Child – Physical

Is the child under the age of 2?

Is the child under the age of 2 years?

  1. Yes
  2. No

Video Transcript:

For this item you’re going to be answering whether the child was under the age of 2. The reason you’re being asked this is because it determines later branching, specifically with actual physical injury or physical impact. The ratings assigned to certain physical impacts or physical injury vary based on the age of the child.

Was there an injury (including non-observable injuries marked by pain)?

Was there an injury (including non-observable injuries marked by pain)?

  1. Yes
  2. No

Video Transcript: 

For this item, you’re going to indicating whether or not there was any physical injury or any physical impact. So you would indicate yes if there were things as severe as loss of consciousness down through a minor superficial scratch. You’re considering any and all physical injuries or physical impacts based on maltreatment for this item.

Was the MOST SERIOUS injury in the incident any of the following: (List of serious injuries)

Was the MOST SERIOUS injury in the 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

Video Transcript: 

If you’ve indicated there was a sustained physical injury or physical impact, the next question your going to answer is whether or not it was a severe injury or impact. The list is very straightforward because it is within the item itself: Loss of consciousness, loss of functioning (which include several things like those that are listed), heatstroke or heat exhaustion, damage to internal organs (again with some language within the item itself to help you), disfigurement and death. It is very straightforward and if any of these occurred, then you indicate yes. This brings you to a severe rating for the incident.

Which of the following was the MOST SERIOUS injury?

Which of the following was the MOST SERIOUS injury?

  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

Video Transcript: 

So if the victim did not sustain any of these severe physical injuries or physical impacts as listed in the previous item, you are brought to this item which contains a fairly extensive list of other possible physical injuries or physical impacts. Three key things to remember here, first wording of the question itself. You are rating the most serious physical injury or physical impact. Often in cases victims report multiple types of physical injuries or physical impacts. If they do, take the most serious from what they are reporting and click it from the list in this item.
The second thing to remember is that you will almost always be asked a pain question as a follow-up. So let’s say your victim is reporting significant bruising, minor scratches, and pain. You indicate that bruising is the most serious, and you’d answer the type of bruise that the victim sustained, and assuming the bruising is not severe in nature, you will be asked to rate pain as a follow-up question. You will get to do that pain follow-up based on any of these that are selected as long as it’s not a severe injury from that list. The third thing to keep in mind is that there is a nice catchall category at the bottom called physical impacts not listed here. You are probably not going to use this often, but there were a few cases in the pilot that used the catchall category.

Which best describes the injury? (Bleeding, Child over 2)

Which best describes the injury?

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

Video Transcript: 

For this item you are going to be rating how long direct pressure was required to stop the bleeding. This information is not always found in reports unless medical or police attention was required to stop the bleeding. If you’re directly interviewing someone, there are some techniques you can use to get this information. You can ask: Were you bleeding? What did you do to stop the bleeding? How long did you do that to stop the bleeding? And if needed, you can ask some follow-up questions. Okay so you said you used gauze, how many gauze pads did you use? At any point did the blood soaked through a gauze pads requiring a new one? Or instead of gauze pads fill in what they’re telling you, paper towels, bandages, and try to get at that information through your interviewing techniques. If you’re unable to ask these questions directly, use your clinical judgment and try to piece together based on the reports that you do have at hand to determine the best possible option.

Which best describes the injury? (Bleeding, Child under 2)

Which best describes the injury?

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

Video Transcript: 

For this item, you are going to be rating how long direct pressure was required to stop the bleeding. This information is not always found in reports unless medical or police attention was required to stop the bleeding. If you’re directly interviewing someone, there are some techniques you can use to get this information. You can ask: Were you bleeding? What did you do to stop the bleeding? How long did you do that to stop the bleeding? And if needed, you can ask some follow-up questions. Okay so you said you used gauze, how many gauze pads did you use? At any point did the blood soaked through a gauze pads requiring a new one? Or instead of gauze pads fill in what they’re telling you, paper towels, bandages, and try to get at that information through your interviewing techniques. If you’re unable to ask these questions directly, use your clinical judgment and try to piece together based on the reports that you do have at hand to determine the best possible option.

Which best describes the injury? (Welts, Child over 2)

Which best describes the injury?

  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)

Video Transcript: 

If welts were the most serious physical injury or physical impact, you’re going to need to know the condition of the victim’s skin to accurately be able to answer the follow-up item. Specifically, you need to know whether or not there was broken skin, blistering, and in the case of older injuries, scarring.

Which best describes the injury? (Welts, Child under 2)

Which best describes the injury?

