Code of Ethics for School Nursing

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

Child Protection

Introduction

Child abuse and neglect can have serious implications for both the victims and the families. The

goal is always to prevent maltreatment from occurring. School nurses are well-positioned to be

able to assess and identify children at risk for, or victims of, maltreatment.

In 2014, Wisconsin counties reported 42,300 children for suspected abuse or neglect to Child

Protective Services (CPS). In the last five years, the rate of referrals for CPS has increased six

and a half percent. Other 2014 Wisconsin findings include the following:

• Primary caregivers accounted for 88.9 percent of the substantiated maltreatment.

• Education personnel make the most child protection referrals (19 percent).

• Children under the age of three account for one-third of the victims of abuse or neglect.

• Thirteen children were maltreatment fatalities.

• Fifty-four percent of victims were girls and 46 percent were boys.

• Sixty-two percent of maltreated children suffered neglect; 16 percent were physically

abused; 21 percent were sexually abused; and less than one percent suffered emotional

damage for which their parents/guardians failed to obtain treatment.

This chapter will help school nurses to:

• report, as required by law, suspected cases that come to their attention;

• understand disclosure, documentation, reporting, investigation, and follow-up;

• understand the importance of developing relationships with community resources to

assist children and their families;

• increase and/or assess their knowledge of risk factors and symptoms of abuse and

neglect;

• know when, where, and to whom to report suspected incidents of abuse or neglect;

• understand the statutory requirement to report as well as exceptions to that mandate;

• develop and/or review, in cooperation with district administrators, student services

colleagues and other partners, existing school district child protection policies,

procedures, and reporting tools to assess compliance with local procedures and state laws.

This chapter will meet these goals by investigating the following topic areas:

• Legal Considerations

o Wisconsin Legal Definitions of Child Abuse

• Role of the School Nurse

o Signs and Symptoms of Abuse and Neglect

o Sexual Abuse

o School and Community Resources

• Special Considerations

o Children with Special Healthcare Needs

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

o Cultural and Ethnic Issues

• Disclosure

o Informal Disclosure

o Formal Disclosure

• Mandatory Reporting

o Exception to Mandatory Reporting

o School Reporting Policies

o Reports and Investigations

• Conclusion

• References

In May 2017, federal Public Law 114-22 went into effect requiring the investigation of alleged

child sex trafficking, regardless of the type of relationship between alleged victims of child sex

trafficking and alleged traffickers. As a result, 2015 Wisconsin Act 367 was enacted, which

aligns state statue with this federal legislation. Both federal and state law refers to “sex

trafficking.” “Human trafficking” is another term with a broader definition including forced

labor. These broader areas are not addressed in this chapter, but it behooves school nurses to

educate themselves in all areas of human trafficking so they are able to assess and identify

children at risk for, or victims of, all forms of maltreatment.

Legal Considerations

Wisconsin Legal Definitions of Child Abuse

The purpose of the Children’s Code, Wis. Stat. sec. 48, is to protect the health and welfare of

children by encouraging educators, parents, social service agencies, and others to effectively

prevent and/or report cases of abuse and neglect. It defines child abuse and neglect, and details

the responsibilities of officials in the CPS agency. School nurses should be familiar with the

following forms of abuse and neglect:

• Physical abuse is any physical injury inflicted on a child other than by accidental means.

Physical injury means, but is not limited to, lacerations, fractured bones, burns, internal

injuries, and severe or frequent bruising or great bodily harm (Wis. Stat. sec. 48.02(14g)

• Emotional damage is harm to a child’s psychological or intellectual functioning which is

exhibited by extreme anxiety, depression, withdrawal, outward aggressive behavior, or a

combination of these behaviors, for which the parent, legal guardian, or other legal

custodian has failed to obtain the necessary treatment to remedy. Emotional damage may

be demonstrated by observable changes in behavior, emotional response, or learning that

is incompatible with the child’s age or stage of development (Wis. Stat. sec. 48.02(5j)).

