Child Neglect Maltreatment

Select the type(s) of child neglect.

1. Medical
2. Exposure to physical hazards
3. Educational
4. Lack of/Inappropriate/Inadequate Supervision
5. Abandonment
6. Deprivation of necessities

Is the child under the age of 2 years?

1. Yes
2. No

Was there a physical impact (including non-observable injuries marked by pain) from the Exposure to Physical Hazards?

1. Yes
2. No

Was the MOST SERIOUS injury in the Exposure to Physical Hazards incident any of the following:

• Loss of consciousness,
• Loss of functioning (including, but not limited to, broken bones, detached retina, loose or chipped teeth),
• Heat stroke or heat exhaustion,
• Damage to internal organs (including, but not limited to, internal bleeding or swelling),
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location),
• Death

1. Yes
2. No

Which of the following was the MOST SERIOUS injury from the Exposure to Physical Hazards?

1. Damage to skin (cut/more than superficial scratch)
2. Welt
3. Swelling
4. Bruise
5. Pain
6. Damage to eye (cut/scratch)
7. Red marks
8. Scratch
9. Bloody nose
10. Cut inside the mouth
11. Burn
12. Physical impact not listed here

Which best describes the injury from the Exposure to Physical Hazards?

1. Direct pressure of longer than 10 minutes to stop bleeding
2. Direct pressure of less than 10 minutes to stop bleeding
3. Superficial cut

Which best describes the injury from the Exposure to Physical Hazards?

1. Direct pressure of longer than 10 minutes to stop bleeding
2. Direct pressure of less than 10 minutes to stop bleeding
3. Superficial cut

Which best describes the injury from the Exposure to Physical Hazards?

1. Welts with broken skin, blistering (or, for older injuries, scarring)
2. Welts where the skin is not broken or blistered (or, for older injuries, not scarred)
3. Superficial mark (e.g., red mark)

Which best describes the injury from the Exposure to Physical Hazards?

1. Welts with broken skin, blistering (or, for older injuries, scarring)
2. Welts where the skin is not broken or blistered (or, for older injuries, not scarred)
3. Superficial mark (e.g., red mark)

Which best describes the injury from the Exposure to Physical Hazards?

1. Notable swelling that significantly limits functioning (for example, swollen ankle that requires crutches)
2. Notable swelling that impacts but does not significantly limit functioning (for example swollen ankle that causes limp)
3. Just noticeable swelling

Which best describes the injury from the Exposure to Physical Hazards?

1. Notable swelling that significantly limits functioning (for example, swollen ankle that requires crutches)
2. Notable swelling that impacts but does not significantly limit functioning (for example swollen ankle that causes limp)
3. Just noticeable swelling

Which best describes the injury from the Exposure to Physical Hazards?

1. Bruising that covers a total area about the size of the victim’s hand (in one or multiple bruises)
2. Bruising that is painful in the course of normal activities
3. Non-superficial bruising (dark in color) that covers a total area less than the size of the victim’s hand (in one or multiple bruises)
4. Superficial (very light) bruising

Which best describes the injury from the Exposure to Physical Hazards?

1. Bruising that covers a total area about the size of the victim’s hand or greater (in one or multiple bruises)
2. Bruising that is painful in the course of normal activities
3. Non-superficial bruising (dark in color) that covers a total area half the size of the victim’s hand (in one or multiple bruises)
4. Non-superficial bruising (dark in color) that covers a total area less than half the size the victim’s hand (in one or multiple bruises)
5. Superficial (very light) bruising

Which best describes the injury from the Exposure to Physical Hazards?

1. Pain that (a) significantly limits functioning in normal activities AND (b) lasts at least 24 hours
2. Pain that (a) impacts but does not significantly limit functioning AND (b) lasts at least 24 hours
3. Pain reported (a) that does not limit or impact functioning OR (b) lasts less than 24 hours

Which best describes the injury from the Exposure to Physical Hazards?

