Abuse Reporting in Maryland
Abuse is the physical, psychological, or sexual maltreatment of another person. Several populations are vulnerable to abuse.
Domestic violence includes behaviors used by one person in a relationship to control the other. These two people can be, or may not be, married. Domestic violence can include husband against wife, wife against husband, brother against brother, or even roommate against a roommate. It encompasses anyone in a close type of relationship.
Other types of abuse can be identified as elder abuse and child abuse. The populations are especially vulnerable and frequently cannot speak for themselves.
The Centers for Disease Control and Prevention (CDC) defines child maltreatment as any act or series of acts or commission or omission by a parent or other caregiver that results in harm, the potential for harm, or the threat of harm to a child.
Vulnerable Adult Abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or serious risk of harm to a vulnerable adult.
Currently, there are four widely recognized and identifiable categories of abuse, including:
- Physical Abuse
- Psychological/Emotional Abuse
- Sexual Abuse
Other types of abuse can fit under these categories, such as financial abuse and exploitation, as well.
Neglect is defined as a type of maltreatment that refers to the failure by the caregiver to provide needed, age-appropriate care, although financially able to do so or offered financial or other means to do so.
Types of neglect can include:
- Physical neglect
- Educational neglect
- Emotional/Psychological neglect
- Medical neglect
Example of child neglect:
Samantha is arrested for drug possession and neglects to tell the arresting officer that her 4-year-old daughter is home alone because she had only intended to be gone for an hour to obtain drugs. Samantha is held overnight in jail until she plans to post bail. The neighbors hear Samantha’s daughter crying for her mommy at 2:00 a.m. They call the police who find the 4-year-old alone in the apartment.
Example of elder neglect:
An 86-year-old man arrived at the emergency room from his son’s home with multiple bed sores all over his back, and on his heels, and with severe dehydration. He had restraint marks on his wrist. His son said they felt like they had to restrain him, or he would wander off during the night.
Psychological abuse is also referred to as emotional abuse and is a form of abuse characterized by a person subjecting or exposing another to psychologically harmful behavior. It involves the willful infliction of mental or emotional anguish by threat, humiliation, or other verbal and non-verbal conduct. It is often associated with situations of power imbalance, such as abusive relationships.
Psychological abuse may occur as bullying of individuals by groups, often children, or it may be by one partner in a relationship. In domestic abuse, psychological abuse nearly always precedes physical violence when this occurs and also accompanies it.
Modern technology had led to new forms of abuse, particularly in children and young adults, through text messaging and online cyberbullying. Methods of abuse include causing fear by intimidation, threatening physical harm to self, partner, children, or partner’s family or friends, destruction of pets and property, and forcing isolation from family, friends, or school or work. More subtle tactics include putdowns, hiding objects such as keys, then putting them back without the victim seeing, and denial that previous incidents happened.
Examples of psychological abuse can include:
- Threats to leave
- Threats to take things away
- Hiding keys
- Locking the windows or doors to keep someone in
Example of psychological abuse:
Rachel wanted to be well-liked at her school. She didn’t care if her boyfriend was one of the cool guys, but she just wanted someone to like her. When Jake, one of the most popular boys in school, asked her to meet him outside of the locker room after school she was very excited! They met and he moved fast…too fast. She wanted to say “no”, but she wanted him to like her so much that she just went along with his advances. She hoped he would ask her on a date. When she got home and finished her homework she went online and found that the other boys, Jake’s friends, had taken pictures of her that afternoon. The pictures were embarrassing. The messages under the pictures from the other kids at school were horrible. When Rachel got to school the next day, she found her locker was covered in pictures. When she got to her first class there was a picture on her seat. The week continued with pictures and ugly remarks all over the place.
Physical abuse involves contact intended to cause feelings of intimidation, pain, injury, or other physical suffering or harm.
There are several indicators of physical abuse:
- Frequent physical injuries are attributed to being clumsy or accident-prone.
- Injuries that do not seem to fit the explanation
- Conflicting explanations
- Patches of hair missing
- Frequent absences
- Awkward movements that suggest the person is in pain or sore
- Flinching behavior
Example of physical abuse:
From around the age of 10, nothing Amy did was good enough for her mom. They led a very chaotic lifestyle and for one year they lived in 12 different places. The houses were all in bad condition and they were always dirty.
At school people would say “you smell” and Amy was bullied because she was different. The bullies said that if they saw her out of school, they’d kill her. She was always scared.
