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Pediatrics 2 Flashcards

1
Q

____ in the early 1900s was the first person to closely observe infants and establish developmental norms

A

Gesell

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2
Q

By mid-century, theories that stressed the importance of nurture began to prevail by ___, ___, and ___

A

Pavlov
Watson
Skinner

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3
Q

Prior to the 1900s, most people thought infants were a _____

A

blank tablet

because they coudln’t tell us what they’re thinking, we assumed they were devoid of intelligence

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4
Q

____ was the first to describe the infant as having intelligence (in the second half of the century)

A

Piaget

he said that children actually have the ability to learn, they actively explore the environment and learn how the world works this way

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5
Q

Infant development occurs in an ___ and ___ manner

A

orderly

predictable

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6
Q

infant development occurs from ____ to ____ and ____ to _____

A

cephalic to caudal

proximal to distal

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7
Q

responses to stimuli proceed from general reflexes involving ____ to discreet voluntary actions under _____

A

entire body

cortical control

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8
Q

Why is development important? early development lays the foundation for ___ and ___

A

learning ability

mental health

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9
Q

early language skill predicts

A

later language complexity

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10
Q

growing evidence suggests that early signs of autism can be identified ___.

A

before the first birthday

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11
Q

early temperament predicts

A

later disruptive behavior disorders

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12
Q

> _____% of adults with mental health disorders had Sx in early childhood

A

50%

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13
Q

MC concern presented to PCPs:

A

developmental and/or mental health concerns

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14
Q

formal developmental screening is now recommended by the AAP at ___, ____, and ____ month well child visits and developmental surveillance at the other visits

A

9, 18, 24-30

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15
Q

What major problems should we be looking for in time of development? (9)

A 
cerebral palsy
speech/language impairment
hearing impairment
visual impairment
ADHD
intellectual disability
autism
learning disabilities
social-emotional or behavioral disorders
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16
Q

why is screening important?

A

Early intervention has proven success

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17
Q

4 early intervention options

A
  • early child hood intervention (ECI) at 0-3 years old.. most important.. includes PT, OT, speech therapy, etc
  • head start program at 2-5 years old
  • preschool programs for children with disabilities at age 3-5 years
  • special education programs through the local school district at age 5-21 years old
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18
Q

when screening development, look for at the 5 major areas of development:

A
  1. physical growth
  2. gross motor
  3. visual perception and fine motor skills
  4. language
  5. social-emotional
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19
Q 
normal weight patterns: birthweight is...
regained by \_\_\_\_
doubled by \_\_\_\_
tripled by \_\_\_\_
quadrupled by \_\_\_\_
A

2 weeks
5 months
12 months
24 months

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20
Q

head growth is measured by ___

A

FOC

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21
Q

head growth during the first 5-6 months is due to ____.

A

neuronal cell division

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22
Q

later head growth is due to ____ and _____.

A

neuronal cell growth

support tissue proliferation

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23
Q

head is approximately adult-sized by how old?

A

5 years

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24
Q

4 physical growth RED FLAGS

A
  • short stature or poor weight gain
  • small head or microcephaly (almost always reflects cerebral pathology with cognitive implications)
  • large head or macrocephaly (50% is familial and benign, but WATCH OUT FOR HYDROCEPHALUS)
  • dysmorphisms: minor variations or abnormalities on PE
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25
Q

> ___ dysmorphisms is highly associated with genetic syndromes

A

3

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26
Q

most dysmorphisms are ____.

A

non-consequential and normal

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27
Q

gross motor skills proceed from a sequence of ____ to _____ and then through a _____ sequence

A

prone milestones
sitting
standing/ambulating

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28
Q

gross motor skills must always be considered in context of a ______

A

neurological exam

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29
Q

It’s important to look at ____ and ____ in addition to a regular neurological exam

A

postural reactions

primitive reflexes

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30
Q

What’s the tonic labyrinthine reflex?

A

when you flex the head and neck&raquo_space; UE go into flexion too

when you extend the head and neck&raquo_space; UE go into extension too

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31
Q

What’s the asymmetrical tonic neck reflex?

A

when you turn the head to the side, that side goes into extension and the other side flexes

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32
Q

What’s the positive support reflex?

A

put a little pressure on their feet and they’ll push against the ground

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33
Q

Name 3 primitive reflexes. These go away at what age?

