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Week 2 – Assignment

Research Paper Proposal

Topic – Mandated Reporting of Child Abuse

1. Mandated Reporting of Child Abuse: Laws requiring the mandated reporting of child abuse have been enacted in every state in the United States. Mandated reporting laws cross disciplines (counseling, psychology, medicine, nursing, education, etc.). Some professionals have criticized these laws on the basis of interfering with their professional relationship with children.

Based on your career interests, choose a topic relevant to human service policy from the list of topics found under the instructions for the Final Paper (Mandated Reporting of Child Abuse, Mental Health Policy, Prison Diversion, or Prescription Privileges for Psychologists). The topic you choose for this assignment will be the topic you use for your 12-15 page Research Project which is due in Week 6.

For this week’s assignment, write a 700-1,050 word (2-3 page) paper, citing a minimum of two peer reviewed sources, which achieves the following:

1. Summarize your chosen topic/policy issue(s).

2. Define the issue(s) clearly and specifically.

3. Describe what you already know about the issue(s).

4. Explain why and to whom the topic is important.

APA 6th edition format is required for this assignment.

Farberman, H. A., & Finch, S. J. (1997). Confidentiality vs. mandated reporting of child abuse: A.. Applied Behavioral Science Review5(1), 101. https://doi-org.proxy-library.ashford.edu/10.1016/S1068-8595(97)80009-8

Duncan Lindsey. (1994). Mandated reporting and child abuse fatalities: Requirements for a system to protect children. Social Work Research18(1), 41–54.

Bourne, R., Newberger, E. H., & White, C. S. (1991). Mandated child abuse reporting. Ethics & Behavior1(2), 145–153. https://doi-org.proxy-library.ashford.edu/10.1207/s15327019eb0102_6

EBSCO Publishing Citation Format: APA 7th Edition (American Psychological Assoc.):

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Farberman, H. A., & Finch, S. J. (1997). Confidentiality vs. mandated reporting of child abuse: A.. Applied Behavioral Science Review, 5(1), 101.

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The tension between protecting the privacy rights of a respondent and the legally mandated obligation to report suspicion of child abuse
confronts the researcher with a dilemma: to breach confidentiality is unethical; to not report is illegal. Example cases are presented in which
the reporting of suspected child abuse breaches respondent confidentiality. The argument is advanced that the decision to breach
confidentiality may well lead to: self-censorship by researchers, lack of candor by respondents, suppressed survey response rates,
interviewer deception, oppression of disempowered groups, and impairment of the self-correcting aspects of disciplined inquiry.

Each state in the United States has statutes that list and mandate certain human service professions to report actual, suspected, or potential
child abuse to a local reporting agency (Kalichman, 1993). Typically, these professions engage in direct contact with citizens that often
involves some type of therapeutic relation. While state statutes differ in subtle but significant definitions and reporting requirements, they all
basically reflect the federal standards for mandated reporting set in The Child Abuse Prevention and Treatment Act of 1974 and encourage
child abuse reporting by conveying to persons reporting in good faith legal immunity from civil and criminal liability. The spirit and letter of the
law is to encourage practitioners to err on the side of over reporting child abuse even if this means inaccurately identifying cases (Thompson-
Cooper et al., 1993).

A growing scholarly literature that speaks primarily to the concerns of direct practitioners focuses on the dilemma between the legal mandate
to report versus codes of professional ethics that seek to protect the privacy rights of clients through promises of confidentiality. In essence
the dilemma is this: to break confidentiality is unethical; not to report is illegal. (Kinard, 1985; Miller & Weinstock, 1987; Koocher & Keith-

Spiegel, 1990; Stein, 1991). While there is some literature that specifically addresses the concerns of researchers who work within the mental
health delivery system and may happen upon evidence that evokes suspicion of child abuse, a recent review (Kalichman, 1993) suggests
that there is a need for literature addressed to researchers working outside of the mental health service delivery system who develop cause
for reasonable suspicion. [ 1]

Our aim here is to examine the tension between confidentiality and mandated reporting by: (a) presenting two cases in child welfare research
that involve a research team’s search for an understanding of its responsibility relative to legally mandated reporting; (b) reflect upon the
complications that arise when legal statutes, codes of professional ethics, and individual moral convictions collide; and (c) consider the
adverse implications of these issues for disempowered groups and scientific inquiry.

We give here two summaries of cases arising from research into child welfare issues. We present only summaries to preserve the privacy of
the researchers and clients who were involved in these incidents.

Case A
A research program certified by University A’s Committee on Human Subjects Review studied an agency working with parents who had been
determined to be abusive to their children. Each client had been abusive and was involved in a supervised program to help the parent cope
with the difficulties of raising children without being abusive. The regular staff of the agency was supplemented with research staff from
University A. Worker A from the research staff who was working with clients felt that one of the clients was out of control and about to
become seriously abusive to the client’s children. He felt that the mandated reporting requirement held and discussed the matter with
Professor A, who was directing him and who was responsible for the research. Professor A and the executive staff of the agency reviewed
the matter and felt that Worker A had a more pessimistic view than was warranted. Although Professor A and the staff who worked with the
client on a regular basis felt that there was not an imminent danger to the child, Worker A nonetheless reported the client to the state child
abuse system.

Case B
A research program certified by University B’s Committee on Human Subjects Review studied the experiences of foster parents in caring for
foster children as reported to interviewers using a standardized questionnaire. During the interviewer training sessions, questions arose
concerning the possible mandated obligation to report on child abuse, especially by those staff interviewers who were certified social workers
and who had worked in child protective services for most of their careers. These interviewers had been hired initially as trainers, counselors,
or evaluators but not as researcher interviewers. Professor B, who was in charge of the conduct of the research, did not believe that anyone
on the team was under a legal mandate to report on the respondents. He asked for and received a written opinion of the legal requirements
from Lawyer B, who was on the University’s staff.

