Mandated Reporting: Safety or Surveillance?

Is mandated reporting critical to achieving child and family safety in our communities, or is it an outdated strategy that facilitates family surveillance? Who is this policy serving and why? What is driving the shift in thinking about mandated reporting? Join Jill Richard, MEd. & Dr. James Metz as they set the stage to learn from our history and create new possibilities.

Guest Info: 

Dr. James Metz is a pediatric hospitalist, head of the Child Protection Team at the University of Vermont Children’s Hospital and an assistant professor at the Larner College of Medicine at UVM. He specializes in child abuse medicine and child protection and prevention. His research interests include post-mortem skull fractures, medical child abuse, and post-mortem imaging. Dr. Metz believes caring for children is a privilege. His goal as a pediatrician is to ensure that every child has the opportunity to grow up in a safe, healthy, and nurturing environment.

Jill Richard MEd. is a Program Manager at the Vermont Child Welfare Training Partnership, a partnership between the University of Vermont and the Vermont Department for Children and Families. Jill is also a consultant for Evident Change, a non-profit that works with child welfare organizations nationally on the implementation of strength and safety-organized practice skills and their integration with the Structured Decision Making® system. Jill is a Vermont native, completed her undergraduate degree at UVM in 1991 and later earned her Master of Education at UVM in 2004. Jill has worked and held many leadership roles in the child protection and anti-violence community for 30 years.

Jill has recently earned her professional certificate in Teaching English as a Second Language (TESOL) from the University of California at Berkeley in May of 2024. She also has a professional certificate in Project Management that she earned in 2018 from the University of Vermont. She enjoys being active as well as quiet, has a passion for travel, and is driven by the belief that benevolence and justice are the root of authentic and deep connections with individuals and the collective and it is in these relationships that we will experience change

Host Info: 

Cassie Gillespie, LICSW, is a full-time faculty member in the University of Vermont’s Social Work Department, and the host of the SOCIAL WORK LENS podcast. Cassie is a former child welfare worker, and training team lead at the Vermont Child Welfare Training Partnership (VT-CWTP) with over 15 year’s experience serving children, youth, families, and helping professionals.

Transcript:

 Dr. James Metz (00:00):

You know, I hate to harp on it, it just is so, rings true to me, is that reporting is not benign, and our intentions are good, we wanna protect children and I think that that’s a lofty goal. I feel like we just need to be aware and think about all the ways that we can protect children and think about all the different resources we can bring to bear to help children be safe.

Cassie  (00:30):

Hello, I’m Cassie Gillespie, and you’re listening to the Social Work Lens. The Social Work Lens is a podcast produced by the University of Vermont’s Child Welfare Training Partnership and the State of Vermont. Today, we are bringing you a very special episode on a very complicated topic, mandated reporting. We have two guests in the studio joining us is Jill Richard. Jill has a Master’s of Education and is a program manager at the Vermont Child Welfare Training Partnership and we’re also joined again by Dr. James Metz. Dr. Metz is a child abuse physician at the University of Vermont Medical Center and an associate professor of pediatrics at the Leaner College of Medicine. He’s also the director of the Child Safe Program and an alum of our podcast. I think this is maybe the third time we are having you here. Does that sound right?

 Dr. James Metz (01:21):

I think it is.

Cassie  (01:22):

Okay. Well, welcome.

 Dr. James Metz (01:23):

Thank you.

Cassie  (01:24):

So from here, how about, I’ll start with you, James, and then we’ll come to you in a minute, Jill, to each introduce yourself, but maybe in your introduction share a little bit about your relationship to this topic, the topic of mandated reporting.

 Dr. James Metz (01:36):

Sure. Thanks for having me back. It’s great to be back and to talk about this important topic. As you mentioned, I have been at the University of Vermont Medical Center as a child abuse physician since 2018, and work both as the director of the Child Safe program and as a hospitalist, a pediatric hospitalist, seeing patients when they’re admitted to the hospital. In relation to the topic that we’re gonna speak about mandated reporting, It’s interesting because my views on this topic have really evolved over time, and I think as I’ve worked in this field of child abuse medicine for the time that I have, I just feel like I have a much deeper respect and sophistication in thinking about this topic And it’s brought up a lot of questions for me and challenged me in a lot of ways that I, I didn’t expect to. So, yeah, I, I appreciate the opportunity to speak about it,

Cassie  (02:33):

And I think that was a great teaser for just how complicated and nuanced it’ll be as we have this conversation today.

