Child Protective Services (CPS)

Many CPS professionals will receive no formal training on dealing with child abuse and neglect cases involving Munchausen by Proxy/Medical Child Abuse. These cases can be some of the most complex and challenging they will come across in the course of their careers, with often-devastating effects on the victims, families, and communities.

Some jurisdictions have created protocols and guidance to support CPS (e.g., Arizona Department of Child Safety, 2012; Michigan Governor’s Task Force), but many do not.

We highly recommend reading the APSAC’s Practice Guidelines and the APSAC Advisor. Complete guidance for visitation can be found here.

Important Points for CPS

The Victim

  • Victims of Medical Child Abuse experience far-reaching effects on their sense of self and their most important relationships due to the distortions of their caregiver, including:
    • Associating medical care with fear, pain, manipulation, and secrecy.
    • A sense of betrayal from having been harmed by the person meant to protect them.
    • A sense of betrayal at other family members for failing to protect them.
    • Disempowerment from having their will, desires, decision-making, and sense of self-efficacy violated.
  • Victims often experience no reprieve as the perpetrator seeks to control all aspects of their lives, making this from of abuse and neglect similar to that of a cult leader.
  • Perpetrator often has significant influence over how others relate to the victim.

The Abuser

  • The vast majority of perpetrators of this abuse are women with co-morbid personality disorders and/or depression or factitious disorder imposed on self.
  • Abusers often appear to be loving, competent caregivers.
  • It is extremely common for perpetrators to befriend CPS workers and other professionals with influence over a case in an attempt to garner access to the child and/or to gain support in their court cases.
  • It is crucial to remember that this type of abuser is deceptive and manipulative, and that it is often not possible to discern when the individual is lying.
  • Most abusers are generally well-liked with superficially normal social skills and functioning.

The Case

  • Consultation with professionals with experience in MCA is highly recommended. (Contact us.)
  • Always consult with law enforcement before making the first contact with the offender.
  • Initial interview with the offender should be in-depth, detailed, and non-confrontational. Focus on getting a medical and social history for the victim, all siblings, and the offender herself.
  • Suspected victims should never be placed with family members who disbelieve the allegations or are sympathetic to the offender. Temporary placement with foster parents allows for a neutral third party to document the victim’s symptoms during separation from the offender.
  • If the prospective victim is placed with relatives, they may experience unrelenting pressure from the abuser to gain access to the child.
  • Placement guardians should be required to keep a daily log of the victim’s food intake, physical activity, and any statements made by the victim that pertain to the investigation.
  • The risk for chaos is high and all professionals working on the case should communicate directly and consistently with one another and MCA experts.
  • The offender should not be allowed to bring anything into the visitation or give the victim any item.
  • Victims must never be left alone with or allowed to privately communicate with the suspected abuser, even for a few minutes’ time.
  • The supervisor of the visitation should be close enough to hear the conversation between the offender and the victim at all times.
  • The ACCEPTS model can be used to assess progress in treatment of the abuser
  • Victims benefit from a rehabilitation plan to regain normal health and functioning and many victims will require psychotherapy.