An Evidence-Supported Approach to Reporting Child Maltreatment

The workshop begins with the trainer providing a personal introduction and posing the following three questions in a slide show.
These questions provide an outlet for participants to indicate both good and bad experiences with the reporting process and provide an opportunity for the instructor to empathize with participant responses prior to the presentation of training material. Participants are typically quick to engage when these questions are presented, appearing more receptive to subsequent workshop information. This is important as some participants may be compelled to attend the workshop by their employers and may lack intrinsic motivation to receive training.

The training agenda includes a summary of the 2-h workshop format and topics to be discussed (see Fig. 17.1). It is reported that a PowerPoint presentation will be utilized to review definitions of the various types of child maltreatment and legal requirements specific to reporting suspected child maltreatment in their respective state or province (including a timetable of when reports must be made, report content, and what occurs within CPS after a report is made). The agenda indicates that participants will have opportunities to practice and discuss child maltreatment reporting skill sets with their peers after viewing videotapes of a professional initiating a child maltreatment report with a caregiver who later becomes upset about the report.

After the agenda is reviewed, instructors engage workshop participants about the impact of inaccurate reporting of child maltreatment, the intent of which is to establish their motivation for training in accurate reporting of suspected child maltreatment. Two slides are presented to address professionals’ failure to report suspected child maltreatment accurately. It is indicated that approximately 40 % of mandated reporters fail to report suspected child maltreatment at some point in their careers and that 6 % consistently fail to report (Besharov 1994; Camblin and Prout 1983; Kenny and McEachern 2002; Zellman 1990a, b). Attendees are also informed that overreporting by professionals leads to a high proportion of unsubstantiated reports (Besharov 1994; Foreman and Bernet 2000; Kalichman 1999; Zellman and Coulborn-Faller 1996), some of which are clearly not warranted and can cost governments valuable resources. Instructors also provide information that is relevant to failure of professionals to report suspected child maltreatment as a result of perceived negative consequences. For instance, although it is reported by Baxter and Beer (1990) that about a quarter of professionals fear legal retaliation due to reporting suspected child maltreatment, this information is not true due to federal immunity for anyone reporting child maltreatment to officials in good faith. Relevant to concerns specific to physical retaliation by suspected perpetrators, it is pointed out that only approximately 4 % of clients respond with threats or attempts to harm professionals (Weinstein et al. 2000). Of course, trainers need to be careful to avoid negation of the potential for harm, however unlikely this may be to occur.

It is reported that Kalichman and Craig (1991) found 31 % of psychologists believed reports of child maltreatment would adversely affect relationships they had with their clients, and Kalichman et al. (1989) found 42 % of licensed psychologists believed reporting child maltreatment negatively impacted family therapy. It is therefore pointed out that some professionals may struggle between wanting to report in an attempt to improve circumstances for the child and fearing reporting efforts will result in further harm to the family unit. The instructor balances this tension in discussion, pointing out that the absence of mandated reporting may lead to continued child maltreatment, whereas reporting may lead to the provision of social and medical services to the family by CPS. It is also pointed out that Steinberg et al. (1997) determined that positive reporting of child maltreatment is significantly influenced by the presence of a positive therapeutic relationship prior to reporting, and involvement of clients in the reporting process may enhance relationships between professionals and clients throughout treatment (Levine and Doeuck 1995). For instance, Weinstein et al. (2001) determined that 40 % of reported cases of child maltreatment resulted in unchanged relationships with the professional making the report and that 32 % resulted in improved relationships. Thus, workshop participants are encouraged to utilize clinical judgment in the decision to include caregivers in the reporting process, including suspected perpetrators of child maltreatment.

Accurate child maltreatment identification is frequently identified in the literature to be important in the reporting of child maltreatment (Foreman and Bernet 2000; Kalichman 1999). Therefore, the major types of child maltreatment are reviewed. Child maltreatment generally concerns psychological abuse, physical abuse/excessive corporal punishment, sexual abuse/exploitation, and child neglect, as governed by the state in which the workshop is conducted. However, states or local governing bodies vary as to what is specifically indicated to be child maltreatment. For instance, in Nevada “mental injury” is the concept used instead of “emotional” or “psychological” abuse. Therefore, instructors show specific definitions of child maltreatment that are governed in the state or local jurisdiction for which the workshop is conducted and subsequently attempt to solicit comments from workshop participants that demonstrate their understanding of these definitions.

To assist in further understanding how to accurately identify child maltreatment, the instructor provides a slide that specifies physical, behavioral, and emotional indications of the different types of maltreatment (see Fig. 17.2). The trainer stresses that many of the indicators of child maltreatment (e.g., difficulty sleeping) are often shared between the victim and perpetrator of child maltreatment and that victims and perpetrators of child maltreatment often experience multiple indicators of child maltreatment (e.g., low self-esteem, anxiety, depression, speech impairments). However, participants are also cautioned that specific indicators of child maltreatment may be present due to conditions or causes other than child maltreatment. For example, academic difficulties in adolescents may be indicative of physical abuse, but may simply result from a learning disability. In addition, participants are encouraged to consider developmental appropriateness of the presented indicators. For instance, self-stimulation of genital areas may indicate sexual abuse or simply be indicative of normal developmental exploration. Although the aforementioned information suggests that apparent signs of child maltreatment may be influenced by factors that are not specific to child maltreatment, it is emphasized that, in general, professionals should attempt to validate or disconfirm their initial suspicions with other professionals after examining relevant laws governing the protection of children from maltreatment.

