PAC 414 Module 5 Mandated Reporting Example

"I Only Left Them for One Night": A Mandated Report From an Addiction Counselor and Why Hesitation Fails Children

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 414: Child Abuse and Neglect

Instructor Name

Month Day, Year

"I Only Left Them for One Night": A Mandated Report From an Addiction Counselor and Why Hesitation Fails Children

Monique is twenty-nine and in her fourth week of outpatient treatment for methamphetamine use at an addiction program affiliated with Heartland Family Services, the agency invented for this course. During a session with her counselor, Dana, she described how bad things had become before she entered treatment. "I even left the kids alone overnight last weekend to go get high," she said. "Only one night. They were asleep." Her children are four and six. She said they are now staying with her mother while she is in treatment, though she sees them every day. Dana felt the weight of the moment. Monique had been engaged and honest, and Dana feared that a report would end her trust and her treatment. This paper examines Dana's duty and how she carried it out. Dana, Monique and the program are composites; the research is real.

The Duty to Report

Every state requires certain professionals, including counselors, social workers, teachers and health care providers, to report suspected child abuse or neglect to child protective services. The threshold is reasonable suspicion, or in some states reasonable cause to believe, not proof. The reporter's job is to report; the child welfare agency's job is to assess and investigate. Kansas law includes leaving young children without adequate supervision within its definition of neglect. A four-year-old and six-year-old left alone overnight meet the threshold for a report, even though the children are now with their grandmother.

Confidentiality and Addiction Treatment Records

Federal rules give records of substance use treatment special confidentiality protections, stricter than those for most health records. These rules contain an exception that permits programs to make the initial report of suspected child abuse or neglect that state law requires. They do not permit the program to share further treatment records in a later investigation or court proceeding unless the client consents or a court issues an order under the rules' specific procedures. Dana can and must make the report; she should not volunteer Monique's treatment records.

Why Professionals Hesitate

Flaherty et al. (2008) studied primary care clinicians who evaluated injuries in children, asking them about their level of suspicion and whether they reported. Clinicians did not report a substantial share of injuries that they themselves judged likely or possibly caused by abuse. Their reasons included familiarity with the family, uncertainty about whether abuse had occurred and consultations or information that lowered their suspicion. The authors noted that clinicians appeared to apply a higher threshold than the law requires.

Kenny (2004) surveyed teachers about their knowledge of and attitudes toward reporting child maltreatment. Many teachers reported limited knowledge of the signs of abuse and of their school's reporting procedures, and few had ever made a report. Teachers worried about making false accusations, about consequences for the child and about their relationships with families. The two studies show that hesitation is common across professions and that it often stems from uncertainty and from relationships with families, the very pressures Dana felt.

An Unsubstantiated Report Is Not a False Report

Professionals often fear being wrong. Drake et al. (2003) examined child welfare records to compare later outcomes for children whose initial reports were substantiated and those whose reports were not. Later reports came in for children in unsubstantiated cases nearly as often as for children whose first report was confirmed. The authors concluded that substantiation status was a poor indicator of actual risk and that many unsubstantiated reports reflected real concerns. A report that does not result in substantiation is not necessarily a mistake.

The Decision

Making the Report

Dana consulted her supervisor briefly, who agreed a report was required. In the same session, Dana told Monique that what she had described was something the law requires counselors to report, that she was not making the report to punish her and that she would continue as her counselor. She explained what the report would say: the disclosure, the children's ages, their current placement with their grandmother and that Monique is in active treatment. She invited Monique to be present for the call and to speak to the hotline worker herself if she wished. Monique was angry and frightened, then chose to stay. She told the hotline worker about her treatment and her mother's care of the children.

Dana documented the disclosure in Monique's words, the consultation, the conversation with Monique and the report, including the reference number.

Why Telling Monique Mattered

Dana could have made the report after Monique left, without telling her. Some counselors do, fearing confrontation. But Monique would almost certainly have learned of the report when a worker contacted her mother, and she would then have learned that her counselor had acted behind her back. Telling her directly, in the session, preserved what could be preserved: the knowledge that Dana was honest with her. Inviting her to speak to the hotline worker gave her some control and allowed the worker to hear, from Monique herself, about her treatment and her mother's care of the children, information that shaped the agency's response. Transparency did not make the report painless, but it made it survivable for the relationship.

Afterward

In the following session, Dana and Monique talked about the report. Monique admitted she had been afraid her children would be taken. The child welfare agency had assigned the case to its family assessment track, which focuses on services rather than investigation, partly because Monique was already in treatment and the children were safe with their grandmother. Monique remained in treatment.

Conclusion

Dana's duty was clear: a client's disclosure that two young children were left alone overnight created reasonable suspicion of neglect. Flaherty and colleagues and Kenny show how often professionals hesitate when they know a family or feel uncertain, and Drake and colleagues show that unsubstantiated reports are not false alarms. By reporting promptly and transparently, inviting Monique to participate and continuing treatment, Dana met her duty to the children while protecting, as far as possible, her relationship with their mother.

References

Drake, B., Jonson-Reid, M., Way, I., & Chung, S. (2003). Substantiation and recidivism. Child Maltreatment, 8(4), 248-260. https://doi.org/10.1177/1077559503258930

Flaherty, E. G., Sege, R. D., Griffith, J., Price, L. L., Wasserman, R., Slora, E., Dhepyasuwan, N., Harris, D., Norton, D., Angelilli, M. L., Abney, D., & Binns, H. J. (2008). From suspicion of physical child abuse to reporting: Primary care clinician decision-making. Pediatrics, 122(3), 611-619. https://doi.org/10.1542/peds.2007-2311

Kenny, M. C. (2004). Teachers' attitudes toward and knowledge of child maltreatment. Child Abuse & Neglect, 28(12), 1311-1319. https://doi.org/10.1016/j.chiabu.2004.06.010