Lawyer B reasoned that, because a local, lower court already had held that a social service worker “who never met a child or had an
opportunity to observe him personally was not a mandated reporter,” whether or not a researcher would fall within the purview of this section

of the law was clearly open to interpretation and would hinge on the context within which a researcher came into possession of reportable
material. The attorney believed that “it is possible that a researcher’s interview with the parents would not put him/her in direct contact with
the child, and thus, the interaction would not be in a ‘treatment context'” (as required to be a mandated reporter). Nevertheless, if researchers
do learn about child abuse or neglect, they, along with any other citizen, “… would be permitted to report [under a different section of the law]
if they in good faith, had reasonable grounds … “The conclusion was that members of the research team were not mandated reporters but
were permitted reporters, as was any citizen who believed they had information about an actual, suspected, or potential crime.

The attorney also advised that the law requires that a specific reporting format be established beforehand and followed without deviation
should a reportable incident arise. Accordingly, a format was put in place whereby an incident would be brought for discussion and decision
to a committee composed of the two principal supervisors of the staff, both M.S.W.- level, direct practice social workers, and Professor B, a
doctorate in a nonclinical field. If the interviewer disagreed with the committee’ s decision, the interviewer could appeal to the Dean. Any
decision to report an incident to the state crisis hot-line would be made by the group, or by the Dean, if the committee’s decision were
appealed. However, any individual interviewer who found themselves in disagreement with the decision was free, as a matter of conscience,
to report an incident on their own and have whatever protection the law offered them as good faith permitted reporters.

Lawyer B was asked to recommend appropriate language in the informed consent protocol to insure that grants of confidentiality to protect
the privacy rights of the respondent were balanced against the obligations under the mandated reporting law. The attorney recommended
that the standard boiler-plate consent form phrase “there are no risks … “be amended to: “Any information we obtain about you as a
participant in this study, including your identity, will be kept confidential. The only exception is in the event that you volunteer information that
there is current danger of abuse of children. You may then be at risk for appropriate follow-up by agencies responsible for investigating such

The senior members of the team were dissatisfied with what they considered to be the relatively inflammatory language offered by the
attorney for inclusion in the consent form. They believed that simply stating that the implementation of the study would be done in compliance
with state law would be more suitable but felt bound to accept the language recommended by the attorney. Nevertheless, two interviewers
withdrew from the research because they disagreed with the attorney’s opinion and still considered themselves legally mandated reporters
and in good conscience would not proceed on any other basis.

Of the 100 interviews, one triggered the filing of an incident report. A team of two white interviewers had observed a situation that one of the
interviewers felt was within the scope of reporting requirements. An African American foster mother in her 70’s was caring for a five-year-old
African American whom she reported as having been abused by his father prior to placement. The foster mother was open and welcoming to
the interviewers. At the start of the interview, the child was confined to his room. The foster mother said he was being disciplined because he
had broken his bed the night before by jumping up and down on it. The foster mother said that the child was acting out because the agency
had removed an older child from the home just recently. The foster mother allowed the child to come into the room and gave both
interviewers free access to him.

At the time of the interview, the child had a large bump on his forehead with a distinct recent abrasion that was a perfect straight line. The
child told both interviewers that the foster mother beat him with a belt buckle and that this beating was the cause of the bump. He also licked
the male interviewers face and said he wanted to go home with him. The child had no fear of either interviewer and took all the attention that
he could get. The female interviewer inspected the child’s bedroom with the foster mother’s permission and observed a broken frame and
broken slats under the mattress in the bed in which the child slept. Neither interviewer discussed the child’s allegation with the foster mother.

After the interview ended, the two interviewers discussed the situation. The male interviewer felt that the child was manipulative and was not
truthful. For example, he felt that it was unlikely that the foster mother, who was in her 70′ s, could hit the child with a belt buckle with such
force as to leave a perfectly straight abrasion. He believed the foster mother’s explanation fit all the observed facts. The female interviewer
strongly believed that correct professional practice was to take such a report from a child at face value without the need for further
questioning. She also “did not like the foster mother’s attitude toward discipline” and was not convinced by the male interviewer’s
interpretation. She brought the case before the incident committee. Although the committee discouraged her from reporting, she nevertheless
filed a report of the incident with the state child abuse system.[2]

While the philosophy behind federal and state mandated reporting laws takes a protective attitude toward children, it does not provide
guidance to help human service professionals and researchers deal with a host of issues including: (a) exactly who is a mandated reporter,
(b) possible reduction of survey response rates, (c) the chilling effect of risk notification both on researchers and respondents, and (d) the
coercion of interviewer deception. When researchers promise confidentiality to subjects as part of the informed consent document that each
researcher and subject signs before a study begins, they are, in effect, entering into an agreement in which the investigator promises to
protect the privacy rights of the subjects. This promise to act in a confidential manner is a contract. If a researcher were a legally mandated
reporter, then the promise of confidentiality to the subject would have to be broken in deference to the obligation to report in that a contractual
promise cannot be used to supersede state or federal laws. It is critical, therefore, to know who is or is not a legally mandated reporter. And
that, in large measure, is set by state statute.