Mom had two or three partners who she’d had turbulent relationships with. Amy was frightened of mom when she was drunk as she was very unpredictable. Mom frequently yelled at and hit Amy. Once she had shoved her so hard that she fell down the front steps.
Most of the mom’s boyfriends ignored Amy altogether, but some were mean. They would hit her too. One didn’t Amy “hanging around” her own house so told Amy’s mom that he didn’t want her to be there when he was. That is when Amy’s mom moved a sleeping bag into the garage for Amy to stay there when the boyfriend was over.
Sexual abuse is forcing undesired sexual behavior by one person upon another. This also can involve using someone for sexual stimulation. Sexual abuse can involve both touching and non-touching behaviors.
Abusers often do not use physical force, but may use play, deception, threats, or other forms of coercion to engage their victim and to maintain their silence.
Signs of sexual abuse in children:
- An increase in nightmares and/or other sleeping difficulties
- Withdrawn behavior
- Angry outbursts
- Not wanting to be left alone with a particular person
- Sexual knowledge, language, and/or behaviors that are inappropriate for the child’s age
Signs of sexual abuse in the elderly:
- Bruising on inner thighs
- Sexually transmitted diseases or infections
- Any sudden change in personality
- Acting overly compliant
- Odd comments about sex or sexual behaviors
- Agitation or aggression
- Scared or timid behavior
- Withdrawal and wanting to be alone
Although many people who have experienced sexual abuse show behavioral and emotional changes, many others do not. It is critical to focus not only on detection but also on prevention and open communication.
Approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children. Most sexual abuse offenders are acquainted with their victims. Approximately 30% are relatives, and approximately 60% are other acquaintances such as friends of the family, caretakers, or neighbors.
Example of sexual abuse:
Lee was 16 when a friend introduced him to her church youth group. The first time he went, he met the youth leader, Adam. As Lee got more involved in the group, transport started to become an issue, and Adam offered to give him lifts.
Quite early on, Adam and Lee began texting. When Adam suggested we hang out outside of the group, Lee didn’t think anything of it. He thought it was probably common for youth workers to want to spend time with young people.
Lee didn’t have a lot of friends, so it felt like he’d made a close friend in Adam. He was paying attention to Lee, and he enjoyed his company; it felt like he was looking out for Lee.
Then, Adam started to encourage Lee to hang out with him at his house. He started telling Lee that we had a special friendship.
It was gradual and quite innocent to start with, but Lee began to feel increasingly uncomfortable. Adam started sitting closer to him on the sofa, trailing his finger his – things Lee thought were strange but not big enough to react to at the time.
Over time, Adam started to give him extended hugs and kiss Lee’s face. He’d tell Lee I was his best mate, and what they had was special. He said it was normal to do these things, even biblical, reading Lee passages from the Bible.
As things continued, Lee told him he wasn’t comfortable with what he was doing. He didn’t listen and instead ramped things up by kissing Lee on the lips. The kissing on the lips then became more regular, and Lee felt helpless to tell anybody about what was happening.
When Lee told Adam he wasn’t gay – that he liked girls and wanted him to stop – he’d turn things around by telling him he must want this because he’d instigated it. He’d threaten to take Lee off the preaching rotation or stop giving him lifts. He made Lee feel as if he’d be ostracized from the group if he put a stop to things and told Lee constantly that he wasn’t to tell anyone.
Things escalated when Adam made them masturbate in the same room as each other. When they weren’t together, he’d text Lee telling him he thought about him while he was masturbating. He continued to pressure Lee, saying they were going to spend their lives together and that he wanted us to have sex.
Effects of Abuse
When people live surrounded by fear, negative moods, family stress, and parental violence, there is a profound long-term impact. Research shows children who live with domestic violence often develop psychological, emotional, and behavioral problems.
The Centers for Disease Control found that children who witness abuse are at higher risk of:
- alcohol and substance abuse;
- health conditions like cancer, depression, and diabetes;
- poor performance in school, and
- an early death.
Children who grow up around domestic violence also believe it is normal and often repeat the cycle of violence in their own adult lives.
Children may experience a range of feelings about living with abuse, even if they don’t say it out loud. Depending on their age, they may:
- Feel responsible for the abuse, thinking, “If I had been a good girl/boy, the violence wouldn’t have happened.”
- Carry guilt for not stopping the abuse.
- Experience constant anxiety.