  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)

Video Transcript:

If welts were the most serious physical injury or physical impact, you’re going to need to know the condition of the victim’s skin to accurately be able to answer the follow-up item. Specifically, you need to know whether or not there was broken skin, blistering, and in the case of older injuries, scarring.

Which best describes the injury? (Swelling, Child over 2)

Which best describes the injury?

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

Video Transcript: 

If swelling was the most serious physical injury or physical impact, you are going to answer how much the swelling impacted the person’s functioning. So did the swelling significantly limit functioning, did it impact but not significantly limit functioning, or was it just noticeable swelling. If you do go into the item itself you’ll notice there’s some helpful language and some examples to help you determine whether significantly limits functioning such as a swollen ankles requires crutches, or impacts but does not significantly limit functioning. In this swollen ankle example, one does not require crutches but results in a limp for the victim.

Which best describes the injury? (Swelling, Child under 2)

Which best describes the injury?

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

Video Transcript: 

If swelling was the most serious physical injury or physical impact, you are going to answer how much the swelling impacted the person’s functioning. So did the swelling significantly limit functioning, did it impact but not significantly limit functioning, or was it just noticeable swelling. If you do go into the item itself you’ll notice there’s some helpful language and some examples to help you determine whether significantly limits functioning such as a swollen ankles requires crutches, or impacts but does not significantly limit functioning. In this swollen ankle example, one does not require crutches but results in a limp for the victim.

Which best describes the injury? (Bruising, Child under Two)

Which best describes the injury?

  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

Video Transcript: 

If bruising was the most serious injury or impact, you’re going to be using two markers to answer the follow-up item. The first marker is the total area of the bruising as is measured by the size of the victim’s hand. So what you need to do is keep in mind how old the victim is and what size they are roughly. If they are in person it’s easier to do it. If you’re not able to interview in person, age and other descriptors for physical characteristics you will be using those to make determination. The other thing to give in mind that the tenderness or pain caused by the bruising. Using those two in combination you’ll be able to answer the bruising item. Again, as is in the case with all of the other physical injuries and physical impacts, you can use some good interviewing techniques if you are able to speak with the affiliated parties for the child case. If you’re not, what you want to be doing is using clinical judgment and piecing together the reports you do have in order to try and answer this question.

Which best describes the injury? (Bruising, Child over Two)

Which best describes the injury?

  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 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 the size of the victim’s hand (in one or multiple bruises)
  5. Superficial (very light) bruising

Video Transcript: 

If bruising was the most serious injury or impact, you’re going to be using two markers to answer the follow-up item. The first marker is the total area of the bruising as is measured by the size of the victim’s hand. So what you need to do is keep in mind how old the victim is and what size they are roughly. If they are in person it’s easier to do it. If you’re not able to interview in person, age and other descriptors for physical characteristics you will be using those to make determination. The other thing to give in mind that the tenderness or pain caused by the bruising. Using those two in combination you’ll be able to answer the bruising item. Again, as is in the case with all of the other physical injuries and physical impacts, you can use some good interviewing techniques if you are able to speak with the affiliated parties for the child case. If you’re not, what you want to be doing is using clinical judgment and piecing together the reports you do have in order to try and answer this question.

Which best describes the injury? (Pain)

Which best describes the injury?

  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

Video Transcript: 

To answer the pain item, you’re going to need to know two things. One, how long did the pain last? Was it less than 24 hours or was it longer than 24 hours? Two, how much the pain impacted the victim. Did it significantly limit their functioning in normal activities? Were they in so much pain that it was hard to walk, hard to sit, hard to lie down? If it wasn’t, maybe it impacted but not significantly limit their functioning. Perhaps their arm or hand hurt and it was difficult to engage in self-care such as person brushing their teeth or hair. They were able to do it but it did impact. Maybe they reported being uncomfortable or took them a long time due to the pain.

Which best describes the injury? (Damage to Eye)

Which best describes the injury?

  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

Video Transcript: 

To answer the damage to eye item, you are going to need to know how the victim’s vision was impacted. Did the damage significantly limited vision? Was it damage to the eye that impacted but did not significantly limit vision? Was it just noticeable damage to the eye? And within the item itself there are some examples for you to follow to help determine whether the physical impact to the eye significantly limited the vision, or just impacted vision.

Which best describes the injury? (Burn)

Which best describes the injury?

  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.

