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HomeMy WebLinkAboutPolicies - New Hope DV/SAr91 Fids Hope Helping Children become Children again Policy and Procedure Approval Letter June 24, 2019 To: Kids Hope Employees and Volunteers Re: Policies and Procedures =I' It is necessary to establish a framework within which the efforts of employees and volunteers of Kids Hope can be directed which will advance both the objectives of the organization and the interests of individuals served. These operational policies and procedures are meant as a guide for both employees and volunteers when appropriate. It is not meant to be inclusive of every possible situation that may arise. Kids Hope, is a Children's Advocacy Center under the governance umbrella of Grant County. The program reports directly to the Grant County Board of Commissioners. Employees are expected to be familiar with all Kids Hope policies and procedures. Additionally, Grant County provides comprehensive personnel policies and procedures that are introduced during orientation. Any questions regarding the content or intent of this manual should be directed to the Children's Advocacy Center Director. Staff and volunteers may recommend a change in existing policies to the Director at any time. Likewise, matters of importance not covered by the policies and procedures should be brought to the attention of the Director in order that new policies may be formulated if necessary. These policies and procedures have been reviewed and approved, as signified by signatures below. 1 , Tom Taylor, Tir Cindy C ter, Vice Chair Richard Stevens, Member % e2t419 Date Kids Hope Children's Advocacy Center Policies and Procedures Suzi Fode, Director 5/17/2019 Fids Hope Helping Children become Children again This Policy and Procedures document is intended to improve the quality of services to child victim's, non -offending family members, and caregivers through a coordinated multi -disciplinary team response to allegations of child physical abuse, child sexual abuse, and non-accidental child death. The policies and procedures contained herein are designed to be congruent with the Grant County Investigation Protocol for Child Sexual Abuse, Neglect, and Child Fatalities. Any discrepancies between the documents are unintentional and require resolution. Page 1 1 Table of Contents INTRODUCTION AND OVERVIEW................................................................ 3 OPERATIONAL GUIDELINES........................................................................ 4 MULTIDISCIPLINARY TEAM........................................................................ 4 MEMBERROLES.......................................................................................... 5 Policy #1: MULTIDISCIPLINARY TEAM ........................................................ 7 Policy #2: CHILD FOCUSED AND SAFE FACILITY .......................................... 9 Policy #3: VICTIM SUPPORT AND ADVOCACY .............................................. 10 Policy #4: FORENSIC INTERVIEWS............................................................. 11 Policy #5: CULTURAL COMPETENCIES AND DIVERSITY ............................... 13 Policy #6: CASE REVIEW........................................................................... 14 Policy #7: CASE TRACKING....................................................................... 15 Policy #8: MENTAL HEALTH AND THERAPEUTIC SERVICES ........................ 16 Policy #9: MEDICAL SERVICES.................................................................. 17 Policy #10: CONFIDENTIALITY................................................................. 19 Page 12 INTRODUCTION AND OVERVIEW The Kids Hope Children's Advocacy Center (KHCAC) is a neutral, child friendly facility helping meet the needs of children, non -offending family members and caregivers in Grant and Adams Counties. KHCAC provides advocacy and forensic interview services with referrals to partner agencies specializing in medical examination and treatment, and therapeutic evaluation and treatment. The purpose of this manual is to ensure a successful conclusion to each investigation and minimize trauma to child victims by: 1) Establishing a working agreement among the various agencies responsible for investigating allegations of child abuse and neglect (CA/N), and for providing support to victims and their non -offending parents or caregivers; 2) Promoting well -coordinated, efficient, thorough and reliable investigations that benefit from the input of individuals with widely differing skills and experiences; 3) Fostering an attitude of mutual respect and understanding among participating agencies, and; 4) Ensuring that children involved in investigations are protected, supported, and treated with dignity and respect in a trauma informed environment. We recognize that these goals can be achieved through the implementation of a comprehensive and unified approach that recognizes and respects the different training, skills, and experiences of each participant, the