Updated: Mar 15
By Kathryn Krase, PhD, JD, MSW
What is “Autonomy”?
Autonomy is a fancy word used to describe someone’s right to make decisions for themselves. Adults exercise autonomy everyday when we decide what we want to eat, what clothes we want to wear, what shows we want to watch, etc.
Parental Autonomy & Its Limits
Adults have more autonomy than children. Parents can tell kids what they have to eat, what clothes they have to wear, and what shows they’re allowed to watch. These limitations on children reflect the general rights of parents to determine their own children’s care, otherwise known as “parental autonomy”.
The law can be an impediment to parental autonomy. There are laws that say at what ages parents have to provide their kids with an education. There are laws that outline parents’ responsibilities for their children's care, and that define what kind of parenting is not acceptable, including laws that define child maltreatment.
Parents can’t discipline their children however they want to; the law sets limits. Parents can’t leave children unattended whenever, and however, they want; the law sets limits. These laws haven’t always existed, and they have expanded over time.
The laws defining child maltreatment are technically an infringement on a parent’s autonomy. These laws were put in place in an effort to protect children from harm, but they clearly limit a parent’s rights to make decisions for their children’s care. The conflict between protecting children at the expense of parental autonomy is one that society generally accepts, out of our interest in keeping children safe.
Professional Autonomy & Its Limits
Professional autonomy generally means that professionals within disciplines like law, medicine, nursing, social work, psychology, education, etc. have the authority to govern themselves. Members of a profession come together to set up their own ethical codes, and hold each other responsible for abiding by them. They can determine what is appropriate practice in their field.
There is a high level of responsibility given to professionals who have demonstrated an adequate level of skill to make autonomous decisions. In order to assert this responsibility, professionals have to earn certain degrees, pass exams, and meet continuing education requirements. Professionals regularly use their skills at assessment, intervention, and evaluation to determine, in conjunction with clients or patients, colleagues, and supervisors, what is the appropriate course of practice in a particular situation. Professional autonomy ensures that the medical doctor gets to determine what treatment to recommend to a patient with a certain cancer, and a therapist gets to choose which intervention is best for a client who presents with post traumatic stress disorder.
Just like parental autonomy, professional autonomy is not absolute. There are many infringements on professional autonomy. Leadership of professional organizations work with governments at the state and federal levels to determine education and licensing requirements, as well as standards for practice.
A major limitation to professional autonomy is determined by funding sources; who is paying for the professional’s services largely influences the work the professional does. If a professional takes insurance for their services or receives grant funds to provide a certain treatment, they may not have the full scope of autonomy that they ideally would want. Professionals might be limited to fewer sessions, or specific interventions, when they truly believe their clients or patients need more, or different, help.
Mandated Reporting & Professional Autonomy
Mandated reporting laws also infringe upon professional autonomy. Mandated reporting, in the context of child maltreatment, involves a legal obligation of certain adults, usually professionals, like doctors, nurses, social workers, teachers, therapists, etc. to make reports to child protective services (CPS) when the professional has a certain level of suspicion of child maltreatment. The legal requirement of these “mandated reporters” to call CPS in certain cases is an infringement of professional autonomy.
Don’t get me wrong. I am NOT saying that professionals shouldn’t make reports to CPS, especially when they believe that such a report will protect a child and help a family.
What I AM saying is that when professionals are required by the law to do something, it means that we lose our ability to make reasoned, even difficult, decisions for those we serve.
Consider, for instance, a parent who seeks behavioral intervention services from a therapist because they are concerned about how their high stress level is making it difficult for them to be the parent that they wish they could be to their children. They are asking for help.
The COVID pandemic has taken its toll on the parent’s mental health; the parent reports yelling at their children more and drinking a lot of alcohol at night in order to get a good night’s sleep. The parent tells the professional some things they’ve done that they are not proud of, and the professional may have a concern for the impact of the parent’s behavior on the children’s well-being. The professional considers making a report to CPS. However, the professional is concerned that if they make a report to CPS, the client will refuse to continue services with the professional and not feel safe seeking services with other providers in the future.
The professional feels that making a report to CPS might cause more harm than good. The professional fears how the disruption and trauma to the client and family resulting from a CPS investigation might be the “straw that breaks the camel’s back” that causes the client to “lose it.” The professional feels like their work with the client would actually make the family MORE safe than a CPS intervention would make them… and the professional might be right… but, the professional feels constrained in their choices because of mandated reporting laws.
Mandated reporting laws say that if the professional reaches a level of suspicion of child maltreatment that requires them to make a report, they have to make a report. The professional might not want to make the report, but they are also concerned that if they don’t make a report, they’ll get caught, and get in trouble, and maybe lose their license. The professional might make the report, even when they know the report means more difficulty for their already struggling client. This is an example of the professional autonomy conflict with mandated reporting.
What Should the Professional Do?
This is a tough call. I will not tell the professional what to do in this situation. I believe in professional autonomy. I would help the professional explore important questions to guide their decision whether to make the call to CPS. However, I will not tell a professional whether or not to pick up the phone to make the call; that decision is up to them.
What Can Mandated Reporters Do, in General?
Mandated reporters should recognize that there are times when the legal requirement to make a report to CPS might be in conflict with what the professional believes to be in the best interests of the client, child and family. Do not take the decision lightly; Use your assessment, intervention and evaluation skills, and then make a decision that make sense for you.
Professionals are tasked with some serious responsibilities. The more thoughtful we are about our work, the more likely we are to do that for which we came into these careers to do in the first place: to support the world to be the best place it can be.
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About Kathryn Krase, PhD, JD, MSW
Kathryn Krase is a lawyer, social worker, researcher, educator, and expert on the professional reporting of suspected child maltreatment. Over the past two decades she has trained thousands of professionals who are required by the law in their states to report suspicions of child maltreatment to child protective services, or CPS.
Through her writing, presentations and consultation work, she aims to provide professionals with the knowledge and skills they need to help families and protect children.