 Dr. James Metz (02:39):

Absolutely. <laugh>.

Cassie  (02:39):

Thank you, Jill, how about you?

Jill Richard (02:42):

Oh, Well, thanks, Cassie. I’m, this is my, this is my maiden voyage <laugh> on the podcast, so I’m happy to be here cutting my teeth on, on this experience. So I am a program manager at the Child Welfare Training Partnership, have been there for over 15 years, or close to 15 years.

Cassie  (03:03):

Yeah.

Jill Richard (03:04):

And in the field of child abuse and neglect and antiviolence work for my entire career. So in terms of mandatory reporting, we were invited about, close to two years ago by the Family Services Division to look at the current mandatory reporting training and provide some revisions and some updates to what was developed in, I believe, 2017. And has been running since then. And I think upwards of 14,000 people had taken that training.

Cassie  (03:40):

Wow.

Jill Richard (03:41):

And so, me and a couple of my teammates, Tammy Leombruno and Umesh Acharya have taken a deep dive over the past 18 months into the current policy conversations that are happening nationally, the data, the history and the public policy around mandatory reporting, to try to really get a good handle on, you know, what does the State of Vermont need in terms of, you know, an approach to this type of policy that emerged for good reason with good intent but as most public policies do, they evolve and the conditions, the social conditions, cultural conditions sort of shift and move, and we need to adjust to that. So, I’m excited to talk about and to provide, you know, very, very soon a new training and a new experience for all those mandatory reporters out there to experience.

Cassie  (04:37):

We’re so glad to have you, and I think this is like a really long overdue conversation, in some ways. So, this is great. We have lots of listeners all over the place. So, for anyone who doesn’t know, maybe we start at the beginning. What is mandated reporting and what is it intended to do?

Jill Richard (04:53):

So, mandatory reporting laws establish a legal enforceable duty for those who have contact with vulnerable populations, to report to State, state and local authorities when maltreatment or abuse is suspected. So there’s reporting laws for the elderly for other vulnerable populations, but the mandatory reporting law that we’re talking about is related to children and youth. So, this is a Vermont state law, and all mandatory reporting laws are State-based laws that have some federal connections that we’ll talk about. But in Vermont, if you reasonably suspect child abuse and neglect, and you are considered a mandatory reporter, then you are legally required to report that suspicion of abuse within 24 hours of your knowledge of it. To know what qualifies you as a mandatory reporter, you would either a, take the training,

Cassie  (05:50):

Mm-Hmm. <Affirmative>

Jill Richard (05:50):

or go onto the website at the State of Vermont, they have a long list of mandatory reporters, but you should consider yourself if you do have contact with kids and children on a regular basis, be it daycare, physicians, healthcare, childcare, schools, you know, all kinds of community providers that interact regularly with children and families are considered mandatory reporters and are held under this statute.

Cassie  (06:16):

That’s great. And so it sounds like this law is really intended to prevent child’s abuse and neglect, or to alert someone if there’s a reasonable suspicion that it’s, that that’s happened. Yes?

Jill Richard (06:29):

Yeah.

 Dr. James Metz (06:29):

You know, for me, at the very basic level as a physician and medical provider, it’s a mechanism to alert someone else in this regard It’s, it’s DCF in Vermont, to concerns that they might have about child abuse or neglect. That’s at the very fundamental level. It’s a mechanism to raise a flag. Unfortunately, or fortunately, there is a lot more that goes into it than just picking up the phone and making a report. So I think the intentions are, when people make the report from a medical standpoint, I think for the most part, the intentions are good and they’re really, there’s a concern that reaches a threshold by which they feel that they need to make a report. On the unfortunate side, it’s not so easy and it, and it comes with a lot of consequences.

