Mandatory reporting of child abuse “Our children’s future and the world’s future are one”
9.3 Arguments surrounding mandatory reporting legislation
9.3.1 Arguments against mandatory reporting
The Royal College of Paediatrics and Child Health (RCPCH), in a position paper from December 2013, outlined at that time their lack of support for mandatory reporting of child protection concerns and recommended that the UK should not legislate on this issue stating that there is no credible or conclusive evidence that it better protects children at risk of harm, and its introduction would undermine the cultural approach of risk and responsibility sharing that has developed in the current system58.
9.3.2 A number of arguments have been put forwards against mandatory reporting, as
summarised by the NSPCC in their Strategy Unit Briefing paper on Mandatory Reporting, 12 June 201459:
perceived danger of over-reporting
increases in unsubstantiated reports
diversion of scarce resources from already deserving cases
current law is adequate
children fearing the implications of disclosure such as being forced into hostile legal proceedings
diminished personal responsibility leading to a ‘report it and forget it’ culture
research suggesting that despite mandatory reporting many professionals still fail to report abuse
the structure of UK health and social care services and the inter-agency working that exists renders a mandatory system unnecessary due to the current channels of communication and professional accountability
the introduction of external reporting mechanisms may slow down the process of dealing with allegations
professional bodies take prompt action against registrants who persistently or seriously fail to follow their guidance.
9.3.3 Some of the arguments explored in the NSPCC summary have been investigated
scientifically including a belief that there is a lack of international evidence that mandatory reporting increases abuse detection rates60 and that the introduction of mandatory reporting in the USA resulted in a tenfold increase in the number of children investigated for possible abuse and those shown to be ‘unfounded’ increased from 35% to 65% in one decade61.
9.3.4 The majority of mandated reporters do not consistently report all suspected cases of maltreatment and therefore support for an alternative reporting policy among different groups, consideration of alternative strategies and policies that address the concerns of different types of professionals may be appropriate62.
9.3.5 One reason given for not introducing a mandatory duty is that its enactment would be counter-productive and would increase the risk to children overall, first by weakening the professional’s personal sense of responsibility and, second, in casting the shadow of near- automatic reporting over their work which may raise barriers between clinicians and their patients or clients63.
9.3.6 Several decades after implementing a mandatory child-reporting system in the USA many
vulnerable children have been failed to be protected. The diagnosis may be missed, suspicions of abuse may be intentionally not reported, no intervention takes place or the intervention is inappropriate or inadequate6465666768.
9.3.8 Without commensurate financial support, there would be a real risk that those children at the greatest risk and those with the greatest need would either be missed by the saturated system or, if they were identified, they would not be adequately supported by a system that has diverted a significant amount of resource to management and investigation rather than on-going planning, intervention, services and support58.
9.3.9 There is a risk that mandatory reporting would have a negative effect on the existing, or planned, early intervention and prevention programmes, which have been widely advocated for the UK. Mandatory reporting would shift the emphasis to the hard end of child protection, with resources diverted accordingly, which may mean there is no capacity to develop preventative systems and services. This would not sit naturally with recent guidelines and recommendations, which have almost universally extolled the benefits of such upstream approaches58. By giving precedent to forensic and investigative activities, resources would be drained away from providing services to families most at risk.
9.3.10 Recommendation ONE
Any introduction of mandatory reporting must be accompanied by a commensurate increase in resources to child welfare agencies to enable them to cope with the increased number of referrals that will be received and so that the safety of children who are already in need of protection is not compromised.
9.3.11 The issue of whether or not mandatory reporting should be introduced into New Zealand
was considered in 2012 in a review by Professor Felicity Goodyear-Smith, Goodfellow Chair at The University of Auckland. The resounding conclusion of this review was that mandatory reporting by general practitioners of suspected abuse should not be introduced. Indeed, Professor Goodyear-Smith stated that ‘extensive enquiries through a variety of avenues failed to find any paediatrician or other expert who would write in support of mandatory reporting’ and that, in her view, the risks of the introduction of such a policy outweighed the gains69.