A
  • tonic labyrinthine reflex
  • asymmetrical tonic neck reflex
  • positive support

4-6 months

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34
Q

what are 2 postural reactions?

A
  • parachute response

- righting postural reflex (put arm out if get off balance when sitting)

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35
Q

5 gross motor RED FLAGS

A
  • persistent fisting beyond 3 months
  • spontaneous postures (frog-legging is low tone, scissoring is high tone)
  • delays in postural reactions
  • abnormal movement patterns
  • hand dominance prior to 18 months
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36
Q

What are some abnormal movement patterns that would be a red flag for gross motor development (5)

A
  • persistent head lag/floppy baby
  • pulling directly to a stand at 4 months (hypertonicity)
  • W-sitting (low tone)
  • walking without ever crawling
  • persistent toe walking (hypertonicity)
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37
Q

what happens as balance improves in the sitting position and as the infant begins to walk?

A

the hands become more available for manipulation of objects

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38
Q

In the first year of life, fine motor development is highlighted by what?

A

the evolution of the pincer grasp and learning to grasp and explore objects

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39
Q

In the second year of life, fine motor development is highlighted by what?

A

the hands using objects as tools

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40
Q

visual perception and fine motor skills in the first year of life allow the infant to _____ through _____.

A

problem solve

sensory-motor play

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41
Q

What are the three elements of “learning to manipulate”?

A
  • visual inspection
  • reaching, grasping, mouthing
  • refinement of the pincer grasp for closer inspection
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42
Q

When does object permanence occur?

A

9 months

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43
Q

Visual perception and fine motor skills in the first year is described as:

in the second year it is described as:

A

learning to manipulate

manipulating to learn

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44
Q

what are the two elements of “manipulating to learn”?

A
  • recognition of objects and their use through imitative and symbolic play
  • matching and categorizing objects
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45
Q

5 visual perception and fine motor RED FLAGS

A
  • failure to alert to environmental stimuli may indicate sensory impairment
  • failure to reach for objects may indicate motor, visual, or cognitive deficit
  • persistent mouthing past ~12 months
  • lack of imitation by 16 months (AUTISM!)
  • absent symbolic play by 24 months (AUTISM!)
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46
Q

MC type of delay in development

A

language

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47
Q

what is the best indicator of future intelligence?

A

language

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48
Q

____ is the most difficult to screen in the office and relies heavily on history

A

language

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49
Q

what are the 2 domains of language?

A

expressive: Broca’s
receptive: Wernicke’s

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50
Q

what are the 3 periods of language development during infancy?

A
  1. prespeech period (0-10 months)
  2. naming period (10-18 months)
  3. word combination period (18-24 months)
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51
Q

What 3 things occur in the pre-speech period (0-10 months)??

A
  • sound localization
  • cooing
  • babbling
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52
Q

What 5 things occur in the naming period (10-18 months)?

A
  • the infant realizes that people and objects have labels
  • word counts are important to measure expressive language
  • receptive language reflected in understanding simple commands
  • pointing (protoimperitive and protodeclarative)
  • jargoning
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53
Q

protoimperitive vs protodeclarative pointing

A

protoimperitive= help getting what I want (12 months)

protodeclarative= joint attention (15 months)

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54
Q

T/F: autistic kids don’t use many gestures

A

true

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55
Q

What 4 things occur in the word combination period (18-24 months)?

A
  • kids typically begin to combine words 6-8 months after they say their first word
  • giant words: “let’s go” “gimme” “thank you” “stop it” (18-21 months)
  • holophrases.. Ex: point to keys and say “mama” to communicate that those are mom’s keys (18-21 months)
  • word combinations, need an expressive vocab of at least 50 words at 24 months
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56
Q

5 language development RED FLAGS

A
  • inability to localize sound by 4-6 months
  • absent babbling or consonant production by 6-8 months
  • lack of pointing by 12-18 months (AUTISM!)
  • low word counts at 18-24 months
  • advanced, non-communicative speech (AUTISM!)
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57
Q

4 parent-completed tests for cognitive, language, motor development:

A
  • Ages and stages questionaire (ASQ-3)
  • Parent’s evaluation of developmental status (PEDS)
  • Child development inventory (CDI)
  • Survey of wellbeing of young children (SWYC)
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58
Q

2 parent- completed tests for social-emotional behavior:

A
  • Ages and stages questionnaire (ASQ-SE)

- Pediatric symptom checklist (PSC)

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59
Q

A parent-completed tests for autism:

A

Modified checklist for autism in toddlers (M-CHAT)

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60
Q

What are the AAP recommendations for M-CHAT?