Video Transcript: 

For burn being most serious physical injury or physical impact, you need to know one of two things. You either need to know that the rating of the burn whether it was first, second, or third degree, or you need to match the description found in the item that corresponds with first, second, or third degree burn based on interview data you collected or based on the reports that you have from medical personnel, police, or other third parties. If you look at the item itself, for each rating of first, second, and third there is a description that you can use to determine the final rating for the burn. So you need to know the color of the skin, the pain being reported, and whether blistering happened or not.

Which best describes the injury? (Bloody Nose)

Which best describes the injury?

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

Video Transcript: 

If the most serious physical injury or physical impact was a bloody nose you’re going to need to have the information that follows: whether there was an actual broken nose, whether there was swelling involved. Based on that, you will be able to answer the item. If the nose itself is broken, that is a severe rating for the case. If there was swelling involved, you’re going to be branched to the swelling item and you will be answering some specific questions based on swelling. If neither was involved you’ll be directed to to the pain follow-up.

Which best describes the injury? (Cut in Mouth)

Which best describes the injury?

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

Video Transcript: 

During the pilot of severity, this item did not come up very frequently, but it came up often enough requiring its own separate spot in the list of possible physical injuries and physical impacts. The good news for this item, all you need to know is whether medical attention was required to stop the bleeding for the cut inside the mouth or if medical attention was not required to stop the bleeding inside the mouth.

The act(s) or pattern of acts (Physical Functioning)

The act(s) or pattern of acts:

  1. extremely impacted physical functioning
  2. highly impacted physical functioning
  3. somewhat impacted physical functioning
  4. did not impact physical functioning

Video Transcript:

Physical functioning can take many forms. In this item, you are being asked to rate a physical impact resulting from maltreatment that was not covered in the earlier list of items (like bruising, damage to skin, etc).
Instead of giving an example, here is what to look for:
– How did this physical impact or physical injury limit the person’s physical functioning?
– Was the person able to engage in normal activities?
– Was the person limited in what he or she was able to do?

Was there pain?

Was there pain?

  1. Yes
  2. No

Video Transcript: 

So this is a very straightforward item asking you to indicate whether there was pain or not. For this, you’re thinking of any sort of pain from really debilitating pain and severe tenderness, through slight discomfort maybe not lasting long or if it is not lasting long it is low-level and not really impacting the victim.

Which best describes the pain?

Which best describes the pain?

  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

Video Transcript: 

To answer the pain item, you’re going to need to know two things. One, how long did the pain last? Was it less than 24 hours or was it longer than 24 hours? And you also need to know how much the pain impacted the victim. So did it significantly limit their functioning in normal activities? Were they in so much pain that it was hard to walk, hard to sit, hard to lie down? If it wasn’t, maybe it impacted but not significantly limit their functioning. So perhaps their arm or hand hurt and was difficult to engage in self-care such as person brushing their teeth or hair. They were able to do it but it did impact. Maybe they reported being uncomfortable or took them a long time due to the pain.

Was there reasonable potential for any of the injuries to occur? (Serious Injuries)

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

  • 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

Video Transcript: 

Reasonable potential is perhaps the hardest concept in the severity scales. You’re being asked to re-create the actual incident 100 times with reasonable variation. And then evaluate whether or not a serious physical injury or physical impact could have occurred as a result of those slight reasonable variations.

So what is a reasonable variation? I’m going to run through some case examples just to give you a flavor of reasonable variations being asked of you. So let’s say a husband threw a knife and he missed his wife’s shoulder by 2 inches. Could the knife have reasonably hit her shoulder in a reasonable variation recreation? Yes. Follow-up: would that cause loss of functioning? Perhaps, it could’ve caused significant bleeding and significant pain to the wife. Let’s change the actual incident. Let’s say that the husband threw the knife but he missed his wife shoulder by 20 feet. Was there reason potential for the knife to have hit the wife? No. 20 feet is just too great a distance.

Let’s run through another different example. The mother and her teenage daughter are having a fight at the top of a staircase. Mom pushes daughter, the daughter catches herself from falling down the entire flight of stairs, but in the process of catching her fall she twists her ankle and she has some pain. So she has an actual injury. Is there reasonable potential though to have a more serious injury or physical impact? Yes. In your recreations let’s say she doesn’t catch her fall and she falls down more stairs. That could have perhaps caused a loss of functioning.

Let’s change the actual incident and say the actual fight happened in the living room rather than the top of the stairs. Is there is no potential for severe injury? Probably not. Let’s say you’re running your recreations, a lot of times when clinicians are running recreations, questions come up regarding the environment itself. So in your recreations, are you in reasonable variation allowed to move it from the living room to the top of the staircase? No. If that didn’t actually happen during the incident if they didn’t move from us in the living room and are fighting and they walked upstairs and then continue to fight upstairs, you can’t move the environment in such a drastic measure in your recreations.