varying duties and obligations of each agency, and the special needs of child victims. Where appropriate, investigations shall involve one or more of the following disciplines: • Law Enforcement • Child Protective Services • Prosecution • Medical • Mental Health • Victim Advocacy • Children's Advocacy Center (Multidisciplinary Team) Each case involving a child victim is unique. Circumstances may arise when this manual does not provide adequate guidance, or may conflict with the needs of a particular child. In such circumstances, decision-making shall be consistent with the spirit of the "Grant County Child Sexual Abuse, Physical Abuse, Neglect, and Child Fatality Investigation" protocol, and this document. Page 13 OPERATIONAL GUIDELINES The KHCAC primarily serves alleged child victims of sexual or physical abuse or neglect in Grant and Adams Counties. KHCAC also provides forensic interviewing services, and advocacy for child victims living in Grant or Adams Counties whose victimization occurred outside Grant or Adams Counties as well as child victims living outside Grant or Adams Counties in response to a request from Child Protective Services and/or Law Enforcement. MULTIDISCIPLINARY TEAM Members of the multidisciplinary team include representatives of the following agencies: • Law Enforcement o Coulee Dam Police Department o Ephrata Police Department o Grand Coulee Dam Police Department o Grant County Sheriff's Office o Mattawa Police Department o Moses Lake Police Department o Quincy Police Department o Soap Lake Police Department o Warden Police Department o Ritzville Police Department o Othello Police Department o Adams County Sheriff's Office • Prosecution o Grant County Prosecuting Attorney o Adams County Prosecuting Attorney • Child Protective Services o CPS Moses Lake DCYF Community Services Office • Medical Providers o SANE Samaritan Healthcare • Mental Health Providers o Grant Integrated Services o Individual Sub -contracted mental health providers • Victim Advocacy o New Hope • Children's Advocacy Center o Kids Hope Children's Advocacy Center A KHCAC Multi -Disciplinary Memorandum of Understanding (MOU) is agreed to by the above partners. Page 14 MEMBER ROLES Law Enforcement Law enforcement is charged with investigating allegations of criminal conduct occurring within their jurisdiction. Investigations may include interviewing persons having knowledge of the allegations, identifying and collecting evidence, making custodial arrests, placing children in protective custody, and referring investigations to the prosecuting attorney for review. With respect to criminal investigations where allegations of child physical abuse, child sexual abuse, child neglect, or non-accidental child death are made, law enforcement may also be required to report to Child Protective Services, and/or other law enforcement agencies. Child Protective Services Child Protective Services investigates allegations of child neglect, child physical abuse, child sexual abuse, and non-accidental child death. Where allegations may reasonably involve the commission of a crime, CPS is required to report to law enforcement. • CPS will strive to conduct joint investigations with law enforcement to minimize emotional trauma to child victims and reduce duplication of effort. • CPS will report the outcome of cases they investigate to KHCAC. Prosecuting Attorney The Grant and/or Adams County Prosecuting Attorney and his/her deputy prosecutors review criminal investigations and when appropriate, file formal criminal charges against those believed to have committed a crime within Grant or Adams County. • The Prosecuting Attorney will report Criminal Filings associated with child victims and the final disposition of these criminal cases to NHCAC. • The Prosecuting Attorney will regularly communicate with law enforcement regarding ongoing investigations/cases to ensure the best possible outcome. Medical Providers Sexual Assault Nurse Examiners or appropriate medical providers with specialized training in pediatric examinations, conduct physical examinations on children suspected to be the victim of child physical abuse and/or child sexual abuse, for treatment and evidence collection. • SANE examination documentation and any evidence collected will be turned over to the requesting law enforcement agency. Mental Health Grant Mental Healthcare is a part of Grant Integrated Services providing therapeutic services to Children, Families, and Adult clients in Grant County. Services include initial and crisis services, assessment and individual therapy. KHCAC may sub -contract mental health services from individual providers ensuring they use evidence based practices and are trauma informed. Page 15 When appropriate, therapists will ask clients or their parent/guardian to sign a consent to release information form allowing for a sharing of appropriate information with the MDT. Advocacy New Hope is a Grant County agency providing advocacy to victims of sexual abuse, domestic violence, and crime