May 20 Mandated Supporting – Ethics in Medicine and Child Welfare

May 20h in Bold Voices by

(May 20, 2024)

I had the honor and privilege to sit on an ethics panel at the 18th Annual Pittsburgh Conference on Child Maltreatment a couple of weeks ago. I was joined by several medical professionals from Children’s Hospital and the director of CYF in Washington County. The goal of the panel was to discuss basic ethical principles and how these intersect with real life. We used case studies that appear to be in the “gray” in terms of whether a report of child abuse needs to be made or not.

Mandated reporters are required to make a report of suspected child abuse if they have reasonable cause to suspect that a child is a victim of child abuse. A mandated reporter may have general concerns related to the safety of children but may not rise to the level of abuse. In these instances, the solution may be to offer support and resources to the family instead of filing a report. Oftentimes, well-meaning reporters confuse poverty with neglect or fall victim to their implicit bias and at times file unnecessarily reports.

Let us be clear – when in doubt, a mandated reporter should file a report or ChildLine and if you have reasonable cause to suspect a child is encountering abuse or neglect, please call 1-800-932-0313. Before that call is made, we do ask mandated reporters to pause for a moment and ask themselves if this is a case of abuse/neglect or if this is a circumstance of poverty and basic needs not being met. It is important to remember that even a brief interaction with the child welfare system can provide long-term traumatic effects for a child and family. During the panel discussion, we encouraged medical professionals to do just this, pause for a moment and reflect on the situation at hand. For discussion purposes, we were given case studies to discuss and determine what our course of actions would be.

Here is an example of one of the case studies we presented at the panel for discussion.

  • 8 month old male managed by PCP for iron deficiency anemia.
  • Child admitted to hospital and required a blood transfusion.
  • Felt to be nutritional due to an unusually restricted diet.
  • At 11 m/o, the child is developmentally delayed and doesn’t crawl.
  • Noted to have leg pain and found to have a fracture without a trauma history.
  • Bones very demineralized on x-rays.
  • Child no longer anemic.
  • Family has continued restricted diet and this has led to weak bones, maybe contributed to developmental delay.
  • But they are adherent to giving child his iron.

We discussed how this case should be approached before making a decision to file a ChildLine report or not. We all agreed that we need more information and the best way to do this is to talk to the family in a non judgemental way. Here are some questions and comments that were made:

  • What exactly is this restricted diet?
  • Why is there a restricted diet? Is it cultural or religious?
  • Is the restricted diet an effect of poverty?
  • Is the family experiencing food insecurity? If so, do they need information for SNAP or food banks?
  • What supports have been offered to the family?
  • Ensure that an anti-racist lens is being used.
  • Is implicit bias playing a role in this?
  • Have the child’s medical issues been explained in a way in which the family fully comprehends?
  • Many black families do not have good experiences when it comes to healthcare. Black people simply are not receiving the same quality of health care that their white counterparts receive.

Once a professional can gain more information, they can make a more informed decision – whether to refer the family to additional services or to report child abuse or neglect. Parents struggling with limited resources, unable to pay rent or secure stable housing, or who are absent from the home to work could be viewed as unfit and neglectful without the full picture, and we know that black and Indigenous families are more likely to be investigated than white families.

This panel was an excellent first step in addressing some of the disparities within our system and for trying to avoid an intrusive, painful investigation if at all possible. I hope that more of these conversations can be done with families themselves. There is a lot of mistrust from families when it comes to healthcare professionals. In my experience as a child welfare professional, families are worried that any interaction with medical professionals will lead to CYF involvement. I have also seen my clients grow up and continue to have that same hesitation when they become parents themselves. Conversations similar to these could help restore some of the trust, give everyone a more clear understanding, and ultimately allow for more children to avoid an nonessential exposure to a ChildLine investigation.

Heather Wilkes, Allies for Children Policy Manager