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Across the United States, child abuse law is governed by state statute. Pediatricians must report suspected child abuse/neglect in accordance with their state's specific reporting requirements; failure to make a timely report creates civil liability exposures and triggers criminal penalties. The pediatrician's initial report may instigate further investigation by child protective services, and the reporting pediatrician may later become involved as a critical fact witness in ensuing legal proceedings, including criminal prosecutions, custody determinations, and medical malpractice controversies. The reporting pediatrician's testimony may influence the disposition of those matters and significantly affect the well-being of the involved children. As such, dutifully reporting pediatricians promulgate and engage in peerless child advocacy.

ObjectiveTo systematically search for research about the effectiveness of mandatory reporting of child maltreatment and to synthesise qualitative research that explores mandated reporters’ (MRs) experiences with reporting.DesignAs no studies assessing the effectiveness of mandatory reporting were retrieved from our systematic search, we conducted a meta-synthesis of retrieved qualitative research. Searches in Medline (Ovid), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, Education Resources Information Center, Criminal Justice Abstracts and Cochrane Library yielded over 6000 citations, which were deduplicated and then screened by two independent reviewers. English-language, primary qualitative studies that investigated MRs’ experiences with reporting of child maltreatment were included. Critical appraisal involved a modified checklist from the Critical Appraisal Skills Programme and qualitative meta-synthesis was used to combine results from the primary studies.SettingAll healthcare and social-service settings implicated by mandatory reporting laws were included. Included studies crossed nine high-income countries (USA, Australia, Sweden, Taiwan, Canada, Norway, Finland, Israel and Cyprus) and three middle-income countries (South Africa, Brazil and El Salvador). Participants: The studies represent the views of 1088 MRs.OutcomesFactors that influence MRs’ decision to report and MRs’ views towards and experiences with mandatory reporting of child maltreatment.ResultsForty-four articles reporting 42 studies were included. Findings indicate that MRs struggle to identify and respond to less overt forms of child maltreatment. While some articles (14%) described positive experiences MRs had with the reporting process, negative experiences were reported in 73% of articles and included accounts of harm to therapeutic relationships and child death following removal from their family of origin.ConclusionsThe findings of this meta-synthesis suggest that there are many potentially harmful experiences associated with mandatory reporting and that research on the effectiveness of this process is urgently needed.

Background Child abuse and neglect are significant social and health issues in New Zealand. As the government provides free oral care to children and adolescents, oral health practitioners are positioned to respond to child protection concerns. However, research on the knowledge and attitudes of oral health practitioners is limited. This study aimed to understand the knowledge and attitudes of New Zealand dental and oral health therapists in detecting and reporting child abuse and neglect. Methods In this descriptive exploratory cross-sectional study, we invited registered New Zealand dental and oral health therapists treating children and adolescents to the anonymous online survey. Results Among the 92 dental and oral health therapists, 72% agreed that they could recognise the signs and symptoms of child abuse and neglect. Yet, only 48% agreed they were familiar with the reporting process. During their professional careers, 62% had at least 1 suspected case; and only 21% had ever reported their concerns. Fear of false reporting (70%) was the most significant barrier. Conclusions Participants understood child abuse and neglect as significant social issues; however, the knowledge and attitudes to respond were limited. Efforts to enhance the knowledge and attitudes will be necessary to promote child safety and wellbeing.

Many individuals with sexual interest in children express a desire for mental health services but represent an underserved client population. An identified barrier to service provision is mandatory reporting legislation, which requires clinicians to report when they learn of a child who has been, or is at risk of being, sexually abused. We conducted a vignette study to examine the factors that would influence mandatory reporting decision-making when a client discloses sexual interest in children. We recruited a convenience sample of 309 Canadian registered mental health clinicians and student trainees who completed several questionnaires. Clinicians were randomized to one of nine vignettes that were crossed on two situational factors (use of child sexual exploitation material and access to children). The results of the multivariate analysis suggested that stigma towards people with sexual interest in children was associated with an increased likelihood of reporting. Clinicians were more likely to indicate that they would report the hypothetical client was viewing child sexual exploitation material and/or had access to children. These findings are discussed within the context of improving service provision to the underserved population of people with sexual interest in children. De nombreuses personnes ayant un intérêt sexuel envers les enfants expriment le désir d'obtenir des services de santé mentale, mais elles font partie d'une clientèle mal desservie. Un obstacle connu à l'offre de services est la réglementation du signalement obligatoire, laquelle oblige les fournisseurs de services de rapporter les cas d'enfants qui ont été ou qui risquent d'être victimes d'abus sexuels dont ils prennent connaissance. Nous avons mené une étude au moyen de vignettes en vue d'examiner les facteurs qui influenceraient la prise de décisions relatives au signalement obligatoire lorsqu'un client rapporte avoir un intérêt sexuel envers les enfants. Nous avons recruté un échantillon de commodité de 309 cliniciens agréés travaillant en santé mentale et des stagiaires, qui ont répondu à plusieurs questionnaires. On a présenté de façon aléatoire l'une de neuf vignettes aux cliniciens axées sur deux facteurs situationnels (usage de matériel d'exploitation sexuelle d'enfants et accès à des enfants). Les résultats de l'analyse multivariée suggèrent que la stigmatisation des personnes ayant un intérêt sexuel envers les enfants était associée à une plus grande probabilité de signalement. Les cliniciens étaient plus susceptibles d'indiquer qu'ils signaleraient le client hypothétique qui regardait du matériel d'exploitation sexuelle des enfants ou qui avait accès à des enfants. Ces résultats sont discutés dans le contexte de l'amélioration des services à la clientèle mal servie de personnes ayant un intérêt sexuel envers les enfants. Public Significance Statement People with sexual interest in children have identified concerns about seeking treatment due to mandatory reporting legislation. We conducted a study of Canadian clinicians' and student trainees' mandatory reporting decision-making when a hypothetical client disclosed sexual interest in children. We found that clinician stigma towards people with sexual interest in children, the use of child sexual exploitation material by the client, and client access to children were associated with a greater likelihood of reporting. The results have implications for the development of community-based treatment programs for people with sexual interest in children.

