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The DCF-136 form, officially titled "Report of Suspected Child Abuse or Neglect," serves as a critical tool in the fight against child maltreatment in Connecticut. Mandated reporters, a category that includes professionals ranging from teachers to healthcare providers, must utilize this form within forty-eight hours following an oral report made to the Department of Children and Families (DCF) Careline. The DCF-136 requires comprehensive information concerning the child, the alleged abuse or neglect, and any known family dynamics surrounding the situation. Details such as the child’s name, age, race, and home address, as well as pertinent information about the suspected perpetrator, are essential for facilitating an effective investigation. The form also emphasizes the reporting individual's role, requiring their contact information and a description of the circumstances leading to the suspicion of abuse or neglect. The state mandates that reporters act in good faith when submitting this form; thus, they are granted immunity from civil or criminal liability as long as they are not involved in causing the harm. However, failing to report suspected abuse can lead to serious legal repercussions, highlighting the form's role not only in documentation but also in ensuring accountability and protection for vulnerable children. The DCF-136 is more than just a bureaucratic requirement; it embodies Connecticut’s commitment to safeguarding the well-being of its children through structured reporting and intervention processes.
Dcf 136 Example
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REPORT OF SUSPECTED CHILD ABUSE OR NEGLECT |
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Careline |
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05/2015 (Rev.) |
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Within
See the reverse side of this form for a summary of Connecticut law concerning the protection of children.
Please Print or Type
Child’s Name |
☐ M |
Age Or DOB |
Race: |
☐ American Indian or Alaskan Native |
☐ Hispanic |
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☐ F |
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☐ Asian/Pacific Islander |
☐ White (not of Hispanic origin) |
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☐ Black/African American (not of |
☐ Unknown |
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Hispanic Origin) |
☐ Other: |
Child’s Address |
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Name Of Parents Or Other Person Responsible For Child’s Care |
Address |
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Phone Number |
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Name Of Careline Worker To Whom Oral Report Was Made |
Date Of Oral Report |
Date And Time Of Suspected Abuse/Neglect |
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Name Of Suspected Perpetrator, If Known |
Address And Phone Number, If Known |
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Relationship To Child |
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Nature And Extent Of Injury(ies), Maltreatment Or Neglect |
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Describe The Circumstances Under Which The Injury(ies), Maltreatment Or Neglect Came To Be Known
Describe the Reasons Such Persons(s) Are Suspected of Causing Such Injuries, Maltreatment of Neglect
Information Concerning Any Previous Injury(ies), Maltreatment Or Neglect Of The Child Or His/Her Siblings
Information Concerning Any Prior Cases(s) In Which The Person(s) Have Been Suspected Of Causing An Injury(ies), Maltreatment Or Neglect Of A Child
List Names And Ages Of Siblings, If Known
What Action, If Any, Has Been Taken To Treat, Provide Shelter Or Otherwise Assist The Child?
REPORTER SECTION
Reporter’s Name:
Agency Name:
Phone Number:
Agency Address:
City:
Reporter’s Signature
Reporter’s Race
☐American Indian or Alaskan Native
☐Asian/Pacific Islander
☐Black/African American (not of Hispanic Origin)
☐Hispanic (any race)
☐White (not of Hispanic origin)
☐Prefer Not to Answer
☐Other:
Position |
Date |
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WHITE COPY: TO DCF AREA OFFICE (SEE BELOW) IF YOU NEED ADDITIONAL SPACE, YOU MAY ATTACH MORE DOCUMENTATION
Bridgeport |
Danbury |
Hartford |
Manchester |
Norwalk |
100 Fairfield Avenue |
131 West Street |
250 Hamilton Street |
364 West Middle Turnpike |
761 Main Avenue, |
Bridgeport, CT 06604 |
Danbury, CT 06810 |
Hartford, CT 06106 |
Manchester, CT 06040 |
Norwalk, CT 06851 |
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Meriden |
Middletown |
Milford |
New Britain |
New Haven |
One West Main Street |
2081 South Main Street |
38 Wellington Road |
One Grove Street, 4th Floor |
One Long Wharf Drive |
Meriden CT 06451 |
Middletown, CT 06457 |
Milford, CT 06461 |
New Britain, CT 06053 |
New Haven, CT 06511 |
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Norwich |
Torrington |
Waterbury |
Willimantic |
Special Investigations Unit |
Two Courthouse Square |
62 Commercial Blvd |
395 West Main Street |
322 Main Street |
505 Hudson Street, 7th Floor |
Norwich, CT 06360 |
Torrington, CT 06790 |
Waterbury, CT 06702 |
Willimantic, CT 06226 |
Hartford, CT 06106 |
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SUMMARY OF LEGAL REQUIREMENTS CONCERNING CHILD ABUSE/ NEGLECT
PUBLIC POLICY OF THE STATE OF CONNECTICUT (C.G.S.