Cassie  (07:23):

Yeah. Yeah. Well, and that’s sort of the follow-up question I wanted to ask. And Jill, maybe this is a piece where you can come in based on your work. How is this law or this series of laws, even nationally, how are they working right now?

Jill Richard (07:37):

Yeah, I’d love to make the connection here between the State level law and the federal requirement. And the intent of the law as, as James is referencing, Dr. James, Dr. Metz <laugh> is referencing, is to provide safety and protection to children by increasing awareness of unsafe family environments. And it’s a delicate balance, right? When you enlist state intervention into families there’s lots of considerations that should be brought to the table, in addition to the, the raising the awareness. So the federal connection here is that in 1974, the Child Abuse Prevention and Treatment Act well known as CAPTA, linked up some funding to the requirement of states to have certain aspects of mandatory reporting laws in place. And so in 1974, there became sort of a broad brush across the country of states increasing their oversight, their surveillance, so to speak, of families vis-a-vis the mandatory reporting law. And again, good intentions, right? And we all it is not a debatable topic to keep, whether or not we wanna keep children safe and mandatory reporting laws were a first, first pass at a way that we could maybe do that by, by really engaging community providers and members who have that contact to be responsible and accountable to sharing their concerns when they have them. What we also know now, what is it 50 years later yeah, 50 years later from CAPTA, is that there is no evidence that mandatory reporting laws do what they’re intended to do. So there’s no data right now that supports the fact that mandatory reporting is able to prevent or intervene in situations of child abuse and neglect even at its best attempts. And so, lacking that data, what’s next?

Cassie  (09:56):

Yeah, I think people would be really surprised to hear that. Well, you know, if we know that we can’t say, don’t report because we do have a mandate to protect children and child abuse and neglect is, you know, a serious and urgent issue and we know that the mandated reporting system as it currently exists, is at a minimum not effective and we haven’t really gotten into this yet, but there’s a lot of information about out there about how mandated reporting causes harm to specific marginalized communities. How should we think about mandated reporting in that context?

Speaker 3 (10:32):

So, if I can throw a little bit of data out here just as a, just as a foundation, I promise you we won’t go data heavy throughout the rest of the, the podcast.

New Speaker (10:41):

Okay.

Jill Richard (10:42):

But I do, I think this is compelling data, and if it wasn’t, I wouldn’t wanna share it here. So nationally, in 2019, 3.6 million reports were made through the mandatory reporting system. About 16% of those were associated with a substantiated finding, once the report went through the child abuse and neglect system, the DCF system. 83.9% of those were screened out or found to be false after investigation, 83.9, 84% significant amount. So coming down from the national level, specifically to Vermont and our region, Vermont has the highest rate of child maltreatment hotline referrals in the country. All 52 states. That is 160 children per 1000. At the same time, Vermont also has the lowest screen in rate in the country with just 19% of calls to the hotline meeting the acceptance criteria.

Cassie  (11:44):

So what does that mean, <laugh>?

Jill Richard (11:47):

So I wanna compare that to New Hampshire.

Cassie  (11:50):

Okay, let’s do that.

Jill Richard (11:51):

Yeah, give me a second. So, in New Hampshire, compared to 160 children per 1000, they are finding 72 children per 1000 are reported with a screened in rate of 55.7%. So they have a lower number of children per 1000 reported, but a higher number of those children who are reported that are accepted.

Cassie  (12:14):

Yeah.

Jill Richard (12:15):

So the efficacy of that activity in New Hampshire is looking a little bit more effective than in Vermont. I

Cassie  (12:23):

See. I see.

Jill Richard (12:24):

So, the efficacy of those numbers, and the, the comparison of those numbers is important because with a high, high level of reports that aren’t really meeting the threshold for being screened in, we’re having a lot of families who are getting concerned and worried about State intervention into their parenting, into their families for probably reasonable suspicion, but not at a point where the state really should be intervening. So, this is where we start to look at and be concerned about the impact of what many families of color and poor families would experience as a surveillance activity that why is the State continuing to look into these situations when it clearly doesn’t result in an intervention that would be necessary for a child safety issue?

