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Welcome to the Child Abuse/Neglect Reporting & Human Trafficking online training.

A Guide for Title X Family Planning Service Providers in New Mexico.

Please Note The Following Program Requirements for Title X Family Planning Projects Before Beginning This Course:

• Recipients of Title X funding must comply with federal Title X regulations, including regulations on consent to care and confidentiality.
• Recipients must also comply with applicable state law, including mandatory child abuse/neglect reporting laws.
• A copy of the Office of Population Affairs (OPA) APRIL 2014 Program Requirements for Title X Family Planning Projects is available here.
• 9.12 Title X grantees must comply with applicable legislative mandates set out in the HHS appropriations act. Grantees must have written policies in place that address these legislative mandates: "None of the funds appropriated in the Act may be made available to any entity under Title X of the Public Health Service Act unless the applicant for the award certifies to the Secretary of Health and Human Services that it encourages family participation in the decision of minors to seek Title X services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual activities."

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[Title X Program Requirement 9.12 "Notwithstanding any other provision of law, no provider of services under Title X of the Public Health Service Act shall be exempt from any State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest."]

© The New Mexico Department of Health

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Let's Begin!

Getting Started

The purpose of this course is to provide Title X providers with an overview of some pertinent federal and NM consent, confidentiality, and child abuse/negelect and human trafficling reporting laws and is not intended to take the place of your agency protocols or federal and state laws.

This training does not address the confidentiality and reporting laws that may apply in other service settings, such as schools, or with other patient populations, such as dependent adults.

Important Information | Title X grantees are responsible for the training of all project staff

• 8.6.1 Projects must provide for the orientation and in-service training of all project personnel, including the staff of sub-recipient agencies and service sites (42 CFR 59.5(b)(4)).
• 8.6.2 The project's training plan should provide for routine training of staff on Federal/State requirements for reporting or notification of child abuse, child molestation, sexual abuse, rape or incest as well as on human trafficking.
• 8.6.3 The project's training plan should provide for routine training on involving family members in the decision of minors to seek family planning services and on counseling minors on how to resist being coerced into engaging in sexual activities.

Lesson Menu

• Lesson One - Counseling Minors in Family Planning Clinics

  By the end of this course you will be able to:

  • Learn counseling strategies
  • Identify sexual coercion screening questions
  • Practice your communication skills

• Lesson Two - Reporting Child Abuse and Neglect

  By the end of this course you will be able to:

  • Learn New Mexico child abuse/neglect laws
  • Determine when and how to report suspected child abuse/neglect

• Lesson Three - Human Trafficking

  By the end of this course you will be able to:

  • Identify the three categories of human trafficking.
  • Determine when and how to report suspected human trafficking

Lesson One

Adolescence

Adolescence is a time of experimentation and risk taking. Developmentally adolescents are at a crossroads of health. Emerging cognitive abilities and social experiences lead adolescents to question adult values and experiment with health risk behaviors. Some behaviors threaten current health, while other behaviors may have long-term health consequences. The changes in cognitive abilities, however, offer an opportunity to develop attitudes and lifestyles that enhance health and well-being.

Reference:American Medical Association, Guidelines for Adolescent Preventative Services.

(1/15)

Lesson One

Importance of Title X Services for Adolescents

Adolescents in the U.S. must continue to have access to affordable and confidential family planning services.

1. Although there have been declines in teen pregnancy rates, due in part to contraceptive use, the United States still has one of the highest rates in the industrialized world.
2. Adolescents and young adults are at a higher risk for acquiring sexually transmissible infections (STIs) than other adults, and teens account for one-quarter of the approximate15 million new STI cases in this country each year.
3. Yet, high costs, lack of access and concerns about confidentiality keep teens from seeking health services that are crucial to their well-being.

References 1. Teen pregnancy: trends and lessons learned, 2002 Issues in Brief 1, The Alan Guttmacher Institute, April 2002. 2. Sexually transmitted disease surveillance, Tracking the hidden epidemics, Trends in STDs in the United States, Centers for Disease Control and Prevention. September 2002. 3. Zabin, L.S. and Clark, S.D., Why they delay: a study of teenage family planning clinic patients, Vol. 13, No. 5, Family Planning Perspectives.

Did You Know?

