Six Degrees of Prevention:
Easing Parent Fears of Child Protective Services
by Darice M. Good
Parents of a medically fragile child can often be caught in a “Catch 22” when it comes to their child’s medical treatment. If parents fail to seek accepted forms of medical treatment for their child, they may face accusation of medical neglect. If the parents desperately seek every possible medical treatment for their child, they may face accusations of medical abuse. Either route potentially brings Child Protective Services (CPS) to their doorstep and the threat of removing their child into state custody. Where is the line between medical neglect and medical abuse? And what can parents do to ease their concerns regarding CPS?
Understanding the CPS Investigation Process
CPS is a government agency that responds to reports of child abuse and neglect; any person can make such a report. Certain people, like teachers, members of law enforcement, and doctors are mandatory reporters and must make a report if child abuse and neglect are observed or face possible civil and/or criminal penalties. In most states, the person who makes the report of child abuse and neglect is kept confidential to ease fears of reprisal by the accused parents, family and friends. Most CPS investigators are social workers. CPS investigators are different than law enforcement officers investigating a report of child abuse or neglect. A CPS worker investigates for the sole purpose of determining whether the child is safe in the home. A law enforcement officer investigating a report of child abuse or neglect is investigating to determine whether the child is safe in the home and whether a crime has been committed.
Each state has specific policies for investigating an allegation of child abuse and/or neglect. However, most states investigate immediately if a child is in present danger. It investigates within 24 hours if a child is not in present danger, but will be in the foreseeable future. Lastly, it will investigate within five days if there are no present safety concerns. A CPS investigation must usually be completed within 30 days of the report.
A CPS investigation should include interviews, a home visit, and collateral contacts. Most investigators will interview the parents, family members, siblings and child, if they are of verbal age. Investigators will also interview any person recommended by the parents who has helpful information to the investigation. Collateral contacts include interviewing child care providers, teachers, doctors and reviewing documentation provided to the investigator.
Once an investigation is completed, the parents will receive notification of the outcome of the investigation, usually in the form of the letter that will state whether the report was substantiated or unsubstantiated. Each state has different outcome notices, but the language is similar. The letter will also state whether the family will receive any follow-up services.
A child can be removed from the home at any point in this process if he/she is deemed by CPS to be in immediate present danger. Most states require a court order to remove a child. Parents should request a copy of the court order of removal if their child is removed.
As parents of a medically fragile child, the information above can be frightening. However, with this understanding of how CPS operates and the Six Degrees of Prevention discussed below, parent concerns can be eased.
Six Degrees of Prevention
Parents are often overwhelmed, stressed, tired, frightened and a multitude of other emotions when caring for a medically fragile child. The Six Degrees of Prevention was created out of my experience in litigating medical child abuse cases. They can serve as guidelines to what CPS investigators and medical providers review when deciding whether or not state intervention into the family is required. In short, these are six areas parents need to be aware of at all times in caring for a medically fragile child.
1. Have a Team. A team can consist of you and your spouse, a family member, or friend. Attend as many doctor appointments as possible with your Team. Both Team members need to be active participants in medical appointments. The Team should discuss and make all medical decisions after consultation with doctors. Make doctors aware that all medical decisions were discussed and made by the Team.
2. Document Your Child’s Medical Care. Keep a log of doctor’s appointments, the date and time, what the appointment was for, the doctor, who attended, what was discussed with and recommended by the doctor, whether a medical decision needed to be made, the pros and cons of the medical decision, what decision was made after consultation with your team and all your child’s treating doctors, and when these discussions occurred.
Keep a log of all your child’s medical diagnoses. Document when the diagnosis was made, by whom, what tests were done to make the diagnosis, and what symptoms were considered in making the diagnosis. For each diagnosis, document what treatment was recommended, what medications were recommended, what treatment and medications were actually taken, and whether the diagnosis was resolved. Make sure to log each of your child’s medical providers, including name, specialty, telephone number, address and email.
3. Communication! Communicate with your Team at all times about all medical decisions. When communicating with medical providers, remember that they are the experts; let them be the professionals. For each medical procedure or treatment, ask whether it is medically necessary and, if so, why. Specifically request that the medical provider document in the child’s file why the treatment is medically necessary.
Also, request that the medical provider speak with all the other providers treating your child before a final decision is made about a treatment. A red flag is often raised by medical providers when the medical team members are not in communication with one another. If your medical providers are not communicating, include them all in a group email to state what treatment is being recommended by whom and invite them to direct any concerns to that provider.
If a medical provider is recommending a particularly invasive, risky and/or experimental treatment, seek a second opinion. To avoid being accused of “doctor shopping”, make sure that the medical provider who recommended the treatment is in communication with the doctor providing the second opinion.
4. Reporting of Symptoms. Be careful of how reports of the child’s symptoms and complaints are made to medical providers. If the child is of verbal age, allow the child to verbalize his/her symptoms and complaints to the medical provider. Coaching a child to reveal a symptom or complaint may make the medical provider suspicious that parents are seeking medical care for a symptom the child is not suffering. If the child is non-verbal, make sure to document the time, date of the symptom and others who may have witnessed the symptom. Do not exaggerate your child’s symptom or complain because you are worried it may not be treated. This could lead to a misdiagnosis and/or a CPS investigation.
5. Support System. Create and maintain a support system for the Team. Support systems include, but are not limited to family, friends, church members, and colleagues. Create a list of activities to alleviate stress and tension for the Team. Activities can be exercise, yoga, a weekend away, board games, a spa day, or a parent’s night out. Seek regular counseling or therapy for the Team. A counselor or a therapist can help the Team when it appears the Team may be concentrating too much on medical care to the exclusion of all else, which can be a sign of a parent who is medically abusing their child.
Be aware when a Team member needs a break. One or both of you are going to have weak and strong moments; rely upon the other team member to provide relief from the stress. Lastly, be wary of social media, websites for medically fragile children, and posting everything about your child’s medical progress or lack of progress on social media. In my experience, doing so can lead to parents believing their worst nightmare about their child’s medical state and can result in the parents seeking medically unnecessary treatments for their child.
6. A Degree of Normalcy. Remember each and every day, your child is a NORMAL CHILD, who happens to be sick. Do not let your fear of your child’s sickness limit what you do and do not allow your child to participate in unless it is against medical advice.
While caring for a medically fragile child, take time each month to check the Six Degrees of Prevention and whether or not you are abiding by them. Following them may not prevent CPS intervention, but it should make it less likely. If there is state intervention, they can also make it easier to explain your actions and, in worst-case scenario, defend an allegation of medical child abuse.
Darice M. Good is a Child Welfare Law Specialist and a Member of the Steering Committee of the ABA National Parents Representation Project. She represents children and parents in juvenile cases and teaches to child welfare advocates across the country.