9.3.12 Professor Goodyear-Smith stated that whilst it is likely that most professionals would support sharing of information through the integration of services and inter-agency communication, this should not be confused with mandatory reporting of suspected child abuse69.
9.3.13 If general practitioners (GPs) are required to notify the authorities of abuse or neglect as part of their differential diagnosis, then Professor Goodyear-Smith believes that large numbers of unfounded cases may be reported and that too broad a definition of child abuse could lead to unnecessary and counterproductive reporting of minor problems that would be better dealt with by non-punitive agencies and interventions, such as assistance with parenting skills69.
9.3.14 In a retrospective study investigating all referrals received by child health, social services and police of suspected child sexual abuse in South Wales between 1986-1989 it was shown that of the 410 children referred, 197 (48%) were found to have been abused and of those cases where abuse was not proven (52%) only 63 (15% of the total cases referred) were judged to be due to false allegations, some of which were considered malicious. This pattern was found to be similar to that reported in the USA at the time where reporting was, and is, mandatory70. Armed with these figures, some opponents of mandatory reporting are bound to conclude that if detection rates are similar in two jurisdictions with completely different reporting laws – one with mandatory reporting and one without – changing to a system of mandatory reporting would do nothing to improve abuse detection rates.
9.3.15 In the USA one of the most vocal academic opponents of mandatory reporting is Professor Gary Melton, Professor of Paediatrics in the University of Colorado School of Medicine. It is Professor Melton’s belief that mandated reporting is a policy without reason and that there is overwhelming evidence that many of the catastrophic problems in contemporary
9.3.16 Professor Melton believes that the most fundamental mistake that the designers of modern child protection systems made was to grossly underestimate the scope of the problem of child abuse and neglect such that policymakers believed that an effective state response could be applied with existing resources71.
9.3.17 Professor Melton argues that calls to child protective services can be treated as allegations of wrong-doing rather than identifying families that are crying out for help and support. Relying on evidence showing that approximately one-eighth of referrals to child protective services in the USA are screened out without investigation and that approximately two-thirds of the reports of suspected child maltreatment that are investigated are never substantiated or found to be indicated72, Professor Melton believes that mandated reporting has transformed public child welfare agencies into investigatory bodies with diminished involvement in the provision of social services per se.
9.3.18 Professor Melton concludes that the mandatory reporting system has had paradoxical effects – and that some of those negative side effects probably adversely affect children’s safety. It is his belief that in aggregate there can be little question that jurisdictions with mandated reporting laws should be revising their systems to facilitate voluntary assistance to children and families – to create or sustain the norms of caring that prevent children from harm and that those countries without the USA-style child protection system should develop other models as both common sense and empirical research lead naturally to the conclusion that mandated reporting is bankrupt policy71.
9.3.19 If there were to be mandatory reporting in the UK the implementation of it would be key to avoiding overloading child protective services which was, in part, responsible for 6000 cases reported to Arizona’s Child Protective Services division, dating back to 2009, not being investigated as caseloads were on the rise and staff were over-burdened (77% above standards)73.
9.3.20 Arguments in favour of mandatory reporting
Policies aimed at improving detection and referrals of suspected child abuse have not been effective overall. Unless mandatory reporting by clinicians is legally enforced, existing organisational and professional barriers may continue to hinder the ability of agencies to safeguard children from harm74.
9.3.21 In New South Wales, Australia, in July 1987, the category of professionals required to report suspected cases of child sexual assault to the Department of Family and Community Services was extended to include teachers and other school professionals. There was a significant increase in the number and proportion of reports of suspected sexual assault received from teachers but there was no change in the quality of teachers’ reports as measured by the percentage of reports which were verified on assessment75.
9.3.22 The consistent observation that reporting falls short even in the presence of a legal mandate should not be interpreted as undermining the importance of these mandatory reporting laws. The experience in the USA supports the importance of a reporting mandate in the UK as well, at the very least as a counterweight to the considerable systemic bias against proper child protection. Mandatory reporting must be accompanied by effective quality improvement and educational and policy efforts64.
