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Mandated Reporting Thresholds for Community Professionals

This study examines how community-based mandated reporters understand and inter- pret reasonable suspicion, the standard threshold for mandated reporting of sus- pected child abuse. Respondents were asked to identify the probability necessary for “suspicion of child abuse” to constitute rea-

sonable suspicion. Data were analyzed for internal consistency, evidence of a group standard, and associations with profes- sional and educational demographics. There was a 90.4% response rate (1,233/1,364). On both ordinal probability and estimated probability scales, respondents demonstrated wide variability in the thresholds they identified for what consti- tutes reasonable suspicion. Comparing individual responses for the two scales, 83% were inconsistent. Responses on the estimated probability scale were correlated with frequency of reporting child abuse, professional background, and prior education on child abuse. Lack of consensus in how com- munity professionals interpret reasonable suspicion raises the question of whether more specific training is needed for this threshold to be understood, interpreted, and applied in a con- sistent manner.

Kathryn Crowell Penn State Children’s Hospital

Benjamin H. Levi Penn State Children’s Hospital

35Child Welfare • Vol. 91, No. 1

Acknowledgments: We thank Susan J. Boehmer, M.A., for her invaluable help with statistical analysis. This research was supported by grants from the Penn State Children, Youth, and Families Consortium, and the Penn State Children’s Hospital. We have no relevant conflicts of interest to disclose, had full access to all study data, and take responsibility for the integrity of the data and the accuracy of the data analysis.

Approximately one million cases of child abuse occur annually inthe United States (Gaudiosi, 2009), and it is estimated that child abuse is present in 50% to 80% of families in which domestic violence occurs (Appel & Holden, 1998; Edleson, 1999; Garbarino, Kostelny, & Dubrow, 1991). In the United States, any individual who interacts with children in a professional capacity is legally required to contact child protection services whenever they have reasonable suspicion that a child has been abused. Thus, teachers, school coun- selors, school administrators, school nurses, daycare providers, social workers, psychologists, and law enforcement officials are all con- sidered mandated reporters by law, and are often the first to have contact with a child who is suspected of being abused. Despite state- by-state variation in statutory language identifying the threshold for mandated reporting, most laws use some variant of “suspicion” (Gateway, Child Welfare Information, 2008), and the umbrella ter- minology for the various thresholds is reasonable suspicion (Myers, 2001). While substantial literature guides mandated reporters in identifying conditions, injuries, and behavior that warrant concern for possible child abuse, there is little guidance as to definitions of the term reasonable suspicion or, more specifically, what levels of con- cern must be reported.

Significant problems arise from this lack of guidance: inconsis- tent reporting of (possible) abuse, unequal protection of children, inequitable treatment of parents and families, and inefficient use of child protection services resources (Flaherty, Jones, & Sege, 2004; Flaherty, Sege, Mattson, & Binns, 2002; Flieger, 1998; Hickson, Cooper, Campbell, & Altemeier, 1998). These difficulties are com- pounded by the vast number of individuals who qualify as mandated reporters (Gateway, Child Welfare Information, 2009; Hansen et al., 1997), the lack of education regarding circumstances that warrant reporting (Alvarez, Kenny, Donohue, & Carpin, 2004; Carter, Bannon, Limbert, Docherty, & Barlow, 2006; Kenny, 2007), the absence of meaningful oversight regarding reporting practices (Kalichman, 1999; Vulliamy & Sullivan, 2000), and reporters’ immu- nity from civil or criminal liability (Gilbert et al., 2009; Kalichman, 1999; Levi & Loeben, 2004; Singley, 1998).

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Multiple factors contribute to the variability in how mandated reporters understand, interpret, and apply their responsibility to report suspected child abuse. Central to each mandated reporter’s decision are the circumstances of individual cases, the perceived efficacy of child protection services, perceptions of blame, the reporter’s relationship with the child and their family, and the individuals’ personal experi- ence with abuse (Alvarez et al., 2004; Bonardi, 2000; Delaronde, King, Bendel, & Reece, 2000; Flaherty et al., 2006; Flaherty et al., 2008; Flieger, 1998; Warner & Hansen, 1994). Despite considerable inves- tigation into the root causes of inconsistency, little research has exam- ined the role played by mandated reporters’ confusion over what the terms “suspicion” and “reasonable suspicion” actually mean. To ensure that reporting practices are consistent, just, and effective in protect- ing children, mandated reporters must share a consensus regarding the meaning and application of reasonable suspicion. The present study investigates the extent to which community-based mandated reporters share a common understanding of reasonable suspicion.