• Sexual abuse is inappropriate sexual behavior or conduct with a child and includes any

inappropriate sexual touching (Wis. Stat. sec. 48.02(1)(b), (c), (cm), (d), (e), (f)).

• Neglect is the failure, refusal, or inability by a parent, legal guardian, or caretaker, for

reasons other than poverty, to provide necessary care, food, clothing, medical or dental

care, or shelter, so as to seriously endanger the physical health of the child (Wis. Stat.

sec. 48.02(12g)).

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

• Trafficking of a Child means whoever knowingly recruits, entices, provides, obtains,

harbors, transports, patronizes, or solicits or knowingly attempts to recruit, entice,

provide, obtain, harbor, transport, patronize, or solicit any child for the purpose of

commercial sex acts, as defined in s. 940.302(1)(a), Wis. Stat. sec. 948.051(1).

Laws prohibiting sexual abuse against children can be found in a variety of different Wisconsin

statutes, all of which serve to better define the abuse or exploitation. School nurses need to be

knowledgeable regarding these terms as they relate to crimes against children in order to report

accurate information:

• Sexual intercourse means vulvar penetration as well as cunnilingus, fellatio, or anal

intercourse between persons or any other intrusion, however slight, of any part of a

person’s body or any object into the genitals or anal opening either by a person or upon

the person’s instruction. The emission of semen is not required (Wis. Stat. sec.

948.01(6)).

• Sexual exploitation of a child entails any person who is willing and with knowledge of

the content and character of the sexually-explicit conduct or material:

o Employs, uses, persuades, induces, entices, or coerces any child to engage in

sexually-explicit conduct for the purpose of recording or displaying in any way

the conduct.

o Records or displays in any way a child engaging in sexually explicit conduct

(Wis. Stat. sec. 948.05).

• Sexual contact means any of the following:

o Any type of intentional touching, whether direct or through clothing, if that

intentional touching is either for the purpose of sexually degrading or for the

purpose of sexually humiliating the victim or sexually arousing or gratifying the

perpetrator or if the touching contains the elements of actual or attempted battery

(Wis. Stat. sec. 948.01(5)).

o Intentional penile ejaculation of ejaculate or intentional emission of urine or

fecesby the perpetrator or upon instructions of the perpetrator by another person

upon any part of the body clothed or unclothed of the victim (Wis. Stat.

sec. 940.225(5)(b)).

Additionally, methamphetamine manufacture in a child’s home, on the premises of a child's

home, in a motor vehicle on the premises of a child’s home, or where a reasonable person should

have known that the manufacture would be seen, smelled, or heard by a child is considered child

abuse in Wisconsin, Wis. Stat. sec. 48.02(1)(g). This form of maltreatment should also be

reported.

The Role of the School Nurse

School nurses are involved in prevention, early identification, reporting, and treatment related to

child abuse and neglect. It is the role of the school nurse to recognize and report suspicion of

abuse; the role of CPS to investigate the suspicion. Because of their professional expertise, the

school nurse is uniquely equipped to not only prevent and identify victims of abuse, but to assist

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

students once identified to meet both their physical and emotional needs. Further roles of the

school nurse may include:

• identifying students with frequent somatic complaints which may be indicators of

maltreatment

• educating and supporting staff regarding the signs and symptoms of child maltreatment

• supporting victims of child maltreatment

• providing personal body safety education to students and advocate for school health

education polices that include personal body safety

• linking victims and families to community resources including a medical home

• collaborating with community organizations to raise awareness and reduce incidence.

Signs and Symptoms of Abuse and Neglect

Early identification of physical, emotional, sexual abuse, and neglect is crucial in promoting

recovery and preventing further victimization. School nurses should be trained in identifying

signs and symptoms of abuse and neglect. In order to effectively assess students, school nurses

must know the risk factors, signs, and symptoms of abuse and neglect; and familiarize

themselves with the cultural and ethnic norms of children and their families in the school

community.

