The prosecution of child sexual abuse is a key component of our promise as a society to protect our children. The benefits of teamwork in prosecuting child abuse are well established. The success of multidisciplinary teams made up of law enforcement, primary care providers, school personnel, and the Department of Human Services (DHS) begins with the enforcement of mandatory reporting requirements.

Mandatory reporting
Mandatory reporters in Iowa must orally report child abuse to DHS within 24 hours of noticing it. If the child appears to be in imminent danger, the reporter must also notify law enforcement. Within 48 hours of filing an oral report, a mandatory reporter must file a written report with DHS. (List people in Iowa who are mandatory reporters in Iowa)

Defining abuse
The Iowa Department of Human Services has specific legal authority to conduct investigations of child sexual abuse as defined below:

• Child abuse - Non-accidental physical injury or sexual abuse of a child that results from the act or omission of a caregiver
• Sexual abuse - Sexual contact with, or penetration of, the genitalia of either party
• Child - A person younger than 18
• Caretaker - A person responsible for the care of a child. This may be a parent, guardian, foster parent, other relative, any other person who lives with the child, or who provides care for the child but does not live with the child.

Independent of the mandatory report requirements above, other Iowa laws also protect children from sexual abuse. Under these laws, sexual abuse is defined as:

• Forcible sexual contact with a child of any age
• Consensual sexual contact with a child under the age of 14
• When a minor 14 or 15 years old has sexual contact with a person four or more years older, with a member of the same household, with a close relative (by blood or affinity to 4th degree), or with a person who is in a position of authority over the child

Indecent Contact with a Child and Lascivious Acts with a Child are further crimes defined as follows:

• The perpetrator is older than 18
• The child is younger than 14
• Fondling with sexual intent occurs of specified areas of a child’s body, with or without the child’s consent

If DHS does not have jurisdiction over a case that is reported to them, they must report the suspected abuse to law enforcement. When DHS has jurisdiction, they must tell the parents about the allegations of abuse within 5 days of the report. If doing so would create a danger to the child, DHS will get a waiver from the court so that they are not required to notify the parents.

DHS can also conduct a home visit. If they are refused access to the child, the court can give them authority to see the child without parental permission. DHS also has authority to visit the child’s school. Parents do not need to provide prior permission, and schools are required to cooperate. In addition, DHS can remove a child from the home, or impose a no contact order to prevent the abuser from coming into the home or having contact with the child.
 

The role of the health care provider The medical exam is an important component of an allegation of child sexual abuse. It is important for you as a health care provider to carefully document both the child’s history and the physical exam.

It is important for you as a health care provider to carefully document the child’s history and the physical exam.

Documenting information
During the investigation of a child abuse report, DHS or law enforcement personnel will gather physical and documentary evidence, and will observe and interview the child, the perpetrator, and others. For this reason, carefully document any information that the child provides to you as part of the diagnosis and treatment process. Such well-documented information can often be used in court, and the child may not have to testify again. If the child does testify, this documentation can be used to support their testimony.

When you examine the child, it is wise to talk with the child separately from accompanying adults. Children are often embarrassed when asked about sexual acts performed on or by them. Having a parent or other caretaker present can raise the specter that somehow the child has done something wrong, that they need to be ashamed, or that they may face repercussions. Regardless of who the perpetrator is, children are generally more comfortable talking about sexual acts outside the presence of their caretakers.

Caretakers should also be interviewed separately from the child. The information they provide should likewise be carefully documented, because at the time of the original interview the identity of the abuser may be unknown. If an accompanying adult is, in fact, the perpetrator, health care personnel may need to testify to what was said.

The forensic interview. A second component of a medical exam may be a forensic interview to specifically gather information for use in a court of law. Regional child protection centers can link you with professionals who are skilled in conducting such interviews. Contact information for these centers is provided on page 3, “Iowa Child Protection Resources.”

Testimony by this mental health professional may include the child’s statements if these are gathered for purposes of diagnosis or treatment. Forensic interviews should be videotaped so that the child need not face multiple interviews. The interview can provide important evidence; furthermore, it presents the child in a comfortable setting, responding to questions asked by a trained professional. This can make it easier for jurors and judge to assess the child’s body language, demeanor, and physical condition. In addition, a videotaped interview by a forensic professional may eliminate the need for a trial, as offenders who view such videotapes are more likely to plead guilty.

Confidentiality. Mandatory reporters, including health care providers, are given a waiver of confidentiality when they report child abuse. The law says that when a child’s injuries or their cause is under investigation by the court, legal protections related to “privileged communications” with health care or mental health professionals do not apply.

Liability. As mandatory reporters, health care and mental health professionals also have “good faith immunity”; that is, freedom from liability for a report of suspected abuse that is reasonable in light of circumstances.

On the other hand, a mandatory reporter who fails to report suspected abuse is subject to criminal prosecution, as is a person who knowingly makes a false report of abuse.

A prime function of any community is the protection of its children. The cooperation of professionals from health care, DHS, and law enforcement is central to the successful prosecution of abuse. The better we understand our specific roles in this process, and the more information we share, the safer our children will be.

Resources

Child Abuse: A Guide for Mandatory Reporters

Code of Iowa, Chapter 709, Sexual Abuse