Methods A 12-item survey (based on previously published instruments (Levi & Brown, 2005; Levi, Brown, & Erb, 2006) was developed after extensive review of the medical, legal, social science, and philosoph- ical literature.

For the purposes of this survey, “child abuse” was defined as com- prising physical abuse, sexual abuse, psychological abuse, and neglect. Respondents’ professional experience was measured by self-report, as was prior education on reasonable suspicion.

The survey instrument included four sections, two of which are the subject of this report (see Figure 1). For each of these two sections, respondents were asked to imagine the following scenario: You have encountered a child who has an injury (or condition) that might have been caused by abuse AND you have gathered as much information as you feel is possible, given the sources readily available. Respondents were then asked to identify how likely (suspected) child abuse would have to be as the cause of the injury/condition for reasonable suspicion to exist. Using an

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ordinal scale framework, respondents identified whether to qualify as rea- sonable suspicion abuse would have to be first (most likely) on a rank order list of 10 possible explanations (10 being the arbitrary limit chosen for the survey), last (least likely), or somewhere in between. Respondents were then given an analog scale framework and asked to mark an “X” on a 10-centimeter scale (Gracely & Wolskee, 1983; Houde, 1982) at the point corresponding to the percent likelihood necessary to constitute

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Figure 1 Questions for Rank Order (i.e., Ordinal Probability) (Q5) and Estimated (numerical) Proba- bility (Q6) Scales

reasonable suspicion. This scale ranged from 0% (no probability) to 100% (certainty), and marks were measured to the nearest fifth percentile.

Procedures Following IRB approval and waiver of written informed consent (in accord with federal regulation 45 CFR part 46.116[d]), the survey was distributed to individuals at 18 urban, suburban, and semirural sites in Pennsylvania who were attending continuing education pro- grams on child welfare. Individuals who turned in a completed sur- vey received a five dollar gift certificate, and no protected health information was accessed for this study.

Data Analysis Descriptive statistics were generated including means, medians, and standard deviations for continuous variables and frequency tables for discrete variables. Associations between demographic factors and rea- sonable suspicion were characterized by using contingency table analy- sis; significant levels were determined by Pearson’s x2 statistics and two sample t-tests. The ordinal and analog scale frameworks were compared using linear regression.

Results The response rate was 90.4% (n � 1,233), representing a diverse group in terms of professional background and reported experience and expertise (see Table 1). It is notable that 60% of participants indicated that they had received prior education regarding what constitutes reasonable suspicion of child abuse and 42% had worked in a professional capacity with children for more than 10 years.

Rank Order Scale (ROS) On the ordinal scale, wide variation was found in thresholds that participants set for what constituted reasonable suspicion (see Figure 2). For 14.5% of respondents, “abuse” had to be the most likely or

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Number (percent)* Characteristic (n 5 1223)

Race White 893 (75) African American 203 (17) Hispanic 48 (4) Other 40 (4)

Reported cases within 24 months 0 677 (56) 1–5 442 (32) 6–10 45 (4) 11–15 30 (2) �15 24 (2)

Professional occupation Teacher 340 (30) Social worker 265 (23) Daycare provider 259 (23) Law enforcement 155 (14) School administrator 90 (8) School counselor 15 (1) School nurse 13 (1)

Prior education on child abuse None 139 (11) A little 439 (36) Moderate amount 486 (40) Extensive 150 (12)

Prior education on reasonable suspicion Yes 727 (60) No 485 (40)

Years working with child children �3 173 (15) 3–5 240 (20) 6–10 283 (24) 11–15 173 (15) �15 323 (27)

Children of one’s own Yes 802 (67) No 389 (33)

*Totals may not sum to 100 due to missing data or rounding of data.

Table 1 Participant Demographic Characteristics

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second most likely explanation for a child’s condition/injury before the possibility rose to the level of reasonable suspicion; 32.1% indi- cated a rank of third or fourth; and 53.3% reported ranks of fifth to as low as tenth could still constitute reasonable suspicion.

