Visual Inspection of Children

0070-531.10 | Revision Date: 07/07/22

Overview

This policy reviews how to conduct a visual inspection of a child which includes the removal or adjustment of clothing in accordance with best social work practices, as well as, state and federal legal requirements.

TABLE OF CONTENTS

Policy

When Should a CSW Visually Inspect a Child?

Disrobing

Documentation

Authorization Required to Disrobe a Child

Exigent Circumstances

Consent

Court Order

Procedure

Conducting a Visual Exam of the Child

CSW Responsibilities

Approvals

Helpful Links

Forms

Referenced Policy Guides

Statutes

Version Summary

This policy guide was updated from the 07/01/14 version to provide more detailed guidance as to when a CSW should do a visual inspection of a child as well as the documentation of the visual inspection in the CSW/CMS Delivered Service Log and the DCFS 550, Body Chart form.

POLICY

When Should a CSW Visually Inspect a Child?

Emergency Response (ER) CSWs need to conduct visual inspections of a child during the investigative stages when assessing for physical harm resulting from an act of abuse or neglect, other than sexual abuse or exploitation.

Continuing Services (CS) and Dependency Investigator (DI) CSWs need to conduct visual inspections of a child during the first home visit to establish a baseline for the child’s appearance and/or during any following visits, when any of the following concerns are expressed regarding a child who has an open case:

• The child presents with visible injuries;

• Concerns of physical abuse;

• Concerns of neglect resulting in failure to thrive or malnutrition;

• Concerns of medical neglect of certain conditions;

• Concerns of self-injury and/or suicidal ideation; and/or;

• Any other allegation, aside from sexual abuse or exploitation, which may create physical evidence on a child’s body.

The CS CSW should assess whether or not they need to have the child or parent/legal guardian/caregiver disrobe or rearrange the clothing of the child during face-to-face visits and/or whether a referral to the medical Hub for a forensic and/or medical assessment is appropriate.

If there are allegations of malnutrition, the child being under weight, suspicion of failure to thrive, and/or allegations that the child is not being fed enough, the CSW should conduct a visual inspection to assess the child’s physical condition. It is particularly critical that this be done for children 0-36 months of age. The CSW should submit a referral for consultation to utilize the in-office Public Health Nurse (PHN) to obtain professional opinions, resources, and technical assistance and to address the appropriateness of a referral to the Medical Hub for medical assessment.

Disrobing

A visual inspection of a child may necessitate having the child or the parent/legal guardian rearrange a child’s clothing or disrobe. Whenever possible, have the non-offending parent/legal guardian assist with rearranging/disrobing of the child’s clothing. Having the child or the parent/legal guardian rearrange a child’s clothing or disrobe the child should be done only when the CSW has reasonable cause to believe that physical harm occurred or any other situation where there may be physical evidence observed on a child’s body and the CSW has either consent, exigent circumstances, or a court order.

Before conducting a visual inspection of any child, it is important to talk to the child and make sure they understand the need for the disrobing or rearranging, and are comfortable with it. If the child reports that they are not comfortable, this should be documented. Since non-verbal children cannot consent to having their clothing rearranged or being disrobed, CSWs are to seek the parent/legal guardian/caregiver’s consent.

The process of rearranging clothing or disrobing any child under five (5) years of age must stop if the child appears to be uncomfortable and/or says “no.” If this occurs, ask if the parent or caregiver will take the child to a HUB/medical facility for an examination; the CSW can accompany them. If the parent/legal guardian does not consent to this, determine whether exigent circumstances exist or if a court order is necessary for visual inspection, rearranging, and/or disrobing of a child.

Any child nearing puberty or older (i.e. a child who is nearing physical, emotional and/or psychological maturity) should not be disrobed or be asked to disrobe by the CSW. An alternative for children of this age is to ask for their consent to a limited visual inspection, which can consist of them rearranging their clothing, e.g., raising shirt sleeves or pant legs and/or changing into active wear, e.g., a short-sleeved shirt or shorts.

If the CSW is the person having the child or the parent/legal guardian rearrange a child’s clothing or disrobe a child five (5) and under, the CSW must have an adult witness.

