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.
Important Points for CPS
- 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 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.
- 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.