(2/15)

Lesson One

Consent

The Title X program eliminates many of the obstacles that prevent teens from accessing reproductive health-care services. Title X funds health-care facilities across the country to provide low-cost and confidential services for adolescents and adults. Currently, minors can obtainTitle X services without parental consent or notification in most circumstances. Research has highlighted the importance of confidentiality to teens' willingness to seek care.

Under the law, minors can access services without notification or consent of parents or guardians. The cost of Title X services is based on the income of the minor, not the parents. While confidentiality is required, Title X programs must, to the extent possible, encourage family participation.

Requirements regarding confidential services for individuals regardless of age are stipulated in Title X regulations 42 CFR, 59.5(a)(4) 59.11 and repeated in the Title X Program Requirements:

• 9.3 Services must be provided without regard to religion, race, color, national origin, disability, age, sex, number of pregnancies, or marital status (42 CFR 59.5 (a)(4)).

(3/15)

Lesson One

Confidentiality

Every project must have safeguards to ensure client confidentiality. Information obtained by the project staff about an individual receiving services may not be disclosed without the individual's documented consent, except as required by law or as may be necessary to provide services to the individual, with appropriate safeguards for confidentiality. Information may otherwise be disclosed only in summary, statistical, or other form that does not identify the individual (42 CFR 59.11).

While clinics must comply with the federal Health Insurance Portability and Accountability Act (HIPAA), which permits disclosure of certain protected health information (PHI), the Title X regulations are more stringent and do not allow the disclosure of information about individuals receiving services through the Title X except:

• With documented consent
• To provide services to the client or
• As required by law.

Did You Know?

(4/15)

Lesson One

Growth

Teens are growing and changing...

Teens are among the most vulnerable to sexual abuse, sexual violence, and sexual coercion. As a Title X provider, you probably work with a number of adolescents. They experience enormous growth and change - physically, cognitively, socially, emotionally, and behaviorally.

These changes affect how they respond to peers and adults, how they absorb and apply information, and how they make decisions. Familiarity with stages of adolescent development will help you connect with your teens clients and deliver the best health care possible.

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Developmental Changes

Click Here to read the "Facts for Families" artice from the American Academy of Child and Adolescent Psychiatry, then check your knowledge about the artice below.

(5/15)

Lesson One

Identifying With Your Teen Clients

To provide quality health care, you need to connect and identify with your clients on some level. You may or may not find it especially challenging to communicate with pre-teens and teens. Sometimes it can be difficult for adults to understand why teens communicate, respond, or make decisions the way they do - and vise versa.

You may come from a different era and environment than the adolescent whom you serve. On the other hand, you probably have some shared experiences that can help you identify with decisions these teens face. It is your responsibility as the adult provider to make the effort to connect. The better you can connect with your client, the better you will "get" each other, and your job will be a whole lot easier and more enjoyable.

(6/15)

Lesson One

Establish a Rapport With the Client

Strategies to achieve these goals include: (PATH OPEN)

• P | Ensure Privacy & Confidentiality
• A | Demonstrate expertise, Accessibility and
• T | Trustworthiness
• H | How personal information will be used (HIPAA)

• O | Use Open ended questions
• P | Listen to and observe the client by Paraphrasing, Play back, reporting back main points he/she said
• E | Encourage communication-Encourage the client to ask questions and share information
• N | Non-defensive statements- Be encouraging, demonstrate empathy & acceptance, convey understanding, use reflective statements

(7/15)

Lesson One

6 Steps for Counseling Teens in Title X Clinics

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Lesson One

Counseling Teens

When providing basic healthcare, health counseling, and education to an adolescent, it is important to keep in mind where he/she is in terms of their emotional, intellectual, and social development. Meeting a client "where he/she is" is important.

Consider the following general points when working with a teen:

What Works:

• Using age as a guideline (but not an indicator) to level of development.
• Accepting that peer approval is really important at this time of life and can strongly influence decisions.
• Acknowledging that family values and attitudes have a huge impact on decision making, especially about sexual activity.
• Being conscious of how you share information, not just what you share.
• Assuring client that you believe her. Approaching her/him as a unique person, using your knowledge of adolescent development as a guide.
• Visual aids, two-way conversation and other engaging interaction works better.

