To Protect Children, Both Process and Programs Need Work : Reform: If professionals could use their discretion and report fewer borderline cases, more children might be helped and some abuse prevented.

Not only are abused children in trouble in Los Angeles County, but the system set up to help them is in trouble as well. Not only do children need more programs to help them, but the process of handling reports of child abuse needs fixing as well.

The fact that the Los Angeles County Department of Children’s Services is “deluged,” as reported this month by the Inter-Agency Council on Child Abuse and Neglect, surprised no one who works in or with that system. Nor is it news that as a direct consequence of this situation, the county department cannot respond as it might like to many cases of alleged maltreatment.

The county is hardly alone; there is a nationwide emergency. Experts have recommended many reforms, including smaller caseloads and vastly expanded treatment services.

The reforms they suggest would certainly contribute to improving the county system, but the money needed to make them isn’t there. The state doesn’t have it, and the Legislature doesn’t trust the child protective services system to do the job anyway. If more money is not available, we must consider other ways to respond.

One way is to alter the role of “mandated reporters,” permitting them to become active participants in the system to protect children. Public child-protective services, or CPS, systems were established to prevent and treat child abuse by investigating alleged abuse and intervening with supportive services when abuse was indicated. In many agencies, every report was to be investigated.

Fundamental to these systems were the child abuse reporting laws, passed in every state by 1967, which require specified professionals who are likely to come in contact with children--for example, physicians, school staff, psychologists--to report suspected maltreatment to child protective agencies. When abuse or neglect is suspected, the mandated reporter is to make a report quickly, without taking the time for follow-up, and without exercising professional discretion concerning the wisdom, efficacy, or likely benefits for the child of making a report.

The discretion accorded professionals was eliminated to ensure that CPS agencies learned of not only serious cases, but the less serious ones as well. These latter cases, it was hoped, would benefit from early intervention, and the children involved might be saved from more serious abuse.

Few child-welfare activists and planners anticipated the dramatic and enduring effect that the mandatory reporting laws would have. For the past 20 years, virtually all child-protective agencies have experienced consistent and substantial annual increases in reports.

Every agency visited in a recent national study conducted by the RAND Corp. had initiated a range of procedures to reduce workload as reports far outstripped resources. Workload is typically reduced by limiting the number of children taken into the system. In some agencies, certain types of reports--alleged physical abuse by a parent against an adolescent child, for example--are screened out.

In most, a triage system assigns priorities on the basis of severity. Reports assigned the lowest priority often receive no response at all. The preventive mission of CPS effectively had been buried under an avalanche of child-abuse reports.

The RAND study makes clear that many mandated reporters recognize the system’s inability to achieve its preventive goals. While most study participants complied with the law by reporting all suspected abuse, large group of “discretionary reporters” sometimes reported and sometimes did not.

These “discretionary reporters” were as knowledgeable and well-trained in child abuse as the consistent reporters. What most distinguished them was their negative views of the professionalism and capability of child-protective services staff, and their beliefs that reports often had negative consequences for the children involved.

This latter concern emerges repeatedly when professionals discuss less serious abuse. One pediatrician who cares for extremely impoverished families spoke out at a recent national conference about her reasons for sometimes failing to report suspected maltreatment. In her experience, families often failed to return for essential health services after a report was filed, but only in the most serious cases was CPS able to provide any assistance. Thus, because the abuse was reported, the family lost health services and the pediatrician lost the opportunity to monitor the child’s welfare and possibly intervene to improve family functioning.

Such decisions not to report less serious abuse violate the reporting laws, expose professionals to anxiety and liability for failure to report, and deprive the protective system of valuable data. But they also indicate the willingness of child abuse experts to assume some of the CPS burden. That they must violate the law to do so attests to their motivation to help maltreated children.

My colleague at the University of New Hampshire, David Finkelhor, and I think this practice among expert mandated reporters should be formalized. Our plan would extend to skilled child-abuse professionals a special “registered reporter” status, allowing options not currently available under the law.

If they qualified for the new status on the basis of specialized training and a history of past reporting, these registered reporters might be able to defer reports of mild abuse, or make the report in confidence, without triggering an investigation. They would still have to submit information on the case and be subjected to a review process to assure an emergency response to imminent danger.

This proposal has several advantages. First, involving skilled mandated reporters in protective work would reduce the number of investigations. Sparing CPS staff from having to investigate less serious cases that a skilled professional was already handling would allow them to concentrate on cases where no qualified professional was involved, or where serious harm was threatened.

Creating a flexible reporting system that explicitly did not treat certain kinds of cases might also compel other community professionals and agencies to take more responsibility for children living in dysfunctional families. As it is now, a mandated report alleging mild abuse too often frees professionals from looking further for help.

Like any change, this proposal raises concerns. Perhaps the most compelling is that flexible reporting might allow some serious abuse to go undetected until too late, and a child would be seriously injured or killed. Moreover, police and prosecutors are extremely sensitive to the risks to successful prosecution inherent in delay. Limiting flexible reporting to cases where there is no question of imminent danger or need for criminal prosecution should allay these concerns.

One worries that these changes might be just another example of reforming the process and thus distracting attention from solving the deeper problems. That happens all too often. But these changes are worth pursuing because larger and more fundamental changes are currently stymied by political and economic realities. Modifications to the reporting system could make an important difference to children at risk of abuse.

Whatever risks a flexible reporting system might introduce, it is important to weigh them against how the current system works, not against an idealized version of how it ought to work. Child-protective services agencies receive over 2 million reports annually, but they can respond with needed services to only a fraction. By involving expert reporters in protective work, more children might be better served.