Mandated reporters’ lack of knowledge regarding reporting requirements for suspected child maltreatment has been identified repeatedly in the literature and is problematic. Therefore, the federal mandate for professionals to report suspected maltreatment as required by the Child Abuse Prevention and Treatment Act (CAPTA) of 1974 for children less than 18 years of age is reviewed, including relevant laws of the state or province for which training occurs. Instructors need to adjust workshop content to accommodate local jurisdictional laws. Although child maltreatment protection laws may vary across states, instructors disclose that all states require that a report of child maltreatment has to be made when a professional believes (e.g., have reason or cause to believe, or have reasonable cause to believe) or suspects (e.g., have reason or cause to suspect, or have reasonable cause to suspect) child maltreatment has occurred or when “a reasonable person would suspect child maltreatment has occurred.” Thus, attendees are strongly urged to consult with at least a couple of professionals prior to initiating the reporting process of child maltreatment with CPS and to document any discussions that influence the reporting process. It is also highlighted that the timeline for reporting child maltreatment is usually determined to be as soon as possible, but no later than 24 h after suspicion of child maltreatment. It is mentioned that some states require a formal written report to be filed within a week of the initial report of suspected child maltreatment.

The distinction between objective evidence and feelings, both of which may be acceptable in the consideration of child maltreatment depending on the local jurisdiction, is discussed. Lack of evidence has been reported as a substantial factor in the decision by professionals not to report child maltreatment (Finalyson and Koocher 1991; Kalichman et al. 1989). Therefore, concepts of suspicion and belief are discussed in light of evidence.

The workshop is best suited for professionals (usually mental health professionals). Therefore, clarification is provided that confidentiality privileges and obtaining information in the context of research do not negate the reporting mandate. Many workshop participants are surprised to learn they should only provide information about the suspected perpetrator and victim of child maltreatment that is specific to the incident or incidents of suspected child maltreatment and future protection of the child. Additional information is provided to participants regarding immunity in the United States for reporting child maltreatment in “good faith,” and that failure to report may result in fines, jail time, civil liability, and/or sanctions by professional licensing boards. Workshop participants are encouraged to follow reporting practices of their employers, but are also informed that persons who suspect or believe child maltreatment has occurred are mandated to report to CPS, regardless of the beliefs or suspicions of their employers. Instructors encourage participants to consult with professional colleagues and professionals within CPS when they are unsure how to proceed and to document child maltreatment reports in clinical records as well as specific rationales leading to decisions not to report.

Workshop participants are informed that reports could be made to either local law enforcement or CPS and that these agency representatives will request specific information that is necessary to determine when official reports of child maltreatment are needed. Therefore, with few exceptions (i.e., important circumstances leading to suspected child maltreatment, information specific to the protection and whereabouts of referenced child) mandated reporters should generally not report information that is not relevant to suspected child maltreatment to assist in protecting confidentiality of clients. When children are suspected to be in immediate danger, or when suspected perpetrators are not family members or within the household of children who are suspected of child maltreatment, workshop participants are encouraged to contact the local police department rather than CPS.

Workshop participants often do not realize that it may be advantageous to involve caregivers in the reporting of child maltreatment, including perpetrators suspected of child maltreatment when clinically determined. Similarly, they may be unfamiliar with various factors that suggest inclusion of caregivers in the reporting process is contraindicated. To assist workshop participants in gaining a better understanding of this tension, the workshop facilitators are trained to first solicit situations in which caregivers should be excluded from this process. Facilitators generally empathize or validate these scenarios and subsequently solicit situations in which the participation of caregivers in the child maltreatment reporting process may be indicated. Workshop participants are informed that clinical judgment should be emphasized in determining the appropriateness of involving caregivers in the reporting process to assist in assuring self- and other-preservation (Berliner 1993). Along these lines, it is emphasized that professionals exclude caregivers in the reporting process if they are uncomfortable doing so or suspect this process may be clinically contraindicated. Indeed, exceptions to including caregivers of child maltreatment in the reporting process are reviewed and may include their history of abrupt aggression, emotional instability or intoxication, and indications that caregivers may attempt to influence suspected victims to retract child maltreatment incidents that are valid (see Stadler 1989).