Background Within Canadian provinces over the past half-century, legislation has been enacted to increase child protection organization (CPO) involvement in situations of child maltreatment (CM). This study had two objectives: 1) to document enactment dates of legislation for mandatory reporting of CM; 2) to examine reported CPO involvement among people reporting a CM history in relation to the timing of these legislative changes. Methods The history of mandatory reporting of CM was compiled using secondary sources and doctrinal legal review of provincial legislation. The 2012 Canadian Community Health Survey - Mental Health (CCHS-MH) with n  = 18,561 was analyzed using birth cohorts to assess associations between the timing of legislation enactment and contact with CPO. Results All Canadian provinces currently have mandatory reporting of physical and sexual abuse; 8 out of 10 provinces have mandatory reporting for children’s exposure to intimate partner violence. Increases in reporting CM to CPOs paralleled these laws’ enactment, particularly for severe and frequent CM. Conclusions These findings show that mandatory reporting laws increase reporting contact with CPO, particularly for severe and frequent CM. Whether they have had the intended effect of improving children’s lives remains an important, unanswered question.

Child maltreatment (CM) is an important public health issue linked to significant physical and mental health complications across the life span. Given the association between CM and health, general practitioners (GPs) and primary care nurses (PNs) are well-placed to identify and respond to this issue and are mandated to report suspected CM in many jurisdictions. Research has found that primary care doctors and nurses need support when responding to CM. This scoping review sought to answer the following question: What factors influence GPs and PNs decision to report CM when fulfilling their mandatory reporting duty? By exploring these factors, areas where support is needed were pinpointed. A systematic search was run across four databases: Medline (Ovid), PsycINFO, Embase, and CINAHL. Articles that reported on studies conducted in a location that had mandatory reporting legislation specific to CM and had a study population sampled from primary care were included in analysis. Thirty-three articles met the inclusion criteria. This review found that four principal factors influenced the decision to report CM: personal threshold of suspicion of abuse, relationship with the family, faith in the child protection system, and education and discussion. We conclude that improving the support and training to address these four areas may be beneficial for GPs and PNs in responding to CM.

Objectives. To examine the relationships between universal mandatory reporting (UMR), child physical abuse reporting, and the moderating effect of UMR on physical abuse report outcomes by report source. Methods. We used a national data set of 204 414 children reported for physical abuse in 2013 to compare rates of total and confirmed reports by states or territories with and without UMR. We estimated odds and predicted probabilities of confirming a physical abuse report made by professional versus nonprofessional reporters, accounting for the moderating effect of UMR and individual-level characteristics. Results. Rates of total and confirmed physical abuse reports did not differ by UMR status. Nonprofessionals were more likely to make reports in UMR states compared with states without UMR. Probability of making a confirmed report was significantly lower under UMR; this effect almost doubled for nonprofessionals compared with professional reporters. Conclusions. Universal mandatory reporting may not be the answer for strengthening the protection of children victimized by physical abuse. Implementation of child protection policies must be exercised according to evidence to exert the fullest impact and benefit of these laws.

Background: Internationally, various laws govern reporting of child abuse to child protection services by medical professionals. Whether mandatory reporting laws are in place or not, medical professionals need internal thresholds for suspicion of abuse to even consider a report (“reasonable suspicion” in US law, “gewichtige Anhaltspunkte” in German law). Objective: To compare internal thresholds for suspicion of abuse among US and German pediatricians, i.e., from two countries with and without mandatory reporting laws. Participants and Setting: In Germany, 1581 pediatricians participated in a nationwide survey among child health professionals. In the US, a survey was mailed to all Pennsylvania pediatricians, and 1249 participated. Methods: Both samples were asked how high in their rank order of differential diagnoses child abuse would have to be when confronted with a child’s injuries to qualify for reasonable suspicion/gewichtige Anhaltspunkte (differential diagnosis scale, DDS). In a second step, both had to mark a 10-point likelihood scale (0–100%) corresponding to reasonable suspicion/gewichtige Anhaltspunkte (estimated probability scale, EPS). Results: While for almost two-thirds of German pediatricians (62.4%), child abuse had to be among the top three differential diagnoses for gewichtige Anhaltspunkte, over half of the US respondents (48.1%) had a lower threshold for reasonable suspicion. On the estimated probability scale, over 65% in both samples indicated that the probability of abuse had to exceed 50% for reasonable suspicion/gewichtige Anhaltspunkte. There was great variability between the two countries. Conclusions: There are similar uncertainties in assessing cases of suspected child abuse in different legal systems. There is a need for debates on thresholds among medical professionals in both countries.