Table 1

Typical Signs and Symptoms of Abuse and Neglect

Physical Abuse

Physical Signs and Symptoms of Physical Abuse

• Unexplained burns, bites, lacerations, bruises, broken bones, or black eyes

• Multiple physical injuries in various stages of healing

• Injuries that are shaped like objects, such as electrical cords, belt buckles, etc.

• Injuries on multiple body surfaces

• Circular burns on palms, soles, back, and buttocks

• Burns in the shapes of objects such as irons

• Multiple or spiral fractures

Behavioral Signs and Symptoms of Physical Abuse

• Shrinks or cowers at approach of adult

• Behavioral extremes such as severely aggressive or withdrawn

• Dramatic change in temperament

• Afraid to go home

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

Physical Abuser Characteristics

• Unconvincing, confusing, or no explanation for the child’s injuries

• Describes child as “evil” or in some other very negative way

• History of being a victim of abuse

Emotional Abuse

Physical Signs and Symptoms of Emotional Abuse

• Lag in physical development

• Failure to thrive

Behavioral Signs and Symptoms of Emotional Abuse

• Attempted suicide

• Habit disorders (sucking, biting, rocking)

• Sleep disorders, inhibition of play

• Fears: including compulsion, obsession, phobias, somatic complaints

Neglectful Parent or Guardian Characteristics

• Constantly blames, belittles, or berates the child

• Overtly rejects the child

• Unconcerned about child’s welfare

Neglect

Physical Signs and Symptoms of Neglect

• Constant hunger, poor hygiene, inadequate or inappropriate dress

• Consistent lack of supervision

• Body odor and/or matted hair

• Unmet health or physical problems

• Low body weight to height ratio or body mass index

Behavioral Indicators of Neglect

• Frequently late or truant from school

• Passive and withdrawn or disruptive and troublesome behavior

• Delinquency

• Alcohol and substance abuse

• Seeking adult attention

• Constantly fatigued, listlessness, or falling asleep in class

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

• Extended stays at school before and after school hours

Neglectful Caregivers Characteristics

• Alcohol or substance abuse

• Home is chaotic and unsanitary

• Depression, indifference, flat affect

• Indifference to child

Information adapted from the Child Welfare Information Gateway, “What is child abuse and neglect:

Recognizing the signs and symptoms.”

Botash, A.S. (n.d.). Child Abuse Evaluation & Treatment for Medical

Providers. Retrieved from: http://www.childabusemd.com ³

School nurses also play a critical role in the documentation of the physical, emotional, and social

indicators of abuse and neglect. Careful record keeping of the physical signs and statements by

the student and the family members can assist the child protection services and law enforcement

agencies in the investigation of child abuse and neglect allegations. Details in documentation

such as the size, color, location of marks, lesions, or distortion is important. Documentation of

sequence, date, and time of student visits, statements, and injuries can be very helpful for further

investigations.

Sexual Abuse

Sexual abuse is a unique form of violence against children which is seldom discussed and often

poorly understood. Inappropriate sexual contact may have lasting negative effects on children

and their development. Because of the strong feelings many people have regarding sexual abuse,

dealing with the problem in a compassionate and rational way can sometimes be difficult.

Sexual abuse in children is sometimes described as a hidden problem with reports only

representing a fraction of the true number of children abused. Tables 2 and 3 list many indicators

of sexual abuse in children and adolescents. For children and adolescents, there are sexual and

nonsexual indicators of sexual abuse. Although the sexual indicators render a greater likelihood

of sexual abuse than the nonsexual indicators, school nurses should be observant for all signs of

sexual abuse with students in their care. School nurses should also assess for the possibility of

sexually transmitted infections and pregnancy when sexual abuse is suspected.

