REPORTING CHILD ABUSE AND NEGLECT

The government has a responsibility to protect children when parents fail to provide proper care and to intervene in cases of child maltreatment. The federal Child Abuse Prevention and Treatment Act (CAPTA) requires each state to have a system in place that requires certain individuals to report suspected child abuse and neglect. All states list the mandated reporters, responsibilities of institutions, standards for making reports, and how confidentiality of the reporting party is maintained.

Who Must Report Abuse?

Anyone may report suspected child abuse at any time and is encouraged to do so. Such reports are typically confidential and may be made anonymously by members of the public.

Nearly all states designate certain professions whose members are mandated by law to report child maltreatment. Typically, these individuals have frequent contact with children. Such persons may include:

  • Social workers
  • Teachers and other school personnel
  • Physicians, nurses, and other healthcare workers
  • Mental health professionals
  • Child care providers
  • Medical examiners or coroners
  • Law enforcement officers

Some other professions include film or photograph processors, computer technicians, substance abuse counselors, probation or parole officers, and attorneys and clergy in certain circumstances. Domestic violence workers, animal control or humane officers, and court-appointed special advocates are also required to report in some states.

In more than one third of states, any person who suspects child abuse or neglect is required to report it. In most of those states, professionals who are mandated to report are also listed, but all persons who are aware of abuse are required to report.

It is important that all professionals be informed of the laws that pertain to the jurisdiction(s) of their own practice (CWIG, 2019b).

What Situations Require That a Report Be Made?

State statutes vary, but generally a mandatory reporter must make a report when they suspect or have reason to believe that a child is abused or neglected. In some states, the reporter must observe a child in a situation that is likely to result in harm to the child. The reporter does not have to provide proof of the suspected abuse or neglect (CWIG, 2019b).

(For state-by-state information on mandated reporting, see “Child Welfare Information Gateway” in the “Resources” section at the end of this course.)

REASONABLE CAUSE

There can be “reasonable cause” to suspect that a child is abused or maltreated if, considering the physical evidence observed or told about, and based on the reporter’s own training and experience, it is possible that the injury or condition was caused by neglect or by nonaccidental means.

Certainty is not required. The reporter need not be certain that the injury or condition was caused by neglect or by nonaccidental means. The reporter need only be able to entertain the possibility that it could have been neglect or nonaccidental in order to possess the necessary “reasonable cause.” It is enough for the mandated reporter to distrust or doubt what is personally observed or told about the injury or condition.

In child abuse cases, many factors can and should be considered in the formation of that doubt or distrust. Physical and behavioral indicators may also help form a reasonable basis of suspicion. Although these indicators are not diagnostic criteria of child abuse, neglect, or maltreatment, they illustrate important patterns that may be recorded in the written report when relevant.

CASE

Sharon, a sixth-grade math teacher, stops by her friend Anh’s house for coffee on the way to work. While she is there, Anh’s 5-year-old son, Tran, who has been diagnosed with autism, runs into the kitchen and for no apparent reason shoves his 2-year-old sister, who falls to the floor. The sister is not injured, but Anh rages at Tran, picks him up, and throws him across the kitchen, where he slides into a cabinet, hitting the back of his head.

Sharon takes off her coat and examines Tran, who is okay. While she knows that laws in her state do not require her to report a suspicion of child abuse since she is not currently acting in her professional capacity, Sharon also knows the importance of taking action for the safety of her friend’s young son.

Sharon first sits down with Tran on her lap to talk to Anh. She empathizes with her friend and expresses her concern for the family. She acknowledges how frightening and stressful it must be for Anh to have a child with a serious condition and asks Anh if she could refer Tran to a program for autistic children that is provided by the school district. Anh tearfully agrees, and Sharon makes a few calls to the school district to gather information about the program.

Sharon makes a point to call Anh the next day and frequently thereafter. One month later, Any tells Sharon that the school social worker has helped her find a program in which she has learned appropriate new ways of dealing with Tran’s acting-out behaviors. Tran has also been enrolled in the school district’s program for autistic children and is doing much better.

How Is a Report Made?

In most jurisdictions, a telephone report should be made immediately and then followed by a written report. States often provide standardized forms for this purpose.

Most healthcare facilities also have policies and procedures in place regarding the reporting of suspected child abuse. Healthcare professionals and other mandatory reporters must know what guidelines are in place at their place of employment as well as state mandates.

At the time of an oral telephone report, frequently to a state-subsidized 800 number, a Child Protective Services (CPS) specialist will typically request the following information:

  • The condition of the child
  • Names and addresses of the child and parents or other person responsible for care
  • Location of the child at the time of the report
  • Child’s age, gender, and race
  • Nature and extent of the child’s injuries, abuse, or maltreatment, including any evidence of prior injuries, abuse, or maltreatment to the child or its siblings
  • Name of the person or persons suspected to be responsible for causing the injury, abuse, or maltreatment (“subject of the report”)
  • Family composition
  • Any special needs or medications
  • Whether an interpreter is needed
  • Source of the report
  • Person making the report and where reachable
  • Actions taken by the reporting source, including taking of photographs or X-rays, removal or keeping of the child, or notifying the medical examiner or coroner
  • Any additional information that may be helpful

A reporter is not required to know all of the above information in making a report; therefore, lack of complete information does not prohibit a person from reporting. However, information necessary to locate a child is crucial.