In New York State, for example, the occupational category of researcher has been omitted from the state statute; thus, the research
investigator is not mandated by law to report.[3] However, the researcher is permitted to report, as might any other citizen who acts in good
faith. But, where the mandated reporter, as a matter of law, is immunized against both civil and criminal liability, with the burden of proof
falling upon any retaliating party, the permitted reporter is in no way immunized. Should the permitted reporter fail to meet the burden of proof
in a civil case, then professional malfeasance might culminate in being sanctioned by a professional association or being decertified by a
governing authority. Should it be in a criminal case, then a misdemeanor level sanction might be imposed.[4]

However, even when the researcher acts as a citizen, which opens the possibility of fulfilling the role of permitted reporter, and the subject is
given fair notice that there is a risk that what they say during the course of an interview may become grounds for reporting them to some
authority, additional problems emerge. For example, Martin et al. (1992) used a 65 question interview to survey Tennessee foster parents
about their motivation to be foster parents and had a 35% response rate with follow-ups. Finch et al. (1995) used a 190 question interview to

survey New York State foster parents about their reaction to a training curriculum and had a 34% response rate with follow-ups. These rates
are 15-25% lower than typical survey response rates (Rubin & Babbie, 1993). Subjects who have been told that they run some risk of
investigation and criminal prosecution as a result of what they say during an interview may simply decline to participate.

The element of risk, moreover, also induces censorship among researchers. They must seek to reduce the risk for respondents by removing
items from the data collection instruments that may ensnare or entrap the subject into a line of response that an interviewer might interpret as
indicating a reportable offense. Human subjects research committees at some universities simply will not approve instruments that might
entrap a subject. In case B, the team felt compelled on ethical grounds to edit out just such items. Nevertheless, a mature and experienced
women spoke candidly about her approach to discipline in child rearing, and this became a contributing factor in an interviewer’s judgment
that there was reasonable cause to suspect child abuse. It should be noted that the interviewer and the subject were from different
ethnocultural groups and were two generations apart in age.

Kalichman (1993, pp. 52-54) has reviewed some conflicting findings on the role of confidentiality in clinical situations and suggests that more
empirical investigation should be done to establish whether the provision of limited confidentiality has either a positive or negative effect and
the degree to which outcomes depend upon the way limited confidentiality is presented to the client. The underlying proposition is that if trust
has been established between a practitioner and a client, then a promise of limited confidentiality, which carries the risk of reporting, may well
be incorporated into the therapeutic process in a positive way.

The tradition of “limited confidentiality” that operates among treatment oriented professionals, who share pertinent case information across
disciplines and agencies, still amounts to a breach of confidentiality in a research situation because research subjects are respondents, not
clients or patients who implicitly may be giving stewardship over their well-being to a clinician, and thereby conveying a therapeutic privilege
that might empower the clinician to act on their behalf even without their knowledge or consent. This does not apply in a research situation.[5]

Perhaps most troubling of all is the possibility of duplicity and entrapment that an interviewer engages in once the interviewer regards her or
himself as a potential reporter. An investigator who begins an interview with the aim of both pursuing knowledge and pursuing compliance
with the law starts the interviewing process with an ambiguous definition of the situation.[6] The interviewer begins the encounter in the
situationally appropriate identity of researcher, which, in turn, casts the co-participant into the situationally appropriate identity of respondent.
However, inherent in the situation is the possibility that, at some point unknown to the respondent but as a result of what the respondent has
said or the interviewer has observed, the researcher may or must switch into the situated identity of permitted or mandated reporter and
acquire data that will become the basis for a report to an authority alleging that there is either reasonable cause to believe there is child
abuse in the situation, or that the child is in imminent danger, which altercasts the unknowing and self-incriminating respondent into the
imputed but unarticulated situated identity of potential criminal defendant. The respondent qua potential defendant, however, has been kept
in the dark by the researcher qua mandated or permitted reporter. Thus, while the researcher is fully aware of what is going on, the
respondent is not. The researcher is withholding information, and, as a reporter, is now involved in a covert data gathering operation on
behalf of the state. An act of deception has been superimposed upon a research inquiry.[7]

This is a dramatic example of what Glaser and Strauss (1967) have referred to as “awareness contexts.” Namely, that every interaction has a
structural aspect having to do with the way participants strategically withhold or disclose information to each other about their respective
identities as they jockey for position and control during the course of an encounter or in a relationship. By controlling the flow of information
they manipulate each others awareness of what is actually going on. In this case, the interviewer has moved into a “closed awareness”
context in which the respondent is left completely in the dark. This results in what Hall (1985) has referred to as an asymmetric balance of
power in which one participant can dominate the other without giving the appearance of doing so.

Kopels and Kogle (1994) argue that breaches of client confidentiality constitute discrimination and oppression because they
disproportionately occur when clients are poor, members of a sexual, racial, or ethnic minority, or of a discredited or low status group. When
clients are stigmatized and labelled as social deviants and are perceived to present a threat to third parties or the community at large, their
rights to privacy may become sub-ordinated to the security interests of others. In this event, mandated reporting is both a medium as well as
an outcome of oppression. This may be exacerbated when an entire field of professional expertise that revolves around the advocacy and
protection of children is imbued with a measure of what Becker (1963) has called moral entrepreneurism. Whereas most professions seek
ever greater freedom and autonomy from external regulators and regulations and especially seek separation from and protection against
state mandates, many in the profession of protective services have been employed as agents of state compliance. Their role reduces the
independence normally associated with professional practice.

Within the social sciences, researchers have enacted a wide range of precedents when their code of professional ethics have put them in
conflict with the law. Researchers have been held in contempt of court and have been jailed for refusing to turn over data that had been
subpoenaed by district attorneys rather than breach promises of confidentiality given to subjects (Pope & Bajt, 1988; Wells, 1988).

The rationale behind this commitment to the privacy rights of subjects is that getting at the fullest approximation of truth requires a sanctuary
or safe zone in which an ideal speech situation exists in which candid, forthcoming respondents engage in communication free from duress,
now and in the future. Immunity from self-incrimination and from retaliation by others may well be the best climate for such candor. Without
these threats, individuals may disclose things about phenomena that, ordinarily, would never come to light. The researcher has an initial
methodological obligation to be nonjudgmental or value-free in order to establish an ideal speech situation that may facilitate lifting the veil
that cloaks reality in order to see what lies under the surface of appearances.

