The Bruise, the Contradictory Recess Account, and the Principal's Delay
You are a school-based OT in Clark County. During a session, 7-year-old M, who has autism spectrum disorder and limited verbal communication, has a fresh 4-cm linear bruise on the back of the thigh. M flinches when you lightly touch the area. The classroom teacher says M 'fell at recess,' but the playground aide says M was not on the playground that morning and was in the quiet room. M whispers, 'Don't tell; I'll get in trouble.' M's individualized education program includes OT twice weekly. You have no reason to believe the parent caused the injury, but you cannot explain the inconsistency. The school principal asks you to 'wait until the end of the day and let the district investigate' before calling anyone.
1. Are you a mandatory reporter here, and what must you do?
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Yes. Nevada law makes licensed health professionals, including OTs in relevant settings, mandatory reporters of child abuse or neglect. The fresh 4-cm linear bruise of unexplained origin, the inconsistency between the teacher's account and the playground aide's account, M's flinching, and M's plea not to tell create reasonable suspicion. You do not need proof or to identify the perpetrator. Report promptly to the appropriate Nevada child protective services agency or law enforcement as required by law and district policy. Do not promise M secrecy; say gently that your job is to keep M safe and that you will tell someone who can help. Ensure M is in a safe, supervised setting before you leave. Do not investigate, photograph the bruise unless district protocol and law permit, or question M repeatedly. Make the report yourself; do not rely on the principal to do it.
2. The principal says to wait until the end of the day for a district investigation. What do you do?
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Follow the law, not the delay. A school investigation does not replace your individual mandatory reporting duty, and waiting until the end of the day may violate the required timeframe. Tell the principal politely that you are required to report promptly and that you will do so now; you can also notify the principal after reporting, consistent with district protocol. If the principal orders you not to report, escalate to the district's designated reporter, risk management, or legal counsel, and still make the report. Do not let fear of retaliation stop you; retaliation for good-faith reporting is generally prohibited. Document the principal's instruction and your response factually. If M's safety is at immediate risk, call law enforcement or emergency services. The district can conduct its own investigation later, but it cannot override your legal duty.
3. How should you document and handle confidentiality?
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Document objectively in the health or OT record or the confidential reporting file as district policy requires: the date, time, location, who was present, M's exact words, the bruise's size, color, shape, and location, M's reaction to touch, the teacher's and aide's statements, your report to the agency, the person you spoke with, the time, and any instructions. Avoid conclusions such as 'abuse occurred'; state 'suspicious for abuse' or 'reported as required.' Do not put detailed abuse allegations in a widely shared education record if district policy provides a confidential file. Share information only with those who need it for the report or M's safety. FERPA and HIPAA permit disclosures required by law for child abuse reporting; they do not require you to tell the parent before reporting. Do not discuss the case in the staff lounge or with other students' families. Follow up with the reporting agency and cooperate with the investigation, but do not conduct your own.