child.  

1. Tell me about the injury.  Describe the result of the action.
2. What are the signs of injury such as marks (burns, bruises, cuts) on the child/vulnerable adult/victim’s body, internal injuries, broken bones or sprains, marks that look like they were hit with an object or instrument, and whether any photos have been taken.
3. Any need for medical treatment such as medical treatment provided on site or elsewhere, a current need for medical treatment.  Describe the nature of the medical treatment, if known.  
4. Reporter’s belief of the perpetrator’s explanation of the injury and/or the alleged vulnerable adult/victim’s explanation of the injury?
5. Describe the child/vulnerable adult’s injury.  
6. Location, size, color.  When did the injury occur?
7. Does the injury need medical attention?
8. Who was present when the injury occurred?
9. What is the parent/caregiver’s explanation for the injury?
10. What is the child/vulnerable adult’s explanation for the injury?
11. Is the child/vulnerable adult afraid of the person who caused the injury?
12. Given the child/vulnerable adult’s age and/or physical condition, could what happened have caused serious injury?
13. Has the child/vulnerable adult been confined or restrained in any way?  How?
14. Does the caregiver withhold food or water, or make the child/vulnerable adult consume excessive water or harmful substances?
15. Is the parent or caregiver using sadistic methods of discipline?
16. Tell me about the relationship of the alleged victim with the alleged perpetrator.
17. Listen for and document any reason to believe that the alleged vulnerable adult/victim currently afraid of the alleged perpetrator, any history of domestic violence, and frequent use of the emergency room/hospital care.

5.  PHYSICAL NEGLECT  (CPS ONLY)  or  DENIAL OF ESSENTIAL SERVICES  (APS ONLY)

Essential services mean those services necessary to safeguard the person or property of a vulnerable adult. Such services include, but are not limited to, sufficient and appropriate food and clothing, temperate and sanitary shelter, treatment for physical needs, and proper supervision. Neb. Rev. Stat. § 28-357

Physical injury means damage to bodily tissue caused by nontherapeutic conduct, including, but not limited to, fractures, bruises, lacerations, internal injuries, or dislocations, and includes, but is not limited to, physical pain, illness, or impairment of physical function.  Neb. Rev. Stat. § 28-363

Denial of Essential Services may be perpetrated by a caregiver or other person against the alleged victim or the Denial of Essential Services may be self-inflicted and referred to as Self-Neglect.

Describe how the adult is being neglected and describe the result of the neglect.

Denial of or failure to provide food or essential nutrition.

Parent/caregiver/vulnerable adult withholds or does not provide essential food in adequate amount, at regular intervals and/or of sufficient nutritional value to sustain health which results in physical injury or imminent danger of suffering physical injury or death.  The result is severe physical harm to the child/vulnerable adult as evidenced by emaciation, malnutrition, dehydration, failure to thrive, weight loss.

1. What makes you think the child/vulnerable adult does not have adequate food?  

2. Has the child/vulnerable adult lost weight?  How much?

3. Has a doctor indicated concern about the child’s growth and development?

Denial of or failure to provide essential shelter and utilities.

Parent/caregiver/vulnerable adult failure to provide any shelter to the child/vulnerable adult or shelter is hazardous and jeopardizes physical safety for the child/vulnerable adult including but not limited to exposed wiring, inadequate heating, broken shards of glass, inadequate hearing, pest infestation, no source of water or hear, feces or rotting garbage.  

The living environment has caused an actual physical injury or creates an imminent danger of suffering physical injury or death.   Hoarding behavior that results in a health or safety hazard is included in this category.  Hoarding behavior includes an unmanageable number of animals/pets in the residence or the presence of an unmanageable amount of possessions that create a hazard (newspapers, garbage, clothing, etc.).  

1. Does the family have a home or place to live?
2. What about the family home do you think is dangerous?
3. How many pets does the person have?

Denial of or failure to provide essential clothing and hygiene.

Parent/caregiver/vulnerable adult chronically does not provide care for child/vulnerable adult’s need for physical hygiene.  A chronic lack of hygiene results in continual demonstration of serious physical and/or social/emotional impact as evidenced by severe diaper rash, ulcers, bedsores, tooth decay,  isolation from others, and/or humiliation, ridicule by peers.  Failure to provide essential clothing includes a lack of clothes and underclothes as needed for daily living and the weather conditions that has created a physical injury or places the child/vulnerable adult in imminent danger of suffering physical injury or death.  Another example is when the parent/caregiver does not provide items such as dentures, bedside commode, glasses when resources are available; resulting in weight loss or other injury

1. How long have you been concerned about the child’s/vulnerable adult’s hygiene?
2. What problems has the hygiene caused for the child/vulnerable adult?
3. Do the child’s/vulnerable adult’s peers comment about their hygiene?
4. Does the child/vulnerable adult have appropriate clothing for weather conditions?
5. How has the child/vulnerable adult been physically injured or harmed by the lack of hygiene?