 Dr. James Metz (13:18):

You know, for me, it brings back the, you know, the comparison to public safety and the thought that if concerned, raise the red flag. And I think when you’re in an airport and you see a bag and you’re concerned, tell someone. And I think that, that in Vermont, I think that’s been the mantra and I’d wonder, Jill, if what you think about the history of Vermont and, and some significant cases of bad outcomes, having, you know, the effect of having people buy into that mantra of, if in doubt, make a report. And I think that, while that is face value sounds reasonable and sounds like the right thing to do, it’s only one side of the equation and I think what we need to move past and move forward in thinking about, what’s the other side of that equation, what’s the unintended consequences of making that report? And I think that that’s where we need to start to be a little bit more sophisticated in our thinking about mandated reporting.

Cassie  (14:26):

Yeah. Yeah. So it sounds like, you know, really what we’re driving towards is a more sophisticated, a more nuanced, a more accurate system. That’s what we’re working to build. And it sounds like that’s what the training you’re, you’re creating, Jill, is is cultivating, I’m thinking here, don’t you have a saying about this, James, the surgical, like the pause in surgery you were telling me, can you explain this for the listeners?

 Dr. James Metz (14:49):

So two things that I always say is, when I teach to the hospital, to physicians, to other medical providers about mandated reporting, I say reporting is not benign. So benign meaning, it has harm potentially. And the other thing I’d say is when we do make a report, we have to be surgical in the way we do it. And when I say surgical, you know, for anyone who’s been in surgery, it should give you some, it should make you feel better to know that before they operate on you or someone, they take a pause or a timeout. And that timeout is an intentional moment to make sure that the medical providers are providing the right treatment on the right patient at the right time, and for the right reason. And I think if we adopted a similar approach in mandated reporting, meaning that we know why we’re reporting, we know the reasons for it, and that we’re reporting at the right time and on the right person, I think that that would go a long way in helping us to get out of our current situation.

Cassie  (15:59):

Yeah, I’m thinking just as I’m listening to you, maybe one thing I didn’t ask explicitly that I do wanna ask explicitly of either of you is, what are some of the unintentional harms that can happen when we’re reporting on families that don’t need to be scooped up when we’re not being surgical about those reports?

Jill Richard (16:15):

Yeah, I, I’d love to jump in here. When, when we’re looking at a one size fits all kind of mentality or approach, and when we when we see the data that we are talking about that the high rate of calls didn’t, does not necessarily lead to a similar rate of intervention, then we need to be curious about the impact of policy on families, be it fear of state intervention, as I was saying, people are not going to and this is demonstrated in the research as well, like, people are not going to convey their worries or their fears or their struggles with their children, with their finances with their partner with substances. They’re not going to confide in providers who they know are mandatory reporting if they think they’re going to be reported to, the state for, for those reasons. So there’s kind of a backlash impact potentially, where you have people sort of hunkering down and isolating themselves or keeping themselves cut, cut off from the very resources that are intended to support them. So that’s a big impact. I think bias and disproportionality is another impact that I think is long standing in the system where we’re talking about families who, for the, for the history of our last 100 years, we, we moving from you know, the resettlement and the settlement into the west and the Indian boarding schools, as well as the civil rights evolution, and the, the movement of African American families, black and Indian families, from an approach that started with them not having access to any resources. So inevitably, American Indian, native American, black African American families, are are evolving into this system in a way that predisposes them to intervention by the system because of their lack of access to resources. And because of the government’s efforts to enculturate native American families into white European school systems and white European communities. So, I think there’s, you know, we need to think about the implications for different marginalized groups including our bipoc families, including economically disadvantaged families, including those families who are struggling with substances, struggling with domestic violence, violence in the home, etc. These are all families that are adding increased vulnerability for state surveillance, for having the state really keep an eye on what’s going on here. And when we’re keeping an eye on our communities, you have to wonder what the, what the reasoning is there. So moving away from families too, there is an impact, there’s an impact on the system, right? We all know as community providers, as mandatory reporters, we don’t have enough community resources to meet the needs out there.

Cassie  (19:34):

Yeah.

Jill Richard (19:34):

And some of the needs that we’re reporting to the state system are needs that should not, and do not need to be met by the state child abuse and neglect system.