Let’s do a younger child example for child neglect. So let’s say a two-year-old left unsupervised in the backyard when dad fell sleep in a hammock because he had a couple of beers. The neighbor saw the child at the top of the pool ladder try to get to the pool, but the neighbor was able to run over to the backyard to move the child away from the pool before falling into the pool, and the child is not able to swim. Is the reason potential for injury in this incident? Yes, certainly. The potential is certainly very high for a loss of consciousness and loss of functioning.

In the recreations would it be reasonable to say the neighbor did not witness this and intervene? Certainly. You can add that to recreations. Would it be possible to change the scenario in ways that there was not potential for serious injury? No, because that is just too many changes. You can’t say “well what if the child could swim?” because it is too unreasonable of a variation. “What if dad was not sleeping?” You can’t add that because dad was actually sleeping. So these are some guidelines to consider in your reason potential recreations as you answer this item in the severity scales.

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

There was reasonable potential for one of these 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 to 1 in 2 chance of happening)
    3. Incredibly dangerous (more than 1 in 2 chance of happening)

    Video Transcript: 

    Reasonable potential is perhaps the hardest concept in the severity scales. You’re being asked to re-create the actual incident 100 times with reasonable variation. And then evaluate whether or not a serious physical injury or physical impact could have occurred as a result of those slight reasonable variations.

    So what is a reasonable variation? I’m going to run through some case examples just to give you a flavor of reasonable variations being asked of you. So let’s say a husband threw a knife and he missed his wife’s shoulder by 2 inches. Could the knife have reasonably hit her shoulder in a reasonable variation or recreation? Yes. Follow-up: would that cause loss of functioning? Perhaps, it could’ve caused significant bleeding and significant pain to the wife.

    Let’s change the actual incident. Let’s say that the husband threw the knife but he missed his wife shoulder by 20 feet. Was there reason potential for the knife to have hit the wife? No? 20 feet is just too great a distance.

    Let’s run through another different example. Let’s say a mother and her teenage daughter are having a fight at the top of a staircase. Mom pushes daughter, the daughter catches herself from falling down the entire flight of stairs, but in the process of catching her fall she twists her ankle and she has some pain. So she has actual injury here. Is there reasonable potential though to have a more serious injury or physical impact? Yes. In your recreations let’s say she doesn’t catch her fall and she falls down more stairs. That could perhaps cause a loss of functioning.

    Let’s change the actual incident. Let’s say the actual fight happened in the living room rather than the top of the stairs. Is there is no potential for severe injury? Probably not. Let’s say you’re running your recreations, a lot of times when clinicians are running recreations, questions come up regarding the environment itself. So in your recreations, are you in reasonable variation allowed to move it from the living room to the top of the staircase? No. If that didn’t actually happen during the incident if they didn’t move from us in the living room and are fighting and they walked upstairs and then continue to fight upstairs, you can’t move the environment in such a drastic measure in your recreations.

    Let’s do a younger child example for child neglect. So let’s say a two-year-old left unsupervised in the backyard when dad fell sleep in a hammock because he had a couple of beers. The neighbor saw the child at the top of the pool ladder try to get to the pool, but the neighbor was able to run over to the backyard to give a child away from the pool before the child fell in, and the child was unable to swim. Is the reason potential for injury in this incident? Yes certainly. The potential is certainly very high here for a loss of consciousness and loss of functioning.

    In the recreations would be reasonable to say that the neighbor did not witness this and intervene? Certainly you can add that to recreations. Would be possible to change the scenario in ways that there was not potential for serious injury? No because that is just too many changes. You can’t say “well what if the child could swim?” because it is too unreasonable of a variation. “What if dad was not sleeping?” Can’t add that because dad was actually sleeping. So these are some guidelines to consider in your reason potential recreations as you answer this item in the severity scales.

The fear or anxiety caused or exacerbated by the incident: (Overall Functioning)

The fear or anxiety caused or exacerbated by the incident:

  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

Video Transcript: 

Here’s one of the typical current functioning items that you will see in the severity scales. But in this case it relates directly back to the fear and anxiety caused or exacerbated by the incidents. So when you’re thinking about the child, bear in mind those symptoms are either reported or simply observed. Therefore, was the child verbalizing by saying they are in fact feeling fearful or anxious, and how is that impacting the functioning. Or are they not saying it but perhaps acting in a way that implies they are in fact fearful or anxious after the incident that is impacting those five major areas of functioning.