A

do at the 15-18 month visit and the 24-30 month visit

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61
Q

6 clinician-administered screening/eval test for cognitive and language development

A
  • Denver developmental screening test (DDST-2)
  • Battelle developmental inventory screening tool
  • Gesell
  • Bayley infant developmental screen (BINS)
  • Cognitive adaptive test (CAT)
  • Clinical linguistic auditory milestone scale (CLAMS)
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62
Q

T/F: we should watch for red flags of development and make referrals early rather than employ “watchful waiting”

A

true

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63
Q

the 3 types of abuse are:

A 
neglect (70%)
physical abuse (20%)
sexual abuse (10%)
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64
Q

what age group has the highest rate of victimization?

A

<1 year

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65
Q

most fatalities of abuse happen to what age group?

A

< 3 years

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66
Q

what percentage of abuse cases are due to parents?

A

80%

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67
Q

how many children die per year from maltreatment/

A

1,720

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68
Q

ethical consideration:

parents have an ethical and legal responsibility to…

A

protect the life and health of their kids

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69
Q

ethical consideration:

the legal responsibility is spelled out in the…

A

legal codes of states

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70
Q

ethical consideration:
when there is variance between parental action and stated legal responsibility to protect their minor children, the state is empowered to…

A

take action to restore health and safety to the child

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71
Q

ethical consideration:

al healthcare personnel have moral and legal professional responsibilities and expectations to…

A

protect the well being of their patients

this is stated in professional codes of ethics and in licensing regulations put forth by licensing and credentialing bodies as a condition of practice

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72
Q

ethical consideration:

it is ethically and legally the responsibility of professionals to…

A

protect their patients

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73
Q

ethical consideration:

pediatric PC provides a unique opportunity to…

A

tackle child abuse and neglect

74
Q

ethical consideration: pediatricians, at their core, are essentially ____ for children

A

advocates

75
Q

ethical consideration:

many practitioners identify a concern about what may happen to children after a CPS report is made as a reason for…

A

choosing not to report suspected maltreatment

76
Q

ethical consideration:
AAP states, “HIPAA permits disclosure of information without legal guardian authorization in matters that affect ____ and ____ the child and intervention and investigation of matters that relate to abuse or neglect, public health, and safety.”

A

treatment of and medical intervention for

77
Q

according to the law: professionals have ___ hours to make a report

A

48

78
Q

according to the law:

reports about child abuse are confidential or not?

A

confidential

79
Q

according to the law:

reporting child abuse does or does not breach patient confidentiality?

A

does not

80
Q

according to the law:

you are ____ from criminal and civil liability

A

immune

81
Q

according to the law:

it is a _____ for failure to report suspected abuse

A

class B misdemeanor

82
Q

according to the law:

it is a _____ for failure to stop or report sexual assault of a child

A

class A misdemeanor

83
Q

“professional” means an individual who is _____ or who is an employee of a facility licensed, certified, or operated by the state and who, in the normal course of official duties or duties for which a license or certification is required, has direct contact with children.

A

licensed or certified by the state

84
Q

5 reasons to report suspected or child abuse

A
  1. to prevent further injury or death of a child
  2. maltreatment is linked to life-long health consequences
  3. healthcare staff have a moral and legal responsibility to ensure the safety and well-being of patients
  4. legal obligation to report child maltreatment
  5. consequences for not taking action may include criminal and civil actions against the professional and/or license and institution
85
Q

What’s a sentinel injury?

A

commonly missed, minor injuries that should pique your suspicion for abuse.

ex: bruises, subconjunctival hemorrhages

86
Q

What is meant by “escalation of injury”?

A

when sentinel injuries are missed, the patient then comes back with more serious injuries later

87
Q

what kind of family does child abuse occur in?