1. The nose was broken
2. There was swelling
3. The nose was broken AND there was swelling
4. Neither

Which best describes the injury from the Exposure to Physical Hazards?

1. Medical attention is required to stop the bleeding
2. Bleeding stopped without medical attention

Which best describes the injury from the Exposure to Physical Hazards?

1. Notable damage to eye that significantly limits vision (for example, cut/scratch to the eye area that one cannot keep one’s eye open, or a patch is required while the cut/scratch heals)
2. Notable damage to eye that impacts but does not significantly limit vision (for example, cut/scratch to the eye but one can keep one’s eye open most of the time, it may hurt to blink)
3. Just noticeable damage to eye

Which best describes the injury from the Exposure to Physical Hazards?

1. (a) Third degree burn OR (b) burn that is very deep and marked by skin turning bright red, white, or black and leathery. Pain is typically not reported due to nerve damage.
2. (a) Second degree burn OR (b) a burn that is marked by redness, blisters, and pain.
3. (a) First degree burn OR (b) a burn that is marked by redness, occasional swelling, and some pain.

Was there pain from the Exposure to Physical Hazards?

1. Yes
2. No

Which best describes the pain from the Exposure to Physical Hazards?

1. Pain that (a) limits functioning in normal activities AND (b) lasts at least 24 hours
2. Pain that (a) is felt in the course of normal activities AND (b) lasts at least 24 hours
3. Pain reported but (a) is not felt in the course of normal activities OR (b) lasts less than 24 hours

List of Serious Injuries

• Loss of consciousness,
• Loss of functioning (including, but not limited to, broken bones, detached retina, loose or chipped teeth),
• Heat stroke or heat exhaustion,
• Damage to internal organs (including, but not limited to, internal bleeding or swelling),
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location)

Was there reasonable potential for any of the injuries to occur from the Exposure to Physical Hazards?

1. Yes
2. No

List of Serious Injuries

• Loss of consciousness,
• Loss of functioning (including, but not limited to, broken bones, detached retina, loose or chipped teeth),
• Heat stroke or heat exhaustion,
• Damage to internal organs (including, but not limited to, internal bleeding or swelling),
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location)

How lucky was the person to have not sustained one of these injuries? In other words, what was the inherent dangerousness of the act?

1. Incredibly dangerous (more than 1 in 2 chance of happening)
2. Very dangerous (1 in 4 chance of happening)
3. Dangerous (less than 1 in 4 chance of happening)

The act(s) or pattern of acts for Medical Neglect:

1. extremely impacted the child’s physical functioning
2. highly impacted the child’s physical functioning
3. somewhat impacted the child’s physical functioning
4. did not impact the child’s physical functioning

The act(s) or pattern of acts for Medical Neglect:

1. is extremely likely to impact the child’s physical development
2. is highly likely to impact the child’s physical development
3. is somewhat likely to impact the child’s physical development
4. will not impact the child’s physical development

The act(s) or pattern of acts for Exposure to Physical Hazards:

1. extremely impacted the child’s cognitive functioning
2. highly impacted the child’s cognitive functioning
3. somewhat impacted the child’s cognitive functioning
4. did not impact the child’s cognitive functioning

The act(s) or pattern of acts for Educational:

1. extremely impacted the child’s social functioning
2. highly impacted the child’s social functioning
3. somewhat impacted the child’s social functioning
4. did not impact the child’s social functioning

The act(s) or pattern of acts for Exposure to Physical Hazards:

1. extremely impacted the child’s psychological and somatic functioning
2. highly impacted the child’s psychological and somatic functioning
3. somewhat impacted the child’s psychological and somatic functioning
4. did not impact the child’s psychological and somatic functioning

The act(s) or pattern of acts for Deprivation of Necessities:

1. extremely impacted the child’s functioning (psychological, cognitive, social)
2. highly impacted the child’s functioning (psychological, cognitive, social)
3. somewhat impacted the child’s functioning (psychological, cognitive, social)
4. did not impact the child’s functioning (psychological, cognitive, social)