Denial of or failure to provide essential medical care and/or behavioral health care.

Parent/caregiver/vulnerable adult failure to obtain, administer and supervise medication or failure to follow a prescribed treatment plan for the child/vulnerable adult.  The failure to provide or obtain medical treatment due to a religious belief is not included.  This category includes intentional, inappropriate, or excessive administering of drugs including prescription and non-prescription medication.  The failure to provide medical care and/or behavioral health care to the child/vulnerable adult creates a serious harm to a child/vulnerable adult. This may include a caregiver failure to seek timely and appropriate medical care for a serious health problem.

Medical Neglect:

Parent/caregiver’s pattern of refusing or failing to seek/obtain medical treatment or rehabilitative care for conditions that have potential life threatening or long term health effects, including failure to thrive.  This does not include failure to seek treatment for behavioral health issues.  (Examples include appropriate hydration, nutrition, medication, medical or dental care; speech or physical therapy.)

1. Does the child/vulnerable adult see a doctor when sick or hurt?
2. Is the parent/caretaker able to provide necessary medication?
3. Does the child/vulnerable adult need any special care, treatment, equipment?

Denial of or failure to provide proper supervision.

Failure on the part of a parent/caregiver or other person to provide supervision of a child/vulnerable adult to the extent that the child/vulnerable adult has been injured or is/was in imminent danger of physical injury or death.  Included in this category are allegations where a caregiver has been hospitalized or incarcerated and has not made arrangements for the care of the vulnerable adult.  Other examples include leaving vulnerable adult in a car during extreme temperatures and the vulnerable adult has no way to get out.  

1. Does the child/vulnerable adult have any special needs for supervision?
2. When is the child/vulnerable adult left alone?  For how long?    
3. Is the child responsible for supervising other children?  
4. Is there anything about the parent/caregiver’s behavior that prevents him/her from providing necessary supervision?
5. Due to the failure to provide proper supervision, how was the alleged victim injured or in imminent danger of injury or death?

6.  ABANDONMENT (CPS only)

1. Did the parent/caregiver indicate he/she does not intend to care for the child?
2. How long has the parent/caregiver been gone?
3. Were arrangements made for necessary care of the child/vulnerable adult, including medical?
4. Has the parent/caregiver contacted the person providing care?  How often? When was last contact? Do you know how to reach the parent/caregiver?
5. Does the person providing care have written consent to obtain medical care, etc?

7.  SEXUAL ABUSE

Sexual Abuse means any sexually oriented act, practice, contact, or interaction in which a vulnerable adult is or has been used without his/her knowledgeable consent for the sexual stimulation of the perpetrator, the adult, or another person. Examples of sexual abuse include, but are not limited to fondling, sexual intercourse, sexual stimulation, incest, and sexual exploitation. (See Neb. Rev. Stat. Sections 28-317 to 28-321 and 28-703.)  

Sexual abuse, defined. Sexual abuse shall include sexual assault as described in section 28-319 or 28-320 and incest as described in section 28-703.   Neb. Rev. Stat. § 28-367

Inappropriate sexual acting out of children/vulnerable adult’s not consistent with the age AND/OR development AND parents/caregivers are not providing intervention or supervision.  Sexual abuse and physical neglect allegations are both added as allegations on a report of sexual activity between children/vulnerable adults.

Sexual Exploitation:

Includes but it not limited to, any person causing, allowing, permitting, inflicting or encouraging a child/vulnerable adult to engage in voyeurism, exhibitionism, prostitution, or in the production of lewd, obscene, or pornographic photographs, films, or depiction of the child/vulnerable adult in same, when the child/adult is unable to understand or give consent as those acts as defined by state law.