What Does NOT Work:

• Meeting in a formal environment with the provider in a "power role": this can be intimidating.
• Lecturing.
• Focusing on the long-term: A teen absorbs information best if you discuss with them how their choices may affect them at age 20, rather than at age 60, especially when those choices involve negative consequences.

(9/15)

Lesson One

Minors and Coercion

Sexual coercion among teens is a serious public health issue. Dating violence, sexual harassment, sexual abuse and unhealthy relationships are too common. The majority of these incidents go unreported, leading some teens to believe sexual coercion is an acceptable part of sexual behavior.

When screening for coercion, be aware of time. Do not ignore a situation or start a conversation that cannot be finished in the allowed time. Ask open-ended questions to allow for unanticipated and multiple answers. Phrase questions in a neutral way, and be mindful of your tone of voice and body language. If the client feels the practitioner is disapproving they will shut down.

Also, ask specific questions about sexual coercion, including:

• Have you ever had sex without protection because your partner didn't want to use it?
• Has anyone, including your partner, pushed, coerced, or forced you to have sex?
• Have you ever had too much to drink or taken drugs and then had sex when you didn't want to?
• Have you ever had a sexual experience that hurt you, or was frightening, confusing, or you felt had to be kept secret?
• Have you confided in your parents about any of these experiences?

Listen carefully, validate feelings, and offer tangible help.

(10/15)

Lesson One

Screening and Assessing for Abuse

A client who does not initially appear to be at risk of being harmed may be the very client who is suffering. That is why screening is so important. It involves asking questions that allow you a peek inside your client's world - beyond the medical exam.

Screening helps you determine if there are circumstances that may be reportable. This should be part of your session with every client, regardless of gender, race, ethnicity, education, or socio-economic status.

If a client denies sexual coercion but you are still concerned, some suggestions for what to do next are:

• Schedule short-term follow-up with your client. Offer your continuous support and willingness to talk.
• Ask your client if they could bring a supportive adult with them to the next visit.
• Consider asking your client to bring their sexual partner to the next visit.
• Consult with your clinician/supervisor.
• Call one of the people listed in your resource list.
• You may choose to call your local Child Protective Services (1-855-333-7233) for a consultation and disclose Protected Health Information ("PHI") only if you "know or have reasonable suspicion that the child is an abused or neglected child." If you do not have knowledge or reasonable suspicion of abuse or neglect, then pose your questions without revealing names and ask for advice and recommendations.
• Discuss your concerns in a non-judgmental way with your client – (e.g., "I'm concerned about your sexual activity. What are you getting out of this? Is there any part of this that makes you uncomfortable?").
• Consider referral to a social worker or therapist.

It helps to use a gentle tone and a balance between fairly direct and open-ended questions. Avoid "leading" your client to the answer he/she thinks you want to hear.

(11/15)

Lesson One

Ask Open-Ended Questions

Ask open-ended questions - questions that require more than a "yes" or "no" response. You will get a lot more information, especially if a client is a bit nervous and distrustful, closed questions will likely solicit one-word answers and limited information.

Examples:

• "Have you ever felt threatened or unsafe with your family, your partner, or anyone else?"
• "I noticed some bruises on your arm. "How did you get those?" If a client offers an explanation that sounds improbable, continue to probe. If he/she seems to dodge the question, pose the question more directly. "Did someone hit you?"

(12/15)

Lesson One

Caring and Empathy

Always express caring and empathy, no matter what your client's concerns are. Whether he/she talks about an ill family member, feeling embarrassed about his/her body, or violence or abuse, he/she needs to know you care.

Abuse survivors in particular often feel ashamed, and it can be difficult to open up to someone who does not seem appropriately compassionate. Maintaining an objective demeanor can make a client feel unimportant, and expressing horror or shock can make the client feel fearful or intimidated.

Remember:

How much a client continues to share depends largely on his judgment of your response.

(13/15)

Knowledge Check

Lesson One Knowledge Check

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Question 1:

Based on what you have learned in this section, which of the following would be GOOD examples of questions that you could ask your client?

What is your relationship with your family like? How close do you feel to them? Does anyone else know you are here with me today? If you have had romantic relationships or sexual experiences, tell me what they have been like for you. Have any of your sexual experiences been uncomfortable or confusing for you? Or, has anyone ever touched private parts of your body in a way that made you uncomfortable or confused? (You might want to specify and use the words "breasts", "vagina", "penis", etc.) What do you know about - or have experience with - in using protection? Have you ever experienced pregnancy or STI, or had a "scare"? All of the Above

Right! Good Job!