Cassie  (19:44):

Give me an example for this.

Jill Richard (19:45):

There are needs that need to be met by community resources. Affordable housing, substance abuse treatment

 Dr. James Metz (19:53):

Childcare.

Jill Richard (19:54):

Childcare, yeah. Affordable childcare. Right?

Speaker 1 (19:57):

I mean, I, if I might give an example.

Cassie  (19:59):

Yeah.

 Dr. James Metz (19:59):

You know, again, it’s well-intentioned, mandated reporters concerned about a condition of a child that makes them want to reach out for resources.

Cassie  (20:10):

Yeah.

 Dr. James Metz (20:11):

So a child comes into the hospital with completely dirty <laugh>, you know, mud on them, you know, not washed hair caked in mud, and the medical provider might be concerned about what’s happening in that household. And so they reach out and potentially make a report. And I would just suggest that there’s lots of reasons for a child to be muddy and dirty. In fact, I actually, as a pediatrician, think sometimes that’s a good thing because it shows that they’re not behind a television.

Cassie  (20:45):

A screen. Yeah, screen.

 Dr. James Metz (20:46):

But, I guess what I would suggest is that we have to think about why, what we can do before we make a report, and whether that is reasonable suspicion of child abuse and neglect, and more than, you know, anything step into that.

Cassie  (21:03):

Yeah.

 Dr. James Metz (21:04):

Step into that problem if you think it’s a problem. And maybe there’s other resources we can use apart from, you know, the State intervening.

Cassie  (21:13):

I think, you know, and I’ll ask you both to pull me out if I get too deep into this rabbit hole here, but I, I think one of the things that I’ve noticed in my practice is that community members, or maybe folks who aren’t working so closely with children and families aren’t aware of the impact that structural factors has on child abuse. Like, people tend to work up child abuse as being perpetrated by monsters rather than families who don’t have resources. You know, and that’s one of the things I have spent a lot of time talking about community members with, even the students in my classes now that I’ve worked with so many families where abuse and neglect was present. And I don’t know that any of them were monsters, but I know that all of them were struggling with not being able to meet the needs of their children in different ways.

 Dr. James Metz (22:01):

Absolutely. I mean, I, we at, at UVM Medical Center at the Children’s Hospital see abuse and neglect all the time, and it’s not perpetrated most of the time by evil people.

Cassie  (22:17):

Yeah. Exactly.

 Dr. James Metz (22:17):

It’s people that are in very unfortunate circumstances for a lot of reasons. And I would say that’s the majority of, of these cases that come across my desk. Of course, there are some terrible cases that are the exception, but these, it’s not to suggest that we need to ignore them.

Cassie  (22:36):

No.

 Dr. James Metz (22:37):

By any stretch of the imagination, it’s just we need to figure out another way to support families and suggest that reporting might not be the most effective tool for changing the behavior of these families.

Cassie  (22:51):

Yeah. ’cause if, if it’s not about kind of farting out a monster or an evil person, maybe we wanna resource how we support families in need, you know, a little differently before we call the Child Protection Agency. Is that, does that feel accurate?

Jill Richard (23:07):

Absolutely.

 Dr. James Metz (23:07):

I think so. I, I, I think it’s too easy sometimes to just pick up the phone and make the call. I know from a medical standpoint it feels like the right thing to do at the right time. And quite frankly, it moves the problem off of my desk onto someone else’s desk.

Cassie  (23:26):

Yeah.

 Dr. James Metz (23:26):

And I don’t say that lightly. I’m just saying in a busy, in pediatric practice where we are also under-resourced, we don’t have a lot of social work support, we don’t have a lot of resources to help families in some ways the easy thing and the logical thing might be to think that we can make a report and that things will be taken care of.

Cassie  (23:49):

So based on your professional expertise, then, what do you recommend someone should do if they suspect child abuse or neglect?

 Dr. James Metz (23:56):

It’s a great question, and I, and I struggle with this because I think, I don’t want people to get the impression that we don’t want them to make reports when they’re concerned.

Cassie  (24:05):

Right.

