The decision making processes adopted by rurally located mandated professionals when child abuse or neglect is suspected

Karen Francis
Rural Nursing, School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Gippsland Campus, Churchill VIC

Ysanne Chapman
Dean and Professor of Nursing and Midwifery, CQUniversity, Mackay, QLD

Kenneth Sellick
School of Nursing and Midwifery, Monash University, Gippsland Campus, Churchill VIC

Ainsley James
School of Nursing and Midwifery, Monash University, Gippsland Campus, Churchill VIC

Maureen Miles
School of Nursing and Midwifery, Monash University, Gippsland Campus, Churchill VIC

Janet Jones
School of Nursing and Midwifery, Monash University, Gippsland Campus, Churchill VIC

Julie Grant
School of Nursing and Midwifery, Monash University, Gippsland Campus, Churchill VIC

PP: 58 - 69

Abstract

The reporting of suspected child abuse and neglect is a mandated role of medical doctors, nurses, police and teachers in Victoria, Australia. This paper reports on a research study that sought to explicate how mandated professionals working in rural Victorian contexts identify a child/ren at risk and the decisions they make subsequently.

Keywords

Mandatory reporting, medical doctors, nurses, police, teachers

Article Text

The World Health Organisation and the International Society for Prevention of Child Abuse and Neglect advocate that all nations protect and provide children with environments that nurture their physical and emotional growth and development (WHO & ISPCAN, 2006). In Australia all jurisdictions have legislation that ensures the safety and protection of children. Currently there are differences between states and territories regarding how authorities deal with breeches of the act/s and how the legislation is enacted (ARACY & ACG, 2008). The World Health Organization and the International Society for Prevention of Child Abuse and Neglect report (2006) suggests that every child has a right to a safe and nurturing childhood and reminds us that one way of ensuring that children are protected is by mandating targeted professional groups who have a role in the care and protection of children. This study which was undertaken in rural Victoria aimed to understand and highlight the decision making processes of four (4) relevant mandated professional groups, namely, medical practitioners, nurses, police and teachers.

Background

Abuse can be defined as physical, emotional and sexual maltreatments. Physical abuse is where a child is intentionally, outwardly harmed or maimed; whereas emotional abuse refers to non violent behaviours that make the child feel unloved, unsupported and reduce their confidence by ridiculing and other non physical forms of rejection. Sexual abuse is any conduct that has a sexual connotation including but not limited to sexual penetration, sexual advances or sexual innuendo to a child whose maturity prevents them fully comprehending these behaviours (WHO & ISPCAN, 2006). In addition neglect can be added to this list as failure to provide for the development or wellbeing of a child (WHO & ISPCAN, 2006).

Protecting children from abuse and neglect is an important social and health issue. It impacts directly on those groups of professionals mandated by legislation to report any cases where they suspect, on reasonable grounds, that a child is at risk of significant harm due to physical or sexual abuse. All Australian states and territories have now introduced legislative regulations for compulsory reporting of suspected child abuse and neglect (AIFS, 2010). In Victoria, those groups with mandatory reporting obligations include nurses, medical practitioners, teachers, and police. In addition, while suspected cases of child neglect or emotional abuse are not required to be reported, any professional or member of the community forming a belief that a child is at risk from these forms of abuse can notify authorities voluntarily (Blaskett & Taylor, 2003).  The guidelines currently offered to assist professionals to report, however, are vague and open to individual interpretation. There are also indications that continuing education about child abuse is patchy, varies by profession and workplace, and has not kept pace with legislative changes. While the processes for managing a notification of suspected child abuse and neglect are similar in all jurisdictions (AIHW, 2006) confusion about what procedures follow a notification is widespread among mandated professionals. Little is known about how mandated professionals verify their own obligations to report and negotiate the systems in place to manage notifications. There is also a dearth of information concerning the decision making processes that lead to notification by professionals mandated to report.

The Australian statutory child protection system is overburdened with notifications of alleged child abuse and neglect almost tripling nationally between 1999-2000 (107,134 reports received) and 2006-07 (309,517 reports received) (ARACY & ACG, 2008; Australian Research Alliance for Children and Youth (ARACY) & Allen Consulting Group, 2008, p.vi; Blaskett & Taylor, 2003). The dramatic increase in the volume of child abuse reports currently being experienced in Australia also occurred in the United States of America during the 1980s following the introduction of mandated reporting in 1974.  The regulation of mandatory reporting in Australia is fragmented. The earliest state to have a relevant act that covered mandatory reporting was Queensland in 1937; other states introduced legislation culminating in 1997 when Tasmania introduced their laws (AIFS, 2010). By 1990 the escalating rate of allegations led the US Advisory Board on Child Abuse and Neglect to declare that the child protection system was in a 'state of national emergency' (Kimbrough-Melton & Campbell, 2008, p.100).  The Board concluded that

the most serious shortcoming of the nation's system of intervention on behalf of children is that it depends on a reporting and response system that has punitive connotations and requires massive resources dedicated to the investigation of allegations. ... If the nation ultimately is to reduce the dollars and personnel needed for investigating reports, more resources must be allocated to establishing voluntary, non-punitive access to help (Kimbrough-Melton & Campbell, 2008, p.101).

Consequently, US child welfare policy has moved towards community-based child protection in the form of programs such as the Durham Family Initiative and the 'Strong Communities for Children' (SCFC), which is being trialled and evaluated in two counties in South Carolina from 2002 to 2012 (Melton & Holaday, 2008).

In Australia, although the number of notifications is increasing, some professionals who are mandated to report child abuse and neglect often choose non-compliance when faced with professional dilemmas about balancing mandatory reporting requirements with their subjective judgements about the child's best interests (Blaskett & Taylor 2003). This situation reflects experiences in other countries such as England and the Republic of Ireland, where governments have introduced 'a plethora of guidance outlining the procedures that professionals should follow when they have concerns that a child is being maltreated' (Horwath, 2007, p.1286). However, as the UK investigation following the death of Victoria Climbié made clear, procedural guidance alone is not enough (Lord-Laming, 2003); professionals 'struggle not only with not knowing what to do if they have concerns that a child is vulnerable to maltreatment but also with making decisions about the types of concern that warrant a discussion with other professionals or a referral to social work services (Horwath, 2007, p.1286). Mandated professionals' own cultural values, cultural identity, acculturation, and gender role socialization also influence their view of the reporting dilemma and the degree to which they perceive neglect or mistreatment as child abuse or maltreatment (Garcia, McGuire-Kuletz, Froelich, & Dave, 2008).

Australian research indicates that additional reasons for non-compliance include poor understanding of,  and a lack of confidence in the processes following notification, limited feedback on outcomes of notification, and in some cases a belief that the professional is in a privileged position to assess the environment, community and family and therefore able to respond more effectively to protect the child (Cheers, Derracott, & Lonne, 2007). These factors can be characterised as wicked problems as defined by Head and Alford (2008). Wicked problems are determined by dimensions of complexity and diversity. Complexity is driven by a 'patchy knowledge base; complex interdependencies of processes and structures; and uncertainties arising from the contingent and dynamic nature of social issues and processes; while diversity concerns the number and variety of stakeholders involved (Australian Research Alliance for Children and Youth (ARACY) & Allen Consulting Group, 2008, p.10).

Understanding the circumstances and thence the decision making processes of mandated professionals employed in rural communities will inform ongoing education of these professionals and contribute to the strengthening of child protection policies and guidelines.

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