For allegations and/or suspicions of sexual abuse or exploitation, the CSW is not to disrobe or rearrange the child’s clothing. The CSW must immediately submit a referral for a forensic evaluation at a Medical Hub. The Medical Hub forensic practitioner will determine whether a forensic evaluation is needed and the timing of the evaluation.

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Documentation

Any time marks or bruises are observed and/or when investigating physical abuse allegations, the CSW must complete the DCFS 550 Body Chart form, in its entirety, according to the instructions on the form. The completed Body Chart form must be placed in the child’s physical case file. CSWs are encouraged to upload a legible DCFS 550 Body Chart Form to the Green Folder in CWS/CMS. Uploading the DCFS 550 Body Chart Form in CWS/CMS is not a substitute for documenting written details in the CWS/CMS Delivered Services Log. Additionally, a consult or conversation with the SCSW will assist in dialogue around assessing physical abuse indicators, even in situations where physical abuse was not initially suspected, not part of an allegation, or not the reason for an open case.

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Authorization Required to Disrobe a Child

A CSW must have one of the following to have the child or the parent/legal guardian rearrange a child’s clothing or disrobe a child when investigating allegations of physical harm to the child or any other situation where there may be physical evidence on a child’s body:

• Exigent circumstances

• Consent

• Court order

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Exigent Circumstances

• The CSW can have the child or the parent/legal guardian rearrange a child’s clothing or disrobe a child if the facts support reasonable belief that the child requires immediate medical attention and the CSW does not have time to get an order/warrant because the emergency nature of the situation places the child at immediate risk of physical harm (e.g. the child complains of pain or injury and/or there are visual clues that a serious injury exists).

• If the child’s parent or legal guardian prevents the CSW from examining the child despite exigent circumstances, the CSW should call law enforcement for assistance. The CSW should not leave the child alone in the home if the child is in danger.

• Facts that establish exigent circumstances for a visual inspection of the child must be documented within three (3) business days.

• The CSW should inform the SCSW of the situation and determine the best course of action. If exigent circumstances support a detention, (separate and apart from the exigent circumstances that might exist to visually inspect a child, rearrange a child’s clothing and/or disrobe a child), the CSW should proceed accordingly.

Consent

The CSW can have the child or the parent/legal guardian rearrange a child’s clothing or disrobe a child if the CSW has obtained permission from the child’s parent/legal guardian.

A child twelve (12) years of age or older, who is a suspected victim of abuse or neglect, and who, in the opinion of the CSW, is mature to understand the purpose of the interview, can consent to a limited visual inspection by a CSW. Conversely, a child twelve (12) or older may overrule a parent/legal guardian's consent for disrobing. For suspected victims of physical abuse, a parent/legal guardian’s objection would overrule the child’s desire to show injuries.

• The child twelve (12) who is mature enough or older and parent/legal guardian must give consent freely and voluntarily.

• The CSW must never coerce, threaten, or force consent from the child and parent/legal guardian.

• The child and parent/legal guardian may withdraw or limit their consent at any time.

• If consent is given for a visual inspection in the child’s or parent’s/legal guardian’s home, the CSW should ask the non-offending parent/legal guardian (when possible) to rearrange the child’s clothing, disrobe the child, or request that the child do it themselves.

• If during an interview, without any prompting from the CSW, a child under (12) twelve years of age spontaneously removes or adjusts clothing, the CSW must take note of any marks or bruises which are plainly visible (by completing the DCFS 550 body chart and documenting in CWS/CMS within three (3) business days), but the CSW cannot encourage a child to remove and/or adjust clothing to enhance a visual inspection without valid consent.

• If a parent/legal guardian is not willing to consent to a visual inspection by a CSW, as an alternative, the CSW can ask if the parent/legal guardian is willing to bring the child to a Hub/medical facility for an examination and whether the CSW can accompany them.

• For allegations and/or suspicions of sexual abuse or exploitation, the CSW is not to disrobe or rearrange the child’s clothing. The CSW must immediately arrange for a forensic exam by a medical practitioner to take place as soon as possible.

