Treatment of Child Abuse: Common Ground for Mental Health, Medical, and Legal Practitioners

1. Identification, Mandated Reporting Requirements, and Referral for Mental Health Evaluation and Treatment

mental health providers) as mandated reporters, while New Jersey and Wyoming required all persons to report suspicions , without specifying any particular professional group (Child Welfare Information Gateway, 2010). Typically, state statutes require some level of certainty akin to “reasonable suspicion” or simply require that the reporter should have “reason to believe” or “suspect” that maltreatment has occurred before mandating a report, but there is ample room for interpretation and the provider may struggle with the decision. The purpose of the law is to empower mandated reporters and others to serve as a “safety net” for victimized children. As such, the level of certainty required to report suspected abuse is intended to be considerably lower than that associated with child protective service “case substantiation ” or criminal conviction. Providers need not be certain that abuse or neglect has occurred before making a report, and typically this level of certainty is not possible without investigation that goes beyond the actions of the medical provider. It is the provider’s responsibility merely to report concerns about possible abuse and then allow authorities to assess the situation and determine whether maltreatment has occurred. Nearly all states (47 and the District of Columbia, as of December 2009) define penalties for a mandated reporter who fails to report suspected child maltreatment (Child Welfare Information Gateway, 2009); in most states the act is considered a misdemeanor. On the other hand, all 50 states and the District of Columbia also provide immunity from civil and criminal liability for any mandated reporter who makes a report “in good faith.” This immunity is effective even when abuse or neglect is not substantiated by investigation (Child Welfare Information Gateway, 2012). In addition, many states also provide immunity for actions taken by the mandated reporter after the initial report, including participation in judicial proceedings and assistance with the investigation. GENERAL CONSIDERATIONS A medical provider may encounter a child victim of abuse or neglect under a variety of circumstances, whether routine pediatric visits with the primary care physician or nurse practitioner , or acute care in the emergency department or surgical suite for injuries related to abuse or neglect, or intake exams at a juvenile detention center. The allegations of maltreatment may or may not have been previously identified and known to the provider. The child may disclose abuse spontaneously to the clinician, surprising both professional and parent. In some cases, the parent seeks medical attention for the child specifically because of concerns about maltreatment . Rarely, a child may present for medical care unaccompanied by an adult, with an allegation of abuse and a request for treatment and protection. This chapter considers issues relevant to the clinician who is providing care to a possible victim of abuse or neglect, including mandated reporting, patient privacy rules, and confidentiality, and provides an overview of the medical evaluation in cases of suspected maltreatment . We discuss how to determine the type of mental health treatment appropriate for a child and the best “fit” between child and therapist. MANDATORY REPORTING OF ABUSE AND NEGLECT As a condition for receiving federal funding through the Child Abuse Prevention and Treatment Act (CAPTA; Pub. L. No. 93-273; 43 U.S.C. §§ 5101–5119), states are required to implement statutes mandating certain adults to report suspected child abuse and neglect to authorities (National Association of Counsel for Children, 2012). As of April 2010, 48 states and the District of Columbia defined specific types of professionals (typically including health care workers and Identification, Mandated Reporting Requirements, and Referral for Mental Health Evaluation and Treatment JORDAN GREENBAUM, M.D. MARIANNE CELANO, PH.D. 1 4 Initial Contact with the Abused Child information without authorization of the legal guardian; such limitations do not apply to child protective service agencies . In some situations the health care provider may believe the child or someone else is in imminent danger, and the health professional is then allowed to provide PHI to law enforcement . Occasionally, health care providers are asked to provide PHI even when they themselves have not reported the suspected abuse or neglect. They are allowed to do so without guardian authorization under certain conditions, including when it is permissible by state law, when it is necessary to protect the child or others from serious harm, and if the PHI released is relevant to the alleged maltreatment. Further details of the HIPAA regulation, Privacy Rule, and exceptions to HIPAA may be found elsewhere (Committee on Child Abuse and Neglect, American Academy of Pediatrics, 2010; Podrid, 2003). The HIPAA...