Reporting Child Abuse

Most laws are vague in defining the reporting requirements for child abuse. Generally, they require reporting if someone "has reasons to believe that a child has been subjected to abuse." Such laws do not attempt to quantify the degree of suspicion, the quality of the evidence, or the likelihood of abuse that must be present to compel a report. In the crafting of such laws, it seems that the goal was to protect people who report abuse by allowing broad latitude to individuals in defining what they mean by a "suspicion" of abuse. A utilitarian calculus seems to be at work—that it would be better to have reports made that prove to be groundless than to allow subtle cases of abuse to go unreported. Even with such vague and permissive requirements, evidence suggests that abuse is underreported rather than overreported.

There are a number of reasons why people might not report child abuse even though they believe it to be wrong. Child abuse may be ignored because people have difficulty defining and recognizing it (Besharov; Zellman, 1992). It may go undiscovered because adults who are aware that a child is being abused are reticent to get involved and do not report it (Dhooper et al.). Or professionals may feel reticent to threaten what they perceive as a therapeutic relationship with the adult or adults involved. When abuse is reported, health professionals and legal agencies need to weigh the relative risks and benefits of preserving the family against those of removing the child from it (Zellman, 1990).

Reticence to report suspected child abuse may be based on the sociology of healthcare delivery, on respect for confidentiality in the doctor-parent relationship, on unwillingness to stigmatize parents when there is doubt about the actual occurrence of abuse, or on a desire to preserve a therapeutic relationship or avoid the perception that professionals are enemies.

Pediatricians in private practice are paid by the parents or other adults responsible for the children to whom they provide care, and often develop long-term relationships with these adults and the children. In such situations, relationships must be based on mutual trust. Pediatricians may give adults the benefit of the doubt regarding injuries that may be associated with abuse. They may also be fearful that child-abuse reports will be bad for business. These factors may partially explain why reports of abuse are more likely to come from hospital emergency rooms than from private doctors' offices (Badger).

In addition to economic considerations, moral aspects of the doctor—parent (or other adult) relationship may impede reporting. Generally, doctors promise confidentiality, and the moral reasons for confidentiality are compelling. Adults must confide in doctors, and may need to tell them information that would be embarrassing or damaging were it known by others. However, this promise of confidentiality may conflict with a pediatrician's concern about the child's best interest. Although the law requires doctors to report suspected child abuse, reporting is quite sporadic and inconsistent (Dhooper et al.; Zellman, 1990; Oates). Studies of pediatricians reveal that older doctors are less likely to report child abuse than are younger doctors, and males are less likely to report it than females (Kean and Dukes). None of the studies that document inconsistent reporting disentangle the economic, moral, and legal considerations that lead doctors and other child-welfare professionals to report or not to report abuse.

Reticence to report may also result from a lack of faith in the efficacy of interventions. Many child-protection agencies are underfunded and understaffed. In times of tight budgets, they may not receive the highest legislative priority. As a result, they may be unable to provide counseling and supervision services to every child or family reported to them. In some states, child-protection agencies operate under court supervision because they have been found to neglect the children in their custody. While such agencies clearly provide excellent services to most children, highly publicized cases in which they have failed to provide adequate protection may lead to skepticism about the efficacy of reporting.

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