On the other hand, instructors explain that involving caregivers in the reporting process may assist in maintaining positive therapeutic relationships, particularly when limits of confidentiality are detailed during informed consent (see Weinstein et al. 2000). In doing so caregivers are less likely to become upset should a report of child maltreatment be indicated later in therapy (Steinberg 1994). Moreover, Nicolai and Scott (1994) empirically determined that professionals who routinely reviewed limits of confidentiality were more likely to report child maltreatment in case presentations, and reporting outcomes are generally more positive when caregivers are informed of the decision to report (Weinstein et al. 2001). Consistent with Taylor and Adelman (1998), instructors encourage workshop participants to explain to caregivers why reports need to be made, soliciting their input in the process of reporting and reviewing possible outcomes of reporting. Instructors also inform workshop attendees that it is generally a good idea to provide caregivers options in the reporting process. Following recommendations of Stadler (1989), instructors emphasize that caregivers should first be presented the option of initiating the report themselves. If this option is declined, professionals may offer to initiate the report in the caregiver’s presence. When both of these options are declined by caregivers, professionals are encouraged to indicate that the report can be made outside the caregiver’s presence. This strategy is likely to decrease anxiety while satisfying legal reporting requirements.

Workshop participants are informed about the process CPS undergoes after reports are initiated, which has been identified to be an important training strategy (Levine and Doeuck 1995; Weinstein et al. 2001). Compaan et al. (1997) found professionals are more likely to report child maltreatment when they have an understanding of the reporting process from the perspective of CPS, which helps them to guide caregivers through this process (Brosig and Kalichman 1992). The instructor indicates that there are several steps that occur after the report is made to CPS. First, the CPS agent may or may not accept the report. Reports are generally accepted when the extent of information provided is sufficient to permit an investigation to occur (e.g., identifying information provided), and the incident appears to be indicative of child maltreatment. If a report is accepted, it may or may not be recommended for investigation. If a report is accepted for investigation, most CPS organizations have a priority system to assist in determining their response time. For instance, if an incident is associated with imminent risk, the agency may need to respond immediately or at least within 24 h. In such events, the child may be removed prior to the conclusion of the investigation. In all jurisdictions, child abuse investigations must be initiated within 48–72 h of the report to determine whether maltreatment occurred and create a case plan to address potential concerns. It is explained to workshop participants that it is comforting for caregivers to learn mandated reports of suspected child maltreatment can include supportive feedback from them, such as outstanding efforts of caregivers to participate in treatment and demonstrations of affection and concern for their children. Similarly, caregivers are soothed to learn professionals can provide recommendations during their initial reports that children not be interviewed during school hours or that caregivers will be available by telephone to arrange investigative meetings that do not occur in their place of employment.

Workshop participants are informed that CPS and/or differential response agencies may provide services to families regardless of investigative outcomes and that services may be provided free of charge. Potential services may include mental health therapies, employment services, financial assistance, and parenting resources. Services are generally voluntary, although CPS agents may seek a court mandate to assure completion of services and well-being of children. Professionals and caregivers are often concerned that children will be removed or that criminal prosecution of the suspected perpetrator will occur. To reassure them, participants are informed that although this is a possible outcome of the reporting process, these consequences are unlikely unless maltreatment is severe. Indeed, separation of children from caregivers who are assessed to perpetrate child maltreatment generally occurs only when risk of harm is determined by CPS to be imminent, and in such cases separation is almost always temporary and in the homes of family members. For instance, participants are informed that prosecution rates have been reported to be 17 % for sexual abuse and approximately 2 % for other types of child maltreatment (Tjaden and Thoennes 1992). Lastly, instructors remind workshop participants that the goal of CPS is ultimately family welfare and reunification even in cases where a child needs to be removed for protective reasons.

Two videotapes are presented to model the process of reporting child maltreatment with a caregiver, including skills that are specific to the management of an upset caregiver. The respective skill sets are consistent with the previously reviewed material. Participants are informed that the professional’s modeling corresponds to the behavioral instructions specified in Appendices A and B (which are distributed to participants immediately before the workshop). To assist workshop attendees in paying attention to important details, they are asked to put checks next to each behavioral instruction that is reviewed by the professional. The instructor presents the first videotaped scenario in which the professional informs a caregiver of his intent to report child maltreatment. The caregiver reacts with delayed compliance, suggesting disbelief and concern. After all behavioral instructions in Appendix A are modeled, the caregiver demonstrates her upset with the report. This permits the professional an opportunity to model each of the behavioral instructions listed in Appendix B. At the conclusion of the videos, participants are prompted to answer two questions that are biased to solicit positive responding (i.e., What did you like about the professional’s skills? If you were the professional, what would you do differently, if anything, to fit your style?). The videotapes may be obtained by the authors, or the behavioral instructions may be modeled by the instructors.

After the videotapes are briefly discussed, participants are divided into pairs and instructed to take turns role-playing the two skill sets listed in Appendices A and B, respectively. They should be told to utilize the instructions in Appendices A and B to guide their efforts. In doing so, many participants are initially hesitant to engage in role-plays and are assisted in their practice with encouragement and descriptive praise. It is also helpful to inform participants to glance at the respective checklist prior to initiating each behavioral step, rather than memorizing instructions. During role-play interactions, instructors should briefly visit with participants, pointing out their demonstration of skills and briefly answering their questions.