victims in Grant and Adams Counties. New Hope will provide advocacy services, and referrals to other social service agencies to any child victim and his/her non -offending family members when appropriate. Children's Advocacy Center The Kids Hope Children's Advocacy Center (KHCAC) is responsible for providing a child friendly neutral environment for child victims, non -offending family members, and caregivers to receive services, conduct child forensic interviews, and work with an advocate. KHCAC will collect information on active investigations involving child victims and facilitate regular case review (MDT) meetings, report demographic information, and facilitate peer reviews. KHCAC will organize, schedule, and host quarterly meetings with partnering agency heads to review County and CAC policies and protocols governing the investigation, prosecution, and review of Child Abuse, Neglect, and Non -Accidental Death in Grant and Adams Counties. KHCAC will provide advocacy services, and referrals to other social service agencies to any juvenile crime victim and his/her non -offending family members when appropriate. KHCAC will provide a forensic interview room for use by law enforcement and CPS. In addition, KHCAC will conduct forensic interviews of child victims and witnesses when requested by law enforcement or CPS. KHCAC will schedule use of the forensic interview room upon request and will provide the requesting agencies representative with an audio/video DVD at the conclusion of the interview. Page 16 Policy 1: MULTIDISCIPLINARY TEAM Definition: The Multidisciplinary team (MDT) is comprised of representatives of core systems necessary for an optimal response to allegations of child abuse. These include: • Law Enforcement • Medical Services • Child Protective Services • Prosecutor's Office • CAC • Mental Health Services • Victim Advocacy Policy: Multidisciplinary Teams (MDTs) are the basis for the operation of the Kids Hope Children's Advocacy Center (KHCAC), in both the oversight of the CAC and in meeting client needs. A coordinated MDT approach facilitates efficient interagency communication and information sharing, ongoing involvement of key individuals, and support for children and families. Procedures: • The KHCAC MDT meetings are a monthly forum used as the basis for the review of CAC cases, to exchange information, and to discuss challenging cases. The KHCAC MDT meeting includes CAC staff, various law enforcement agencies, child protective services, prosecution, mental health services, medical staff, and victim advocates. • KHCAC seeks administrative members of their agencies to sign a Memorandum of Understanding agreeing to support a multidisciplinary process in child abuse investigation and providing support services for victims and families. The Memorandum of Understanding is signed at least every other year by participating agencies. This document commits the signed parties to a multidisciplinary child abuse intervention response. • Information on KHCAC processes and partner services is provided to non -offending caregivers at the time of the child forensic interview. This includes an overview of victim support, medical, and mental health services. • As stated in the Memorandum of Understanding and the County Protocol on Investigation and Prosecution of Child Abuse and Child Fatalities, personnel participating with the KHCAC agree to maintain confidentiality of all records and information gathered on any cases, as required by state and federal law. Attendees sign a Multidisciplinary Team Confidentiality Agreement. • An assessment of MDT functioning is done periodically through bi-annual OMS surveys of MDT functioning. Surveys are dispersed both electronically and on paper prior to 2 MDT meetings each year. It addresses teamwork elements such as: trust and respect, collaboration and well-defined purpose, role of disciplines, feedback opportunities, group Page 17 confidence, case review and productivity, resource sharing and success in accomplishing goals. The CAC will regularly provide or facilitate training or other education opportunities to MDT members focused on issues relevant to investigation, prosecution, and service provision for victimized children and their non -offending caregivers. Page 18 Policy 2: CHILD FOCUSED AND SAFE FACILITY Policy: Kids Hope Children's Advocacy Center is maintained as a welcoming, neutral and safe place for children and their non -offending caregivers and/or family members. Essential Components: • The facility is maintained as a clean, comfortable space in which forensic interviews, medical evaluations, referrals for other services, and meetings can take place. • Private meeting spaces are available to assure confidential discussions among investigation team members and families. • Live observation of forensic interviews is available to MDT members. • The building is physically accessible to clients with special needs. • In performing the duties of the CAC, the CAC ensures separation of victims and alleged offenders. • All