9.3.23 Although the reporting process can be time-consuming and, at times, confrontational a physician’s moral and professional obligation to keep children safe from harm should outweigh all of these concerns and they must report cases of suspected child abuse and neglect in accordance with the laws of the jurisdiction in which they are working76.
9.3.24 Individuals responsible for the spiritual, emotional, athletic or educational upbringing of children such as teachers, coaches, health care professionals, religious officials and scout leaders are in positions of trust. Parents rely on these adults to safeguard the health and
9.3.25 In the UK, Dr Tom Sanders and Cathy Cobley present a convincing case for the introduction of mandatory reporting. They argue that a law imposing a legal duty on doctors to report non-accidental injury in children cannot function effectively without a support structure enabling reporting procedures to be conducted in collaboration with clinicians and other child protection professionals. They believe that a sea-change, greatly assisted by a mandatory system of reporting, is required63:
Greater open collaboration and dialogue between clinicians during the initial clinical investigation of suspected non-accidental injury.
The removal of the institutional stigma attached to the child protection process.
A culture change where clinicians begin to view non-accidental injury as requiring the application of both scientific and social evidence.
9.3.26 Many professionals who were spoken to during the Travelling Fellowship that resulted in the publication of Living on a Railway Line acknowledged the impact mandatory reporting can have on referral rates to child protective services but believed that mandatory reporting laws help encourage the referral of all children who have been clinically investigated for possible abuse. Moreover, it was a common belief that a system of mandatory reporting that is widely known and accepted by society makes conversations with families about possible abuse a lot easier for both parties and facilitates the ability of educational professionals working in child advocacy centres to deliver comprehensive educational programmes to both professionals and the community alike.
9.3.27 In Australia and the USA, Professors Benjamin Mathews and Donald Bross strongly believe that mandated reporting is still a policy with reason on empirical evidence and philosophical grounds. Without a system of mandated reporting, they say, a society will be far less able to protect children and assist parents and families, because many cases of abuse and neglect will not come to the attention of authorities and helping agencies77.
9.3.28 It is accepted that mandated reporting schemes are imperfect but using child safety as the primary concern and drawing on evidence from several nations they argue that a child protection system needs a form of case identification beyond voluntary help-seeking; that mandated reporting produces a large number of substantiated reports and to sacrifice this compromises child protection; that the most serious problems in systems having mandated reporting appear to lie not within the reports, but with the responses; and that the economic and social justice advantages of mandated reporting far outweigh any disadvantages77.
9.3.29 A society with mandated reporting will have more cases of abuse and neglect brought to
the attention of authorities than will a society with no such system and substantiation rates of abuse and neglect per 1000 children in jurisdictions with mandatory reporting compared to those without it indicate the superiority of mandatory reporting in revealing true cases:
England 2005/2006 (no mandated reporting): 2.4/100078
Western Australia 2004/2005 (no mandated reporting at that time): 2.3/100079
USA 2004 (mandated reporting): 11.9/100080
Canada 2003 (mandated reporting): 13.9/100081
Australia 2004/2005 (jurisdictions with mandated reporting): 5.5-14.1/100079.
9.3.30 Mandatory reporting would be a mechanism by which to prevent and reduce child abuse
by signalling to society a clear statement of intent through legislation so to do and to ensure the by-products of this, such as increased public and professional awareness, contribute to the overall aim. Introducing such legislation would demonstrate the seriousness of intent in reducing levels of maltreatment and would afford greater protection to victims of abuse58.
9.3.31 Professors Mathews and Bross argue that enhancing voluntary help-seeking by parents in communities that provide family support would be welcome, as would more widely delivered primary prevention programmes, but they believe that there is insufficient evidence in experience or science to justify leaving child protection to voluntary help- seeking by parents alone. Even with a good system of mandated reporting in place, many children’s adverse experiences as they grow up will go undetected. Without a system of mandated reporting, and without a scientifically proven alternative, many hundreds of thousands more children will be left to suffer, incurring even more health and economic costs77 and social injustice.