To protect children whose health and welfare may be adversely affected through injury and neglect; to strengthen the family and to make the home safe for children by enhancing the parental capacity for good child care; to provide a temporary or permanent nurturing and safe environment for children when necessary; and for these purposes to require the reporting of suspected child abuse or neglect, investigation of such reports by a social agency, and provision of services, where needed, to such child and family.
WHO IS MANDATED TO REPORT CHILD ABUSE/NEGLECT?
Child Advocate and OCA Employees |
Mental Health Professionals |
Chiropractors |
Optometrists |
Coaches and Directors of a Private Youth Sports, |
Persons Paid to Care for Children |
Organization or Team |
Persons who Provide Services to |
Coaches and Athletic Directors of Youth Athletics |
and have Regular Contact with |
Dental Hygienists |
Students |
Dentists |
Pharmacists |
Department of Children and Families Employees |
Physical Therapists |
Domestic Violence Counselors |
Physician Assistants |
Office of Early Childhood Employees and Department |
Podiatrists |
of Public health Employees who are Responsible |
Police Officers |
for Licensing Day Cares and Camps |
Probation Officers (Juvenile or Adult) |
Family Relations Counselors (Judicial Dept.) |
Psychologists |
Family Rel. Counselor Trainees (Judicial Dept.) |
Public or Private Institution of Higher |
Family Services Supervisors (Judicial Dept.) |
Education Administrators, Faculty, |
Licensed Foster Parents |
Staff, Athletic Directors, Athletic |
Licensed Marital and Family Therapists |
Coaches and Athletic Trainers |
Licensed or Unlicensed Interns at Any Hospital |
Registered Nurses |
Licensed or Unlicensed Resident Physicians |
School Administrators |
Licensed Physicians |
School Coaches |
Licensed Practical Nurses |
School Guidance Counselors |
Licensed Professional Counselors |
School Paraprofessionals |
Licensed Surgeons |
School Superintendents |
Licensed/Certified Alcohol and Drug Counselors |
School Teachers |
Licensed/Certified Emergency Medical Services Providers |
Sexual Assault Counselors |
Medical Examiners |
Social Workers |
Members of the Clergy |
Substitute Teachers |
DO THOSE MANDATED TO REPORT INCUR LIABILITY?
No. Any person, institution or agency which, in good faith, makes or does not make a report, shall be immune from any civil or criminal liability provided such person did not perpetrate or cause such abuse or neglect.
IS THERE A PENALTY FOR NOT REPORTING?
Yes. Any person required to report who fails to do so may be prosecuted for a Class A misdemeanor and may be required to participate in an educational and training program. Any person who intentionally and unreasonably interferes with or prevents a report may be prosecuted for a Class D felony.
IS THERE A PENALTY FOR MAKING A FALSE REPORT?
Yes. Any person who knowingly makes a false report of child abuse or neglect may be fined not more than $2,000 or imprisoned for not more than one year or both. The identity of such person shall be disclosed to the appropriate law enforcement agency and to the alleged perpetrator of the abuse.
WHAT ARE THE REPORTING REQUIREMENTS?
An oral report shall be made by a mandated reporter by telephone or in person to the DCF Careline or to a law enforcement agency as soon as practicable, but not later than 12 hours after the mandated reporter has reasonable cause to suspect or believe that a child has been abused or neglected or placed in imminent risk of serious harm. If a law enforcement agency receives an oral report, it shall immediately notify Careline. Oral reports to the Careline shall be recorded.