- Grieve when they are separated from the abuser. They may also grieve for the positive image they had of the abuser before they knew about or experienced the abuse.
- Feel ambivalent. They may have positive and negative feelings about the abuser and/or the victim.
- Be afraid of abandonment. After leaving behind the abusive parent/guardian, they may be scared the victimized parent will leave them or die.
- Seek constant attention from adults.
- Fear of being physically harmed. A significant percentage of children who witness domestic violence are also physically abused.
- Be embarrassed. Older children may especially be ashamed of how other people view the family.
- Worry deeply about the future. Because violence is unpredictable, children learn to live in a state of constant uncertainty.
Signs of Abuse in Children
Signs of Physical Abuse
- Unexplained changes in the child’s body or behavior or regression to earlier developmental stages
- Any injury (bruise, burn, fracture, abdominal or head injury) that cannot be explained
- Watchful and “on alert” behavior, as if the child is waiting for something bad to happen
- Shying away from touch flinches at sudden movements or seems afraid to go home
- Appears to be afraid of adults
- Wears clothing inappropriate to the season or weather to cover injuries, i.e., long-sleeved shirts on hot days
- School failure
- Frequent headaches or stomachaches with no medical cause
Signs of Emotional Abuse
- Behavioral changes
- Speech disorders
- Substance abuse
- Developmental delays
- Lack of attachment to the parent
- Excessively withdrawn, fearful, or anxious about doing something wrong
- Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumb-sucking, tantrums)
- Extremely passive or aggressive behavior
Signs of Sexual Abuse
- Extreme sexual behavior that seems inappropriate for the child’s age
- Sexual acting out on other children
- Genital pain, itching, swelling, or bleeding, as well as a sexually transmitted disease
- Refusal to change for physical activities (e.g., P.E. class) or refusal to participate in physical activities
- Fear of being alone with adults, especially of a particular gender
- Suicide attempts
- Trouble walking or sitting
- Nightmares or bedwetting
- Sudden changes in appetite
- Fear of a particular person or family member
Signs of Neglect
- Frequently absent from school
- Theft of food or money
- Consistently poor hygiene
- Lack of appropriate clothing for weather or season
- Frequently unsupervised left alone or allowed to play in unsafe situations and environments
- Lacks needed medical or dental care
Signs of Abuse In The Elderly
- Dehydration, malnutrition (without illness-related cause), untreated bedsores, poor personal hygiene unattended or untreated health problems hazardous living conditions/arrangements (for example, improper wiring, no heat, or no running water)
- Unsanitary and unclean living conditions (for example, dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing)
- A nursing home resident report being mistreated
- An injury that has not been cared for properly
- An injury that is inconsistent with an explanation for its cause pain from touching
- Cuts, puncture wounds, burns, bruises, welts
- Poor coloration, sunken eyes or cheeks
- Inappropriate administration of medication
- Frequent use of hospital or health care/doctor-shopping
- Lack of necessities such as food, water, or utilities
- Lack of personal effects, pleasant living environment, personal items
- Forced isolation
- Fear; Anxiety; Agitation; Anger
- Isolation, Withdrawal; Depression
- Non-responsiveness; Resignation; Ambivalence
- Contradictory statements; Implausible stories
- Hesitation to talk openly; Confusion or disorientation
Signs by Caregiver:
- Prevents the elder from speaking to or seeing visitors
- Anger, indifference, aggressive behavior toward the elder
- History of substance abuse, mental illness, criminal behavior, or family violence
- Lack of affection towards the elder
- Flirtation or coyness is a possible indicator of inappropriate sexual relationships
- Conflicting accounts of incidents
- Withholds affection
- Talks of elder as a burden
You are a mandated reporter if you are one of the following:
- Health Practitioner
- Human Service Worker
- Police Officer
Reporting does NOT require PROOF that abuse or neglect has occurred. Incidents are to be reported as soon as they are suspected. Waiting for proof may involve grave risk to the individual and impede services. Witnesses of abuse and neglect are rare. Professional judgment and knowledge should be used to evaluate any suspicion.
Please note that effective October 1, 2016, if a local department has reason to believe that a mandated reporter knowingly failed to make a report of suspected abuse or neglect of a child, the local department must file a complaint with the appropriate licensing board or employer of the mandated reporter. Anyone making a “good faith” report is immune from civil liability and criminal penalties.
We need to work together to stop the abuse.