 Dr. James Metz (24:05):

That’s not the, the message here, the message again, is somewhere in that surgical realm of being very targeted in making that report. So, you know, on the very logistical level, when you’re concerned, what I usually say is share that concern with someone else to get another opinion about what your concern is. Why do I say that? Well, because we know that bias plays a huge role in the workup of child abuse and neglect. And so, you know, knowing that it’s, it’s good to just check that with someone to make sure you’re.

Cassie  (24:44):

Yeah.

 Dr. James Metz (24:44):

You’re making the report for the right reason.

Cassie  (24:46):

Get a case consult.

 Dr. James Metz (24:47):

Absolutely. You know, not to put a plugin for our program.

Cassie  (24:50):

<Laugh>, No, do It. Put a plugin for your program.

 Dr. James Metz (24:53):

Okay. I will. The Child Safe Program offers that opportunity and that resource to talk about your concerns, whether it be of physical abuse, neglect, whatever form of maltreatment before picking up the phone and making a report. Now, we are not by any means the arbiter of making a report, and that’s not a message that I wanna send.

Cassie  (25:15):

Right.

 Dr. James Metz (25:16):

But we can help you in better defining why you are making that report and help you make a more targeted report.

Cassie  (25:24):

That’s Great.

Jill Richard (25:25):

I would jump off from there too, just to kind of, to really bring some attention to the, the nuanced approach that we as providers and practitioners take when we are thinking about supporting a family. One of the policy positions that’s out in the country right now in terms of really dialing back our response here in the mandatory reporting realm, is you don’t have to report a family to support a family. Right.

Cassie  (25:59):

Oh.

Jill Richard (25:59):

so do we really, I mean, how can we pull back on our surveillance reaction, right? Like, when people are being surveilled, when communities are being surveilled, we all know now that those consequences are not positive. Right. When I feel surveilled, I’m going to retreat. Right. But if I feel supported, if I feel engaged, if I feel like someone I’m having contact with is interested in helping me solve the challenges or the barriers that I’m facing to my day-to-day life, then I’m not, you know, there’s no reason for me to retreat.

Cassie  (26:38):

Yeah.

Jill Richard (26:38):

So really, not only do you not have to report to support, but it’s actually counterproductive and counterintuitive. So ,states at this point have not only started sort of actively talking and, and explicitly talking about that approach and how that plays out, but have started offering help lines as alternatives to reporting lines.

Cassie  (27:00):

Oh, interesting.

Jill Richard (27:01):

Right, and the helplines are really intended to get at those cases where practitioners don’t know what to do to solve the problems that are getting in the way of kids’ education or whatnot. Whether it be finances, whether it be housing support, whether it be a livable wage, right? All these underpinnings of our social framework, our social infrastructure that parents deal with all the time, that inevitably are going to come to the door of the guidance counselor come to the door of the, of the school counselor or the pediatrician. These are the kinds of things that a more nuanced approach, a more complicated approach and more individualized approach would help to address.

Cassie  (27:45):

And does it feel fair to kind of plug at this point? Because I’m imagining if I’m listening, I’m like, well, when I don’t know when to report <Laugh>,

 Dr. James Metz (27:52):

You know, I, I think it comes back to the mandate of the department of DCF or CPS. The mandate was never, unfortunately to support families. It was to step into very challenging situations and protect children. And so when we reach out to DCF or CPS with concern, the reaction that they can bring is fairly binary. It’s not to wrap this family necessarily in supports. Now, they do have an alternative path, but it’s still through

Cassie  (28:29):

Differential Response

 Dr. James Metz (28:30):

It’s differential response. But still, the question you have to ask yourself before making that report is, is this something that’s in the realm of child safety and child welfare? That’s that DCF and CPS can respond to? Now, you might not know that.

Cassie  (28:47):

Yeah.

 Dr. James Metz (28:48):

And that’s okay. And so you might just go ahead and report, and they might not accept it. And a lot of as,

Cassie  (28:54):

as most, and most are not, Yeah.

 Dr. James Metz (28:55):

And most are not. And that’s okay in some regard that we have a very high bar or a standard by which we accept reports and that’s important. But, you know, to catch that one very serious case, we need to screen out a lot. But the point is, can we do something before picking up the phone to make that report?

