CFSP 5 Year Plan - RI Department of Children, Youth & Families

Survey for Evaluating Emotional Abuse
Thank you for your participation in this survey. Emotional abuse is a repeated pattern of
interactions between caregivers and children that can include belittling, degrading,
threatening, rejecting and isolating. The operational definition of emotional abuse used
by the Rhode Island Department of Children, Youth and Families (DCYF) is listed below
for your reference:
Definition: Impairment to the intellectual or psychological capacity of a child as
evidenced by observable and substantial reduction in the child’s ability to function within
a normal range of performance and behavior, with due regard to his/her culture.
Usage: The child’s emotional condition must be directly attributable to a direct act by the
caregiver.
Caveat: To indicate this allegation, a medical professional such as a physician,
psychiatrist, psychiatric social worker, or psychiatric counselor must be the source of
diagnosis.
1. Please check the group that best identifies your profession:
Pediatrician Pediatric Emergency Medicine
Psychiatrist
Psychologist
Family Medicine Nurse Practitioner
Nurse
Social Worker
Other _________________
2. What type of setting do you work in?
School
Pediatric Hospital
Psychiatric Hospital
Private Practice
Mental Health Center
Ambulatory Health Center
Other _________________
3. How long have your worked in your profession? ____________________
4. What age group(s) of children do you work with? (Please check all that apply)
1 – 11 months 5 – 9 yrs 15 – 18 yrs
1 yr – 4 yrs 10 – 14 yrs All Ages
5. Have you ever been concerned about emotional abuse by a parent/caregiver of a
patient/student? Yes No (If No, go to question 10)
If Yes, have you been concerned within the last:
Year? Yes No
Two years? Yes No
Five years? Yes No
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