To protect patient confidentiality, Maryland does not have mandatory reporting laws for domestic violence or sexual assault. You may not report suspected or confirmed domestic violence or sexual assault unless the adult victim consents or for one of the following exceptions:
Exceptions: Disclosure is mandated in the following three conditions:
- If the case involves physical or sexual abuse of a child up to age 18 by a parent, guardian, another person with permanent or temporary custody, or family or household member, then health care professionals are mandated to report to Child Protective Services (CPS) or law enforcement.
Vulnerable adult abuse
- If the case involves neglect, self-abuse, or exploitation of a vulnerable adult (adult aged 18 or older lacking the physical or mental capacity to provide for daily needs), then medical personnel, police, and human service workers should report to Adult Protective Services (APS) or law enforcement.
Treatment of an injury by a health care provider
- If the injury was caused by a gunshot or a moving vessel, then medical personnel must report it to law enforcement.
- In Allegany, Anne Arundel, Charles, Kent, Montgomery, Prince George’s, Somerset, Talbot, and Wicomico counties, if the injury is caused by an “auto accident or lethal weapon,” then medical personnel must report to law enforcement.
To report the abuse of children or vulnerable adults, call 1-800-332-6347 or 911.
Other resources include:
Child Abuse Prevention 1-800-243-7337
Department of Aging 1-800-243-3425
Maryland Coalition Against Sexual Assault 1-800-983-RAPE (7273) Maryland Network Against Domestic Violence 1-800-MD-HELPS (634-3577)
Legal action is immune to anyone who makes a report in good faith. Know that even when a report is not required, you can refer the person for help.
By law, reportable child abuse is abuse committed by a parent, guardian, another person with permanent or temporary care or custody, or family or household member. Reports are confidential.
ANYONE who suspects the physical or sexual abuse of a child (up to age 18) is required to report to Child Protective Services (CPS) within the local Department of Social Services or law enforcement. CPS will also investigate neglect.
If someone under the age of 18 is being abused by a dating partner, Child Protective Services will not generally become involved unless it involves minors who are family or household members. But, since the abuse may be a crime, the teen should be encouraged to seek assistance.
Intimate Partner Abuse and Sexual Assault
You must obtain consent from the adult victim to report suspected or confirmed domestic violence or sexual assault.
Maryland state law authorizes disclosure as follows:
- The case involves abuse of a child or vulnerable adult, reported to CPS, APS, or law enforcement.
- A health care provider must report to law enforcement if he or she treats a person for an injury that was caused by:
1) an auto accident or a lethal weapon (only in the following counties: Allegany, Anne Arundel, Charles, Kent, Montgomery, Prince George’s, Somerset, Talbot, and Wicomico) or
2) a gunshot or moving vessel of any type.
NOTE: Some police reports are legally required of individuals who treat a certain injury, which would include the individual in charge of a hospital, or a physician, pharmacist, dentist, or nurse. Other health care workers (e.g., social workers) may be required by their institution to report internally according to protocol.
Abuse of Vulnerable Adults
A ‘vulnerable adult’ is defined as an adult who lacks the physical or mental capacity to provide for the adult’s daily needs. Not all older adults are vulnerable adults; not all vulnerable adults are elderly.
Health care professionals, police, and human service workers who have reason to believe there is abuse, neglect, self-abuse, or exploitation of a vulnerable adult in the community must report it to Adult Protective Services. All persons are permitted to make reports.
If an older victim is being abused by a spouse or an intimate partner, do not report unless the victim gives consent, is a vulnerable adult, or reporting is required by law (refer to Intimate Partner Abuse and Sexual Abuse section), even if the victim has a mild disability.
When is a report required and where does it go?
When is a report required?
- Vulnerable Adults: When there is reason to believe that the alleged vulnerable adult has been subjected to abuse, neglect, self-neglect, or exploitation.
- Developmentally Disabled Persons: When anyone believes that an individual with a developmental disability has been abused.
- Mentally Ill Residents in Facility: Upon receipt of a complaint of abuse, or when anyone observes or has reason to believe that abuse has occurred.
- A resident of a Related Institution: When anyone believes that a resident of a related institution has been abused.
Where does it go?
- Vulnerable Adults:
- To the local department of social services (which is the department that has jurisdiction in the county where the vulnerable adult lives, or where the abuse is alleged to have taken place); and
- If acting as a staff member of a hospital or public health agency, to the head of the institution or the designee of the head.