Within 48 hours of making an oral report, a mandated reporter shall submit a written report to the DCF Careline on the
When a mandated reporter is a member of the staff of a public or private institution or facility that provides care for children or a public or private school, the reporter shall also submit a copy of the written report to the person in charge of such institution, school or facility or the person's designee.
DCF CHILD ABUSE AND NEGLECT CARELINE:
STATUTORY REFERENCES:
DEFINITIONS OF ABUSE AND NEGLECT
Abused Child: Any child who has a
Neglected Child: Any child who has been abandoned or is being denied proper care and attention, physically, educationally, emotionally, or morally or is being permitted to live under conditions, circumstances or associations injurious to his or her
Exception: The treatment of any child by an accredited Christian Science practitioner shall not by itself constitute neglect or maltreatment.
CHILD UNDER AGE 13 WITH VENEREAL DISEASE: A physician or facility must report to Careline upon the consultation, examination or treatment for venereal disease of any child who has not reached his or her 13th birthday.
DO PRIVATE CITIZENS HAVE A RESPONSIBILITY FOR REPORTING?
Yes. Any person having reasonable cause to suspect or believe that any child under the age of 18 is in danger of being abused or has been abused or neglected may cause a written or oral report to be made to the Careline or a law enforcement agency. Any person making the report in good faith is immune from any liability, civil or criminal. However, the person is subject to the penalty for making a false claim.
WHAT IS THE AUTHORITY AND RESPONSIBILITY OF THE DEPARTMENT OF CHILDREN AND FAMILIES (DCF)?
All child protective services in Connecticut are the responsibility of the Department of Children and Families.
Upon the receipt of a report of child abuse or neglect, the Careline shall cause the report to be classified, evaluated immediately and forwarded to the appropriate Area Office for the commencement of an investigation or for the provision of services within timelines specified by statute and policy.
If an investigation produces evidence of child abuse or neglect, DCF shall take such measures as it deems necessary to protect the child, and any other children similarly situated, including,
but not limited to, immediate notification to the appropriate law enforcement agency, and the removal of the child from his or her home with or without the parents’ consent consistent with
state law.
If DCF has probable cause to believe that the child or any other child in the household is at
imminent risk of physical harm from the surroundings, and that immediate removal from such surroundings is necessary to ensure the child’s safety, the Commissioner or designee shall
authorize any employee of DCF or any law enforcement officer to remove the child and any other child similarly situated from such surroundings without the consent of the child’s parent or
guardian. The removal of a child shall not exceed 96 hours. If the child is not returned home within such
WHAT MEANS ARE AVAILABLE FOR REMOVING A CHILD FROM HIS OR HER HOME?
to the detection of child abuse or neglect and to provide necessary medical care with or without the consent of such child’s parents or guardian or other person responsible for the child’s care, provided the physician has made reasonable attempts to (1) advise such child’s parents or guardian or other person responsible for the child’s care that the physician suspects the child has been abused or neglected, and (2) obtain consent of such child’s parents or guardian or other person responsible for the child’s care. In addition, such
physician may take or cause to be taken photographs of the area of trauma visible on a child who is the subject of such report without the consent of such child’s parent’s or guardian or other person responsible for the child’s care. All such photographs or copies thereof shall be sent to the local police department and the Department of Children and Families.
Bench order of temporary custody – Whenever any person is arrested and charged with an offense under Section
amended, the victim of which offense was a minor residing with the defendant, any judge of the Superior Court may, if it appears that the child’s condition or circumstances surrounding the case so require, issue an order to the Commissioner of the Department of Children and Families to assume immediate custody of such child and, if the circumstances so require, any other children residing with the defendant and to proceed thereon as in other cases.
