Child Advocacy Clinic Referral Guidelines

The Guilds Child Abuse Prevention and Treatment Center at Valley Children’s Hospital is a full-service practice providing expert diagnosis and management of suspected child maltreatment cases in infants, children and adolescents. We encourage a full multidisciplinary approach to patient care utilizing community resources as well as experts on staff in many fields who become part of the child’s care team. Our medical professionals will assist to protect an injured child or intervene preventively in all cases identified and referred.

Child maltreatment is a specialty that typically deals with a multitude of child maltreatment issues, including unexplained injuries, emotional abuse, suspected histories for sexual abuse or physical abuse, neglect and exposure to domestic violence. Early identification and clear documentation of findings are paramount to the child’s safety and wellbeing. The clinic identifies child maltreatment through forensic sexual abuse and physical abuse exams. For the child entering foster care, medical clearance exams are completed at the request of Child Protective Services and foster care agencies.

Refer to Child Advocacy

Refer to the Guilds Child Abuse Prevention and Treatment Center online through CareLink or our referral portal, or refer via fax.

Refer a patient

Child Advocacy Office Numbers

Contact Child Advocacy via phone (559-353-6022) or fax (559-353-7176).

Contact a Physician Liaison

Physicians can reach a physician liaison for help with referrals or other questions by calling 559-353-7229.

Download these referral guidelines as a PDF

As a medical professional, you are a mandated reporter. You must report to your local Child Protective Services if you suspect abuse. A person who fails to make a required report is guilty of a misdemeanor punishable by up to six months in jail and/or up to a $1,000 fine (Penal Code 11172[e]).

Patients should be referred if they have disclosed physical or sexual abuse. If the physician suspects injuries or findings are suspicious for abuse, please refer the child to the clinic for evaluation.

Condition	Pre-referral Work-up	When to Refer
Child Sexual Abuse	Urine PCR. Do no treat positive cases prior to referral.	Any child or adolescent who discloses abuse. Pain or bleeding from the genital or perineal area. Sexually transmitted infection (STI) in nonsexually active children and adolescents. Pregnancy in children younger than 18 years old. Sexualized behavior.
Child Physical Abuse	Children under 2 years old need skeletal survey if fractures or significant injuries are seen. Bleeding studies including PT, PTT, INR, CBC if significant bruising is noted. Acute fractures need X-rays.	Significant bruising not age appropriate. Unexplained injuries. Injuries in a child not ambulating. Multiple visits for injuries in a young child (under 1 year of age).
Child Maltreatment: Emotional Abuse and/or Domestic Violence	Report to law enforcement and Child Protective Services. Referral to Victims of Crime if possible.	When a history or suspected history is disclosed. Worried about safety of child with caregivers. Injuries are seen on the child. Self-inflicted injuries are identified.
Medical Clearance Examination	Rule out any emergency medical situation and contact appropriate emergency room, if needed. Document any injury or bruising	Placed in protective custody and general physical exam is required. Recent change in foster care placement.

California Abuse Reporting Law, Penal Code Section 11164-11174.5; http://www.leginfo.ca.gov/cgi-bin/waisgate?WAISdocID=93760323573+0+0+0&WAISaction=retrieve