No significant differences were found for respondents’ ordinal scale rankings with regard to professional occupation, years of working with children, number of children previously reported, hav- ing children of one’s own, child abuse education, or previous educa- tion on reasonable suspicion. A statistically significant association was noted for race (see Table 2).

Estimated Probability Scale (EPS) When asked to correlate reasonable suspicion with the estimated probability that abuse occurred, 12.3% of respondents identified the

Figure 2 Community Mandated Reporters’ Responses (n � 1,233) to the Question How High Would (Suspected) Child Abuse Have to Rank Before You Felt There Was Reasonable Suspicion? (1 � most likely, 10 � least likely)

necessary probability at various points between 10% and 30%; 19.1% identified various points of probability between 30% and 50%; 46.9% identified a probability at some point between 50% and 80%; and 21.8% required a probability of more than 80% before they felt that reasonable suspicion could be concluded (see Figure 3).

On the EPS, there were no significant associations for years of working with children or previous education on reasonable suspicion.

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ROS (1 5 highest; EPS

Variable 10 5 lowest) (scale: 1–100%) Number of reports over past five years p � 0.48 p � .0001 0 52.3 (SD 22.7) 1–5 48.1 (SD 23.4) �6 38.2 (SD 22.6)

Prior education on child abuse p � 0.15 p � 0.006 None 53.4 (SD 22.5) A little 50.6 (SD 23.1) Moderate 47.9 (SD 22.3) Extensive 44.7 (SD 25.0)

Professional occupation p � 0.48 p � 0.006 Daycare provider 53.0 (SD 22.6) Teacher 52.4 (SD 22.1) Law enforcement, other 46.6 (SD 24.3) Social worker 46.1 (SD 22.6) School counselor/admin./nurse 45.2 (SD 23.2)

Prior education on reasonable suspicion p � 0.38 p � 0.05 No: 50.8 (SD 22.1) Yes: 48.0 (SD 24.0)

Race p � 0.0003 p � 0.31 White 4.9 (SD 2.2) Other 4.4 (SD 2.1) African American 4.3 (SD 2.1) Hispanic 3.9 (SD 2.2)

Number of years working with children p � 0.23 p � 0.06 Children of one’s own p � 0.12 p � 0.52

Table 2 Association Between Respondent Characteristics and Mean Scores Gauging Reasonable Suspicion Using the ROS and EPS

However, respondents who had reported six or more children in the past five years identified significantly lower thresholds for reasonable suspicion (38.2% vs. 52.3% for those reporting zero cases, p � 0.0001; and 47.5% for one to five cases, p � 0.0006, see Table 2)—that is, abuse could be less likely and still qualify as reasonable suspicion. Additionally, respondents who had received extensive prior educa- tion about child abuse also reported significantly lower thresholds compared to those with no prior child abuse education (44.7% vs. 53.4%, p � 0.006, see Table 2). Professional occupation was also of significance on the EPS scale. Both teachers and daycare providers reported significantly higher thresholds for what constituted reason-

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Figure 3 Community Mandated Reporters’ Responses (n � 1,233) to the Question How Likely Would (Suspected) Child Abuse Have to Be Before You Felt There Was Reasonable Suspicion?

To render it more accessible, this figure groups data cumulatively by tenth percentiles (i.e., 0–10, 10–20, etc.). Because actual data points were measured to the nearest fifth percentile, their description in the Results differs slightly.

able suspicion (52.4% and 53.0%, respectively, see Table 2) than school counselors/administrators/nurses (45.1%), social workers (46.1%), and law enforcement officers (46.6%), p � 0.0001.

ROS Versus EPS To look for possible differences in threshold settings related to which framework was used, paired comparisons were conducted between each individual’s responses for the ROS and EPS. A strong relation- ship (r 2 � 0.6) would indicate that as the EPS score increased, respondents would designate a high rank on the ROS (a rank of 1 being the highest). Linear regression yielded a very weak relationship in the expected direction between these two measures of likelihood (r 2 � 0.037, see Figure 4). Moreover, 83% of these paired responses were logically inconsistent. To be consistent, any score greater than or equal to 50% on the EPS would need to correspond with an ordi- nal ranking of 1; an EPS score of greater than or equal to 34% would need to correspond with an ordinal ranking no lower than 2; an EPS score of greater than or equal to 25% no lower than an ordinal rank- ing of 3; and so on. By contrast, participants commonly indicated that reasonable suspicion required a more than 50% probability of abuse while also responding that child abuse could rank as low as fourth or fifth on the ROS and still qualify as reasonable suspicion.