(See also “Childhelp National Child Abuse Hotline” in the “Resources” section at the end of this course.)

Mandatory Notification of Substance Exposed Infants

The CAPTA Reauthorization Act of 2003 contained legislation that called for mandated reporters to notify Child Protective Services when infants were identified as affected by substance abuse or withdrawal symptoms resulting from in-utero exposure to substances. The CAPTA Reauthorization Act of 2010 included additional legislation requiring that mandated reporters notify CPS for infants affected by fetal alcohol spectrum disorder (FASD). In 2016, further changes to CAPTA were made in response to the nation’s opioid epidemic, for instance, no longer specifying “illegal” in regard to substance abuse.

CAPTA also requires a plan of safe care, immediate screening, risk and safety assessment, and timely investigation for substance- and alcohol-affected infants. Safe care plans must address the affected caregiver as well as the infant. CAPTA also requires that states report data on affected infants and create and provide oversight systems to assure that safe care plans are implemented (NCSACW, 2017).

HEALTHCARE PROVIDERS REQUIRED TO REPORT

The healthcare providers required to submit this notification vary by state but generally include licensed hospitals or healthcare facilities or persons who are licensed, certified, or otherwise regulated to provide healthcare services. These professions typically include physician, podiatrist, optometrist, psychologist, physical therapist, certified nurse practitioner, registered nurse, nurse midwife, physician’s assistant, chiropractor, dentist, pharmacist, and those accredited or certified to provide behavioral health services.

PLAN OF SAFE CARE

After notification of a child born affected by substance use or withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder, a multidisciplinary team meets prior to the child’s discharge from the healthcare facility. The meeting informs an assessment of the needs of the child and the child’s parent(s) and immediate caregiver(s) to determine the most appropriate lead agency for developing, implementing, and monitoring a plan of safe care. Depending on the needs of the child and parents/caregivers, ongoing involvement of a county agency may not be required.

The child’s parents and immediate caregivers must also be engaged to identify the need for access to treatment for any substance use disorder or other physical or behavioral health condition that may impact the safety, early childhood development, and well-being of the child.

For the purpose of informing the plan of safe care, the multidisciplinary team may include public health agencies, maternal and child health agencies, home visitation programs, substance use disorder prevention and treatment providers, mental health providers, public and private children and youth agencies, early intervention and developmental services, courts, local education agencies, managed care organizations, private insurers, hospitals, and medical providers.

Consequences for Failing to Report

Nearly every state imposes a penalty of a fine or incarceration for mandated reporters who willfully do not report suspected child abuse or neglect. Such mandated reporters may be charged with a misdemeanor or felony for the failure to report. In several states, mandated reporters can also be held liable by civil statutes for damages that result from their failure to report (CWIG, 2019c).

Perhaps more importantly, failure to report can also lead to more serious consequences for the child and family. CPS cannot act until child abuse is identified and reported—that is, services cannot be offered to the family nor can the child be protected from further suffering.

Legal Protections for Reporters

CAPTA requires states to provide immunity from liability for individuals making good-faith reports of child abuse or neglect. States must comply with this mandate in order to be eligible for federal grants. In addition, the identity of the reporter is protected from disclosure to the alleged perpetrator (CWIG, 2019d).

Mandatory reporting laws may recognize the right to maintain confidential communications between professionals and their clients, patients, or congregants. In order to provide protection to maltreated children, the reporting laws in most states and territories restrict this privilege for mandated reporters.

Among the requirements for receiving federal funding under CAPTA is that states must also preserve the confidentiality of all child abuse and neglect reports and records. This mandate protects the privacy of the child and their parents or guardians, except in certain limited circumstances. All jurisdictions have provisions that protect abuse and neglect records from public view, and many jurisdictions include specific provisions for this purpose (CWIG, 2017b).

REPORTING IMPLICATIONS OF HIPAA

Mandated reporters often express reluctance to report child abuse because they are concerned they may compromise patient privacy under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA provisions do not, in fact, inhibit the responsibilities of mandated reporters of child abuse and neglect. HIPAA 164.512, b (1) states that “a covered entity may use or disclose protected health information for the public health activities and purposes described in this paragraph to a public health authority or other appropriate government authority authorized by law to receive reports of child abuse or neglect.” This means that mandated reporters may report suspected child abuse and neglect to a local agency that is authorized to receive the information. The agency may be a social services department or a police department, for example (USDHHS, 2020).