Child Abuse ReportingIn an ideal world the child abuse reporting statutes would be clear, the opposite appears to be the case.Not only are there inconsistencies between states, but there are also inconsistencies within jurisdiction, within each state. For example, child abuse reporting is a statutory requirement in every state.In Massachusetts, the standard for reporting is "...reasonable cause to believe...” whereas in Mississippi the standard is "...that a child brought to him or coming before him...” Thus the standard can vary from reasonable suspicion to actually seeing the abused child.Similarly, it has been the authors experience that a child protective service worker in one county in California, when given a specific set of circumstances, will suggest making a formal report whereas another worker either in the same or different county may not recommend making a formal report. When surveyed, mental health professionals indicated that the child abuse-reporting mandate was the most common of a number of confidentiality issues confronted in the course of their work.The findings of numerous studies have indicated that a significant number of clinicians have complied inconsistently with the legal mandate to report abuse.While there has been speculation that under-reporting results from professional responsibility and clinical judgment being subordinated to clinicians serving a policing function and concern for the patients’ welfare others believe that under-reporting, in part, stems from differences in the interpretation of the child abuse laws as well as situational and therapist characteristics.The problem of reporting is critical in cases of domestic violence as treatment decisions will be made based on the types of abuse occurring within the family and reports of child abuse may ultimately affect the client’s status within the criminal justice system.Moreover, additional acts of abuse are frequently detected and/or perpetrated after the commencement of treatment and therefore the clinician working with this population must be prepared to deal with the need to report child abuse in addition to family violence. The decision to report or not report is complex where the interests of the individual, the family, the profession and the community potentially come into conflict.Although most would agree that child abuse is appalling, there are many disagreements as to what actions should be taken to protect children who have been victimized and are at risk for further abuse.The fact that many therapists do not report abuse, in spite of the potential legal and ethical consequences, is evidence that legislation is not a panacea to address this complex social phenomenon.In exploring clinicians’ decision making, researchers have determined that a variety of factors appear to influence this process. These factors include responsibility for the abuse, history of abuse, severity of abuse, recantation, perception of the therapist’s role, type of abuse, socioeconomic status of patient and license of professional, years of practice, clinicians’ expectation of what potential expectations reporting may have on the individual or family, the perpetrators admission or denial of abuse, sex of therapist and alleged perpetrator, age of child, behavior of alleged victim, therapists’ history of reporting, perpetrators’ relationship to child, therapists’ knowledge of law and clarity of legal requirements.Given the significant number of variables identified, it is clear that in any given potential reporting circumstance how any unique combination of variables may operate synergistically to impact the decision to report or not. Therefore, at the least, clinicians must be intimately familiar with their state’s reporting statute. The basic information that clinician need in order make informed clinical decisions is to be clear what constitutes child maltreatment according to scholars in the field and what is the reporting threshold within any particular community.This information, in conjunction with clinical consultation, will provide clearest direction necessary to enhance optimal decision-making and thus, outcome. What is Child Maltreatment?Mental health professionals use multiple categories to define and study child maltreatment. In general, child maltreatment is defined as "acts of omission or commission by a parent or guardian that are judged by a mixture of community values and professional expertise to be inappropriate and damaging to the development of a child or adolescent". The developmental effects of maltreatment and neglect will vary depending on the child's age (e.g., during infancy, lack of food could result in failure to thrive and potential brain damage while an older child could find ways to obtain food outside the family); the amount of force used (what's necessary to produce a concussion in an infant would probably cause a black eye for an adolescent); and the number of abusive acts committed (one vs. many over the period of years). Specifically, there are four areas of maltreatment to consider when interviewing a client and his or her family to determine the presence of child abuse: physical abuse, sexual abuse, physical neglect, and psychological maltreatment.More recently the category, psychologically unresponsive, has been defined to fit those families that do not meet the threshold definition of psychological maltreatment but nevertheless have a negative impact on the developing child(ren). However, there is no known reporting requirement for the category of psychologically unresponsive parenting. Physical maltreatment involves the inappropriate and developmentally damaging use of force against children or adolescents that results in a non-accidental physical injury. The inflicted physical injury most often results from unreasonably severe corporal punishment or unjustifiable punishment. Although this would seem clear on the surface, there are differing opinions about the value of corporal punishment.Additionally, it is not always clear when corporal punishment crosses the line to abuse. Physical neglec is the negligent treatment of a child resulting in harm or threatened harm to the child's health or welfare. California law defines two categories of physical neglect: severe neglect and general neglect. Severe neglect means the negligent failure of a parent or caretaker to protect the child from severe malnutrition that could result in non-organic failure to thrive. It also includes the intentional failure to provide adequate food, clothing, shelter or medical care that results in physical injury to the child.General neglect means the negligent failure to provide adequate food, clothing, shelter, medical care or supervision where no physical injury to the child has occurred.Once again, here there can be considerable disagreement as to what constitutes neglect.For example, not procuring certain types of medical or mental health treatment may reflect personal and religious values in one situation but may be considered neglect