But even when people say things free from duress, what they say is accepted only as raw data that must be penetrated and probed; data
whose full meaning and significance becomes known only as it is placed in the context of other data. The meaning, value, reliability, and
validity of a subject’s responses can be ascertained only as a result of analysis and not before. Analysis takes time in order to replicate the
observations and logics that justify findings. It requires going back again to the same or similar sources to see if things hold up under
repeated scrutiny. Access to sources becomes difficult if it entails risk to those sources.

The advent of managed care throughout the health and welfare complex is placing ever greater pressure on the ethics of confidentiality. The
forgoing review offers a glimpse into just one of a series of challenges to the principle of confidentiality. We hypothesize that the present
cases, in which well controlled and identified problems were reported, point out the impracticality of the current shotgun approach. Children’ s
welfare would be better served by more focused and better enforced practices than the existing muddle of mandated reporting.

Direct all correspondence to: Harvey A. Farberman, School of Social Welfare, State University of New York at Stony Brook, Stony Brook, NY

Acknowledgments: We wish to thank Shelly Cohen, Jeanne Finch, Vicki Lens, and Robert Marmo for responding to an earlier version of this

[1.] Mental health and social work researchers may find some general guidance in their professional association’s respective codes of ethics.
For example, the American Psychological Association’s standards for confidentiality in research and the National Association of Social
Workers Code of Ethics, Part 1, Section 5 respectively state that:

If the Ethics Code establishes a higher standard of conduct than is required by law, psychologists must meet the higher ethical standard. If
the … standard appears to conflict with the requirements of law, then psychologists make known their commitment to the Ethics Code and
take steps to resolve the conflict in a reasonable manner (APA, Intro., 1992).

The social worker engaged in evaluation or research should obtain voluntary and written informed consent from participants … with due
regard for participant’s privacy and dignity … should protect participants from unwarranted physical or mental distress, harm, danger, or
deprivation … should protect participant’s confidentiality by omitting identifying information unless proper consent has been obtained
authorizing disclosure … should inform participants … of any limits of confidentiality. (NASW, Code of Ethics Revision Committee, 1996).

[2.] Despite the attorney’s opinion and the instructions from the senior team members, the interviewer filed the report using the paperwork
and procedure that a mandated reporter is required to use, apparently sincerely believing that the mandate to report still applied.

[3.] Act of June 23, 1973, ch. 1039, s. 1, N.Y. Laws 1893 (McKinney), codified as amended in 1985 NY Soc. Serv. Law ss. 411-428
(McKinney Supp., 1989). The premise underlying this view is that, under the rule of construction, “expressio unius est exclusio alterius,”
where a law expressly describes a particular act, thing or person to which it shall apply, an irrefutable inference must be drawn that what is
omitted or not included was intended to be omitted or excluded. (Martin, 1996; Mckinney’s Consolidated Laws of New York, Book 1, Statutes
S. 240.). To date, though, this has not been tested in any court in New York State.

[4.] At the practical level of deciding who is a mandated reporter, and whether a report should be filed, the following model may be useful. It
builds upon aspects of reporting decisions models for human service professionals offered by Stein (1991, pp. 48-50) and Kalichman (1993,

p. 63). We do not offer this model to further encumber the collaborative research process, but as a sensitizing guide to a reality that is more
complex than it appears.

Situational Factors. Basis for suspicion. Verbal allegation by child. Verbal allegation by other. Disclosure by adult perpetrator. Objective
physical indicators. Subtle signs. Availability of evidence. Severity of apparent or potential abuse.
Individual Characteristics. Special training. Years of experience. Prior reporting experience.
Professional Code of Ethics.
Employment Role and Structure. Knowledge of the employment contract. Knowledge of the reporting “chain of command.” Knowledge of the
team leadership structure.
Legal Factors. Knowledge of all relevant sections of state statute. Specific knowledge of named occupational categories. Specific knowledge
of case law within local jurisdiction. Specific knowledge of the difference between mandated and permitted reporting including legal liabilities
and penalties. Knowledge of the difference between “imminent danger” and “reasonable cause.”
Our own inclination is to mitigate some of the tensions by suggesting that individuals who practice professions that are listed in mandated
reporting statutes are mandated only within the context of the official, professional treatment relationship. Individual attributes such as
training, credentials, and experience are necessary but not sufficient conditions. The sufficient condition is the situationally appropriate
professional context of service delivery.

[5.] Studies have shown that the absence of confidentiality has no discernible effect when innocuous topics are involved, especially where the
investigator is perceived as trustworthy (Ash & Abramson, 1952). However, when sensitive topics are involved, promises of confidentiality
yield more candid information (Boruch & Cecil, 1979). When promises of confidentiality are conditional and include the possibility of legally
mandated breaches, then client disclosure to attorneys decrease (cf., Note, 1962) and patient disclosure to therapists decrease (cf., Project,
1978). And in a study that compared the cooperation rates of otherwise similar participants who had been assured of confidentiality versus
those who had not been assured, the rate was positively associated both with the promise of confidentiality and the devices used to actualize
that promise (Shuman & Weiner, 1982). There appears, moreover, to be an emerging consensus among child protective services
professionals that the most effective way to deal with suspected child abuse is to contact the agency case worker who has long-term, first-
hand knowledge of both the foster parent and the foster child and thus is in a better position to assess the situation and fashion a proper
response. Workers in county child protective service units, district attorney’s offices, and police departments tend to characterize state child
abuse hot-lines as relatively ineffective because district attorneys and police departments prosecute these cases with varying degrees of
vigor so that outcomes depend largely on what jurisdiction a case is in rather than on the merit of the case (Newberger, 1983; Weinstock &
Weinstock, 1989; Watkins, 1989; Ansell & Ross, 1990).

