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It’s taken more than half a century but slowly, some people in family policing (a more accurate term than “child welfare”) are realizing that mandatory child abuse reporting laws were a huge mistake. These laws force many professionals who deal with children, and, in some states, everyone, to report their slightest suspicion of whatever state law considers child abuse or neglect.
The research is clear: Mandatory reporting has backfired. It drives families away from seeking help. They fear that if they confide that they are under stress or take their child to the ER with a broken bone or even a bruise it might be confused with child abuse or neglect -- and they’ll be turned in to the family police who will inflict a traumatic investigation and, maybe, take the children.
Mandatory reporting also deluges the system with so many false reports that workers have less time to find the relatively few children in real danger. In short, mandatory reporting makes all children less safe.
One key solution is to replace mandatory reporting with permissive reporting – in which professionals exercise their professional judgment concerning when to report and when not to report. Sadly, no state has yet gone that far. Instead, there have been small tentative steps: A commission tasked with studying how to expand mandatory reporting in Massachusetts rebelled against its own chair and refused. A commission in Colorado actually recommended removing one category of mandated reporter -- advocates for survivors of domestic violence – and narrowing the definition of “neglect.” A bill has been introduced to implement those recommendations. By the standards of family policing, those acts are revolutionary.
But, of course, there also are states that haven’t gotten the memo. In Washington State, some lawmakers, and media, remain obsessed with allowing the family police to, in effect, barge into the confessional, by forcing clergy to be mandated reporters.
And then there’s Maine, where some clueless politicians and advocates have spent more than a decade undoing reforms that once made the state a national leader in getting child welfare right.
Among the foolish changes was a clause in the state’s mandatory reporting law that takes away what little professional judgment medical professionals are allowed to exercise in certain cases of alleged physical abuse.
Backers of this theory cite research claiming that children found to be abused are more likely to have had such injuries at some point than children who are not found to be abused. But that is not the same as saying every child or even most children with a “sentinel injury” got that injury because of abuse or is likely to be abused in the future.
I discussed the research and its limits in detail in this Blog post. That post focused on a paper by two doctors who actually told their colleagues that when there is a sentinel injury they should “think less, screen more.”
But even the most fanatical devotees of thinking less argue for more medical tests and consultation with specialists – such as child abuse pediatricians, of course. That alone can bring down a world of trauma on children and their families. But at least they’re not advocating writing an anti-thinking clause into state law.
But Maine already has such a clause – thanks to the same governor who began the dismantling of the state’s reforms, the state’s former “Trump before Trump” governor, Paul LePage.
Since 2013 Maine’s mandatory reporting law demands that in any case where there is a so-called “sentinel injury,” medical professionals must suspend all professional judgment, do no thinking at all, and automatically report the family to Maine’s family police agency, whether the medical professionals think the cause of the injury is child abuse or not. Then, caseworkers who, of course, have far less medical expertise than medical professionals, launch their investigation and make the call as to whether it’s child abuse.
During a legislative committee meeting earlier this month, some lawmakers heard about this and were appalled. But alas, they weren’t appalled that Maine has a clause in state law that is almost literally brain-less. No, they were appalled that it’s not being enforced. They were shocked that no one has made an example of some doctor somewhere who dared to exercise what they thought was their right, indeed their duty to think, and decided not to report a child with a “sentinel injury” because, in that doctor’s professional judgment, the injury was not caused by child abuse.
better to educate doctors that they have no right to think in these cases or punish them for thinking. The headline on one news account reads: “Gap in Maine’s mandated reporter law raises questions about accountability for mandated reports.”
Much of the impetus for making thinking more difficult seems to come from Mark Moran, a social worker who chairs Maine’s Child Death and Serious Injury Review Panel. In 2021, the panel devoted a huge section of its annual report to “sentinel injuries.” But the panel’s credibility might be viewed as compromised by the report’s very next section. That section dealt, entirely uncritically, with “shaken baby syndrome” – only the report prefers another term. Perhaps because Shaken Baby Syndrome has been called into question so often one court has called it “junk science,” the Maine committee has adopted the new preferred euphemism: abusive head trauma.
By 2023, the report was no longer talking about shaken baby syndrome – by any name – but it still was talking up sentinel injuries. But even that report said in such cases the child should receive “a careful, multidisciplinary evaluation” – which is not the same thing as a knee-jerk call to the family police.
But Moran certainly isn’t against the law. According to the Maine Morning Star:
“We’re looking to identify what the problem is, fix the problem and put the family back together,” Moran said.I’m sure he means it. As with so many in and around family policing, I don’t doubt that his motivation is to save lives.
But scaring families away from going to doctors and subjecting children who are taken anyway to traumatic investigations and, perhaps, hauling them off to foster care doesn’t seem like the best way to identify a medical problem.
As for the whole punish-or-educate dilemma, Moran says: Why choose? From the story:
Moran said the panel is more interested in changing people’s behavior than handing out punishments, but it doesn’t have to be one or the other; it could be both.
He may as well have added: But for God’s sake, medical professionals, stop that damn thinking!
Maine legislators need to think twice about a law that doesn't let doctors think even once.
