Make the call to CPS

[zombieghoast]

This is my second year as a school nurse and I had this student last year who broke his toe and mom only ever took him to the ER and never the follow up appointments as instructed because "it cost too much". The social worker helped me with the case because she has had issues with mom. She had to threaten to call CPS on mom because we never received any documents that he was healed. So now he broke his jaw during summer and came to school with a wired jaw. Grandma now has custody of him and grandma said he can go to gym. Principal said that we need a doctor's note and all of the paper work to verify this. Two weeks ago he got the wire removed and I got nothing... Called grandma multiple times and she never called me back. Then I saw her last week in the office and I told her I need the papers from the doctor and she can call the office to have it faxed to me. A week has gone by and I talked to the social worker and she told me she is no longer going to deal with that student's behavior (the really bad misbehaving kids have to see her) and for me to call CPS. I have never done this so I don't know how to approach this.

[JustBeachyNurse, LPN]

Are you calling for suspicion of abuse, neglect, medical neglect, emotional abuse/neglect? Look up state guidelines as you are a mandated reporter for legitimate suspicions of abuse or neglect. Just because the SW doesn't want to deal with behaviors is not necessarily a CPS call.

Does your protocol permit you to follow up directly with the physician for school/PE clearance? Does grandma have legal custody or is the child considered a state ward in kinship foster care? If a ward of the state, a CPS social worker would have to obtain the medical release if the grandmother doesn't legally have custody.

Know what you are reporting when you call. Report facts, observations, and assessments. Follow district protocol for reporting as often administration must be notified that you are initiating an investigation.

[SnowyJ, RN]

The lack of follow through medically would be a reason to call CPS. (Medical neglect.) However, if your counselor has concerns, she needs to document them and should be wiling to be named on the report re: her concerns. I am not sure what your state guidelines are, but keep in mind you are a mandated reporter. You may need to let your building administrator know that you called..Check your policy.

Your student may already have an open case with CPS, you never know. Especially if there has been a transfer of custody to Grandma.

Always better safe than sorry if you feel a child isn't being cared for properly. Especially with medical concerns or injury.

[atki]

I'm not a nurse (I'm currently in nursing school) but I did work for CPS for a couple years and can answer any questions that you might have. I'm not sure what the CPS issue is in this case since they seem to have gotten the child appropriate medical care but if your school told you to call you probably should to CYA. I can't imagine CPS doing much with this though. To call you just need names, contact info, and what the concern is. It's not a difficult process and the person you call should be able to walk you through it. Let me know if you need anything else.

[SnowyJ, RN]

There is actually no proof this child had appropriate medical care...Or proper follow up.

[OldDude]

You can approach this from the avenue that a wired jaw is a self evident excuse to excuse a student from PE or other physical activity at school; just like coming to school with a cast on your arm. You don't need a note from the doctor restricting the kid from activity. You do however need a note from the MD releasing the kid to full activity when the treatment regimen is over. In your case the GM has indicated the treatment for the broken jaw is complete but the school can't release the child for full activity unless they received something in writing from his doctor. So, since PE is a mandatory part of the school curriculum, the GM or whoever is the legal guardian, has now placed themselves in a position of neglect in not allowing the child to participate in the required school curriculum. So, yes, I believe a report to CPS would be indicated. Just my opinion of course - which I often have!!!

[NutmeggeRN, BSN]

Begs the question....how did the jaw get broken?

[FolksBtrippin, BSN, RN]

If what you are telling me is accurate , the social worker is incompetent and may even be guilty of bullying the family.

You should call CPS if you suspect child abuse or neglect. The social worker was wrong to threaten the family with a CPS call. If you have reason to believe there is abuse or neglect, you call and you don't make threats. Failing to provide the school with paperwork is not a valid reason to call cps. In addition, threatening the parent destroys the relationship, creates distrust, and makes it very unlikely they will cooperate with you in the future.

The parent indicated she could not afford follow up care, which is a legitimate problem for many people in the US. It was the social worker's job to address that problem and connect the family with resources and support. She failed to do that.

The social worker is also a mandated reporter. She has already called cps on this family. Why doesn't she want to do it again? Why is she trying to get you to do it? These are important questions you need to think about. I warn you against becoming this social worker's pawn.

You have a few problems here that you need to deal with and you have got to separate them.

It is worth restating that threatening to call cps is wrong all around. You call or don't call, you never threaten to call.

Calling cps will not solve your paperwork issue, nor will it answer the question of whether or not this child ought to be in gym class. In fact, it will probably make the paperwork issue worse, because you're going to get more avoidance from grandma if you call cps on her.

Call or don't call cps based on evidence or not of abuse/neglect. Now scratch that off your list and deal with the other problems.

1.Do you have an (ethical and/or professional) obligation to keep this child out of gym class?

Figure this out. This is on you. If you decide the answer is no, tell the principal that you have no professional or ethical reason to keep him out of gym class. If you decide the answer is yes then you need to answer q#2.

Do you have a right to keep this child out of gym class and if so, for how long?

This is probably a custody issue. If grandma has custody, and she says he can go, and there is no doctor order saying he can't, is that a decision you can override?

It's up to the principal to find out who actually has custody, so keep that problem off your list.

Be strong, do the right thing, do what's best for your patient. Good luck.

[tining, BSN, RN]

Send a certified letter requesting information, add a medical record release (you can send directly to any MD/hospital) have it signed by the principle. Maybe they will respond to that. Sad situation, but not an isolated event unfortunately.

[huffmannurse]

I don't know what other state's laws are. But, as of the last year. In Missouri, every call to the Abuse and Neglect Hotline is kept in the computer system. No matter if it was actually taken as a report of abuse and / or neglect. With this in mind. I would go ahead and make the call. Therefore, it is on record. The concern and information were passed along to a higher authority, and if in the future (or if there has been in the past) more Hotline calls have been made/are. This could be a helpful piece to the puzzle.

[huffmannurse]

I have a form that I made up that has the basic information that I fill in before I ever make the Hotline call. Many many of my staff / teachers have used it. It helps to make sure all "the ducks are in a row", before ever picking up the phone. I thought there was a way to send an attachment. But, I can't figure out how to do it. Did I dream this up?

[JustBeachyNurse, LPN]

I have a form that I made up that has the basic information that I fill in before I ever make the Hotline call. Many many of my staff / teachers have used it. It helps to make sure all "the ducks are in a row", before ever picking up the phone. I thought there was a way to send an attachment. But, I can't figure out how to do it. Did I dream this up?

There is but you haven't posted enough/been active enough to gain access. A work around is to start a thread in the admin help desk and staff can post for you