• The CSW may take pictures of injuries if the parent/legal guardian gives consent. CSWs must use their County cellphone when taking pictures. Personal cellphone use runs the risk of uploading sensitive and/or confidential information to the CSW’s personal iCloud. Additionally, any pictures on a personal cellphone would be subject to a public record request.

• When a County issued cellphone is unavailable, a discussion with a supervisor must be had to determine an appropriate course of action. Document discussion with SCSW in CWS/CMS

• CSW’s must not take pictures of a child’s genitals. If the CSW learns of photos of genitals that reportedly show sexual/physical abuse (i.e. photographs taken by parents/legal guardians or relatives to document abuse), CSWs must work with law enforcement and sexual/physical abuse forensic teams to make sure they receive the photographs.

• Photographs of injuries should be stored on the employee’s county cellphone and uploaded only to the DCFS cloud. Hard copies must be printed and filed.

• Photographs can be shared with members of law enforcement and the DA when investigating abuse/neglect, medical personnel when determining whether there is abuse/neglect, other child welfare agencies, members of multidisciplinary teams, and ultimately, the parents/legal guardians.

• If a CSW deems that a medical examination of the child’s reported injuries is necessary, they should consider whether or not visual inspection of the child via rearranging clothing or disrobing is necessary. If the medical examination is to take place immediately, (preferably a Medical Hub) rearranging the child’s clothing may be redundant and may cause unnecessary distress to the child.

Court Order

• If a CSW does not have consent or exigent circumstances to support a visual inspection of the child a search warrant will be required before the CSW may conduct such an inspection. The visual inspection is limited to rearranging the child’s clothing as indicated in the search warrant.

• The CSW cannot take pictures of the child’s injuries unless it is permitted on the search warrant, which is indicated when the judge signs off on the “You Are Commanded to Search” section of the search warrant and/or a CSW may take pictures of injuries if the parent/legal guardian gives consent. CSWs must only use their County issued devices when taking pictures.

• After a child is taken into protective custody, but before a detention hearing, the warrant desk assists DCFS in obtaining orders for remedial medical care if the child is in need of care, a doctor recommends that care, and the parent does not consent.

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PROCEDURE

Conducting a Visual Exam of the Child

ER/CS/DI CSW Responsibilities

1. Emergency Response (ER) CSWs need to conduct visual inspections of a child during the investigative stages, when assessing for physical harm resulting from an act of abuse or neglect, other than sexual abuse or exploitation. Continuing Services (CS) and Dependency Investigator (DI) CSWs need to conduct visual inspections of a child during the first home visit to establish a baseline for the child’s appearance and/or during any following visits, when any of the following concerns are expressed regarding a child who has an open case:

• The child presents with visible injuries; 

• Concerns of physical abuse; 

• Concerns of neglect resulting in failure to thrive or malnutrition; 

• Concerns of medical neglect of certain conditions; 

• Concerns of self-injury and/or suicidal ideation; and/or 

• Any other allegation, aside from sexual abuse or exploitation, which may create physical evidence on a child’s body. 

2. If it is determined that there is reasonable cause to believe physical harm occurred and that a visual inspection of the child is required, ensure that one of the following criteria is met:

1. Exigent circumstances exist; or,

2. Consent has been obtained from the parent or legal guardian.

1. If a child is a dependent of the Court in out of home care and the CSW is investigating allegations of physical abuse and/or malnutrition/ medical neglect, consent of the parents/legal guardians and/or caregivers is not required. However, if the child has been released to a parent/legal guardian, parental consent, a warrant, or exigent circumstances are still needed.

2. If the child says no, the CSW must stop the inspection immediately.

3. Youth twelve (12) or older may consent to a limited visual inspection and can overrule a parent/legal guardian’s consent for disrobing. For suspected victims of physical abuse, a parent’s objection would overrule the child’s desire to show injuries.

3. A Court Order has been obtained.

1. For assistance with this process, consult with SCSW, who may contact a Warrant Liaison and/or County Counsel, as necessary.

3. When conducting or observing the rearranging or disrobing of a child’s clothing the CSW must remember the following:

1. For children five (5) years of age and under, CSW must have an adult witness. (A parent/legal guardian qualifies as an adult witness).

2. The name, address, and phone number of the witness and their relationship to the child must be documented on the DCFS 550 Body Chart form and on the CWS/CMS Delivered Services Log.