WHAT IS THE CENTRAL REGISTRY OF PERPETRATORS OF ABUSE OR NEGLECT? The Department of Children and Families maintains a registry of persons who have been substantiated as responsible for child abuse or neglect and pose a risk to the health safety or
File Breakdown
| Fact | Description |
|---|---|
| Form Purpose | The DCF-136 form is used to report suspected child abuse or neglect in Connecticut. |
| Submission Timeline | A mandated reporter must submit this form within 48 hours of making an oral report. |
| Governing Law | This form is governed by the Connecticut General Statutes, specifically C.G.S. §17a-101. |
| Mandatory Reporters | Various professionals, including doctors, teachers, and social workers, are mandated to report suspected child abuse. |
| Confidentiality Protection | Individuals making reports in good faith are immune from civil or criminal liability unless they caused the abuse or neglect. |
| Penalties for Non-Reporting | Failure to report can result in criminal charges, specifically a Class A misdemeanor. |
Guide to Using Dcf 136
Filling out the DCF-136 form is a necessary step for mandated reporters who suspect child abuse or neglect. Once the oral report is made, this form should be completed to provide detailed information regarding the circumstances surrounding the situation. It's important to ensure that all sections are filled out accurately, as this document aids in the investigation and pursuit of necessary actions to protect the child.
- Begin by printing or typing the **Child's Name** along with their **Age or Date of Birth**.
- Select the appropriate **Race** option by marking the corresponding checkbox.
- Provide the **Child's Address**.
- List the **Name of Parents or Other Person Responsible** for the child’s care, followed by their **Address** and **Phone Number**.
- Fill in the **Name of Careline Worker** to whom the oral report was made.
- Record the **Date of Oral Report**.
- Write the **Date and Time of Suspected Abuse/Neglect**.
- If known, indicate the **Name of the Suspected Perpetrator** along with their **Address and Phone Number**, and clarify their **Relationship to the Child**.
- Detail the **Nature and Extent of the Injury(ies), Maltreatment, or Neglect**.
- Describe the **Circumstances Under Which the Injury(ies), Maltreatment, or Neglect Came to Be Known**.
- Explain the **Reasons Such Persons(s) Are Suspected of Causing Such Injuries, Maltreatment, or Neglect**.
- Provide information about any **Previous Injury(ies), Maltreatment, or Neglect** of the child or their siblings.
- Include details regarding any **Prior Cases(s)** where the persons involved have been suspected of causing similar issues.
- If known, list the **Names and Ages of Siblings**.
- Indicate what **Actions, If Any, Have Been Taken** to treat, provide shelter, or otherwise assist the child.
- In the **Reporter Section**, write your own **Name**, **Agency Name**, **Phone Number**, and complete the **Address** and **City** fields.
- Sign the form as the **Reporter** and indicate your **Race** by selecting the appropriate checkbox.
- Finally, ensure the **Date** is filled out before submitting the form.
After completing the form, it must be submitted to the relevant Area Office within 48 hours of making the initial oral report. This step is essential for ensuring that proper procedures are followed to protect the child in question and to assist relevant agencies in their investigations.
Get Answers on Dcf 136
What is the DCF-136 form used for?
The DCF-136 form, also known as the "Report of Suspected Child Abuse or Neglect," is used to report suspected child abuse or neglect in Connecticut. Mandated reporters, such as teachers, healthcare professionals, and social workers, must complete this form within 48 hours of making an initial oral report. The information provided in the DCF-136 helps the Department of Children and Families investigate and take necessary actions to protect the child.
Who is required to complete the DCF-136 form?
A variety of professionals are mandated to report suspected child abuse or neglect and complete the DCF-136 form. This includes:
- Teachers and school staff
- Healthcare providers
- Social workers
- Law enforcement officers
- Coaches and youth organization leaders
Anyone who suspects that a child may be abused or neglected has the responsibility to report. Private citizens may also report their concerns, although they are not legally obligated to do so.
What happens after the DCF-136 form is submitted?
Once the DCF-136 form is submitted, the Department of Children and Families will review the report. They classify and evaluate the allegations. If necessary, they will initiate an investigation. During the investigation, they might take steps to safeguard the child based on the severity of the situation. This may include providing services or, in extreme cases, removing the child from a potentially harmful environment.
Are there penalties for failing to report suspected abuse?
Yes, there are legal consequences for failing to report suspected child abuse or neglect. Individuals who are mandated reporters and fail to report risk prosecution as a Class A misdemeanor. Additionally, they may be required to undergo training. If someone intentionally interferes with the reporting process, they could face more serious consequences, including a Class D felony charge.