Table 2

Typical Signs and Symptoms of Sexual Abuse for Children and Youth

Indicators in Children and Youth

Sexual Signs and Symptoms

• Precocious sexual knowledge

• Sexually explicit drawings

• Sexual interaction with others

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

• Sexual interactions involving animals or toys

• Masturbation to the point of injury and numerous times a day

• Inserting objects into genitals

Nonsexual Signs and Symptoms

• Sleep disturbance reports nightmares or bedwetting

• Enuresis and Encopresis

• Regressive behavior

• Psychosomatic complaints

• Self-destructive or risk-taking behavior

• Impulsivity, distractibility, difficulty concentrating

• Refusal to be left alone

• Fear of alleged offender

• Fear of people of a specific type or gender

• Fire-setting

• Cruelty to animals

• Role reversal in the family

Information adapted from the Child Welfare Information Gateway, “What is child abuse and neglect:

Recognizing the signs and symptoms.”

Botash, A.S. (n.d.). Child Abuse Evaluation & Treatment for Medical Providers. Retrieved from:

http://www.childabusemd.com ³

Table 3

Typical Signs and Symptoms of Sexual Abuse for Adolescents

Signs and Symptoms for Adolescents

Sexual Signs and Symptoms for Adolescents

• Sexual promiscuity/multiple sexual partners

• Peeping, exposing, or frottage (rubbing against others as a sexual gesture)

• Adolescent prostitution

• Violation of other’s body space, such as pulling down pants, pulling up shirt

Nonsexual Signs and Symptoms for Adolescents

• Eating disturbance (bulimia and anorexia)

• Difficulty walking or sitting

• Reports nightmares or bedwetting

• Suddenly refuses to change for gym or to participate in physical activities

• Running away

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

• Substance abuse

• Self-destructive behavior

o Suicidal gestures, attempts, and successes

o Self-mutilation

• Incorrigibility

• Criminal activity

• Depression

• Social withdrawal

Information adapted from the Child Welfare Information Gateway, “What is child abuse and neglect: Recognizing

the signs and symptoms.”

Botash, A.S. (n.d.). Child Abuse Evaluation & Treatment for Medical Providers. Retrieved from:

http://www.childabusemd.com ³

Sex Trafficking

Sex traffickers use force, fraud, or coercion to lure their victims and pressure them into

commercial sexual exploitation. They look for children who are susceptible for a variety of

reasons, including psychological or emotional vulnerability, economic hardship, or lack of a

social safety net. Along with the signs of sexual abuse, school nurses should learn to recognize

key indicators of sex trafficking that might be noted in the school setting (Table 4).

Table 4

Possible Indicators of Sex Trafficking

Signs and Symptoms

• Appears disconnected from family, friends, and extracurricular activities

• Poor school attendance or stops attending school

• Appears fearful, timid, or submissive particularly in the presence of certain individuals

• Shows signs of having been denied food, water, sleep, or medical care

• Displays “gifts” of jewelry, clothing, electronics, money, or other items without valid

explanations

• Seeming to adhere to scripted or rehearsed responses in social situations

• Tattoos/branding on the neck and/or lower back

• Seen entering or leaving vehicles with unknown adults

Information adapted from Homeland Security “Indicators of Human Trafficking.”

Hope For Justice “Spot the Signs.”

Self-inflicted injuries, such as cutting and threatened suicide attempts or gestures are not

considered abuse and reports for suspected abuse should not be made under Wis. Stat. sec. 48.

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

However, these behaviors are indicative of emotional damage. A report is warranted if the parent

has failed to obtain treatment.

School and Community Resources

School nurses are in a unique position to assist in the prevention of child maltreatment. Child

maltreatment is a complex problem with a multitude of causes.

Prevention requires recognizing

and responding to multiple needs. Lack of information regarding parenting, child development,

and knowing where and how to find support and resources in the community often contribute to

incidences of child abuse and neglect. School nurses have opportunities to share this type of

information with parents at health fairs, registrations, and school/community events.

School nurses gather information through health assessments and through conversations with

students, parents, administrators, teachers, and other student services providers. School nurses

can use their unique perspective to suggest curricular and systems-based changes that empower

students and create greater awareness.

A school nurse’s ability to identify and mobilize school and community resources can support

child abuse/neglect and child sex trafficking prevention efforts. School nurses should familiarize

themselves with community-based mental health, social services, and other resources that can

support both the student and family.