1. Tell me what makes you have reason to believe the person was sexually abused.
2. Describe what you saw happen.  
3. Describe what you were told by the alleged victim.
4. What happened in the child/vulnerable adult’s own words?
5. Are any other children/vulnerable adults involved?
6. Where, when, who was responsible?  How old are they?  
7. Is the person responsible around other children/vulnerable adults?
8. Was the child/vulnerable adult injured?  Has he/she had a medical exam?
9. Is the child/vulnerable adult acting out in sexual ways?
10. Describe the signs of sexual abuse that you observed.
11. Is the child/vulnerable adult in contact with any known sex offenders?

12. Tell me about the relationship with alleged victim to alleged perpetrator

    Listen for and document information about the alleged perpetrator’s current access to the alleged vulnerable adult/victim and other vulnerable adults, any reason to believe that sexual abuse is occurring to any other children/vulnerable adults, any steps being taken to prevent further contact between the alleged perpetrator and the alleged vulnerable adult/victim, any expression of fear of certain individuals or situations from the vulnerable adult,

13. Is there any indication that the alleged perpetrator knew or did not know what they were doing?
14. Is there any indication that the alleged perpetrator is also a child/vulnerable adult?

15. Tell me about the impact on the alleged victim.

    Listen for and document information that suggests that a medical exam took place, a sudden change in her/his sexual behavior or knowledge, that a vulnerable adult/victim having difficulty walking or sitting, experiencing genital pain or itching,  engaging in compulsive masturbation and/or engaging in inappropriate sex play, or is acting out in a sexually aggressive manner?

16. Tell me the caregiver’s role in the incident?

    Listen for and document and reason to believe there was a lack of supervision that resulted in the sexual abuse.

8.  SUBSTANCE ABUSE

Is there reason to believe that substance abuse contributes to the maltreatment of the child/vulnerable adult?  

If yes, additional questions.

1. How does the parent’s use of substances harm the child?
2. What substances do the parents use?  How much? How often?
3. How does the substance use affect the parent?  How do you know the parent is using?  
4. Where is the child when substances are being used?  
5. How does the parent pay for the substances used?
6. Is the child able to access the substances?  Things like syringes?
7. Is the parent (or anyone else) growing or manufacturing drugs in the house?
8. Were any of the children exposed to substances prior to birth?
9. Was there a positive drug screen done at the hospital?  What substance?
10. How long has the parent/caregiver been using?  
11. Has he/she ever been to treatment?

9.  DOMESTIC VIOLENCE

Situations of Domestic Violence involving parents/adults/caregiver in the household with the child/vulnerable adult physically present when physical injury has occurred OR a child/vulnerable adult has intervened or a child/vulnerable adult has called someone for help (911) OR a child/vulnerable adult is fearful OR weapons are used.

Does Family violence or Domestic Violence play a role in the maltreatment of the child/vulnerable adult?

If yes, additional questions/areas to probe:

1. Has anyone in the household been injured during a disagreement between the adults?
2. Describe the injuries.
3. Have the police been called?  Was anyone arrested?  Anyone have protection order?
4. How does family violence impact the child/vulnerable adult?
5. How is the victim of the violence able to protect him/herself?  The children?  Other vulnerable persons?
6. How often does this happen?  Has there been a change in the frequency or intensity?
7. Does anything seem to trigger the violence?
8. Are weapons used or available in the household?
9. Are other forms of control used?  Isolation, control of finances, lack of phone or transportation?
10. What might be the best way to reach the non-offending parent/caregiver safely?

10.  DEPENDENCY (CPS only)

Is the parent unavailable or unable to care for the child due to mental illness, hospitalization, incarceration, or something similar?

Has the child’s other parent been contacted to provide care? If not, why not?

Have other relatives or neighbors been contacted to provide care?

11.  EXPLOITATION  (APS only)  

This means the taking of property of a vulnerable adult by means of undue influence, breach of a fiduciary relationship, deception, or extortion or by any unlawful means.  Neb. Rev. Stat. § 28-358

Fiduciary relationship means a legal relationship in which one person holds a position of trust with respect to another person.  

1. Describe what makes you think the adult is being financially exploited.

2. Describe the signs that adult is being exploited.

   Listen for and document things such as bills are not being paid and the adult has resources, unexplained charges/overpayment for goods or services, missing checks, unusual checks or missing money, unexplained decreases in bank accounts, missing jewelry, art, silverware,

3. Describe any changes in the alleged victim.

   Listen for and document items such as frequent or unexplained changes in power of attorney, wills or other legal documents, changes in the spending habits of the adult, or changes in level of activity of withdrawals from automated banking machines, or signed checks when the adult can’t write anymore.

(03-2010)

NFOAPW11