An expert on ethical and professional concerns regarding the reporting of suspected child abuse, Dr. Benjamin H. Levi recently shared his research and insights on this topic, and some of the challenges associated with it.
Levi, pediatrician, philosopher and professor in the Departments of Humanities and Pediatrics at the Penn State College of Medicine and Penn State Children’s Hospital, presented “Suspecting Child Abuse: Challenges and Guidelines,” at the Agricultural Sciences and Industries building on Penn State’s campus.
Hosted by The Rock Ethics Institute at Penn State, Levi’s seminar focused on accuracy and judgment calls when it comes to reporting; ethical challenges surrounding perceived risk of abuse and how to interpret guidelines; reasonable suspicion; and competing values.
Levi says, though, what counts as abuse is self-disputed, some common types include physical abuse, neglect and emotional abuse.
“It can be very difficult to draw a line in harsh parenting,” he says.
Other types of abuse include imminent risk and sexual abuse. Sexual abuse, compared to other kinds, he says, is typically more pre-meditated.
One challenge when looking at potential abuse is accuracy in the accounts of those involved. This may involve asking how an event occurred, and figuring out the intentions of those involved, and whose story is credible, in terms of adult versus child.
Another challenge when it comes to reporting is defining an acceptable threshold of risk, and what counts as reasonable protection, Levi says.
Sometimes there is a resolution for these challenging questions, he says, such as better data, expert knowledge and improved communication in both relationships and understanding. Regarding better data, this would mean learning if certain bruises or injuries are more consistent with abuse than other bruises and injuries, he explains.
Other potential resolutions to these issues, Levi says, include the ability to move beyond assumptions and bias, and better definitions of what counts as abuse.
Some ethical challenges when faced with a potential child abuse case, Levi says, includes not knowing what to believe, not knowing the actual risk of abuse, and not knowing how to interpret guidelines.
A common predisposition to abuse is stress, Levi says, such as finance, medical or otherwise.
“(A) challenge is figuring out if there is reasonable suspicion,” he says, which may be able to be solved through interviews with family members and examination of lifestyle.
“Investigation for child abuse can be as gentle as a tax audit,” he says, and varies by state.
In addressing reasonable suspicion to report, Levi says some people believe reasonable is any suspicion.
“These things require careful thought,” he says.
Some examples of what may count as reasonable suspicion to report in some cases include a child suddenly becoming sad or anxious, or a sudden injury, such as falling off the monkey bars.
Levi said one case of abuse he uncovered was that of a child who became anxious, which was out of character for him. After asking some questions, it was discovered the child was being abused, he says.
“If you’re not looking, if you’re not asking the right questions, you’re not going to find things,” Levi says.
“(There is an) enormous variability” in the ethical dilemmas of how and when to report suspected abuse and how to allocate funds to improve this area, he says.
Levi also addressed the question of how “most likely” abuse is the case of an incident before one should report it.
In looking at any one injury or symptom, is abuse the first or second most likely cause? Levi asks.
There are no standards of reasonable suspicion, Levi says.
“The question (of) whether something is abuse is a binary issue,” he says.
To put the dilemma into perspective, Levi uses the example of a fire. A fire is either arson or it’s not. With abuse, “it’s either abuse or everything else,” he says.
“How you conceptualize reasonable suspicion makes a difference,” he says, explaining that this varies from person to person. “All mandated reporting is triggered by someone having reasonable suspicion.”
Some competing values Levi discussed are: if it’s worse to leave a child in abusive home or remove a child from a non-abusive home, or if it is worse to put an innocent person in jail or let a child continue to be abused.
In this area, there aren’t sufficient resources or tools to find the truth, Levi says.
“If you miss it, a child remains in harm’s way,” he says.
Levi compares an abuse case to that of a man who paints his body to blend into the background, or a chameleon that changes color to blend in to its surroundings.
“(You) have to find it, seek it out,” he says.
“What kinds of, and how much harm are we willing to tolerate?” Levi asks, explaining that there are not always straight answers to the questions and challenges he posed during his lecture.
“We’re facing conceptual dilemmas … that don’t necessarily have a right answer,” he says.
In addition to his work in bioethics, Levi has published and lectured widely on this topic, both nationally and abroad. Levi is director of Penn State Hershey’s Center for the Protection of Children; along with colleagues has been instrumental in developing Penn State Children’s Hospital initiatives for the treatment and prevention of child abuse; and is co-creator of Look Out for Child Abuse, an extensive online resource that includes the Commonwealth’s only web-based tool for reporting suspected abuse, according to The Rock. Click HERE for more information about The Rock. For more information about Look Out for Child Abuse click HERE.
Tips for parents, provided by Penn State Hershey’s Center for the Protection of Children:
- Be aware of who your child spends time with, who your child’s best friend is, and why.
- Avoid any overnight trips alone with an adult.
- Do not put your child’s first name on clothing or school books; this puts your child on a first name basis with anyone.
- Listen when your child tells you that he or she doesn’t want to be or go with someone.
- Teach your children that they have a right to say “no.” Never make your child submit to physical contact if they don’t want to.
- Know the signs that a child may have been assaulted: unexplained injuries, depression, fear of a certain adult, difficulty trusting others or making friends, sudden changes in eating or sleeping patterns, inappropriate sexual behavior, poor hygiene, secrecy and hostility.
Tips for parents to teach children, provided by Penn State Hershey’s Center for the Protection of Children:
- No one has the right to touch the private parts of their bodies or make them feel uncomfortable. A child has a right to say “no” to an adult.
- Never go near a car with someone in it, and never get in a car without your permission.
- Tell you immediately if any adult asks them to keep a “secret.”
- Tell you if anyone gives them gifts or money.
- Never admit to anyone over the phone that they are home alone.
Resources:
– In the event of suspected child abuse or neglect, call the PA CHILD Abuse hotline at (800) 932-0313
– Childhelp USA: (800) 4-A-CHILD
– National Domestic Violence Hotline: (800) 799-SAFE
– National Center for Missing & Exploited Children: (800) THE-LOST or www.missingkids.com
– National Children’s Alliance: (800) 239-9950 or www.nca-online.org.