[6.] Maines and Kappas (1978) have commented generally on the structural or social organizational basis of bioethical problems among
physicians who may simultaneously fulfill …

EBSCO Publishing Citation Format: APA 7th Edition (American Psychological Assoc.):

NOTE: Review the instructions at http://support.ebsco.com.proxy-library.ashford.edu/help/?
int=eds&lang=&feature_id=APA and make any necessary corrections before using. Pay special attention to personal
names, capitalization, and dates. Always consult your library resources for the exact formatting and punctuation

Duncan Lindsey. (1994). Mandated reporting and child abuse fatalities: Requirements for a system to protect

children. Social Work Research, 18(1), 41–54.
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Mandated reporting and child abuse fatalities: Requirements for a system to protect children
Research by pediatricians and radiologists during the 1950s uncovered evidence that large numbers of
children were being physically abused and killed by their caretakers. In 1962 Kempe and his colleagues
published their historic study, “Battered-Child Syndrome,” which provided empirical evidence of severe
physical abuse of children by their caretakers. The public concern aroused by this study led to the rapid
development and enactment of mandatory child abuse reporting laws in every state. Since the
enactment of these laws, there has been an enormous increase in the number of child abuse and
neglect reports. In 1962 there were an estimated 10,000 child abuse and neglect reports nationally. By
1992 the number of reports had increased to almost 3 million. This meteoric rise in child abuse reports
has resulted in an unanticipated transformation of child welfare agencies into protective services
agencies. Proponents of this shift have suggested that increased reporting has substantially reduced the
number of child abuse-related fatalities. This article examines trends in national data on child abuse
fatalities and fails to find evidence of a decline. Implications of these findings are discussed.

Key words: child abuse, child protective services, homicide, mandated reporting

One of the most shocking events in a community is the severe brutalization and death of a [young child
because of abuse. Can such deaths be prevented? After the publication of “Battared-Child Syndrome”
(Kempe, Silverman, Steele, Droegmueller, & Silver, 1962), every state enacted mandatory child abuse
reporting laws designed to prevent severe physical abuse. This legislation redefined the case-finding
function of public child welfare and in the process transformed public child welfare agencies into child
protective services agencies. Since the 1960s mandatory reporting combined with public concern about
the physical and sexual abuse of children has resulted in a thorough refocusing of child welfare on
investigation of abuse reports and protection of children whose alleged abuse has been substantiated.

This article examines the measurable impact of mandatory reporting laws on the rate of child abuse
reports and the number of child abuse fatalities. Because child abuse is a broad term that is difficult to

specify, fatality data from several different sources are examined. In addition, impediments to the
effectiveness of mandatory child abuse reporting legislation are discussed.

Public child welfare agencies have had a historic responsibility to protect children from harm and cruelty
that began well before the turn of the century (Antler, 1981). Although child protection in North America
began with a narrow focus on cases of physical cruelty, it soon broadened its focus to include physical
neglect, abandonment, and child welfare in general (Antler, 1981; Lynch, 1985). Thus, child abuse
became only one of the many concerns of the public child welfare system.

The absorption of protective services into the broader framework of public child welfare services led,
according to Kadushin and Martin (1988), to a “decline of interest [in protective services] between 1920
and the 1960s. Child maltreatment as a social concern dropped out of the public agenda” (pp. 222-223).
The decline of interest in child abuse was mirrored in the limited research on this subject in the child
welfare field from 1900 to 1950 (Wolins & Piliavin, 1964). Costin (1992) observed, “The social work
literature of the early 1900s through the 1950s reflects a sharply diminished discussion of child abuse as
a condition requiring intervention by community agents” (p.177). There were no major studies of child
abuse during this period (Lindsey, 1994). The calls for research in the child welfare field beginning in the
1950s made little mention of the problem of child abuse (Dybwad, 1949; Kahn, 1956; Norris & Wallace,
1965). Nelson (1984) observed that “By the 1950s public interest in abuse and neglect was practically
nonexistent and even social workers did not rate it highly as a professional concern” (p. 12). It was not
until the discovery of unexplained physical injuries to children by medical researchers that interest in
child abuse was reawakened.

Discovery of Multiple Injuries by Radiograph
After World War II interest in child abuse gained new energy from research conducted in medical
settings. Radiologists, pediatricians, and other medical researchers began examining the condition of
children brought into hospitals who suffered from multiple bone fractures for which there was no
adequate explanation, even though at presentation at the hospital the physicians were told the children
fell or had an accident. Many of the injuries did not correspond with the explanation their parents
offered, leaving physicians suspicious of a different etiology (Dingwall, 1989; Parton, 1985).

In 1946 Caffey reported six puzzling cases of subdural hematoma (or a pooling of blood under the skull)
in children. Using radiology to examine the injuries, Caffey also found that these injuries were
associated with multiple long bone fractures. Caffey found 23 fractures and four contusions of the long
bones in these six children (in addition to the subdural hematoma). He did not know the cause of these
injuries but reported them in the American Journal of Roentgenology because of their similarity.
Although Caffey did not report a history of trauma (or externally caused injury), in later meetings and
conferences he pointed out that trauma produces skeletal changes in infants and young children. The
possibility of these injuries being caused by a blow or externally caused injury rather than resulting from
an unknown disease was raised; because rickets and bone syphilis had by the 1950s become rare
diseases, trauma was the most common cause of skeletal changes in infants.

During the decade following Caffey’s (1946) report, several additional radiologists and physicians
reported similar findings. Lis and Frauenberger (1950) in the United States, Smith (1950) in Canada;
and Marquezy, Bach, and Blondeau (1952) and Marie (1954) in France reported cases similar to the six
reported by Caffey. Silverman (1453) reported three cases of infants with symptoms similar to those

observed by Caffey and noted that the bone changes observed in radiographs represented accumulated
injuries that were not the result of a single event. Silverman urged physicians to obtain reliable histories
of patients to understand the etiology of these injuries to infants. However, he cautioned that physicians
not alarm parents with feelings of guilt. Scott (1978) suggested that the early radiologists failed to
understand the role of parents in the traumatic injury to infants because they had limited contact with
parents; radiologists do most of their work “in a darkened and silent room, far from the crying babies and
weeping or sullen parents” (p. 175).