The act(s) or pattern of acts for Exposure to Physical Hazards:

1. is extremely likely to impact the child’s development (psychological, cognitive, social)
2. is highly likely to impact the child’s development (psychological, cognitive, social)
3. is somewhat likely to impact the child’s development (psychological, cognitive, social)
4. will not impact the child’s development (psychological, cognitive, social)

The act(s) or pattern of acts for Exposure to Physical Hazards:

1. extremely impacted the child’s physical functioning
2. highly impacted the child’s physical functioning
3. somewhat impacted the child’s physical functioning
4. did not impact the child’s physical functioning

The fear or anxiety caused or exacerbated by the incident for Exposure to Physical Hazards:

1. extremely impacted the overall level of functioning
2. highly impacted the overall level of functioning
3. somewhat impacted the overall level or functioning
4. did not impact the overall level of functioning

The act(s) or pattern of acts for Educational:

1. extremely impacted the child’s cognitive functioning
2. highly impacted the child’s cognitive functioning
3. somewhat impacted the child’s cognitive functioning
4. did not impact the child’s cognitive functioning

The act(s) or pattern of acts for Educational:

1. is extremely likely to impact the child’s development (psychological, cognitive, social)
2. is highly likely to impact the child’s development (psychological, cognitive, social)
3. is somewhat likely to impact the child’s development (psychological, cognitive, social)
4. will not impact the child’s development (psychological, cognitive, social)

1. Yes
2. No

Was there a physical impact (including non-observable injuries marked by pain) from the Lack of Supervision?

1. Yes
2. No

Was the MOST SERIOUS injury in the Lack of Supervision incident any of the following: 

• Loss of consciousness,
• Loss of functioning (including, but not limited to, broken bones, detached retina, loose or chipped teeth),
• Heat stroke or heat exhaustion,
• Damage to internal organs (including, but not limited to, internal bleeding or swelling),
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location),
• Death

1. Yes
2. No

Which of the following was the MOST SERIOUS injury from the Lack of Supervision?

1. Damage to skin (cut/more than superficial scratch)
2. Welt
3. Swelling
4. Bruise
5. Pain
6. Damage to eye (cut/scratch)
7. Red marks
8. Scratch
9. Bloody nose
10. Cut inside the mouth
11. Burn
12. Physical impact not listed here

Which best describes the injury from the Lack of Supervision?

1. Direct pressure of longer than 10 minutes to stop bleeding
2. Direct pressure of less than 10 minutes to stop bleeding
3. Superficial cut

Was there pain from the Lack of Supervision?

1. Yes
2. No

Which best describes the pain from the Lack of Supervision?

1. Pain that (a) limits functioning in normal activities AND (b) lasts at least 24 hours
2. Pain that (a) is felt in the course of normal activities AND (b) lasts at least 24 hours
3. Pain reported but (a) is not felt in the course of normal activities OR (b) lasts less than 24 hours

List of Serious Injuries

• Loss of consciousness,
• Loss of functioning (including, but not limited to, sprains, broken bones, detached retina, loose or chipped teeth),
• Heat stroke or heat exhaustion,
• Damage to internal organs (including, but not limited to, internal bleeding or swelling),
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location)

Was there reasonable potential for any of the injuries to occur from the Lack of Supervision?

1. Yes
2. No

List of Serious Injuries

• Loss of consciousness,
• Loss of functioning (including, but not limited to, broken bones, detached retina, loose or chipped teeth),
• Heat stroke or heat exhaustion,
• Damage to internal organs (including, but not limited to, internal bleeding or swelling),
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location)

How lucky was the person to have not sustained one of these injuries? In other words, what was the inherent dangerousness of the act?