Cassie  (29:19):

I think that’s a really great question. And I, I wanna offer for listeners that on this episode, like all episodes, we’ll have some resources linked in the show notes. We’ll have the link to the updated training too. So I don’t wanna give you a spoiler alert halfway through. But I think really what the three of us want you to walk away with today is, some thinking about how and when you report, and maybe a curiosity to keep learning about it. Does that feel fair?

 Dr. James Metz (29:43):

Absolutely. I, I’m curious every day, and I don’t think it’s a black and white issue, and I think that these debates are being had across the country in all different avenues and spheres, and I think it’s a good discussion to have. And I just feel like, we are at a point where we as Jill mentioned previously, we can move forward and be a little bit more nuanced in our approach.

Jill Richard (30:08):

Yeah. Jumping in with, you know, those typical reflective questions that we all ask ourselves in our own decision making processes. Right? What information do I have? Why am I why am I deciding to report at this point? What am I actually worried about? What is the fact pattern? Right? One of the conversations you and I had Dr. Metz in preparing for the training, is talking a little bit about managing our own bias. Right?

 Dr. James Metz (30:38):

Absolutely.

Jill Richard (30:38):

And so how do we, you know, anticipate those kinds of barriers that we’re encountering as we respond in our typical manner, right? So, how can we bring some intention to the, to the table about, do I have all the information? Do I know enough? What biases am I bringing? And am I controlling for those? Should I talk to a colleague or a supervisor to just talk through making sure that this is the right response at this point in time for this family?

 Dr. James Metz (31:08):

Absolutely. I think that’s why I suggest always, if possible, talk to someone else, elevate your concern to a supervisor, elevate it to our program get more opinions. If it’s, if it’s possible to really check yourself in terms of why now is it the right time to make the report?

Cassie  (31:28):

And do you have a kind of standardized procedure that you recommend to reduce bias in reporting?

 Dr. James Metz (31:36):

Again, I think that one of the ways that I would suggest is talking to someone else and see if it makes sense. You know, an example that’s come up before, and it’s, again, it’s, it’s from the perspective of a busy emergency department where they just don’t wanna miss something. And you can imagine the feeling of a physician who might have a very small amount of time with a child and has some sort of concern and to be fair, we’re told in medical school and, and in nursing school to go with your gut.

Cassie  (32:13):

Yeah.

 Dr. James Metz (32:14):

And sometimes we just need to do a gut check.

Cassie  (32:16):

If it feels wrong, say something.

 Dr. James Metz (32:17):

Exactly. And, you know, sometimes that works, but sometimes it gets us into trouble. And I would just say, when you’re feeling that way, just slow down. It’s not always acute. I know. In a, you know, to tell that to an emergency room physician to slow down.

Cassie  (32:31):

Right. Someone just scoffed <laugh>.

 Dr. James Metz (32:32):

Exactly. They’re like, yeah, right. Dr. Metz, we’re gonna slow down. We have six other patients to see but my point is, we just need to be careful and make sure that we’re reporting for the right reason.

Cassie  (32:45):

Okay. So let’s, let’s pull on that thread for a little bit. Let’s say I’ve experienced something or I’ve, a child has disclosed to me, or in some way I’ve gotten some information, I’ve paused, I’ve consulted, I’ve decided, yeah, I really need to make this report. What information do you recommend gathering before I make that report?

 Dr. James Metz (33:05):

You know, from our perspective, from a medical perspective, I would suggest not every report is accepted. And I think part of that reason is because we don’t make effective reports. And so my, you know, suggestion, and my hope is that when we reach that threshold, and again, it might be different for different people and I respect that, but when we reach that threshold, if we’re really that concerned, then we need to make an effective report that is gonna get accepted.

Cassie  (33:35):

Right.

 Dr. James Metz (33:35):

Or hopefully gonna get accepted. So how do we do that? Well, we intentionally pause and really think about what our concern is. So it’s not because the caregiver has a tattoo of a marijuana leaf on their neck that is our concern. Our concern is that maybe the child has a broken bone, or the child has bruises on them that are very concerning for abuse. So what is the concern? What is our, you know, what have we done so far to help out or to, to try to figure out what that concern is? So have we done lab work? Have we done x-rays? And then what is our recommendation? What more do we suggest? So I think it’s incumbent upon us when we do make a report, as I, as I often say with our mandate to make a report, is the responsibility to make a good report. And I think that that’s really important.