In 1955 Woolley and Evans published a review of the emerging case reports of infants coming into
medical facilities with serious physical injuries that were not accompanied by a readily volunteered or
adequate account of the injury. Woolley and Evans identified two syndromes of serious physical injury of
unknown origin in infants: (1) subdural hematoma with multiple long bone fractures and (2) traumatic
periostitis, a traumatic injury to the membrane of connective tissue around the bone (Barmeyer,
Alderson, & Cox, 1951). They suggested there was little evidence that these syndromes were due to
either a disease process or an unusual bone fragility in the affected infants. They observed that the 12
infants “came invariably from unstable households with a high incidence of neurotic or frankly psychotic
behavior on the part of at least one adult” (Woolley & Evans, 1955, p. 18).

Woolley and Evans (1955) published their work in the Journal of the American Medical Association,
where “it reached the radio, television, and press and electrified the public” (Radbill, 1974, p. 18). Their
work contributed to the emerging concern of, the U.S. Children’s Bureau with child abuse reporting
legislation. Their work also laid the foundation for the “battered-child syndrome” developed by Kempe
and his colleagues (1962).

Battered-Child Syndrome
In 1962 Kempe and his colleagues published their famous study of battered-child syndrome. Based on a
survey of 88 hospitals, they identified 302 children who had been “battered.” The horror of brutality to
young children, many of whom suffered multiple inflicted injuries, ignited a broad-based effort to find
ways to protect children (Gil, 1970; Nagi, 1977). Kempe and his colleagues sharpened the focus on
child abuse by defining the battered child as less than three years old and presenting with unusual
injuries, broken bones, or cranial injuries that were inadeguately or inconsistently explained. This
specific formulation of abuse led to calls for implementation of improved child abuse reporting systems.
The belief was that mandated reporting was necessary to ensure that when abuse was observed, it was
reported so that protective measures could be taken. Consequently, reporting was viewed as the first
step in providing protection to children.

During this same period (early 1960s), the U.S. Children’s Bureau, responding to physicians’ concerns,
developed a model reporting law that mandated that physicians report cases of suspected abuse
(Antler, 1981). The early intent was to limit mandated reporting to physicians only. However, the
American Medical Association objected to being singled out and urged that mandated reporting be
required by other professions as well (Sussman, 1975). No state mandatory reporting laws limit
reporters to medical professionals.

By 1963, 13 states had adopted mandatory reporting laws. Bagley and King (1990) reported that by
1966 all fifty American states had passed new legislation regulating child abuse. Shortly after every
state had developed expanded definitions of abuse that required mandated reporting” (p. 33). During the
development of mandatory reporting statutes there was concern about the consequences of too broad a

definition of abuse requiring reporting. After passage of the 1974 Child Abuse Prevention and Training
Act, Sussman and Cohen (1975) were asked to revise the 1963 model reporting statutes. In the course
of reviewing the available evidence, their views toward expanding the definition of abuse and the range
of mandated reporters changed. Over time, they wrote, we realized that we were creating a system of
reporting . . . which could invade and harm the lives of parents and children as easily as help them” (p
xxiv). Consequently, they recommended that mandated reporting be limited to cases of serious physical
harm, sexual molestation, or serious impairment of physical or mental conditions arising from neglect.

As a result of the reporting requirements a major unanticipated increase in child abuse reports engulfed
public child welfare agencies in the United States (Table 1). One of the most dramatic illustrations of this
avalanche was reported in Florida, where the number of abuse reports increased from 17 in 1970 to
19,120 in 1971. Florida had installed a toll-free 24-hour child abuse report hotline and combined it with a
public information campaign mounted through the mass media (Sussman & Cohen, 1975). Between
1971 and 1975 the number of reports leveled off at 25,000 to 30,000 a year. In 1981 Florida received
68,446 reports. This number increased to 130,393 by 1985. Between 1987 and 1988, the number of
reports in Florida increased 14 percent (Select Committee on Children, Youth and Families, 1989a).

In 1962 there were an estimated 10,000 child abuse reports in the United States (Fontana, 1971). By
1976 there were more than 669,000 reports of child abuse nationwide. The number of reports increased
to 836,000 by 1978 (Pelton, 1981). By 1985 the annual number of child abuse reports had increased to
1,919,000, including 878 child abuse fatalities. During 1992, the National Committee for the Prevention
of Child Abuse (McCurdy & Daro, 1993) indicated that there were about 2,936,000 reports of child
abuse nationwide, including a projected 1,261 child abuse-related fatalities (Table 2). Since 1985 child
abuse fatalities have increased about 44 percent.

This increase in child abuse reports produced the most fundamental change in child welfare during the
1980s. Kamerman and Kahn (1990) reported a national survey of social services to children in the
United States:

Child Protective Services (CPS) (covering physical abuse, sexual abuse, and neglect reports,
investigations, assessments, and resultant actions) have emerged as the dominant public child and
family service, in effect “driving” the public agency and often taking over child welfare entirely…. Child
protective services today constitute the core public child and family service, the fulcrum and sometimes,
in some places, the totality of the system. Depending on the terms used, public social service agency
administrators state either that “Child protection is child welfare,” or that “The increased demand for
child protection has driven out all other child welfare services.” Often, the only other child and family
social service provided is foster care, which in turn serves mostly abuse and neglect cases in most
places. Despite Federal estimates of about 60 percent, current reports in many of the localities we
studied suggest that about 90-95 percent of the children now going into foster care are placed away
from home because of some form of alleged child abuse or severe neglect. (pp. 7-8)