Common mistakes
Completing the DCF-136 form accurately is crucial for the protection of children and the reporting of suspected abuse or neglect. However, many individuals make common mistakes when filling out this important document. One significant error involves omitting essential details about the child, such as the child's exact age or date of birth. Providing an incomplete age can lead to misunderstandings about the nature of the reported situation.
Another frequent mistake arises from not clearly identifying the relationship between the suspected perpetrator and the child. This information is vital for investigators to assess the situation appropriately. Failure to specify this relationship can hinder the effectiveness of the investigation.
Many people do not include sufficient context surrounding the circumstances of the suspected abuse or neglect. A vague description can lead to confusion and misinterpretation of the facts. Inadequate details about how the injury came to be known can result in delays in the vital protective service that may be required.
Often, individuals neglect to mention any previous incidents of abuse affecting the child or their siblings. This type of historical context can significantly impact ongoing investigations and determine the necessary interventions. Providing comprehensive background information is essential to see the complete picture of the child's welfare.
Another common oversight is not signing the form or failing to provide all necessary identifying information about the reporter. The signature indicates that the reporter is aware of their obligations and the seriousness of the report. A missing signature or incomplete contact information can lead to difficulties in following up on the reported case.
Some report submitters forget to specify actions taken to assist the child after the suspected incident occurred. Whether it was seeking medical help or contacting a support service, this information is crucial for understanding the immediate response and care provided to the child.
People also tend to mistakenly use abbreviations or unclear terms that may be difficult for others to interpret. It's essential to ensure that the language used on the form is clear and straightforward, as miscommunication can result in further complications in addressing the child's needs.
Failure to check the appropriate boxes for the child's race or the reporter's race can lead to misunderstandings or misclassification of the report. Accurate demographic information plays a role in understanding trends and allocating resources effectively.
Individuals sometimes attach documentation without clearly indicating it on the form, leading to confusion for the case worker reviewing the submission. Always mention any additional documentation attached to improve the clarity of the report.
Finally, people may miss the critical 48-hour timeline for submitting the DCF-136 after making an oral report. Delays in submission can jeopardize the safety and welfare of the child involved. Timely action is essential when it comes to reporting suspected child abuse or neglect.
Documents used along the form
The DCF-136 form is essential for reporting suspected child abuse or neglect. Along with this form, several other documents may be needed to support the process. Each document plays a significant role in the overall reporting and investigation procedures. Below is a list of commonly associated forms and documents.
- DCF-137: Mandated Reporter Form - This form is used by mandated reporters to provide detailed information about the situation prompting the report of abuse or neglect. It allows the reporter to outline their observations and reasons for suspicion.
- DCF-138: Follow-up Report - After the initial report is filed, this form is used to document any subsequent findings or updates in the case. It helps maintain a clear and ongoing record of the investigation.
- Medical Report Form - If there are injuries involved, a medical report may be required. This document details the child’s medical condition and any treatments administered, providing crucial context for the reported allegations.
- Interview Summary Form - Recorded interviews with the child or witnesses may be summarized in this form. It compiles testimonies and observations relevant to the case and aids investigators in understanding the events leading to the report.
- Safety Plan Documentation - In instances where a child is deemed at risk, a safety plan may be developed. This document outlines the steps taken to ensure the child's safety, including any temporary arrangements made for their care.
- Prior Incident Report Form - This form provides information on previous reports of abuse or neglect involving the same child or family. Prior incidents can shed light on recurring issues and help in assessing potential risks.
Each of these documents not only supports the DCF-136 form but also reinforces the commitment to protecting children's welfare. Accurate and thorough reporting is critical in ensuring that children receive the help they need as promptly as possible.
Similar forms
- DCF-137: Report of Suspected Child Sexual Abuse - This document is specifically designed for reporting suspected sexual abuse of minors. Like the DCF-136, it requires detailed information about the child, the suspected perpetrator, and the nature of the abuse. Both forms are used by mandated reporters to formally document their concerns.
- DCF-138: Child Protective Services Investigation Report - This form is utilized during the investigation process of referred cases of child abuse or neglect. Similar to the DCF-136, it collects critical data regarding the child and their circumstances. Both documents focus on protecting the child's well-being and supporting the investigation efforts.