A

ALL KINDS OF FAMILIES

88
Q

4 common characteristics of missed abuse:

A
  • young infants
  • caucasian children
  • 2 parent households
  • children without seizures or respiratory problems
89
Q

for every Dx of child abuse that’s made, ___ are missed

A

2

90
Q

When ___ in the family increases, there is a decrease in the caretaker’s ability to _____

A

stress

cope

91
Q

maternal ___ is another big factor in cases of child maltreatment

A

depression

92
Q

2/3 of children in the child welfare system in the US have ______ as a contributing factor

A

substance abuse

93
Q

(abuse) things to remember when taking a history from a parent

A
  • remain non-judgemental
  • obtain a detailed Hx
  • use open ended questions
  • ask about other children in the home
  • speak to the parent WITHOUT the child
94
Q

(abuse) things to remember when taking a history from a child

A
  • use age-appropriate language
  • do not suggest persons or actions or probe
  • use open ended questions
  • document the child’s words
  • speak to the patient WITHOUT the parent
95
Q

Definition of physical abuse

A 
a non-accidental physical injury that leaves:
bruises
burns
cuts
broken bones
other injuries
96
Q

Bruises and lacerations that raise abuse suspicion (5 things)

A
  • on a non-mobile infant (usually <6 months)
  • on central or fleshy areas
  • patterned or unusually distributed
  • of different stages of healing
  • frenulum laceration is almost always due to abuse (a commonly missed sentinel injury)
97
Q

TEN-4 rule for bruising:

A 
T: torso
E: ears
N: neck
4: 
- bruising in TEN regions if  < 4 years old
- any bruising if <4 months old
- >4 bruises in general
98
Q

How do you tell the age of a bruise by looking at it?

A

YOU CAN’T

only way to tell is if you know when the incident happened

99
Q

What’s the most common presentation of abuse?

A

bruising

100
Q

what percentage of kids < 6 months have non-abuse bruises?

A

<1%

101
Q

bruising is a precursor to

A

AHT

102
Q

bruising is missed in ____% of fatal or near-fatal cases of abuse

A

39%

103
Q

if an infant has facial bruising, they will most likely return with ___.

A

abusive head trauma

104
Q

2 types of burns common in child abuse:

A
  • forced immersion scald

- patterned contact burns

105
Q

____ burns are less likely to be abusive

A

splatter

106
Q

forced immersion burns are

  • usually seen during ____.
  • pattern includes: (3 things)
A

toilet training;

  • zebra striping
  • doughnut sparing
  • stocking feet
107
Q

intra-abdominal injury S/Sx

A
  • abdominal pain, tenderness
  • abdominal abrasions or bruising
  • palpitation of hematoma
  • blood in urine
  • decreased hematocrit on CBC
  • elevated transaminase
  • abnormal vitals (SBP <90, RR <10 or >29)
108
Q

____ is the MC thing to cause presentation

A

skeletal fracture

109
Q

children with abusive Fx are often too young to ____.

A

provide history

110
Q

the history for skeletal fractures due to abuse may be ____ or ____.

A

lacking

intentionally misleading

111
Q

missed abusive Fx can result in ____.

A

repeated abuse, sometimes with devastating consequences

112
Q

misidentifying an accidental fracture as abuse can have detrimental effects for ___.

A

patient and family

113
Q

incidence of skeletal fractures due to abuse decreases as ___ increases

A

age

114
Q

3 things to Dx abuse in skeletal Fx patient

A
  • skeletal survey
  • bone chemistries
  • history
115
Q

When would you do a skeletal survey in a 0-24 month old, 2-5 year old, and 5+ year old?

A

0-24 months: anytime there is concern for abuse
2-5 years: when abuse is strongly suspected or the child is unable to communicate
5+ years: radiographs of individual sites of injury suspected on clinical grounds

116
Q

high specificity radiologic findings for abuse

A 
CMLs
rib fx, esp posteromedial
scapular fx
spinous process fx
sternal fx
117
Q

greater proportion of children with NAT have multiple fractures as compared to children with accidental fractures.
as the number of fractures _____, the likelihood of NAT _____.

A

increased

increased

118
Q

MC type of fracture seen at TCH

A

skull fx

119
Q

____ skull fractures should raise suspicion for abuse

A

complex

120
Q

complex vs simple skull fractures

A

simple/linear:
single fracture line
usually don’t cross suture lines
< 3 mm separation

complex:
linear, crossing suture lines
branching, stellate
depressed
comminuted
121
Q

suspicion of abuse should arise whenever a caregiver gives an explanation of an injury that: (2 things)