Special Considerations

School nurses and staff are encouraged to pursue additional resources to increase their awareness

and knowledge of risk factors, signs, and symptoms in special needs populations. Additionally,

school nurses must familiarize themselves with the cultural and ethnic norms of the children and

families in their school community.

Children with Special Healthcare Needs

Generally, many researchers believe the younger the child, the greater their vulnerability to

abuse and neglect. This holds true especially for children with physical and intellectual

disabilities. Their risk may be increased because they are more dependent on their caregivers

(often multiple caregivers) to meet their daily needs and because they may have difficulty

communicating. As a result, they may be perceived as “easier” victims because they may be seen

as less likely or able to report. Consequently, these victims are under-represented in the statistics.

According to studies, children with disabilities are at two to three times the risk of being sexually

abused than nondisabled peers.

Additionally, children with special needs may be at greater risk because the demands on parents

or caregivers to provide daily care for the child may cause greater stress for parents or

caregivers. If these families lack parenting or coping skills, the child’s increased needs may lead

to neglect or abuse. School nurses who care for, or supervise staff caring for children with

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

special health care needs, should be aware of the increased risk for these children. School nurses

can provide staff and families with information and connect them to available support services.

As a consultant to teachers working with special needs populations, the school nurse can locate

and provide resources that teach children with special needs how to protect themselves. Such

resources may include the “Skills Training for Assertiveness, Relationship Building, and Sexual

Awareness” (STARS) curriculum (Heighway & Webster) originally developed at the Waisman

Center in Madison.

Cultural and Ethnic Issues

Wisconsin schools have more ethnically-diverse populations than ever before. The vast cultural

differences in schools present a myriad of different traditions of discipline, child care, and

medical care. School nurses must practice cultural sensitivity in all aspects of care including

child abuse identification and reporting.

When considering the possibility of child abuse, the school nurse needs to consider the child-

rearing and discipline practices of the culture from which the child comes. For instance, the

Hmong, immigrants from Southeast Asia, are known for a practice called coining. In coining, the

body is rubbed with a coin to alleviate pain. The bruises this practice leaves on the body may

resemble the marks of child abuse.

Rather than assuming abuse, school nurses can help parents and ethnic leaders understand the

rights of children in America. A culturally sensitive school nurse can promote the safety of

children by providing the parents with information that could help modify cultural practices.

Disclosure

Two basic types of disclosure relate to reporting child abuse and neglect. The first is informal

disclosure, which is often done by the child. The second is formal disclosure, which occurs

between the adults in the school or with CPS addressing the allegations of abuse/neglect or sex

trafficking.

Informal Disclosure

A child’s description of an experience(s) is a type of informal disclosure; generally an informal

discussion or presentation of symptoms. In order to determine if a reporter needs to make a

referral to CPS, it is important to gather only the information necessary to determine a reasonable

suspicion of maltreatment. Going beyond that could potentially contaminate the investigation. It

is important to only ask open-ended questions that elicit, in the child’s own words, what has

happened, rather than ones which can be answered with a simple “yes” or “no.” Often students

will spontaneously reveal what happened to them, if a staff member when observing bruises or

marks, remains calm and inquires sensitively. It is also helpful to learn who may have observed

the incident.

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

School staff members who discover and disclose potential child neglect, abuse and/or sex

trafficking play a crucial role in supporting the child through any subsequent investigation. The

success of such efforts is more likely when staff members follow general guidelines (see Table

5).

A school nurse’s compassion and nonjudgmental messages are critical in providing support and

give the victim the acceptance necessary to disclose the abuse and/or neglect in their lives.

School nurses cannot promise the victimized child that they will not report the abuse (see section

on formal disclosure and mandatory reporting). School nurses can and should assure the child

that they will do everything they can to help.

Table 5

Guidelines for Disclosure

• Find a quiet place to talk to the child.

• Proximity to the child should be designed to make the child feel at ease. Younger

children may feel more comfortable with the adult seated next to them.

• Avoid sitting behind a table or desk.