Discussion Our data demonstrate significant variability in how community- based mandated reporters interpret reasonable suspicion, raising the question whether the threshold for mandated reporting is understood, interpreted, or applied in a consistent manner. These findings support previous work examining how pediatric residents, pediatricians, and experts in the field of child abuse interpret reasonable suspicion (Levi & Brown, 2005; Levi et al., 2006; Levi & Crowell, 2010).

Though respondents’ self-identified race was correlated with their responses on the ROS, it is not clear that the observed differences are likely to be clinically relevant. There were, however, several significant associations between responses on the EPS and reporter character-

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istics. Perhaps not surprisingly, individuals who had reported more children for suspected abuse identified reasonable suspicion with lower probabilities that abuse had occurred. This makes sense because (other things being equal) mandated reporters who think they should report suspected abuse when there is greater than or equal to 25% likelihood that abuse occurred will report more cases than individuals’ whose threshold is greater than or equal to 50%.

We also found that the more education on child abuse an indi- vidual had received, the lower the probability they identified with

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Figure 4 Comparison of Community Mandated Reporters’ Paired Responses for the Rank Order Question and the Estimated Probability Question

Numbers inside the circles denote the number of individuals who provided that paired response. Paired responses that are logically consistent are colored yellow, while those that are logically inconsistent are white. The line representing linear regression has an r 2 value of 0.3, which demonstrates a weak relationship between the two scales. (Because some of the respondents did not answer all questions, there are fewer than 1,233 paired responses.)

reasonable suspicion. Though other studies have shown that educa- tion on abuse can improve individuals’ ability to identify abuse (Carter et al., 2006; Gunn, Hickson, & Cooper 2005) the present data further suggest that education about abuse (risk factors, signs, and symptoms, etc.) may influence people’s threshold for how likely they think abuse must be before reporting becomes mandatory. Interestingly, we found no significant association with “prior educa- tion on reasonable suspicion,” despite 60% of respondents reporting such education. At the very least, this suggests that more attention is needed to develop effective educational strategies for standardiz- ing how people interpret and apply reasonable suspicion.

A slightly curious finding was that teachers and daycare providers identified significantly higher thresholds for what counts as reasonable suspicion. This was independent of either education on child abuse or education on reasonable suspicion. One might have expected that the longer periods of time that daycare providers and classroom teachers have for interacting with individual children (compared to law enforcement officers, social workers, or school counselors, administrators, and nurses) would lead to lower thresh- olds. It is possible, however, that greater exposure to instances of possible abuse actually prompts individuals to set a higher, more dis- criminating threshold to avoid reporting large numbers of children. Alternatively, daycare providers and classroom teachers might believe that a higher probability of abuse is needed to overcome institutional resistance or other barriers to reporting suspected abuse. To more fully understand the nature of this association, more research is needed.

It is interesting that none of the above associations with the EPS were seen with the ROS, and also striking that 83% of individuals’ responses to the two frameworks for measuring likelihood were internally inconsistent. This matters because it suggests that a given individual will operationalize reasonable suspicion very differently depending on which framework is used. For example, 104 respon- dents to our survey indicated that for reasonable suspicion to exist child abuse would have to be at least 50% likely, but could rank as low as fifth on the list of possible explanations for a child’s injury/condition

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(see Figure 4). The reason that such paired responses are logically inconsistent as well as troubling is that when child abuse is being considered, the question is a binary one: Is it child abuse or is it not child abuse? As such, the probability (x%) of a condition having been caused by child abuse is mutually exclusive of all the other possible causes (whose collective probability, then, is 100 to x%). Any proba- bility greater than 50% must (logically) rank first on such a list, and a 50% probability can rank no lower than second. Yet more than 8 out of 10 of those surveyed had responses that contradicted this logic (see Figure 4).