within another context.The effects of poverty also play a significant role in issues relating to neglect. Sexual maltreatment refers to acts of sexual assault or sexual exploitation of minors. Sexual maltreatment encompasses a broad spectrum of behavior and may consist of many acts over a period of time or a single incident.Traditionally these unlawful acts occur when a person over eighteen perpetrates them with an adolescent or child.However, any forced sexual acts with an adolescent or child is considered sexual maltreatment, therefore an adolescent or child could be found guilty of sexual abuse.There are many intricacies in the sexual abuse reporting laws, particularly when it comes to the issue of consensual sexual relations.For example, according to California law, consensual sex between two thirteen year olds is not reportable as child abuse, but consensual sex between a fourteen year old and a thirteen year old is reportable as child abuse.Recently, the California Statutory Rape law (PC 261.5d) has been changed in such a way that fourteen and fifteen year olds having consensual sexual relations with someone over twenty-one is reportable as child abuse.Whereas lewd and lascivious acts (including intercourse) are reportable as child abuse if the adolescent is fourteen or fifteen years old and the adult is over ten years older.For these reasons, it is critical that providers are intimately familiar with their state’s reporting laws. Psychological maltreatment, according to researchers in the field of child maltreatment, refers to the following domains:
Psychologically unresponsive parenting is a newer category of child maltreatment that is very similar to the definition of psychological maltreatment, particularly the subcategory denying emotional responsiveness.However, there are also a number of distinct differences between these categories that make it worth mentioning.Psychologically unresponsive parenting is when the parent(s) derive little pleasure or satisfaction from a relationship with the child.They are poor at comforting the child at times of distress, they are often detached or uninvolved with the child and may only interact when absolutely necessary.Like the above definition, they are often unresponsive to the child's emotional needs and end up passively rejecting them.They are often oblivious to the child's attempts to elicit interaction.These parents are often described as withdrawn or depressed.These behavior patterns are not malicious as much as the parent is just not interested or lack the capacity for interest or empathy because of the preexisting psychiatric illness, such as a mood, personality or thought disorder. While each type of these types of maltreatment is distinct in principle, in practice there is a great deal of overlap so that you will rarely see only one type of abuse. However it is important to understand that each type of abuse, either experienced by a client or perpetrated by the client or other family members in order to adequately address it in treatment. Deciding to Report Child AbuseGiven this information, what can clinicians do to better respond to cases of child maltreatment?Although in many states the law indicates that a therapist must contact social services immediately and follow-up with a written report within thirty-six hours once the threshold standard has been met, consultation with colleagues remains an important component in assisting the clinician in deciding whether or not to report.In fact, empirical studies have found consultation to be positively correlated with child abuse reporting.This may not always be possible, and in those situations when an immediate decision must be made, a clinician may call the appropriate agency and describe to the on-call intake worker the relevant case facts without initially revealing names of the parties.The intake worker may either ask the right questions that will help the clinician decide the best course of action or will inform them whether the reporting threshold has been met.Similarly, it is important for mental health professionals to meet with law enforcement and child protective service personnel in their community to discuss interpretations of the current statutes as well as polices and procedures for reporting and case follow-up.Clinicians are frequently unaware of the outcome of their reports to child social services; therefore building a relationship with these professionals tends to enrich both the clinical community as well as social service personnel. Continuing education in the identification and treatment of child abuse will not only increase the clinician's ability to recognize the threshold standard, which assists in more accurate reporting, but also find more effective methods of treating families experiencing this problem.The literature in the field is rapidly expanding to such an extent that even the most experienced clinician needs to take the time to review the latest advances in treatment and research findings.Unfortunately, it is often all too easy for seasoned clinician to get into a rut by continuing to rely on old research data and treatment methodologies, compromising optimal treatment planning for clients. Lastly, in order to minimize the trauma experienced by the family as a result of a child abuse report, many specialists suggest that the clinician make the report (i.e. call social services) while the client(s) are in the office or ask the client(s) to make the call from the office (the latter being most effective when the treatment is with the perpetrator).Similarly, a therapist may also attend meetings with police or social services as a support to their client(s) should their presence be desired and appropriate.In general, it remains important for the clinician to understand that the potential consequences of the report can be quite devastating to the client(s) and the therapist should be available for continued support and assistance during the investigation and evaluation process. Feelings of betrayal are likely to be experienced by the patient and/or family members towards the therapist for initiating a report to social services.Therefore, the therapist needs to be prepared for handling a great deal of negative affect when providing appropriate boundaries with the goal of positive resolution in mind.However, many clients may not be able to overcome these deep feelings of resentment and lack of trust in the clinician.If this occurs, the therapist needs to seek consultation to evaluate if a referral is appropriate and participate in an orderly transition, if needed. Lastly, when a child abuse report is indeed made, a Critical Incident Form(see Forms) must be completed and included in the patient’s chart, along with a copy of the standard child abuse form forwarded to Child Protective Services or the law enforcement agency identified to received the written report. Required Reading Guidelines on Reporting Child Abuse When you are ready to move on, click on the link below.I am ready to move on! |