• Go slowly, asking open-ended questions.

• Remain calm; do not express shock, anger, disbelief, disgust, dread, confusion, or other

extreme reactions to what the child reveals.

• Allow the child to tell you what he/she wants.

• Express belief that the child is telling the truth.

• Try to get the facts from the child’s point of view.

• Do not interrupt or correct the student.

• Use open-ended questions, which may include:

o What happened to you?

o Who did this to you?

o How did this happen?

o Where did this happen?

o When did this happen?

o Who saw this happen to you?

o Who have you told about this?

• Determine the child’s immediate safety needs.

• Validate the child’s self-disclosure.

• Report the incident to your immediate supervisor or other administrative designee.

• Report the incident to the local child protection or law enforcement agency.

• Let the child know what will happen when the report is made (if applicable).

• Do not promise the child that everything will be OK.

• Follow up with the child to provide support and update what is known.

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

Formal Disclosure

Formal disclosure involves the transfer of information regarding the suspected child abuse and

neglect among adults, either within the school or among child protection agencies and/or law

enforcement. Both federal and state laws protect the sharing of information related to child abuse

and neglect disclosure. The laws that govern the transfer of student information are governed by

the federal law, Family Educational Rights and Privacy Act (FERPA) 34 C.F.R. Part 99 and state

law Wis. Stat. sec. 118.125.

FERPA protects the privacy interests of parents and student’s “education records” by requiring a

written parental release of information for any disclosure of student records (20 USC sec.

1232g(b)(1); 34 CFR 99.30). Information may be shared with “appropriate parties” as defined by

FERPA, to protect the child’s health or safety in emergent situations. The school, when dealing

with a referral for suspected child neglect or abuse, must carefully apply this exception to meet

the needs of the student, and federal and state regulations.

In situations where the decision to share information is unclear, the child protection worker may

request the court to provide the school with an order for the disclosure of additional information.

Such an order relieves the school of the prohibition against sharing information and allows the

school to collaborate with the child protection agency.

Mandatory Reporting

Because children spend a large portion of their time in schools, school nurses and staff members

have the opportunity to observe first-hand the symptoms of possible abuse and neglect and to

become a part of the reporting process. Schools are currently the largest source of reports of

child abuse and neglect.

It is essential that school nurses and other staff members understand the requirements of

Wisconsin’s Children’s Code (Wis. Stat. sec. 48). All school personnel are required to report

child abuse and neglect when the facts and circumstances provide a suspicion of neglect or abuse

of a child or unborn child, or a belief that it will occur. School nurses may find the Wisconsin

Child Sex Trafficking and Exploitation Indicator Response Guide ¹² a helpful resource in

reporting suspected child sex trafficking. In all these circumstances, the school nurse may want

to consult with other knowledgeable school personnel including psychologists, counselors, social

workers, and administrators. School nurses may need to assess areas of a student’s body in the

course of treating a student’s complaints of injuries. Nurses should carefully document size,

location, and color of all lesions, lacerations, or discolorations and their locations. Strip searches

of students are prohibited by state law (Wis. Stat. sec. 118.32). School nurses in the course of

assessing and treating an injury may request a student to move part of their clothing (i.e. lift up

their shirt).³

The law requires that school personnel employed by the school district report suspected abuse,

neglect, and sex trafficking to the county child protective agency or sheriff’s department for

assessment. The Guidelines for Disclosure described in Table 5, recommends steps school staff

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

members should take when they learn of a suspected incident of abuse or neglect which falls

under the statutory mandate for reporting. The Children’s Code (Wis. Stat. sec. 48) refers to such

people as “mandated reporters” and states that they, having seen a child during the normal course

of professional duties and having a reasonable suspicion that abuse and neglect may have

occurred or a reasonable belief that abuse or neglect will occur, must report such an incident.

Failure to do so can result in a fine or imprisonment for not more than six months, or both. It is

important to note that a mandated reporter should not complete an assessment to substantiate

whether an actual case of abuse or neglect exists. The responsibility for such investigation and

determination rests with the child protection agency. However, the mandated reporter will need

to gather information to support any reasonable suspicion.