I'm Sorry, That's Incorrect.

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Question 2:

Javier is 14, lives in an urban neighborhood in New Mexico with his mom and two younger sisters, and is a freshman at a public high school. He will be playing on the baseball team this year, and comes into your clinic alone for a sports physical exam. Which is the better way to approach Javier?

"Hi, Javier. I'm glad you came in today. Let's spend some time talking about your physical health, sexual activity, and any kind of abuse you might be experiencing today, ok?" "Hi, Javier. I'm glad you came in to see me today. Let's spend a little time together talking about your general health, your reasons for coming in today, and anything else that might come up, ok?"

Right! Good Job!

I'm Sorry, That's Incorrect.

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Question 3:

Which is an example of an open-ended question? Hint: An open-endeded question facilitates two-way communication.

"Javier, how would you describe what your relationship is like?" "Javier, do you have any relationship problems with her?"

Right! Good Job!

I'm Sorry, That's Incorrect.

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Question 4:

After some time, Javier reveals more about his relationship. He has been repeatedly pressured and threatened into having sex with an 18 year old neighbor girl. He did not want to have sex the first time and did not like it. He often tries to avoid her. At the same time, he feels like, as a guy, he is "supposed" to want sex; so he usually gives in when she comes on to him. He is very confused, feels like what is happening goes against his personal, family, and religious values, and wishes it would stop. How should you respond to what Javier has shared with you?

" I see. What's happening is against the law here in New Mexico. I must remind you that, given what you just shared, I'll need to put in a call to the authorities." "What?!! I cannot believe she would do that to you! That's so horrible! I would feel so violated if I were you." "That must be a really tough and confusing thing to experience. I'm concerned about you, and I'm glad you told me so that we can take steps to keep this from happening."

Right! Good Job!

I'm Sorry, That's Incorrect.

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Question 5:

Javier's situation, like many others you encounter in your clinic, naturally raises strong reactions and feelings for most of us. It is important to pay close attention to these reactions and to keep our personal values out of the picture. You can be objective, professional, and compassionate all at the same time. What is the most important message that you should convey to Javier?

He should look out for himself and try harder to avoid spending time with that girl. What is happening is not his fault. It is important to forgive and move on. Abstinence is the best choice for someone his age.

Right! Good Job!

I'm Sorry, That's Incorrect, this can be tough. Javier said he has tried to limit his time with her. he needs more guidance and support, including skills and strategies to resist sexual coercion; you can help him with this.

I'm Sorry, That's Incorrect. Javier is going through a rough time and needs support. His situation is more complex than just forgiving and letting go. This is an important time to help him develop skills and strategies to resist sexual coercion.

I'm Sorry, That's Incorrect. This statement may make Javier feel judged and at fault. He feels like he is powerless in this situation; discussing your personal feelings about abstinence is not appropriate right now. He needs you to validate his feelings and help him to develop skills and strategies to resist sexual coercion.

(14/15)

Lesson One

Lesson One Conclusion

Let us assume that you have had a thorough discussion with Javier; have encouraged him to talk with his mom; and have counseled him on ways to resist sexual coercion. You have reminded him of the limits to confidentiality that you talked about earlier. You have also let him know that you can make referrals if he or his mom wants further resources.

You also need to ask yourself:

• Do any of the abuse-related terms described earlier in this course apply?
• Are you required to make a report about the relationship between Javier and his neighbor?

If you are not sure how to answer the question, refer back to Reporting Child Abuse and Neglect or talk with your immediate supervisor.

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Congratulations!

This concludes Lesson One, please use the Lesson Menu button and move onto Lesson Two.

(15/15)

Lesson Two

Sexual Activity and Abuse

Guiding Principles

Some guidelines for practitioners in assessing the presence of abuse or suspected abuse follow below.

