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 individuals 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 individuals who have demonstrated an adequate level of skill to make autonomous decisions. In order to assert this responsibility, they have to earn certain degrees, pass exams, and meet continuing education requirements.
The experts 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. 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 these individuals’ autonomy. Leadership of 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 expert’s services largely influences the work the expert does. If a service provider 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. They 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 an expert’s autonomy. Mandatory reporting , in the context of child maltreatment, involves a legal obligation of certain adults, usually those licensed, like doctors, nurses, social workers, teachers, therapists, etc. to make reports to child protective services (CPS) when the they has a certain level of suspicion of child abuse or neglect . The legal requirement of these “mandated reporters” to call CPS in certain cases is an infringement of professional autonomy. Check out my blog post here where I go into detail about if these professionals should be required to make such a report.
Don’t get me wrong. I am NOT saying that people 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 experts required by the law to do something, it means that we lose our ability to make reasoned, even difficult, decisions for those we serve.
Case Example
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 therapist considers making a report to CPS. However, they are concerned that if they make a report to CPS, the client will refuse to continue services and not feel safe seeking services with other providers in the future.
The therapist feels that making a report to CPS might cause more harm than good. They fear 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 they might be right… but, the they feel 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. They may end up making 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 them explore important questions to guide their decision whether to make the call to CPS.
However, I will not tell them 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 they believe 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 makes 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.
You can find out more about Kathryn at www.kraseconsulting.com, and you can find out more about her work around mandated reporting at www.makingthetoughcall.info.