Child/Elder Abuse Assessment

Child and elder abuse assessment appears throughout the ASWB exam—in Assessment and Diagnosis, Intervention, and Ethics sections. You need to know indicators, assessment procedures, and reporting requirements.

Social workers are mandated reporters in all 50 states. This means you're legally required to report suspected abuse or neglect, even when uncertain. "Suspected" is the key word—you don't need proof, just reasonable suspicion.

Types of Abuse

Physical abuse, sexual abuse, emotional/psychological abuse, neglect, financial exploitation (particularly relevant for elders), and abandonment. These types often co-occur.

Physical Indicators

Look for bruises in unusual patterns or locations (torso, inner arms, genitals), bruises at different stages of healing, burns with clear patterns, fractures inconsistent with developmental stage or explanation, failure to thrive, poor hygiene, untreated medical problems, dehydration or malnutrition despite adequate resources.

Behavioral Indicators

In children: age-inappropriate sexual knowledge, fear of specific people, regression, extreme behaviors (overly compliant or aggressive), reluctance to go home.

In elders: fearfulness around caregiver, withdrawal, unexplained financial changes, hesitation to talk when caregiver is present, caregiver won't leave them alone.

Caregiver Red Flags

Inconsistent or changing explanations for injuries, delays in seeking medical care, overly controlling behavior, isolation of the victim, signs of caregiver burnout without seeking help, unrealistic expectations, indifference to or blaming the victim.

Assessment Process

Interview the victim separately when possible. Use age-appropriate, open-ended questions—don't lead or suggest answers. Document thoroughly: describe injuries specifically, use direct quotes, note behavioral observations. Assess immediate safety: Is the person in immediate danger? Can they return home safely? Are others at risk?

Consider differential diagnosis. Not all injuries indicate abuse—medical conditions, accidental injuries, and cultural practices (like coining or cupping) may look concerning. However, when injury patterns are inconsistent with explanations, suspect abuse.

Reporting Requirements

Know your state's specifics, but generally: Report immediately upon reasonable suspicion (often within 24-48 hours). You report your observations and concerns, not your conclusions. The investigating agency determines if abuse occurred. Good faith reporters have immunity from liability. Failure to report can result in criminal charges and professional sanctions.

Critical Points for the Exam

Your duty to report supersedes confidentiality. You cannot delegate reporting to a supervisor—mandated reporters file directly. Report suspected abuse, not proven abuse. When in doubt, err on the side of reporting. Your obligation is to report and let experts investigate, not to investigate yourself.

After reporting, maintain the therapeutic relationship when possible, document the report (date, time, agency, case number), and continue safety planning.