visitors of the CAC are supervised or observed by a staff person at all times. • The facility decorations and toys reflect the cultural diversity and developmental levels of CAC clients. • Child areas are safe and sanitized. Page 19 Policy 3: VICTIM SUPPORT AND ADVOCACY SERVICES Policy: The Kids Hope Children's Advocacy Center partnering agencies make available free support and advocacy services to CAC clients and their non -offending caregivers as part of the multidisciplinary team response. Active follow-up is completed by case managers and these services are consistently made available, at minimum, throughout the life of the case. Procedure: The Kids Hope Children's Advocacy Center Staff provides: • Greeting and orientation of children and non -offending caregivers to the CAC and the multidisciplinary response team; • Referral to partnering service providers; • Written information on protecting children and recognizing behavior that may indicate the need for counseling for victims of sexual abuse and trauma; • Consultation and coordination with New Hope victim advocates when there are child victims from the same family who are in both the 12 and under, and 13 and older age groups in order to avoid duplication of service and meet the unique needs of the victims and their non -offending caregivers. Coordination meetings will be called as necessary; The New Hope Legal and Community Advocates provide: • Advocacy for child abuse victims (including, but not limited to, physical abuse, neglect, witness to violence, and drug endangerment) and their non -offending care givers; • Assistance in procuring concrete services such as housing, food, transportation, public assistance, protective orders, and domestic violence intervention. • Assistance with accessing information about case status and investigational processes and support during trials and interviews; • Education, resources, and referrals, including information on Crime Victims Compensation; • On-going advocacy including emotional support, informed decision making and safety planning which extends beyond the criminal process; • All New Hope advocates working with CAC clients meet training requirements as required by the National Children's Alliance (NCA). The County Prosecutor's Office Victim Witness Program provides: • Advocacy and support for the victim throughout the criminal justice process from charging to final disposition of the case; • Information about the investigation and prosecution process; • Updates on case status, continuances, dispositions, sentencing. • Court education/support/accompaniment if needed; • Information on and referral to other community-based advocacy services when relevant. Page 110 Policy 4: FORENSIC INTERVIEWS Policy: The KHCAC forensic interviews are conducted in a manner that is legally sound, unbiased, fact-finding, developmentally and culturally sensitive, non -leading and neutral. All interviews are performed by trained staff and follow the guidelines outlined in the Washington State Criminal Justice Training Commission training curriculum. Purpose: The purpose of the forensic interviews is to allow a child to provide clear and complete information about incidents that may be related to criminal activity. Interviews may address alleged physical or sexual abuse of the child, kidnapping, witnessing abuse of others, domestic violence, homicide or other crimes. Procedure: • Forensic interviews are done at the KHCAC whenever it does not compromise the investigation or the safety of the child. The KHCAC is recognized as best equipped to meet the child's needs during the interview. • When a child under thirteen (13) years of age is reportedly a victim of sexual abuse, physical abuse or neglect, the forensic interview should be conducted by a person who has received the training required under RCW 43.101.224 and/or RCW 74.146.010. • When a child between the ages of thirteen (13) years and fifteen (15) years is reportedly a victim of sexual abuse, physical abuse or neglect, the forensic interview is recommended to be conducted by a person who has received the training required under RCW 43.101.224 and/or RCW 74.146.010. • When a child is over the age of fifteen (15) years, when practical the investigator(s) should evaluate the child's developmental level and consider any disabilities the child may have before interviewing the child, or referring the child to a forensically trained interviewer. • Exclusionary criteria prohibit service to youth or adults who are suspected perpetrators of sexual abuse. Exceptions may be made for young children who do not meet the legal standard to be charged with sexual offenses. • Caregivers are asked to reschedule a forensic interview if the child has a fever (100 degrees or higher), is vomiting and/or has diarrhea, flu symptoms, or another other communicable illness. The interview will be rescheduled after the child has been symptom-free for 24 hours. • The referring agency checks availability with the interviewer and schedules the interview