Reference: (Position Paper of the AAFP, AAP, ACOG, and SAM, Journal of Adolescent Health 2004:35:420-423
https://www.adolescenthealth.org/SAHM_Main/media/Advocacy/Positions/Nov-04-Protecting_Adolescents_Ensuring_Access_to_Care_and_Reporting_Sexual_Activity_and_Abuse.pdf

These guidelines include the following:

• Sexual activity and sexual abuse are not synonymous. It should not be assumed that adolescents who are sexually active are, by definition, being abused. Many adolescents have consensual sexual relationships.
• It is critical that adolescents who are sexually active receive appropriate confidential health care and counseling.
• Open and confidential communication between the health professional and the adolescent client, together with careful clinical assessment, can identify the majority of sexual abuse cases.
• Title X providers must know state laws and report cases of sexual abuse to the proper authority, in accordance with those laws, after discussion with the adolescent and parent, as appropriate.

(1/8)

Where Do I Find NM's Mandated Child Abuse Reporting Rules?

Mandated reporting obligations can stem from multiple legal sources — state statutes, state regulations, case law, and attorney general opinions, among others. A good place to start your search is with your state statutes.

The U.S. Department of Health and Human Services (DHHS) maintains a database that makes it easy to find your state mandated child abuse reporting statutes. This source only links to state reporting statutes. It does not always reference other relevant state statutes that may be helpful or necessary to understanding reporting obligations, such as criminal codes, nor does it reference state regulations, case law or other sources of reporting obligations.

Resources: DHHS State Statutes Database: https://www.childwelfare.gov/topics/systemwide/laws-policies/state/?hasBeenRedirected=1
TIP: State statutes may not be the only source of reportng rules in your state. In some states, a court or attorney general opinion or an agency directive may help shape interpretation of the law and ultimately reporting obligations. It can be helpful to discuss this with legal counsel.

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Lesson Two

Definitions

Familiarize Yourself with NM Legal Requirements regarding notification or reporting of child abuse, child molestation, sexual abuse, rape, or incest.

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Lesson Two

The fact that a child is sexually active or contemplating sexual activity does not automatically mean that the child's parents are neglectful or abusive. Neither does the fact that a child is having a sexual relationship with somebody somewhat older necessarily indicate that a child is abused or neglected by the parent/guardian/custodian. Parental knowledge (or lack of knowledge) of a minor's voluntary sexual activity does not necessarily give rise to reasonable suspicion of abuse or neglect. Practitioners are under no legal obligation to ask a client who presents themselves for family planning services about the age(s) of any sexual partner(s).

Although New Mexico courts have not spoken on the issue of voluntary teen sexual activity, other state courts have held that most cases of voluntary teen sexual activity do not give rise to reasonable suspicion of child abuse or neglect. When a health provider does not have a reasonable suspicion or knowledge of child abuse or neglect by the parent/guardian/custodian, then there may be no legal basis to breach a patient's confidentiality by filing a report with CYFD or law enforcement.

(4/8)

Lesson Two

What If I Am Not Sure That Abuse/neglect Has Occurred?

Confirmation of abuse is NOT required.

The mandatory reporting statute (NMSA 1978, 32A-4-3) requires mandatory reporting of abusive or neglectful parent(s)/guardian(s)/custodian(s) when the reporter "knows or has reasonable suspicion that a child is an abused or neglected child." (NMSA 1978, 32A-4-3).

(5/8)

Lesson Two

What's next?

A. Follow your agency's guidelines/protocols for reporting abuse/neglect.
B. Abuse/Neglect must be documented in the client's record.
C. All clinics must have a mechanism in place to track reports made, for example a log.
D. When in doubt as to whether the NM legal requirements apply to your client's situation, consult with your clinician, supervisor, Regional Health Officer and/or agency's legal counsel.

Remember to Document, Document, DOCUMENT!

Documentation Considerations:

• Time and date of call
• Name and title of person to whom you are making the report
• Case number if applicable
• Summary of call

(6/8)

Lesson Two

New Mexico Duty to Report Child Abuse and Neglect

Every person, including a licensed physician; a medical resident or an intern examining, attending, or treating a child; a law enforcement officer; a judge presiding during a proceeding; a registered nurse; a visiting nurse; a school teacher; a school official; a social worker acting in an official capacity; or a member of the clergy who has information that is not privileged as a matter of law, who knows or has a reasonable suspicion that a child is an abused or a neglected child, shall report the matter immediately to:

1. A local law enforcement agency;
2. The department (CYFD's child abuse/neglect hotline: 1-855-333-7233); or
3. A tribal law enforcement or social services agency for any Indian child residing in Indian country.