School nurses and other school staff members play an important role in reporting abuse and

neglect of children in Wisconsin. Annually, the Department of Children and Families prepares a

report for the governor and legislature regarding child maltreatment in Wisconsin. These reports

provide information regarding specific types of maltreatment, age of victims, relationship of

perpetrators to the victims, and mandated reporter statistics.

Exception to Mandatory Reporting

Section 48.981(2)(m) of the Wisconsin Statutes provides an exception to reporting incidents of

sexual contact or intercourse with a child. The exception exists to allow children to obtain

confidential health care services from a healthcare provider. It is important for school nurses to

note that an exception to mandatory reporting exists for nurses providing health care services.

Those services are defined as:

• family planning services,

• pregnancy testing,

• obstetrical health care, and

• screening, diagnosis, and treatment of sexually transmitted diseases.

The only professional working in a school who meets the statutory definition of a healthcare

provider under this statute is the school nurse.

In essence, the exception notes that such providers are not required to report sexual intercourse

or sexual contact involving a child unless:

• the sexual intercourse or sexual contact that occurred or is likely to occur is with a

relative of the child, the child’s guardian or legal custodian, or a person who provides

care or supervision of the child;

• the child—because of age, maturity, mental illness, or mental deficiency—is incapable of

understanding the nature/consequences of sexual intercourse or contact;

• the child was unconscious at the time;

• the other participant was exploiting the child at the time; and/or

• reasonable doubt exists as to the voluntary nature of the child’s participation in the sexual

intercourse or sexual contact.

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

Additionally, a reporting exception exists for school personnel who obtain information about a

child who is receiving or has received health care services from a healthcare provider (Wis. Stat.

sec. 48.981(2m)(c)(1)).

By the very nature of any one of these services, a school nurse may learn of a child having sexual

intercourse or of sexual contact between two children under the age of 16. Should such a

discovery be made, the school nurse is not required to report these incidents as suspected or

threatened abuse unless there is reason to believe one of the exceptions above applies. The law

presumes harm to a child exists when there is sexual contact with a caregiver or exploitation of a

child in any way (including exploitation of one who has a disability, unconscious, or suffering

from mental illness). If there is any question as to whether a child was a willing participant in

such an incident, it should be reported (Wis. Stat. sec. 48.981(2m)(c)(4)). For further

information, see “Reporting Requirements for Sexually Active Adolescents: Suggested

Procedures for Educators,” Wisconsin Department of Public Instruction.

School Reporting Policies

Schools may have specific abuse and neglect reporting policies or procedures that school nurses

and staff members must follow. If guidelines do not exist or seem vague, mandated reporters

should inform administrators of the state’s mandatory reporting statutes. The person with the

most first-hand knowledge of the circumstances raising suspicion should make the report to CPS.

Reports of suspected abuse and neglect need to remain confidential. While they do not become a

part of the child’s school records, they may be kept within the school or district in a separate file

in order to keep any identifying information about the reporter confidential, as required by law.

The state presumes that anyone making a report does so in good faith, thus exempting the

mandated reporter from liability as a result of a report. Because of the sensitive and confidential

nature of such allegations and reports, school districts should consider relevant statutes in

answering the following questions:

• What records should be kept?

• Where should such records be kept?

• How long should such records be kept?

• Who will be responsible for such records?

School nurses who may document their observations or treatment of a student suspected to be a

victim of abuse are cautioned to avoid verbiage that suggests blame or accusations. Such

“charting” by a school nurse becomes part of the student’s (confidential) patient healthcare

record. This school record is governed by FERPA regulations. Best practice suggests concise

factual documentation of direct observations.