1. Dangerous (less than 1 in 4 chance of happening)
2. Very dangerous (1 in 4 chance of happening)
3. Incredibly dangerous (more than 1 in 2 chance of happening)

The fear or anxiety caused or exacerbated by the incident for Lack of Supervision:

1. extremely impacted the overall level of functioning
2. highly impacted the overall level of functioning
3. somewhat impacted the overall level or functioning
4. did not impact the overall level of functioning

The act(s) or pattern of acts for Lack of Supervision:

1. extremely impacted the child’s social functioning
2. highly impacted the child’s social functioning
3. somewhat impacted the child’s social functioning
4. did not impact the child’s social functioning

The act(s) or pattern of acts for Lack of Supervision:

1. extremely impacted the child’s psychological and somatic functioning
2. highly impacted the child’s psychological and somatic functioning
3. somewhat impacted the child’s psychological and somatic functioning
4. did not impact the child’s psychological and somatic functioning

The act(s) or pattern of acts for Lack of Supervision:

1. is extremely likely to impact the child’s development (psychological, cognitive, social)
2. is highly likely to impact the child’s development (psychological, cognitive, social)
3. is somewhat likely to impact the child’s development (psychological, cognitive, social)
4. will not impact the child’s development (psychological, cognitive, social)

Which best describes the injury from the Lack of Supervision?

1. Welts with broken skin, blistering (or, for older injuries, scarring)
2. Welts where the skin is not broken or blistered (or, for older injuries, not scarred)
3. Superficial mark (e.g., red mark)

Which best describes the injury from the Lack of Supervision?

1. Notable swelling that significantly limits functioning (for example, swollen ankle that requires crutches)
2. Notable swelling that impacts but does not significantly limit functioning (for example swollen ankle that causes limp)
3. Just noticeable swelling

Which best describes the injury from the Lack of Supervision?

1. Bruising that covers a total area about the size of the victim’s hand or greater (in one or multiple bruises)
2. Bruising that is painful in the course of normal activities
3. Non-superficial bruising (dark in color) that covers a total area half the size of the victim’s hand (in one or multiple bruises)
4. Non-superficial bruising (dark in color) that covers a total area less than half the size the victim’s hand (in one or multiple bruises)
5. Superficial (very light) bruising

Which best describes the injury from the Lack of Supervision?

1. Pain that (a) significantly limits functioning in normal activities AND (b) lasts at least 24 hours
2. Pain that (a) impacts but does not significantly limit functioning AND (b) lasts at least 24 hours
3. Pain reported (a) that does not limit or impact functioning OR (b) lasts less than 24 hours

Which best describes the injury from the Lack of Supervision?

1. Notable damage to eye that significantly limits vision (for example, cut/scratch to the eye area that one cannot keep one’s eye open, or a patch is required while the cut/scratch heals)
2. Notable damage to eye that impacts but does not significantly limit vision (for example, cut/scratch to the eye but one can keep one’s eye open most of the time, it may hurt to blink)
3. Just noticeable damage to eye

Which best describes the injury from the Lack of Supervision?

1. The nose was broken
2. There was swelling
3. The nose was broken AND there was swelling
4. Neither

Which best describes the injury from the Lack of Supervision? 

1. Medical attention is required to stop the bleeding
2. Bleeding stopped without medical attention

Which best describes the injury from the Lack of Supervision?

1. (a) Third degree burn OR (b) burn that is very deep and marked by skin turning bright red, white, or black and leathery. Pain is typically not reported due to nerve damage.
2. (a) Second degree burn OR (b) a burn that is marked by redness, blisters, and pain.
3. (a) First degree burn OR (b) a burn that is marked by redness, occasional swelling, and some pain.

The act(s) or pattern of acts for Lack of Supervision:

1. extremely impacted the child’s physical functioning
2. highly impacted the child’s physical functioning
3. somewhat impacted the child’s physical functioning
4. did not impact the child’s physical functioning

Which best describes the injury from the Lack of Supervision?

1. Direct pressure of longer than 10 minutes to stop bleeding
2. Direct pressure of less than 10 minutes to stop bleeding
3. Superficial cut

Which best describes the injury from the Lack of Supervision?

1. Welts with broken skin, blistering (or, for older injuries, scarring)
2. Welts where the skin is not broken or blistered (or, for older injuries, not scarred)
3. Superficial mark (e.g., red mark)

Which best describes the injury from the Lack of Supervision?