- Reports may be made by calling the adult abuse hotline at 1-800-91-PREVENT (1-800-332-6347) or to the local department of a social service office in the reporter’s location (http://dhs.maryland.gov/local-offices/).
- Developmentally Disabled Persons:
- The executive officer or administrative head of the licensee and the executive officer or administrative head must report the abuse to the appropriate law enforcement agency.
- Mentally Ill Residents in Facility:
- An appropriate law enforcement agency or the administrative head of the facility.
- Residents of Related Institution:
- An appropriate law enforcement agency and the Office of Health Care Quality in the Department of Aging.
Relating to Vulnerable Adults:
- Any individual other than a health practitioner, human service worker, or police officer who has reason to believe that an alleged vulnerable adult has been subjected to abuse, neglect, self-neglect, or exploitation may file an oral or written report with the local department.
- Any person who in good faith, makes or participates in making a report is immune from civil liability that would otherwise result.
Relating to Developmentally Disabled Persons:
- A person shall have immunity for making a report or participating in an investigation or judicial proceeding arising out of this section.
- A person who acts in good faith is not civilly liable for making a report.
Relating to Mentally Ill Residents in Facility:
- A person who acts in good faith is not civilly liable for making a report, participating in an investigation or judicial proceeding arising out of making a report, or for participating in transferring, suspending, or terminating the employment of any individual who is believed to have abused or aided in abusing a resident.
Relating to Residents of Related Institution:
- A person who acts in good faith is not civilly liable for making a report or participating in an investigation or judicial proceeding resulting from a report.
- Any employee of a related institution who is required to report alleged abuse and who fails to report the abuse within 3 days after learning of the abuse is liable for a civil penalty of not more than $1,000.
Screening For Violence And Safety Assessments
When screening for domestic violence, treat all individuals with dignity, respect, and compassion and with sensitivity to age, culture, ethnicity, and sexual orientation while recognizing that domestic violence is unacceptable in any relationship. Keep in mind that leaving a violent relationship is difficult.
Screening should occur in all primary care settings with every individual. Beyond this setting, any helping professionals should be aware of the clinical findings that may indicate abuse. If any are seen or heard, a conversation should be initiated.
Combining any self-administered questionnaire or screening tool with a face-to-face discussion about violence is strongly recommended as the most effective way to conduct screening AND brief counseling for violence.
Keep in mind:
- Screen in a safe environment. Separate any accompanying persons from the patient when screening for domestic violence. Ask the patient about domestic violence in a private place. If this cannot be done, postpone screening for a follow-up visit.
- Use your own words in a non-threatening, non-judgmental way. “Domestic Violence is so common I ask all my clients about abuse in the home.”
- Use questions that are direct, specific, and easy to understand.
- Do you feel safe in your current relationship?
- Have you or your children ever been threatened or abused (physically, sexually, or emotionally) by your partner?
- Is there a partner from a previous relationship who is making you feel unsafe?
- Discuss with patients the confidentiality of these questions and the mandatory reporting of certain kinds of abuse.
Remember that the individual may deny abuse if they are not ready to deal with the situation or is in denial. Even if you are certain of an abusive situation, do not force the issue. The decision to leave or take action needs to be theirs.
If there is any indication or suspicion that abuse is occurring, a safety assessment should be done to evaluate if the individual is in any immediate danger and if they feel it is safe to go home or back to their home environment.
Safety Assessment should include questions on:
- Are there weapons in the home?
- Has there been an escalation of violence?
- Is there substance abuse?
- Is there a history of strangulation?
- Is there abuse during pregnancy?
- Has the individual had any suicidal or homicidal ideation, intent, or plans?
- Does the individual have a plan for where they could go if they need to leave?
- Does the individual have documents such as their birth certificate, social security card, bank account information, and so forth accessible?
- Is there an extra set of keys for the car accessible?
Approximately 10% of the elderly population is abused in the United States. With a child population of over 4 million, there were 33,612 substantiated reports of child abuse in Florida. The problem is prevalent and serious.
It is important to take into account the effects of traumatic stress on victims of abuse and on their ability to recount the abusive event. With children and the elderly, there is also, at times, difficulty in communicating what they are going through. Please be vigilant to recognize the signs of abuse. Victims frequently feel afraid of the offender or feel shame about the abuse. Many will be incapable of telling about their situation.
We all share a responsibility to protect children and vulnerable adults from harm.
Maryland Statutes Regarding Child Abuse:
Md. Code, FL § 5-701
Md. Code, FL § 5-704
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