The laudable efforts by numerous public interest groups and professionals to raise public awareness
have been a major impetus to increased reporting of child abuse (Select Committee on Children, Youth
and Families, 1987). Kadushin and Martin (1988) observed,

The development of public concern about child abuse was facilitated by the lack of any organized
opposition to the movement, in part, because very few people are willing to be identified as opposing a
movement doing something about child abuse. It was also a consequence of the social distance

between those who labeled the problem, namely middle-class professionals, and those who were most
frequently labeled as child abusers, relatively politically powerless lowerclass families. (p. 224)

Certainly no one would want to suggest that child abuse go unreported (Best, 1990). Nevertheless,
there have been concerns with the reporting laws. For example, Besharov (1990a) suggested that
increased reporting has led to higher numbers of unfounded reports ( see also Giovannoni, 1989).
However, Finkelhor (1990) criticized this view. (Also see Daro, 1991, and Besharov’s, 1991, response.)
In addition, the increased reporting has required substantial resources. Child welfare agencies are
mandated to investigate all reports. Yet the mandated reporting laws have been implemented without
provision of additional funds because laws were expected to improve services without additional costs.
Consequently, the costs of investigating the increased reports have been substantial, some would even
say overwhelming. According to Hutchison (1993), states contained costs by decreasing services as the
number of reports escalated. Research by Dattalo (1991) indicated that in Virginia increases in child
protective services budgets for increased investigations were matched by decreases in Aid to Families
with Dependent Children budgets.

The increase in child abuse reports combined with lack of additional funding to meet the resulting
investigatory demands has led to an unintended consequence–the transformation of public child welfare
(Faller, 1985). Has the transformation improved the overall effectiveness of the public child welfare
system? Has the fundamental shift in resources to protective services reporting and investigations
resulted in major achievements? In particular, has attention to these increased reports led to fewer child
abuse fatalities?

Douglas J. Besharov (1988, 1990b), the first director of the National Center on Child Abuse and
Neglect, articulated the case in support of the value of increased reporting:

Child protective services still have major problems…. Nevertheless, one must be impressed with the
results of this twenty-year effort to upgrade them. Specialized “child protective agencies” have been
established to receive reports (usually via highly publicized hot lines) and then to investigate them. And
treatment services for maltreated children and their parents have been expanded substantially.

As a result, many thousands of children have been saved from death and serious injury. The best
estimate is that over the past twenty years, deaths from child abuse and neglect have fallen from over
3,000 a year (and perhaps as many as 5,000) to about 1,000 a year. (Besharov, 1990b, pp.10-11)

If Besharov is correct, then increased child abuse reporting not only has resulted in saving the lives of
thousands of the most vulnerable children, but has probably also spared even more children from the
horror of physical and sexual abuse that does not end in death but is, nevertheless, a human tragedy.
By specifying child abuse fatalities, Besharov selected the ultimate dependent variable. Death is difficult
to cover up. It calls for the involvement of the police and the courts as well as the social worker. Most of
the time an autopsy is required, especially if there are any unusual circumstances (Greenland, 1987).

Child abuse fatalities are a rare event. In 1992 there was fewer than one fatality for every 2,300 child
abuse reports in the United States. Thus, when examining the entire distribution of child abuse reports,
fatalities are outliers. Nonetheless, fatality data are the most important indicator of abuse for the general
public. Few events mobilize public sentiment more than the death of an innocent child at the hands of
his or her parents.

In relation to the universe of reports to public child welfare agencies, fatalities are the type of incident
most covered in the mass media. The American Humane Association examined the coverage of child
abuse in the major newspapers in 48 states in the same year “Battered-Child Syndrome” was published
(1962) and identified 662 reports of abuse (DeFrancis, 1966). Of these, 178 had led to a child fatality. In
other words, one of every four abuse reports covered in the mass media was a fatality. Corby (1987)
examined the coverage of child abuse in the Guardian newspaper in England in 1985 and found eight
cases where children were abused by their parents. In six of these cases, the children died. Clearly, it is
the dramatic horror of a child fatality that attracts media attention. Unfortunately, this disproportionate
reporting of cases of child brutality and fatalities leads to popular misconceptions about the extent of the
problem of child abuse (Nunnally, 1961).

There is considerable debate about the nature and seriousness of various forms of emotional, sexual,
and physical abuse (Giovannoni & Becerra, 1979; Select Committee on Children, Youth and Families,
1989a). But death is definitive. Although there may be disagreements concerning the definition of the
fatality as a child abuse death, there is usually agreement that a nonaccidental death occurred, even if it
is ruled suspicious. Consequently, if it can be demonstrated that increased reporting has led to a
reduction in child abuse fatalities, measured as either homicide or homicide plus deaths caused by
“injury undetermined whether accidentally or purposefully inflicted,” then the case for increased
reporting will be significantly strengthened.

National Findings
Referring to a supplementary report of national child abuse and neglect incidence data (Sedlak, 1989),
Besharov (1990b) indicated a decline from over 3,000 to about 1,000 child abuse fatalities. These
numbers are not in line with data from the National Center for Health Statistics, which reported that the
homicide rates for both infants (ages zero to one) and young children ages one to four have increased
over the past three decades (Select Committee on Children, Youth and Families, 1989b). In 1975
approximately 720 child abuse fatalities were recorded. By 1986, this number had increased to about
770 (Select Committee on Children, Youth and Families,1989b). Not all of the “undetermined injury”
deaths included in these figures were the result of severe child abuse. Nevertheless, the number of child
homicides also increased from 1970 to 1986.