It is well known in the field of decision analysis that people gen- erally do not respond to rank-order and estimated probability scales in a logically consistent manner. They tend to overestimate the prob- abilities of individual options with rank-order lists, resulting in summed probabilities that greatly exceed the logical cap of 100% (Teigen, 1983, 1988). But while there is no reason to expect man- dated reporters to have given extensive thought to the theoretical constraints of rank order decision analysis, it makes a difference whether abuse needs to be “very likely” or simply “possible”—to rise to the level of reasonable suspicion. Only one in seven of the man- dated reporters surveyed for this study stated that suspected child abuse would have to be the most or second-most likely explanation in order to qualify as reasonable suspicion. But fully six out of seven of these same reporters stated that the numerical probability of child abuse would have to be greater than 34% to qualify as reasonable suspicion—which logically would render “abuse” first or second on a rank-order scale.

These conflicting results suggest that it makes a difference which framework one uses for deciding whether there is reasonable suspicion of abuse. Combined with the variability of the thresholds that com- munity mandated reporters set for reasonable suspicion, the present data raise concerns about the validity of current reporting guidelines.

Rather than require knowledge or a justified belief of abuse, reasonable suspicion sets an intentionally low bar to maximize the detec- tion rate for abuse. The prevailing thought is that it is better to cast a broader net rather than to miss catching a child at risk. What is at stake

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is not only the safety of children, but also significant consequences for entire families (Diaz, Simantov, & Rickert, 2002; Fein et al., 2002; Hillis et al., 2004; Lansford et al., 2002; Melton, 2005; Renke, 1999; Richman, 2000; Saluja, Kotch, & Lee, 2003; Scheid, 2003; Widom, 1999). As such, it is particularly important that mandated reporters accurately and reliably apply reasonable suspicion as the threshold for mandated reporting. Our data suggest that interpreting reasonable suspicion is significantly more complex than previously thought.

We have argued elsewhere (Levi & Loeben, 2004) that in the context of mandated reporting, suspicion is best understood as a feel- ing that child abuse may have occurred—rather than a belief (i.e., the holding of an idea to be true). Because “estimated probability” readily applies to circumstances involving the possible occurrence of abuse, this construct may serve as a useful framework for creating an effective definition of reasonable suspicion. Given that many people are familiar with the general concept of numerical likelihood ( Joslyn & Savelli, 2010; Morss, Lazo, & Demuth, 2010; Plous, 1993), man- dated reporters’ responsibility to report suspected abuse might be clearer if it was spelled out in terms of the percent probability that should trigger mandated reporting. Whether that numerical thresh- old should be 25%, 75%, or something in between will depend upon a fairly complex social calculus regarding the costs and benefits of various thresholds.

Limitations There are several limitations to the present study. First, respondents comprised only a small segment of Pennsylvania community-based mandated reporters—however, the present findings are consistent with a survey of clinical and research experts in child abuse (Levi & Crowell, 2010). Second, it is possible that respondents found the rank order and estimated probability scales confusing. That said, the fact that these same questions have yielded remarkably similar distribu- tions of responses across multiple populations (Levi & Brown, 2005; Levi, Brown, & Erb, 2006; Levi & Crowell, 2010) suggest that the thresholds being identified represent individuals’ actual views on the

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matter, rather than a haphazard set of responses. Third, our results may not accurately reflect the actual behavior of mandated reporters. Still, we know from many studies that there is significant variability in mandated reporters’ behavior. Thus, while the present findings can- not demonstrate any causal relationship, they do shed light on man- dated reporters’ understanding of reasonable suspicion when asked what it means to them.

Conclusions The present findings suggest that mandated reporters hold disparate views on the meaning and application of reasonable suspicion. Further, our data show that these views are frequently internally inconsistent. Child abuse is a critical social issue that affects the welfare of mil- lions of children and families throughout the United States. Community-based mandated reporters form a substantial part of the bulwark for suspecting and reporting child abuse. As such, the cur- rent findings give us pause when considering whether we can expect the 35-plus million mandated reporters in the United States to reli- ably and consistently understand and interpret the meaning of rea- sonable suspicion. This study found that more education regarding child abuse is correlated with lower thresholds for when abuse must be reported. The fact that education on reasonable suspicion had no such effect, and that community professionals’ thresholds for man- dated reporting were so highly variable, argues for both standardiz- ing the definition of reasonable suspicion and developing effective education to clearly explain what this threshold means.

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