By Amanda Szabo & Zachary Winkelmann.

Athletic trainers (ATs) are sports medicine healthcare professional who are in continuous contact with patients, typically adolescents. While ATs are typically familiar with the legal obligations in the United States to provide the proper standard of care to their patients and are familiar with state practice acts regarding services they can and cannot provide, what ATs fail to consider is the legal obligation as a mandatory reporter.  Most licensed healthcare professionals fall within the requirements of mandated reporter laws. These laws state that healthcare providers are under clear obligation to report cases of abuse and neglect to state authorities. By legally requiring certain individuals, such as healthcare providers, to report abuse, there is an assumption that early detection of abuse will help prevent serious injuries and takes pressure off of individuals from seeking help themselves, which enhances cohesion between legal, medical, and service responses.

Laws are enacted at both the federal and state levels defining abuse, more particularly child abuse, as “harm or substantial risk of harm” or “serious threat or serious harm” to an individual younger than 18 years. Despite these mandates, most healthcare professionals remain wary of reporting abuse and neglect. Some of the major concerns in regards to mandated reporting include breaching confidentiality, resulting in liability. This concern, however, will not hold in court as failure to make a mandated report can result in liability under civil law for future harm that may come to an individual should the failure to report be negligent or below the standard of care. Beyond this, there are legal defenses in place that protect against claims of breach of confidentiality.

Besides legal concerns from healthcare providers, several other barriers to mandated reporting include: 1) lack of knowledge and recognition of abuse and neglect and/or the reporting structure and 2) concerns about the impact of reporting (racial and socioeconomic factors). There is consensus among many medical professionals including physicians, medical students, and nurses describing feelings of not receiving adequate training in identification of maltreatment and unfamiliarity with the guidelines for mandatory reporting. Medical professionals also lack confidence in how to interact with child protective services (CPS) to report cases and lack certainty in identifying injury cause; both factors that limit healthcare providers from reporting potentially suspicious injuries. Providers’ relationships with the patient and the patient’s family can skew their willingness to suspect or report possible abuse. It is already difficult to comprehend that a parent or caretaker may be intentionally harming a child, but when a provider is more familiar with a family, this recognition of maltreatment may become even more difficult. This is especially true when we consider this barrier with implicit biases of race and socioeconomic factors.  Families that are either considered a minority group or identify as low socioeconomic status are more likely to be reported for abuse than white, affluent, intact families. Upholding our duty as healthcare professionals to following the appropriate reporting requirements and structure should not be trumped by fear of losing a relationship with a patient and their family.

Solutions to the Problem

As healthcare professionals, it is our duty to become familiar with requirements and standards under which we practice to avoid legal troubles, but to more importantly care for our patients abiding by the highest standards of practice. This includes determining ways in which we can more readily uphold our duty as mandated reporters. In order to facilitate change, we must first take steps to reduce the noted barriers.

First of all, we should improve education and continuing education about child maltreatment. Initial education courses and continuing education conferences should have specific units focusing on identification of maltreatment as well as management of the situation and outcomes, because victims usually try to hide the signs of their abuse. Suggested educational topics include identifying differences between sports abrasions, bruises, lacerations, and burns versus those resulting from abuse, being more aware to casually survey areas that are typically more hidden such as feet when you are taping an ankle, and appropriate forms of questioning that are not abrasive in nature. Legal considerations for failing to report could also be discussed in the education sessions. Legal discussions would equip the healthcare provider for more successful practices, not threatened by legal concerns. Topics falling within this area could include repercussions for not reporting, jurisdiction-specific legislation on reportable child maltreatment, and best practices for filing a report and documenting a possible abuse or neglect situation.

Second, we need to consider the limitations of our decision-making about child maltreatment in terms of implicit biases we may hold about values and other cultural factors. Patient’s rights and well-being should always be prioritized, so we must eliminate our inner thoughts of what we believe child maltreatment to look like and reconstruct them to be more open to different forms. These forms may include physical harm, emotional or psychological harm, sexual abuse, neglect, and/or exploitation. Specifically, administering implicit bias tests to stimulate self-reflection may aid in being able to identify biases they hold and consider ways they can mitigate them to more properly identify forms of maltreatment and move forward with reporting or initiating a difficult conversation with patients, their families, or other healthcare providers.

Authors: Amanda Szabo¹ & Zachary Winkelmann¹

Affiliations:

1. Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, Indiana, USA

Competing interests: None

Social media accounts of post author(s): Dr. Amanda Szabo: Facebook; Dr. Zachary Winkelmann: Twitter