Meanwhile, between 1975 and 1986 the number of official child abuse reports increased sevenfold.
Thus, the substantial increase in child abuse reporting did not lead to a measurable reduction of child
fatalities defined either narrowly as resulting from homicide or broadly as both homicide and
undetermined injury (Figure 1). The number of child abuse fatalities (treated as homicides by the
National Center for Health Statistics) has remained relatively stable for the past 30 years (Select
Committee on Children, Youth and Families, 1989b). The state child abuse fatality data reported by the
Select Committee on Children, Youth and Families (1987, 1989b) and the National Committee for the
Prevention of Child Abuse (Daro & Mitchel, 1990) mirror these trends. Even though the data are derived
from different sources, the data from the National Center for Health Statistics correspond with the data
from the Federal Bureau of Investigation’s Uniform Crime Reports (Figure 2), which also show that the
number of children reported murdered each year has risen over the past three decades (Federal Bureau
of Investigation,1962-1989; see also Christoffel, 1990; Ewigman & Kivlahan, 1989). Since the
implementation of mandated reporting, there has been no discernible decline in the number of children
reported murdered each year.

State Findings

Besharov (1990b) indicated that child abuse fatalities in New York had declined from about 200 to under
100 within five years of the passage of a comprehensive reporting law. Evidently, the effect of the law
was short-lived because in 1986, New York reported 181 child fatalities and in 1988,198 (Select
Committee on Children, Youth and Families, 1989a). Additionally, Colorado reported 26 child abuse
fatalities in 1988, indicating that the decline from about 20 a year reported in Denver hospitals to less
than one a year was not sustained by the progress in child abuse reporting (Select Committee on
Children, Youth and Families, 1989a).

There is substantial variation among states in the rates of child abuse reports per 1,000 children and
fatalities per million children (Figure 3). For example, the rate of child abuse reports per 1,000 children
in Missouri is more than five times greater than the rate in Pennsylvania. Nevertheless, the rate of child
fatalities is similar in both states. Colorado has been a leader in the field of child abuse reporting, but the
rate of reports in Rhode Island is more than three times greater that in Colorado. Why this great

As can be seen by examining Figure 3, there is no apparent relationship between child abuse report
rates and child abuse fatalities. I computed a least-squares regression analysis of the rate of child
fatalities in 1986 with the rate of child abuse reports in 1986 by state (Select Committee on Children,
Youth and Families, 1989a). The analysis of the relationship indicates that states with high rates of child
abuse reports do not have fewer (or more) fatalities than states with low rates of child abuse reports
(R[sup2] = .008).

Is there another measure of harm to children that would more precisely measure abuse than fatalities?
The difficulty of defining child abuse has long been recognized (Giovannoni & Becerra, 1979). Legal
theorists have suggested that the state should intrude into family life only in cases of severe abuse
(Rodham, 1973); that is, children should only be removed from parents when they have been severely
assaulted, systematically tortured, or sexually abused or are in a situation that poses an immediate
threat of serious injury.

The early medical research suggested that the appropriate intervention in cases of severe physical
abuse was removal (Green, 1975). Gwinn, Lewin, and Peterson (1961) reported, “The only certain
method of safeguarding the infant is to remove him from the environment where the trauma occurred”
(p. 929).

Mandatory child abuse reporting was directed initially at the problem of battered-child syndrome.
However, over time mandatory reporting laws have come to encompass a broader concern with
interventions that serve the “best interests” of the child. Rodham (1973) identified the two principle legal
standards used to determine when the state should intervene in situations of child abuse and neglect as
(1) “the best interest of the child standard” and (2) “the least detrimental alternative for the child”
standard. These standards lead to different approaches to child abuse. Rodham (1973) wrote,

Even though state interference with family privacy should be minimized because of the state’s
unwillingness, or inability, to care for children as well as most families do, the state, representing the
community of adults, has the responsibility to intervene in cases of severe emotional deprivation or
psychological damage if it is likely that a child’s development will be substantially harmed by his
continued presence in the family. (p. 514)

The major concern about state intervention in cases of child abuse and neglect is with developing
adequate legal standards. Rodham (1973) observed,

This will involve specifying acceptable reasons for intervention and providing workable review
mechanisms for the initial decision and the child’s placement. Intervention should be allowed only after
the state has attempted to provide services for the child and his parents aimed at ameliorating the
conditions of neglect. Only medically justifiable reasons for intervention should be acceptable….
Parental behavior that does not result in medically diagnoseable harm to a child should not be allowed
to trigger intervention, however offensive that behavior may be to the community. [italics added] (p 514)

However, in 1990 in the state of New York, less than 1 percent of child abuse reports involved “battered”
children (that is, children presenting serious physical injuries including fractures, subdural hematoma,
internal injuries, or death). The most frequent reason for a child abuse allegation was lack of supervision
(Pryor, 1990). Moreover, empirical studies of child removal in cases involving both physical abuse
(Dingwall, Eekelaar, & Murray, 1983; Hampton & Newberger, 1985; Katz, Hampton, Newberger, Bowles,
& Snyder, 1986; Lindsey, 1991a, 1991b; Packman, Randall, & Jacques, 1986) and sexual abuse
(Hunter, Coulter, Runyan, & Everson, 1990) indicate that “severity of abuse” has had little or no
significant influence in predicting removal of a child from the home by protective services.

Although fatality data are imperfect, they may be the most reliable and valid indicator of serious child
abuse currently available. If fatality data are a valid and reliable indicator of serious child abuse, then it
would appear that the increase in child abuse reporting brought about by mandated reporting legislation
has not had the effect of substantially reducing child abuse (Lindsey & Trocme, in press).

It may be that without the increase in child abuse reporting since 1962, there would have been many
more fatalities, and it is possible that increased reporting held down the increase in fatalities. This issue
can be examined by analyzing data on nationwide trends in violence in the family and by comparing
rates of abuse reports and fatalities among states.

Nationwide Trends in Domestic Violence
In 1975, Straus, Gelles, and Steinmetz conducted a study of violence in the family enticed Behind
Closed Doors and estimated that between 3.1 and 4.0 million …