1. Notable swelling that significantly limits functioning (for example, swollen ankle that requires crutches)
2. Notable swelling that impacts but does not significantly limit functioning (for example swollen ankle that causes limp)
3. Notable swelling that impacts but does not significantly limit functioning (for example swollen ankle that causes limp)
4. Just noticeable swelling

Which best describes the injury from the Lack of Supervision?

1. Bruising that covers a total area about the size of the victim’s hand (in one or multiple bruises)
2. Bruising that is painful in the course of normal activities
3. Non-superficial bruising (dark in color) that covers a total area less than the size of the victim’s hand (in one or multiple bruises)
4. Superficial (very light) bruising

The act(s) or pattern of acts for Deprivation of Necessities:

1. extremely impacted the child’s physical functioning
2. highly impacted the child’s physical functioning
3. somewhat impacted the child’s physical functioning
4. did not impact the child’s physical functioning

The act(s) or pattern of acts for Deprivation of Necessities:

1. is extremely likely to impact the child’s physical development
2. is highly likely to impact the child’s physical development
3. is somewhat likely to impact the child’s physical development
4. will not impact the child’s physical development

The act(s) or pattern of acts for Deprivation of Necessities:

1. is extremely likely to impact the child’s development (psychological, cognitive, social)
2. is highly likely to impact the child’s development (psychological, cognitive, social)
3. is somewhat likely to impact the child’s development (psychological, cognitive, social)
4. will not impact the child’s development (psychological, cognitive, social)

Was there reasonable potential for any of the injuries to occur from the Exposure to Physical Hazards?

• Loss of consciousness,
• Loss of functioning (including, but not limited to, broken bones, detached retina, loose or chipped teeth),
• Heat stroke or heat exhaustion,
• Damage to internal organs (including, but not limited to, internal bleeding or swelling),
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location)

1. Yes
2. No

List of Serious Injuries

• Loss of consciousness,
• Loss of functioning (including, but not limited to, broken bones, detached retina, loose or chipped teeth),
• Heat stroke or heat exhaustion,
• Damage to internal organs (including, but not limited to, internal bleeding or swelling),
• Disfigurement (including, but not limited to, scarring that is meaningful due to its size or location)

How lucky was the person to have not sustained one of these injuries? In other words, what was the inherent dangerousness of the act?

1. Incredibly dangerous (more than 1 in 2 chance of happening)
2. Very dangerous (1 in 4 chance of happening)
3. Dangerous (less than 1 in 4 chance of happening)

The act(s) or pattern of acts for Exposure to Physical Hazards:

1. extremely impacted the child’s cognitive functioning
2. highly impacted the child’s cognitive functioning
3. somewhat impacted the child’s cognitive functioning
4. did not impact the child’s cognitive functioning

The act(s) or pattern of acts for Exposure to Physical Hazards:

1. extremely impacted the child’s psychological and somatic functioning
2. highly impacted the child’s psychological and somatic functioning
3. somewhat impacted the child’s psychological and somatic functioning
4. did not impact the child’s psychological and somatic functioning

The act(s) or pattern of acts for Exposure to Physical Hazards:

1. is extremely likely to impact the child’s development (psychological, cognitive, social)
2. is highly likely to impact the child’s development (psychological, cognitive, social)
3. is somewhat likely to impact the child’s development (psychological, cognitive, social)
4. will not impact the child’s development (psychological, cognitive, social)

The act(s) or pattern of acts for Exposure to Physical Hazards:

1. extremely impacted the child’s physical functioning
2. highly impacted the child’s physical functioning
3. somewhat impacted the child’s physical functioning
4. did not impact the child’s physical functioning

The fear or anxiety caused or exacerbated by the incident for Exposure to Physical Hazards:

1. extremely impacted the overall level of functioning
2. highly impacted the overall level of functioning
3. somewhat impacted the overall level or functioning
4. did not impact the overall level of functioning