“I guess I can’t get therapy then.”
I can’t tell you how many times I’ve heard something like this from an adolescent client. Having worked in schools, the Medi-Cal (Medicaid) system, and community organizations, I’ve practiced therapy with thousands of children and families. It’s tragic when one-size-fits-all governmental regulations prevent therapy from being successful.
If you don’t know, “mandated reporting” is a legal requirement for therapists and many other professions working with minors, including teachers, physicians, and in California, now even school volunteers. If a mandated reporter becomes aware of child abuse, they are legally obligated to report that abuse to the government.
This mandate is well-intentioned and, on paper, sounds helpful. Why not report abuse and have authorities come in and put a stop to it? Well, not only is that not how it works in practice, but the very existence of the law prevents a lot of children from receiving needed treatment.
Over the years, I’ve had to file dozens of these reports with Child Protective Services (CPS). I’ll start with the practical failures of this policy.
It’s important to consider that there are many forms or corporal punishment that, while in my opinion are still indefensible, are unfortunately very common. For example, a child telling a therapist that a parent slapped them in the face, perhaps even only one time years ago, may still trigger a report and involvement with the system.
We have to bear in mind that CPS and similar agencies in other states are underfunded and overburdened. They have to prioritize the absolute worst cases of abuse to receive the limited available resources. So when a therapist calls up a CPS worker, who is routinely working with situations of children facing unspeakable horrors, and says, “My client told me that they were slapped once 10 years ago”, the worker may be unmoved, or even irritated that valuable staff hours need to be diverted away from higher priority cases to process the report. Even in cases in which I’ve confirmed that I have a legal obligation to report, I’ve actually had CPS workers berate me for wasting their time and say sarcastically, “What do you expect us to do about this?”.
What often happens then is that the family may get a call, or possibly a home visit, from a social worker. Despite the fact that this requirement was explained in the informed consent process, many families still feel betrayed. In my experience, 9 times out of 10, they then immediately withdraw their child from therapy, with trust in therapy irrevocably shattered.
In these cases, the mandated report did not result in the family or child getting any actual resources or support. Instead, it only resulted in the child no longer receiving treatment. In many cases I suspect the relationship between the parent and child is further eroded by the child’s disclosure triggering CPS involvement and may even result in more abuse, which is now completely hidden from the trusted adults in the child’s life. That is a complete failure of the system.
What’s less observable is how many children and families don’t seek treatment in the first place because they know doing so may involve CPS. But sometimes it is possible to actually see this phenomenon play out. I’ve had many instances in which, for example, a teenager comes to treatment and wants to talk about something. I explain my mandated reporting requirements, and they tell me, “Okay, I’m not going to talk to you then.” They leave, untreated, and live with whatever trauma or pain they are carrying for who knows how many years.
So how do we balance the need to provide intervention and help to abused children while still encouraging children and families to participate in treatment?
What I propose for the therapy profession is a reform from mandated reporting to what I might call “discretionary” reporting. If a therapist could use their professional judgement to weigh the risks and benefits of making a report, that would solve a lot of problems. Severe, high priority cases would still frequently get on CPS’s radar and clients would still have trust in the therapeutic process.
Of course, no system is perfect. Even in such a discretionary reporting framework there would be cases in which a therapist did not report a case of severe abuse and an avoidable tragedy later struck. Such an instance might even become a high-profile story in the media. But the issue is that in my opinion, for every one of these, many more tragedies could be avoided if children and families were incentivized to seek out treatment rather than avoid it.