3. Details noted on the DCFS 550 Body Chart form, including marks and bruises (i.e. location, color, relative size, etc.), must also be documented on the CWS/CMS Delivered Service Log.

4. Any time that a child or parent/legal guardian is asked to disrobe or rearrange the clothing of a child, the reason for the visual inspection and a full description of the findings must be documented in the CWS/CMS Delivered Services Log.

5. The site of an apparent physical injury must not be touched.

6. The child’s genitalia, buttocks or breast must not be touched (Do not photograph the child’s genitalia)..

7. Children older than (3) three years old should never be totally unclothed.

8. Undress only one area at a time.

9. Do not have the child undress in front of anyone other than the adult witness.

10. Do not have the child disrobe or rearrange clothing on a video call. If disrobing or rearranging of clothing is required, a face-to-face visit must take place within twenty-four (24) hours. If a child discloses a mark or bruise on a video call, the CSW should ask follow up questions to determine if a face-to-face visit is required. A referral for a Forensic Evaluation should be submitted to the Medical Hub. The Medical Hub will determine whether an exam should take place and the timing of the exam.

11. If marks/bruises are present and photos are necessary, a CSW may take pictures of injuries if the parent/legal guardian gives consent. (CSWs must use their County devices when taking pictures).

12. Anytime a child/youth expresses being uncomfortable with the process, a CSW must stop the inspection immediately. This should be documented in the CWS/CMS Delivered Service Log.

4. If there is no reasonable cause to believe that physical harm or any other situation where there may be physical evidence on a child's body has occurred, the child must not be disrobed nor have their clothing rearranged. CSWs must still visually inspect the children and document their appearance.

5. If marks or bruises are found on the child’s body, document their size, color, shape, etc. on the DCFS 550 and then determine:

1. If medical assistance is necessary for the child, contact the Medical Hub to determine.

• Whenever allegations of physical or sexual abuse of a child come to the attention of DCFS, as soon as practically possible, the CSW must submit a forensic referral. Consult with a Hub Medical provider (aka Specialist) who has specialized training in the detection and treatment of child abuse injuries and child neglect. It is the responsibility of the specialist to determine if a forensic evaluation is appropriate.

2. Whether a detention is necessary to protect the child.

6. Contact law enforcement for assistance if necessary.

7. Document the following information in the CWS/CMS Delivered Services Log:

1. Consent, court order, and/or the facts which establish exigent circumstances for a visual inspection of the child.

2. The date, place, and reason for the inspection.

3. Whether or not the child’s clothing was rearranged and/or if the child was disrobed and by whom.

4. The name of the witness who was present during the inspection.

5. The date on which the DCFS 550 was completed.

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APPROVALS

None

HELPFUL LINKS

Forms

LA Kids

DCFS 550, Body Chart

Referenced Policy Guides

0070-524.10, Assessment of Failure to Thrive

0070-529.10, Assessing Allegations of Physical Abuse

0070-548.20, Taking Children into Temporary Custody

0070-560.05, Joint Response Referral: Consulting with PHN

0070-570.10, Obtaining Warrants and/or Removal Orders

0600-500.00, Medical Hubs

Statutes

Penal Code Section 11165.3 - defines “the willful harming or injuring of a child or the endangering of the person or health of a child,” as a situation in which any person willfully causes or permits any child to suffer, or inflicts thereon, unjustifiable physical pain or mental suffering, or having the care or custody of any child, willfully causes or permits the person or health of the child to be placed in a situation in which their person or health is endangered.

Welfare and Institutions Code Section 300 (a) - states that “The child has suffered, or there is a substantial risk that the child will suffer, serious physical harm inflicted non-accidentally upon the child by the child’s parent or guardian. For the purposes of this subdivision, a court may find that there is a substantial risk of serious future injury based on the manner in which a less serious injury was inflicted, a history of repeated inflictions of injuries on the child or the child’s siblings, or a combination of these and other actions by the parent or guardian which indicate the child is at risk of serious physical harm. For the purpose of this subdivision, “serious physical harm” does not include age-appropriate spanking to the buttocks where there is no evidence of serious physical injury.

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