Professionals are often aware that they are “mandated reporters” of suspected child maltreatment, but rarely have they been supported in how to explain to their clients and patients what that actually means.
“Mandated reporters” of suspected child maltreatment are required by law to report certain concerns about a child’s treatment to child protective services (CPS). Who is a mandated reporter and when a mandated reporter is required to call CPS are important considerations that are covered in other posts on this website.
Even when a professional is comfortable with the expectations of them under the law, they are often uncomfortable with explaining their role to their client. It is imperative that clients are aided in understanding how working with a mandated reporter impacts their rights and the services they will receive, regardless of their age or other circumstances.
When mandated reporters have an otherwise confidential relationship with a client or patient, like when they are a mental or physical health professional, the mandated reporting role can complicate things. Many professional reporters in these roles are concerned that if they make it clear to the client that they will have to make a report to CPS in certain circumstances, then the client won’t share important information with the professional. That’s true, and likely, and also the client’s right.
Every client has the right to know how sharing information with a professional will be used. While we want clients to share with us as much information as they can so that we can provide them the best service we can, the reality is that the client has the right to determine what information they share.
Some clients are comfortable sharing personal information with professionals. Other clients are more protective of their own privacy. If a client shares information that could lead to CPS being contacted. This is important for the client to understand the potential consequences of sharing information.
However, a client also has a right to not share information. Especially if they do not want to trigger the professional's legal responsibility to make a report to CPS.
In situations where clients do not share information with professionals because they do not want the professional to make a report to CPS, it is possible that the client will miss out on the opportunity to get helpful interventions from the healthcare professional. This is an unfortunate, but real, limitation of mandated reporting laws.
Multiple groups across the country exist to adjust, amend, or even eliminate mandated reporting laws. They argue, and research supports this, that fewer families are getting the help they need. This is because people don’t share concerns with mandated reporters.
Mandated reporting policies were designed to help identify children in need of protective intervention. However, the reality is that millions of children and families a year are reported to CPS when they shouldn’t be. As a result, families and children don’t feel protected; instead they feel victimized.
Professionals should do everything they can to protect families and children from unnecessary CPS intervention. This means professionals should aim to ensure that clients feel comfortable sharing information with the professional, knowing whether the professional will be required to make a report to CPS, or not.
We’ve developed some options for language that professionals can use to help their clients understand the limitations of client confidentiality.
INFORMED CONSENT WRITTEN LANGUAGE ON MANDATED REPORTING
Here’s an example of what a professional can include in their informed consent documentation or practice agreement:
[We] value the relationships we have with our clients, and hold information shared with us through our work as confidential. [We] will not share information outside the therapeutic relationship, except for specific circumstances. Those circumstances include when the client requests of us that [we] share such information, through a release of information process.
Also, under state law, [we] must report information about known or reasonably suspected harm to a child including physical, sexual, and/or emotional abuse, as well as neglect. [We may be] also required to disclose client confidential information when we have reason to believe that a client may harm themselves or somebody else.
When [we] determine that [we] must disclose client confidential information due to a legal obligation, [we] make every effort to ensure that [we] only share information necessary to effectuate our responsibilities under the law, and strive to retain as much confidential information about our client as possible. If you have any questions about the circumstances under which we must disclose confidential information, please talk to [us].
VERBAL INFORMED CONSENT LANGUAGE ON MANDATED REPORTING FOR COMPETENT ADULTS
Writing information in a contract or a form is not enough. You need to talk to your clients, verbally, to ensure their level of understanding.
Here’s an example of what a professional can say to an adult client when the professional believes the client is capable of understanding this language:
We have a confidential relationship. Most things you share with me remain private unless you give me permission to disclose them. However, there are certain times I am required to tell other people things you tell me.
[I will share what you tell me with my supervisor to improve my effectiveness as a therapist. They have the same requirement to keep those things confidential.]
If you tell me that you are planning on hurting yourself, I might need to tell someone else, like the police. But, in most situations I won’t have to tell someone else if I feel like I can help you address those feelings without hurting yourself.
If you tell me that you plan to hurt others, I might need to tell someone else, like the police. But, in most situation I won’t have to tell someone else if I feel like I can help you address those feelings without hurting someone else.
If you tell me about a child hurt through abuse or neglect, I might need to make a report to child protective services. If I have a concern that you might hurt a child, I’ll talk to you about my concerns before I make a report. I will work with you to address the concerns before a child gets hurt.
You may also need to clarify with the client their level of understanding. For instance you can say:
You probably have questions about all this. This can be confusing or scary. What would you like to know?
VERBAL INFORMED CONSENT LANGUAGE ON MANDATED REPORTING FOR CHILDREN AND ADULTS WITH COGNITIVE IMPAIRMENT
Professionals might consider alternative language when working with a child or adult with limited ability to understand complex communications. They may have to rephrase to say
We have a confidential relationship. This means that most things you tell me I cannot tell other people. I can only share this information if you allow me to.
However, there are times I will need to say:
[I will share things you tell me with my supervisor to help make me a better therapist. They have the same requirement to keep those things private.]
At times I may need to share information with someone else. If you tell me that you’re planning on hurting yourself, I may need to tell someone else, like your parent/guardian. But, in most situations I won’t have to tell them if I can help you address those feelings without hurting yourself.
If you tell me that you plan to hurt others, I might need to inform someone else, like the police. However, in most situations, I won't need to involve anyone else if I believe I can help you manage those feelings without harm.
If you tell me that someone is hurting you or another child, I may need to inform someone else. If I am concerned that someone might be hurting you, I will discuss my concerns with you. Together we will create a plan to help you.
Similar to adult clients, it is important to make sure child clients understand what you’ve said to them. You can help determine their level of understanding by saying:
You probably have questions about all this. This can be confusing or scary. I want to make sure you understand all this. What do you think I will need to do if:
You share that you are considering hurting yourself.
You share that you are considering hurting someone else.
You share that someone has been hurting you.
REMINDERS OF INFORMED CONSENT ARE IMPORTANT
Clients aren’t constantly thinking about their confidentiality and its limits. You will need to provide regular reminders of these limitations. Especially if you believe the client is about to share information that would trigger your mandated reporting obligation.
We all strive to do what's best for our clients and to assist them as effectively as possible. We do not want our clients to feel less safe, and more vulnerable because we’ve subjected them to interventions that they did not want to be engaged with.
OTHER RESOURCES
To avoid unnecessary reports to CPS, mandated reporters should:
understand their role
work to support families
not report families, whenever possible.
To learn more about unsubstantiated reports, check out our blog post: “The Best of Intentions”.
You should also aim to learn more about a project to replace mandated reporting with “mandated supporting”.
If you are worried about what could happen to you if you fail to make a report to CPS, I go over that information in this blog post.
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