A
  • seems unlikely due to the child’s developmental abilities

- changes or is implausable

122
Q

2 other red flags for abuse…

A
  • delay in seeking treatment

- frequent changes in healthcare facilities

123
Q

3 things to help date fractures

A
  • resolution of soft tissue swelling
  • loss of fracture definition
  • callus formation
124
Q

most kids with inflicted fractures have ____ bruises

A

ZERO

125
Q

7 things that are not abuse

A
  • birth injury
  • accidents
  • children with weak bones (bedridden)
  • prematurity (osteopenia)
  • nutritional (scurvy, rickets)
  • infection (osteomyelitis)
  • metabolic (osteogenesis imperfecta)
126
Q

______ is one of the leading child maltreatment-related fatalities

A

AHT

127
Q

____% of head trauma-related deaths in the USA in children <2 years old result from abuse

A

50-80%

128
Q

the majority of abusive head trauma victims are ____ old

A

<2 years

129
Q

peak incidence of AHT:

A

3 months

130
Q

put AHT in the DDx anytime an infant has ____

A

vomiting without illness

131
Q

2 common findings in shaken baby syndrome

A
  • retinal hemorrhages

- skeletal Fx

132
Q

AHT does not propose a ____

A

MOI

133
Q

non-specific Sx of AHT

A 
vomiting or poor feeding
extreme irritability
breathing problems
seizures
lethargy
134
Q

specific signs of AHT

A

subdural hematoma
retinal hemorrhages
skeletal fractures

135
Q

AHT is often mis-diagnosed as

A

reflux/colic

viral infection

136
Q

AHT: physical signs of subdural hemorrhage, subarachnoid hemorrhage, parenchymal injury (contusion), and/or DAI in the context of ____

A

an absent or implausible history

137
Q

comment on 3 things when examining retinal hemorrhages:

A
  1. description
  2. distribution
  3. extent
138
Q

____% of children with AHT DO NOT have retinal hemorrhages. When they do have them, ____% are unilateral

A

20%

15%

139
Q

____ is defined as “act of omission or commission which constitutes a failure to provide conditions that are essential for the healthy physical and emotional development of a child.”

A

neglect

140
Q

6 types of neglect

A 
physical
medical
dental
supervisional
emotional
educational
141
Q

consider the following studies in neglect cases:

A 
radiographic skeletal survey
CT scan
bleeding eval: CBC, PT, PTT
toxicology screens
urinalysis
transaminases
142
Q

new name for Munchausen by Proxy

A

medical child abuse

143
Q

definition of medical child abuse

A

fabrication, exaggeration, or induction of Sx resulting in the child receiving harmful or potentially harmful medical Tx at the instigation of the caregiver

144
Q

IMPORTANT in determining MEDICAL CHILD ABUSE

A

RESOLUTION OF SX WHEN SEPARATION OCCURS

145
Q

general concepts of MCA presentation:

A
  • no typical presentation
  • all organ systems are targets
  • Sx presentation is limited only by the perpetrator’s medical knowledge, sophistication and imagination
146
Q

Sx in MOA can be:

  • ______ of existing problem
  • ______ of Sx/disorder, lab reports/specimens
  • ____
  • ____
  • ____
A 
exaggeration
fabrication
persuasion
simulation
induction
147
Q

Dx of MCA

A
  • multidisciplinary approach
  • child’s safety is most important
  • separate caregiver and child to confirm
  • meticulous documentation!!
  • maintain chain of custody with lab specimens
148
Q

prognosis for MCA

A

can run the entire spectrum of physical and psychiatric sequelae

149
Q

secondary gains in MCA

A 
attention
financial gain
involve an absent parent/reconnect
fascination with all things medical
sympathy from the community
150
Q

definition of sexual abuse

A

sexual activity with a child by an adult or an older youth

151
Q

non-touching sexual abuse:

A
  • exposure to porn
  • indecent exposure
  • photographing a child in sexual poses
  • making a child watch or hear sexual acts
  • voyeurism
  • online sexual solicitation
152
Q

touching sexual abuse:

A
  • touching a child’s genitals, anus, or breasts for sexual pleasure
  • making a child touch someone’s genitals
  • playing sexual games
  • putting objects or body parts inside the vulva, vagina, mouth, or anus of a child
153
Q

worrisome behaviors for sexual abuse:

A
  • new words for private body parts
  • sexual behavior inappropriate for age or adult-like
  • simulating sexual activities with toys
  • excessive masturbation
  • persistent and/or aggressive sexual play with other children
  • refusing to talk about a secret, esp one with an adult friend
  • prominent genitals in drawings
154
Q

non-specific symptoms of sexual abuse

A
  • genital discharge
  • anogenital redness
  • urinary pain/itching
  • enuresis
  • encopresis
  • chronic abdominal pain
  • asymptomatic
155
Q

signs that are specific for trauma

A

genital/anal bleeding

anogenital bruising

156
Q

signs that are specific for sexual abuse

A

STIs

pregnancy

157
Q

____ of physical exams of children suspected of being physically abused are without definitive findings

A

3/4ths

158
Q

why aren’t there usually definitive findings of abuse?