with the non -offending caregiver. KHCAC staff informs other relevant Multidisciplinary Team (MDT) members. • The forensic interviewer has access to the information provided by the law enforcement officer and/or discussion with those multidisciplinary team (MDT) members involved in initial contact with the child. Information includes whether the child has any special needs that may be relevant to the interview process, including health care needs, interpreters, modifications in the interview room, or specific interview strategies. • Interviews at the KHCAC are audio and visually recorded on a flash drive or DVD. • Post -interview information sharing includes discussion among those MDT members present and distribution of the recording to designated investigating departments. • Proof of forensic interview training is kept on file at the KHCAC. Page 1 11 • When interviews take place outside the KHCAC, trained interviewers follow the guidelines of the Child Interview Guide. • Interviewers are informed of and encouraged to participate in confidential periodic peer review of interviews. • The KHCAC sponsors periodic training to support quality forensic interviewing by Kids Hope CAC partnering agencies. • Interviews at the KHCAC are routinely observed by partnering agency representatives, which may include the Prosecuting Attorney, CPS, law enforcement, and KHCAC staff. • Others may be approved to watch the interview for training purposes or quality assurance -related functions. Permission of the interviewer and the investigating officer will be requested and a confidentiality form completed. • Multisession and/or subsequent interviews are conducted at the discretion of Law Enforcement, in consultation with MDT members, with consideration of the well-being of the child and the integrity of the investigation. Subsequent interviews may be appropriate when the child is unable to complete the interview in one session, the child is forthcoming with new information, or additional information is needed to complete the investigation. These determinations will be made with caution to prevent harm to the child. • When a backup interviewer is needed, an NICHD trained Child Forensic Interviewer will be requested from Moses Lake Police Department, Grant County Sheriff's Office, CPS or another trained Child Forensic Interviewer may be determined after consultation with the prosecutor. Page 1 12 Policy 5: CULTURAL COMPETENCY AND DIVERSITY Policy: Culturally competent services are routinely made available to all CAC clients and coordinated with the multidisciplinary team response. Procedure: • The KHCAC conducts or obtains a community assessment of CAC client demographics and community demographics every three (3) years. The assessment data is analyzed for disparities and gaps, then strategies to meet those disparities and gaps are recommended by CAC leads to develop goals and strategies that support culturally sensitive services. • Practices and resources are in place which support KHCAC services to non-English speaking and deaf or hard of hearing children and their families. Local language interpretation services or qualified KHCAC bilingual staff provide interpretation services. • Multidisciplinary team members ensure early identification of cultural considerations and special needs of clients throughout the investigation, intervention and case management process. The KHCAC intake form requests relevant cultural issues and special healthcare needs that could affect optimal delivery of services. • KHCAC staff and partnering agencies engage in outreach to minority cultures. Strategies include recruitment of bi-cultural staff and volunteers and providing written materials in the language of clients. • Cultural competency of KHCAC staff and multidisciplinary team members is supported by specialized training. • This policy is reviewed at least every three years and may be updated as needed. Page 1 13 Policy 6: CASE REVIEWS Policy: KHCAC cases will be reviewed on a regular basis by a multidisciplinary team collaborating on issues of protection, advocacy, mental health and medical needs and legal processes. This formal process enables the MDT to monitor and assess its independent and collective effectiveness so as to ensure the safety and well-being of children and families. Procedures: • "Open" cases are those presently within the jurisdiction of a Grant or Adams County law enforcement agency or the prosecutor's office. The CAC Coordinator tracks such cases and enters them in the CAC data base. • A basic triage review of open cases occurs once per month, at the KHCAC MDT Case Review meeting, regularly held at Samaritan Hospital or KHCAC. This group is a core multidisciplinary team (MDT) for the Kids Hope Children's Advocacy Center. • Additional case review time for challenging cases can be requested by any MDT member and scheduled by the CAC Coordinator. The CAC Coordinator will facilitate the case review. • Case reviews cover, at a minimum, the medical evaluation, protection and safety