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October 26, 2023

The #1 Reason Healthcare Workers Don’t Report Child Abuse

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Nurse comforts a scared child. Discover the #1 reason why healthcare workers don’t report child abuse.

Healthcare professionals have direct access to children who are victims of abuse and are in a unique position to identify the physical signs of intentional abuse and neglect. Healthcare professionals understand their role as mandated reporters. However, despite mandated reporting laws requiring them to report suspected abuse and neglect of minors, studies have shown that as many as 40% or more of healthcare professionals around the globe defy those laws and fail to report child abuse.

It’s not a lack of compassion or care that prevents healthcare professionals from reporting. Professionals who have dedicated their lives to the care of others are compassionate, even going as far as to deploy specific strategies to maintain compassion and empathy for patients in their care.

Researchers conducted a systematic review of over 550 published papers to determine what challenges healthcare professionals encounter in reporting cases of child abuse. They identified a number of barriers to reporting suspected child abuse, even in the face of criminal penalties for failing to report.

The #1 Reason Child Abuse Goes Underreported by Healthcare Workers

The study authors concluded that the strongest predictor of child abuse reports is the knowledge of health care professionals. Inadequate knowledge of reporting rules and procedures is one of the most important factors in a healthcare professional’s decision to make a report or not.

Knowing how to make a report is only part of the problem. A healthcare professional’s inadequate knowledge of the laws surrounding child abuse reporting was also a strong factor in their failure to comply with those rules.

Key takeaway: The most significant reason healthcare professionals fail to report suspected child abuse is inadequate knowledge of child abuse laws, rules, and procedures for making a report.

Experience is a Factor in Reporting Compliance

Researchers have identified the experience of a healthcare professional as a factor in failing to report. Inexperienced healthcare professionals may not have effective techniques for interviewing victims, while more experienced professionals are more likely to have adequate training and prior exposure needed to recognize abuse.

In one study of factors associated with reporting child abuse by nurses found those with at least five years of experience were more likely to report.

The nurses who had reported abuse were statistically more likely to:

  • have received training
  • be familiar with the reporting form
  • trust in the protection agencies
  • know the proper place to refer cases
  • did not fear legal involvement
  • had discussed the subject at work
  • believed that reporting was an advantage

Uncertainty of What Constitutes Abuse

Correctly “diagnosing” or identifying what constitutes abuse can be difficult. An Australian survey of nurses revealed they felt more confident in their ability to recognize and report physical abuse and sexual abuse compared to emotional abuse and neglect.

Many health professionals avoid reporting or getting involved in issues such as child abuse when they aren’t sure if they can prove maltreatment or if they fear making an inaccurate diagnosis. Studies show that correct diagnosis of child abuse cases can be challenging when there is no easy distinction between symptoms of child abuse and physical damage caused by an accident. Most healthcare professionals are seeking assurance that they are making a correct abuse diagnosis before making a report, and are hesitant to report when they have an unproven suspicion of abuse.

Uncertainty Around Privacy Concerns

The confidential relationship between patient and provider is an essential component of care. It is even protected by law; patient privacy laws for safeguarding protected health information (PHI) are in place in the United States, Canada, UK, Australia, Dubai, and Saudi Arabia, among others.

In the United States, mandated reporting laws do not violate HIPAA, the national standard for protecting PHI.

There is no conflict between the State mandated reporting law and the Privacy Rule, and no preemption. Covered entities may report such information and be in compliance with both the State reporting law and the HIPAA privacy rule, according to the U.S. Department of Health and Human Services.

Even when not legally protected, a healthcare provider’s commitment to patient privacy can create a barrier to reporting suspected abuse. Mandated reporter laws may leave a healthcare provider feeling as if they are breaching their confidential relationship with a patient.

Key takeaway: Research suggests when a healthcare professional believes that mandated reporting is violating the patient and provider confidential relationship, they will be less likely to comply with mandated reporting laws.

Attitudes and Beliefs about Reporting a Significant Factor

Misconceptions about child abuse reporting can influence the attitudes and beliefs of mandated reporters. Despite knowledge of child abuse, some healthcare professionals have fears about reporting, including threats or retaliation to themselves, or fear for the wellbeing of the affected children, such as isolation, stigma, repetition of the abuse, and uncertainty about the children’s future.

These fears of the repercussions of abuse can prevent even the most experienced healthcare professionals from reporting when they suspect abuse or neglect.

Mandated Reporter Training Increases Reporting Compliance

After reviewing hundreds of published studies regarding barriers to reporting for healthcare professionals, researchers revealed the professionals who were previously trained to recognize child abuse were those most likely to comply with mandated reporting laws and report suspected abuse.

Training also appears to help healthcare professionals overcome some of the barriers to reporting; during training, healthcare professionals find the opportunity to discuss their uncertainty and can overcome their stress to report cases.

Mandated reporter training can help healthcare professionals better understand their legal requirements for reporting, the signs of abuse and neglect, and the processes and procedures for how, where, and when to make a report. Mandated reporter training can be key to overcoming the most common barriers to reporting, helping healthcare professionals feel more comfortable and confident in their ability to stop abuse when they see it.

California nurses can earn CE credits for taking our online Mandated Reporter Training course. Mandated Reporter Training has been approved by the CA Board of Registered Nursing and can fulfill 4 hours of CE requirements. Start your training and earn CE credits now.

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