Reports and Investigations

As soon as the mandated reporter has a reasonable suspicion of the possibility of neglect or

abuse, reports are to be made to the CPS agency or to the local law enforcement agency. Such

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

documentation of alleged abuse or neglect may be used in follow-up contact and for future court

testimony. The report should include the

• reporter’s phone number, position, relationship to the child, and the school or agency

phone number;

• child’s name, address, and date of birth;

• child’s parents’ names, address(es), and work places;

• names and ages of the child’s siblings;

• description of suspected child abuse and neglect;

• documentation including a precise description (size, color, shape, location, and number)

of any injuries;

• suspected abuser;

• child’s statements;

• statements allegedly made by the child to others; and

• related circumstances and conditions in the home of which the reporter is aware.

Be prepared to offer this information to the CPS agency:

• Does the suspected perpetrator have access to the student?

• Do you have any concerns for the student’s immediate safety?

• Does anyone else know about the suspected abuse or neglect?

The CPS agency investigates and establishes whether sufficient evidence exists to substantiate

the report. In so doing, the CPS agency is required to follow the comprehensive standards

established by the Wisconsin Department of Children and Families.

Conclusion

Protecting children is inherent in the practice of school nursing. School nurses can help protect

children and prevent child abuse and neglect by providing parents with health resources,

information, and interventions to ease family stress.

Nursing assessment skills provide early recognition of students at risk of being victims of child

maltreatment. School nurses and personnel need to be cognizant of the mandatory reporting

requirements.

Working with child maltreatment and issues of child abuse and neglect can be emotionally

difficult. In addition to knowing the school nurse’s professional responsibilities of identification

and reporting, school nurses are encouraged to be cognizant of their and their colleagues’

personal needs. Providing services to students and families may create issues for school

personnel. School nurses can and should refer colleagues or themselves for appropriate services

so they may remain effective.

Wisconsin School Nursing Handbook

Chapter 5

Department of Public Instruction

Student Services/Prevention and Wellness Team

School nurses are important partners in preventing, identifying, and responding to child

maltreatment, abuse and neglect. Though challenging, the efforts and interventions of school

nurses and other school personnel can have a profound effect on the life of a child.

References

1. Wisconsin Department of Children and Families. 2014. “Wisconsin Child Abuse and

Neglect Report.”

2. Child Welfare Information Gateway. (2013). What is child abuse and neglect?

Recognizing the signs and symptoms. Washington, DC: U.S. Department of Health and

Human Services, Children’s Bureau.

3. Botash, A.S. (n.d.). Child Abuse Evaluation & Treatment for Medical Providers.

Retrieved from: http://www.childabusemd.com/

4. Wisconsin Department of Public Instruction. (2013). The School's Role in Preventing

Child Abuse and Neglect

5. Kvam, Marit. August 2008. “Is sexual abuse of children with disabilities disclosed?”

Child Abuse and Neglect. 24:8.

6. Heighway, S., & Webster, S.K. 2007. STARS: Skills Training for Assertiveness,

Relationship-Building and Sexual Awareness. Future Horizons

7. National Association of School Nurses (2014). Care of Victims of Child Maltreatment:

The School Nurse’s Role. (Position Statement). Silver Spring, MD: Author.

8. Prevent Child Abuse America (n. d.). Prevention Programs: an approach to prevent

child abuse. Retrieved from http://preventchildabuse.org/resource/an-approach-to-

prevent-child-abuse/

9. Dobrin, L. & Rosenzweig, J. (May 2005). The Role of School Nurses in Recognizing,

Reporting, and Preventing Child Abuse. School Nurse News. Retrieved from:

http://www.schoolnursenews.org/BackIssues/2005/0505/OralHealth0505.pdf

10. Department of Homeland Security, Blue Campaign. Indicators of Human Trafficking.

Retrieved from: https://www.dhs.gov/blue-campaign/indicators-human-trafficking

11. Hope for Justice “Spot the Signs.” Retrieved from: http://hopeforjustice.org/spot-the-

signs/#

12. Wisconsin Department of Children and Families. Wisconsin Child Sex Trafficking and

Exploitation Indicator Response. Retrieved from:

https://dcf.wisconsin.gov/files/aht/pdf/indicatorguide.pdf