issues for the child, and criminal investigation/prosecution activities. • Relevant cultural, medical, developmental or educational issues that may affect the child victim's ability to communicate and assist in the investigation are identified and considered in developing service plans. • Case reviews are utilized as an opportunity for MDT members to increase understanding of the complexity of child abuse cases. Topics may include, but are not limited to, research relevant to child abuse, service gaps, family dynamics, socioeconomics, and child rearing practices. • The week prior to a case review meeting, a KHCAC staff member will send a reminder e- mail to MDT members which will include the proposed agenda, as well as the option for MDT members to request an additional case to review or an additional agenda item. • Members of an MDT for case reviews will include representatives of Law Enforcement, Prosecutor's Office, CPS, KHCAC, mental health, medical and support/advocacy staff. • Confidentiality of information and guiding principles are discussed and agreed to by all those present as representatives of agencies signing the Kids Hope MOU. • KHCAC staff or an advocate communicates information from the case review to other involved parties when necessary. • Cases are closed by the KHCAC when closed by the involved law enforcement agency or prosecutor's office. • KHCAC basic case criteria includes children who are victims of alleged abuse. Cases may address alleged physical or sexual abuse of the child, kidnapping, witnessing abuse of others, domestic violence, homicide or other crimes. Page 1 14 Policy 7: CASE TRACKING Policy: The KHCAC tracks open cases and services to obtain demographic information, monitor progress through the legal system, assess client needs, and to identify issues for improving operational performance. Procedure: • Partnering agencies provide data on referred cases through an initial Forensic Interview Request form and as requested monthly by KHCAC staff. • KHCAC staff track open case activities. "Open" cases are those that meet KHCAC case acceptance criteria and are under jurisdiction of the Grant or Adams County criminal justice systems. • Data is gathered monthly and shared at case reviews. • KHCAC cases are "closed" and moved to an inactive case tracking document when a final legal disposition is reached. • KHCAC staff prepare a spreadsheet of active cases that are currently being tracked to be presented to MDT members at the monthly MDT case review meeting. • At a minimum the KHCAC tracks case information including demographics for victims and offenders, type(s) of suspected abuse, relationship of alleged offender to child, multidisciplinary involvement, charges, criminal disposition, child protection outcomes, and status/follow-through of medical and mental health referrals. • Data tracked is required by the National Children's Alliance and is submitted bi-annually by KHCAC staff. Page 1 15 Policy 8: THERAPEUTIC AND MENTAL HEALTH SERVICES Policy: The KHCAC provides appropriate referral to therapeutic and mental health services for victims and their non -offending caregivers. The common focus is to foster healing by minimizing potential trauma to children and their non -offending caregivers. This may include mental health services, parent education and support services. • The KHCAC consults with the victim and/or family on needs for services, and makes appropriate referrals to qualified and trained mental health providers as agreed to by the client or his/her non -offending caregiver. • Client confidentiality and mental health records are protected in accordance with state and federal laws. • The KHCAC mental health services partners are Grant Integrated Services and private practice providers. Services include assessment, crisis intervention, individual and group therapy for primary and secondary victims served by the KHCAC. • When appropriate, child victims and their non -offending family members are referred to New Hope for services such as case management, advocacy, parent support, etc. • Services are available regardless of the client's ability to pay. • Mental health providers have specialized training in, and deliver trauma -focused, evidence -supported mental health treatment, in accordance with NCA accreditation requirements. • Mental health clinicians provide documentation to the KHCAC to demonstrate completion of 40 hours of therapist core training (including specific training in trauma -informed assessment and treatment) within 6 months of seeing their first KHCAC client, and continuing education in the field of child abuse constituting a minimum of 8 contact hours every 2 years. • Mental health clinicians provide support to the MDT through the following regular activities: attendance and participation in MDT case reviews, sharing relevant information with the MDT while protecting client confidentiality, providing clinical consultation to the MDT on issues relevant to child trauma and evidence -based treatment, and