- DCF-139: Child Welfare Services Referral Form - This form is filled out to request child welfare services and support for the child and family. Much like the DCF-136, it emphasizes the child's safety and welfare, gathering necessary details that can aid in service delivery.
- DCF-140: Family Assessment Response (FAR) Initial Assessment Document - This form is part of a broader family assessment approach to identify needs and strengths. It shares similarities with the DCF-136 in that both documents aim to assess situations effectively and ensure that the child receives appropriate interventions and support.
Dos and Don'ts
When completing the DCF-136 form, there are important dos and don’ts to consider to ensure clarity and accuracy. Here’s a comprehensive list:
- Do: Fill out the form as soon as possible after making an oral report.
- Do: Use clear and legible handwriting or type the information to avoid misinterpretation.
- Do: Provide complete and accurate details about the child and the suspected abuse or neglect.
- Do: List any previous incidents of harm, if known, to help with the investigation.
- Do: Include your contact information, so follow-up questions can be addressed quickly.
- Don't: Include unnecessary personal opinions or assumptions about the situation.
- Don't: Forget to submit the form within 48 hours of the oral report; delays may impede action.
- Don't: Provide vague descriptions; specific details help authorities take appropriate actions.
- Don't: Disregard the confidentiality of the individuals involved; report facts, not personal feelings.
Misconceptions
Understanding the DCF 136 form is crucial for anyone involved in the child protection system. Unfortunately, there are several misconceptions surrounding this important document. Here are seven common misunderstandings:
- Only professionals can report suspected abuse or neglect. Many people believe that only mandated reporters, such as teachers or doctors, are allowed to submit the DCF 136 form. In reality, anyone can report suspected child abuse or neglect if they have reasonable cause to suspect harm, regardless of their profession.
- Filing a report is the same as accusing someone. Some individuals might hesitate to fill out the form, thinking it will automatically label someone as an abuser. Instead, the DCF 136 serves as a means to start an investigation, not a definitive accusation.
- Reporting is optional for mandated reporters. It is a common belief that mandated reporters can choose whether or not to report suspected abuse. This is incorrect. They are legally required to report their suspicions within a specific timeframe.
- The DCF 136 form is only for severe cases of abuse. People often think this form should only be used in the most extreme situations. However, any suspicion of abuse or neglect, regardless of severity, should be reported to protect the child.
- False reports of abuse carry no consequences. Many people believe that making a false report is harmless. In fact, intentionally filing a false report can lead to fines and even imprisonment.
- Submitting a report guarantees immediate intervention. Some may think that submitting the DCF 136 form will result in swift action. While the report will initiate an investigation, the process can take time, and immediate interventions depend on the specifics of each case.
- Your identity as a reporter is disclosed automatically. Many fear that their identity will be revealed when they submit a form. In most cases, reports can be made anonymously to protect the reporter from potential repercussions.
Understanding these misconceptions can empower individuals to act appropriately when they suspect child abuse or neglect. It’s essential to prioritize the safety and well-being of children.
Key takeaways
Filling out and using the DCF-136 form is crucial for mandated reporters in Connecticut. The following key takeaways summarize the essential aspects of this process.
- Timely Submission: After making an oral report of suspected child abuse or neglect, reporters must complete and submit the DCF-136 form within forty-eight hours.
- Accurate Information: The form requires detailed information about the child, the suspected perpetrator, and the nature of the suspected abuse or neglect.
- Mandatory Reporters: Various professionals, including teachers, doctors, and social workers, are legally obligated to report suspected abuse or neglect.
- Good Faith Immunity: Reporters acting in good faith are protected from civil or criminal liability, as long as they are not responsible for the abuse.
- Potential Penalties: Failing to report as required can result in legal penalties, including the possibility of a Class A misdemeanor charge.
- False Reporting Consequences: Knowingly making a false report can lead to fines, imprisonment, or both. Authorities take false reporting seriously.
- Supporting Documentation: If needed, additional documentation can be attached to the form to provide a more comprehensive view of the situation.
- Process Overview: After submission, the Department of Children and Families evaluates the report and may take necessary protective actions for the child.