(7/8)

Lesson Two

The following is a list of information that must be given when reporting

1. Names and addresses of the child and child's parents, guardian, or custodian
2. The child's age
3. Nature and extent of child's injuries and any evidence of prior injury
4. Identity of person responsible for the injuries
5. Any other information that might be helpful such as street address, SS#, names of other professionals in contact with the child, past history of the child or the family, child's affect or disability, history of domestic violence, substance abuse/mental illness, or criminal activity

Anyone reporting an instance if alleged child neglect or abuse or participating in a judicial proceeding brought as a result of a report required by the reporting laws is presumed to be acting in good faith and shall be immune from civil or criminal liability that might otherwise be incurred or imposed by the law, unless the person acted in bad faith or with malicious purpose.

(N.M. Stat. Ann. §32A-4-5(B) (Michie 1995)

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Congratulations!

This concludes Lesson Two, please use the Lesson Menu button and move onto the final lesson, Lesson Three.

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Lesson Three

Human Trafficking

As part of the requirement that grantees comply with all applicable Federal laws, grantees are reminded that they must comply with Federal anti-trafficking laws, including the Trafficking Victims Protection Act of 2000 (Pub. L. No. 106-386), as amended and 18 U.S.C 1591. Noncompliance with these laws may result in the disallowance of Title X funds, or the suspension of the Title X grant award.

What is Human Trafficking?

• A form of modern-day slavery that is widespread throughout the U.S. today.
• The recruitment, transportation, transfer, harboring, or receipt of persons by means of force, fraud, or coercion for the purpose of exploitation.

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Lesson Three

There are Three Categories of Human Trafficking:

1. Minors involved in commercial sex.
2. Those 18 or over involved in commercial sex via force, fraud, or coercion.
3. Adults or minors in forced labor, services or involuntary servitude via force, fraud, or coercion.

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Lesson Three

If you think you have come across a case of trafficking or have identified a trafficking victim:

• In the case of a minor, call the Children Youth and Family Department (CYFD) State Central Intake hotline at 1-855-333-7233.
• For non-minors, you may contact law enforcement to make a report and disclose confidential information only if the client allows you to do so or is incapacitated.

New Mexico Human Trafficking hotline 505-GET-FREE (call or text)

More information about the definition of human trafficking is available at NMSA 1978, §30-52-1.

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Lesson Three

Human trafficking victims found in the state shall be eligible for benefits and services from the state until the victim qualifies for benefits and services authorized by the federal Victims of Trafficking and Violence Protection Act of 2000; provided that the victim cooperates in the investigation or prosecution of the person charged with the crime of human trafficking. Benefits and services shall be provided to eligible human trafficking victims regardless of immigration status and may include:

NMSA 30-52-5. Human Trafficking; Benefits and Services for Human Trafficking Victims

1. case management;
2. emergency temporary housing;
3. health care;
4. mental health counseling;
5. drug addiction screening and treatment;
6. language interpretation, translation services and English language instruction;
7. job training, job placement assistance and post-employment services for job retention;
8. services to assist the victim and the victim's family members; or
9. other general assistance services and benefits as determined by the children, youth and families department.

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Lesson Three

What Would You Do?

Scenario: A Title X provider believes that an adult patient is involved in forced labor.

Counsel the patient and encourage the patient to report the human trafficking activities to law enforcement If the patient gives a written consent, the provider can contact law enforcement Since the client is an adult, nothing is needs to be done by the provider Both A & B

Right! Good Job!

I'm Sorry, That's Incorrect.

(5/6)

Lesson Three

Congratulations! You have reached the end of this course.

When your ready to take the Final Assessment follow the example provided below that illustrates the 4 steps to take the Assessment by marking this course complete. You can also print this page to keep the steps handy while you complete them if necessary.

Step 1

After you close this training, you will see the screen shown above, click on the Home button highlighted in blue found in the top left of the screen.

Step 2

From the Home sreen you will see your Dashboard on the right hand side of the screen, click on the My Learning tab and click on the course you just took which will be highlighted in blue.

Step 3

Confirm that you have completed reviewing this course by clicking the Completed button.

Step 4

The system will then prompt you to begin the quiz by clicking the Assessment button.

Good Luck!

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