supporting the MDT in the monitoring of treatment progress and outcomes Mental health providers are invited to relevant training known by or offered through the KHCAC. Page 116 Policy 9: MEDICAL SERVICES Policy: The KHCAC provides referrals to non -emergent medical evaluations for all KHCAC clients regardless of ability to pay. The purposes of a medical evaluation in suspected child abuse cases include: an accurate and complete history to make a medical diagnosis, assessment of the child for any developmental, emotional, or behavioral problems needing further evaluation and treatment and make referrals as necessary, differentiate medical findings that are indicative of abuse from those which may be explained by other medical conditions, reassure and educate the child and family, and help ensure the health, safety, and well-being of the child. Referral for Emergent Medical Evaluations' Signs or symptoms warranting emergency department care for actual or suspected abuse: • Suspected intentional physical injury (bruises, cuts, fractures, burns) • Genital complaints (vaginal bleeding or genital bleeding bruising or unexplained genital or urinary pain, • Genital discharge or lesions suggestive of STIs, • Report of non-consensual penile -genital or penile -oral contact within 5 days (120 hours) for children up to 18 years old. (Harborview Center for Sexual Assault and Traumatic Stress, 2017) Referral for Urcient Medical Evaluations Sexual Assault evaluations should be scheduled for children who present with none of the criteria for emergent evaluation, and one or more of the following: • Clear disclosure • Witnessed episode of abuse and or developmentally inappropriate sexual contact • Reasonable cause to believe that a child has suffered abuse • Suspicious contact by a known registered sexual offender • Sibling of a known or highly suspected sexual assault victim • Child who is uncooperative with an office exam when abuse is suspected • Reoccurring sexual talk or behaviors in young children that is not typical for their age and development • Genital contact by another peer or older person. Referral for Non -Urgent Medical Evaluations by child's PCP is indicated for • Complaints of sore/red bottom • Painful urination/defecation • Sudden onset of Enuresis (wetting) and encopresis (soiling) Procedures • The KHCAC Coordinator, law enforcement, CPS staff and the parent /guardian review the presenting concerns and determine the need for a medical assessment. ' If the abuse is alleged to have occurred within the last 120 hours and physical evidence is possible the referring agency or family is directed to Samaritan Hospital, where SANE nurses are available to assist with forensic child abuse exams. Page 117 • KHCAC staff are available to assist in the scheduling of a medical examination with a qualified medical provider. • Medical staff are responsible to: • Complete a medical history, a physical exam and a colposcopic exam when appropriate. • Access expert consultation when medical findings indicate possible child sexual or physical abuse. • Inform parents/guardians of medical findings following the physical exam. Information sharing and record security • The medical records (DVD and written report) are maintained at the medical facility, kept in a secure location and are subject to confidentiality laws. These records are only released to law enforcement, CPS, the Prosecutor's Office, and the medical peer review agency. • Findings of the medical evaluation are shared with MDT members present following the evaluation and at case reviews. Page I IS Policy 10: CONFIDENTIALITY Policy: The KHCAC, acting as part of a multidisciplinary team of signatories for the Kids Hope MDT Memorandum of Understanding meets all confidentiality requirements as mandated by the MOU. Written and oral information exchanged or disclosed to partnering agencies is considered confidential and can only be used for purposes of advancing an investigation and providing appropriate services to victims and their families. Procedures: • During multidisciplinary team meetings and case reviews, notes are taken only as related to assignments. Minutes will not identify clients and will be for the purpose of documenting tasks, changes in practice, and any quality improvement related activities. • A "Multidisciplinary Team Confidentiality Agreement' is signed by attending members prior to MDT Case Review Meetings. • Any paperwork that includes client identification is shredded following use. • KHCAC client information is kept in locked files at the KHCAC. • Staff involved in administrative oversight, quality improvement and assessment activities, case consultation and peer review have access to client records and interview materials as needed and are expected to uphold agency, state and federal confidentiality laws. • Forensic interview materials, including video or audio tapes and transcripts which identify the child, can be used for general education purposes only with permission of the client or guardian. Page 1 19