A
  • the child generally knows the perpetrator and physical force is not often used
  • disclosure of abuse is usually delayed
  • mucous membranes heal quickly often without scarring
159
Q

5 elements of medical exam

A
  • STI/HIV testing
  • photographic documentation with colposcope
  • rape kit if under 96 hours since assault
  • blue maxx light for evidence collection in acute cases
  • health care facilities must be able to handle emergency care for sexual assault and provide survivors with emergency contraception info
160
Q

signs of domestic violence

A
  • facial bruising
  • injuries inconsistent with Hx
  • depression/anxiety
  • reluctant to explain discipline in the home
  • repeatedly misses apts
  • frequently asks for medical advice not related to child’s medical needs
161
Q

what to do in domestic violence cases:

  • use ____ screening regularly
  • speak with the ____ alone
  • reinforce _____
  • discretely provide info on _____
  • inform mother of ____
A 
RADAR
mother
confidentiality
community resources
precautionary measures to take to avoid injury to her or her child
162
Q

what is RADAR screening?

A 
R: routinely screen mothers
A: ask direct ??
D: document findings
A: assess her safety
R: respond
163
Q

behavioral effects of parental substance abuse on child

A
  • delayed in development as result of neglect
  • may blame themselves for parent’s use
  • may be reluctant to bring friends home
164
Q

psychiatric effects of parental substance abuse on child

A

increased incidence of depression, anxiety, ED, suicide attempts

165
Q

educational effects of parental substance abuse on child

A
  • inability to concentrate at school or home

- may be tired due to chaos at home and inability to sleep or lack of structure for nutrition and rest

166
Q

emotional effects of parental substance abuse on child

A

exhibit mistrust, guilt, shame, ambivalence, fear

167
Q

____ and ____ account for most of the top drugs abused by 12th graders in the past year

A

marijuana, prescription and OTC meds

168
Q

after several years of decline, current and past year use of ____ has risen among 8th and 10th graders

A

ecstasy

169
Q

alcohol use has continued to ____ among high school seniors

A

decline

170
Q

screening for teen substance use:

A

CRAFFT
C: have you ever ridden in a CAR driven by someone (including self) that was high or drunk?
R: do you ever use alcohol or drugs to RELAX, feel better about yourself, etc
A: do you ever use alcohol/drugs while by yourself, ALONE
F: do you ever FORGET things you did while using alcohol or drugs
F: do your family or FRIENDS ever tell you that you should cut down on your drinking/drug use?
T: have you gotten into TROUBLE while you were using alcohol, drugs?

171
Q

physical warning signs of teen alcohol/drug use

A

fatigue
repeated health complaints
red and glazed eyes
lasting cough

172
Q

emotional warning signs of teen alcohol/drug use

A 
personality change
sudden mood changes
irritability
irresponsible behavior
low self-esteem
poor judgement
depression
general lack of interest
173
Q

family warning signs of teen alcohol/drug use

A

starting arguments
breaking rules
withdrawing from the fam

174
Q

school warning signs of teen alcohol/drug use

A 
decreased interest 
negative attitude
drop in grades
many absences
truancy
discipline problems
175
Q

RF for child abuse/neglect

A 
parental depression
substance abuse
intimate partner violence
parent stress
harsh punishment
food security
176
Q

3 protective factors for abuse/neglect

A

social support
self-efficacy
parenting competence

177
Q

2 challenging behaviors and developmental issues that ay increase the risk for child maltreatment:

A

infant crying

toilet training

178
Q

help parents become more skilled communication about sexuality and sexual abuse in order to ___

A

prevent sexual abuse

179
Q

2 things to do with resources

A
  • understand their availability and effectiveness

- advocate for implementation and sustaining of community-based services to help families prevent maltreatment

180
Q

the law does not require health care professionals to be certain that abuse has occurred before they report, but merely “____.”

A

have a cause to believe

181
Q

3 services offered by CPS

A

investigation
placement assessment
court approves permanency for child

BCM (8 decks)

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