Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 259-266 (doi:10.1542/10.1542/peds.2007-2312)

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ARTICLE

Clinicians’ Description of Factors Influencing Their Reporting of Suspected Child Abuse: Report of the Child Abuse Reporting Experience Study Research Group

Risé Jones, PhD^a,b, Emalee G. Flaherty, MD^c,d, Helen J. Binns, MD, MPH^c,d,e,f, Lori Lyn Price, MS^g, Eric Slora, PhD^h, Dianna Abney, MDⁱ, Donna L. Harris, MA^h, Katherine Kaufer Christoffel, MD, MPH^c,d,e,f and Robert D. Sege, MD, PhD^j

^a Evaluation Solutions, Chicago, Illinois
^b Naomi Morris Center for Assessment and Evaluation, University of Illinois, Chicago, Illinois
^c Department of Pediatrics, Children's Memorial Hospital, Chicago, Illinois; Departments of
^d Pediatrics
^e Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
^f Mary Ann and J. Milburn Smith Child Health Research, Children's Memorial Research Center, Chicago, Illinois
^g Biostatistics Research Center, Tufts-New England Medical Center, Boston, Massachusetts
^h Pediatric Research in Office Settings, Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois
ⁱ Cambridge Pediatrics, Waldorf, Maryland
^j Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts

OBJECTIVES. Primary care clinicians participating in the Child Abuse Reporting Experience Study did not report all suspected physical child abuse to child protective services. This evaluation of study data seeks (1) to identify factors clinicians weighed when deciding whether to report injuries they suspected might have been caused by child abuse; (2) to describe clinicians’ management strategies for children with injuries from suspected child abuse that were not reported; and (3) to describe how clinicians explained not reporting high-suspicion injuries.

METHODS. From the 434 pediatric primary care clinicians who participated in the Child Abuse Reporting Experience Study and who indicated they had provided care for a child with an injury they perceived as suspicious, a subsample of 75 of 81 clinicians completed a telephone interview. Interviewees included 36 clinicians who suspected child abuse but did not report the injury to child protective services (12 with high suspicion and 24 with some suspicion) and 39 who reported the suspicious injury. Interviews were analyzed for major themes and subthemes, including decision-making regarding reporting of suspected physical child abuse to child protective services and alternative management strategies.

RESULTS. Four major themes emerged regarding the clinicians’ reporting decisions, that is, familiarity with the family, reference to elements of the case history, use of available resources, and perception of expected outcomes of reporting to child protective services. When they did not report, clinicians planned alternative management strategies, including active or informal case follow-up management. When interviewed, some clinicians modified their original opinion that an injury was likely or very likely caused by abuse, to explain why they did not report to child protective services.

CONCLUSIONS. Decisions about reporting to child protective services are guided by injury circumstances and history, knowledge of and experiences with the family, consultation with others, and previous experiences with child protective services.

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Key Words: child abuse • clinician decision-making • reporting suspected child abuse

Abbreviations: CA—child abuse • CARES—Child Abuse Reporting Experience Study • CPS—child protective services

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Accepted Nov 27, 2007.

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