Mandated Reporting Policy Acknowledgment Form

Dear Parent/Guardian,

At A to Z Behavioral Services, the safety and well-being of our clients are our highest priority. As an Applied Behavior Analysis (ABA) provider, we are legally required to follow state and federal laws regarding the reporting of suspected child abuse or neglect. This policy outlines our legal obligation and how it may apply to your child.

1. What is Mandated Reporting?

Under state law, all A to Z Behavioral Services staff, including Board Certified Behavior Analysts (BCBAs), Registered Behavior Technicians (RBTs), behavior therapists and administrative staff, are Mandated Reporters. This means we are legally required to report any suspected cases of:

• Physical abuse
• Sexual abuse
• Emotional abuse
• Neglect (e.g., inadequate food, cleanliness, shelter, medical care, or supervision)
• Exploitation (e.g., child labor, human trafficking)

If we have reason to believe a child may be experiencing abuse or neglect, we are required by law to immediately report our concerns to the appropriate Child Protective Services (CPS) or law enforcement agency.

2. Reporting Process

If a staff member suspects abuse or neglect, they must:

• File a report with CPS or law enforcement.
• Follow up only with the investigating agency if required.
• Maintain confidentiality and not disclose details to unauthorized individuals.

3. Confidentiality

• Reports are confidential and can only be accessed by the appropriate authorities.
• Parents/guardians will not be notified by A to Z Behavioral Services, before a report is made.

• Staff members cannot investigate or determine guilt—only report suspected abuse.

4. Protection for Mandated Reporters

Under the law, all reports made in good faith are protected from legal consequences. Our duty is to ensure the safety of all children in our care.

5. Acknowledgment & Agreement

By sending the information through our website, you acknowledge that you have read and understand A to Z Behavioral Services’s Mandated Reporting Policy. You understand that:

• Staff members are required by law to report suspected abuse or neglect.
• Reports are confidential and made directly to CPS or law enforcement.
• A to Z Behavioral Services does not investigate claims—only reports suspicions to the appropriate authorities.

I acknowledge that I have received, read, and understand the Mandated Reporting Policy of A to Z Behavioral Services.