Cassie  (34:34):

Yeah. Because there’s risks and ramifications if you file a report without all the information. Right. And it, it’s not just that that’s not accepted, at times, it can be that it, that it is accepted and then someone experiences kind of an intrusion or an intervention that wasn’t appropriate for that family.

 Dr. James Metz (34:51):

Absolutely. I mean, at the basic level, a child comes in with a skull fracture, and, and again, you know, skull fractures can be very concerning, but actually, we know from the work that we do in our program, skull fractures are fairly common and can happen from fairly innocuous falls, but it gets reported and what happens potentially a police officer goes out to that household that night and knocks on the door of a unsuspecting family, and it starts a chain reaction of potentially unintended harms. And again, I’m not suggesting that we don’t make reports on skull fractures, I’m just suggesting that we really need to understand the reasons we’re reporting before we pull that trigger.

Cassie  (35:36):

Yeah. Because if I’m the person making the report, you know, and I’ve certainly had to make a great money in my career, right. I’ve, I’ve also been the person on the other end kind of going out, knocking on the door. But most often it’s not the person who’s making the report who’s knocking on the door. So you don’t really see what happens after you end that call. What happens for that family? What happens for that kiddo? And I think certainly in Vermont, sometimes with our numbers, it can be hard to be a mandated reporter ’cause you have the experience of calling over and over and, you know, what are they doing? But the opposite is certainly true as well, that when a report is initiated and the child welfare agency goes out and makes contact with the family, you’re, you’re not seeing that either. So there, there really is like this gap between the call and what happens after.

 Dr. James Metz (36:21):

I think that makes it easier to pick up the phone.

Cassie  (36:23):

Yeah.

 Dr. James Metz (36:23):

Because you don’t see it. I mean, that’s, there’s not a lot of areas in medicine where we can do, make an intervention and then we don’t see the results.

Cassie  (36:31):

Yeah.

 Dr. James Metz (36:31):

Of that intervention.

Jill Richard (36:33):

I think the other thing that happens that we don’t think about often when we make a report and don’t think through the, the other possibilities is we expect that there will be a response from the state system.

Cassie  (36:44):

Yeah.

Jill Richard (36:44):

You know, automatically. And so if a report is not accepted for further intervention, oftentimes and in fact the state does not have the purview to make referrals for those families where the report is not accepted, so many people may unwittingly be making a report expecting that something will happen. This family will get some support, some services at least, If not an investigation.

 Dr. James Metz (37:10):

Right, and then when it’s not investigated, they’re like the natural response from a medical provider, you know, in the hospital or in a clinic says, I’ve made, I’ve made dozens of reports and nothing ever happens.

Cassie  (37:21):

And that, I think educators have that experience. Community mental health treatment providers have that experience,

Jill Richard (37:26):

And families have that experience. When the sixth report is made, that is not necessarily a child abuse concern. A sixth report might trigger an you know, enough concern from the State to actually make a contact with that family. So just by virtue of making a number of reports, there may be an intervention there that isn’t necessarily warranted. And then again, drives that reactive place from the family of, we don’t, you know, you’re not being helpful to me. I don’t need your help. I’m not hurting my child. How do we, how do we proceed from there? .

Cassie  (38:02):

Yeah and so it sounds like the trajectory we wanna shift is from simply report or don’t report to be really thoughtful, be a little bit more nuanced in that decision to report or not report. And also, are there ways that you can support the family that we haven’t tapped into yet? Am I summarizing that well/

Jill Richard (38:19):

I think it, I think that’s pretty, pretty good. Cassie. <laugh>

Cassie  (38:24):

Perfect. Okay so I think there’s another kinda leg on the stool that we haven’t explored, which is how we either as service providers or as mandated reporters can and should interact with the families when we’re making a report or have made a report, because that’s another kind of like black hole, you know, where people will feel like they have to report, they’ll report anonymously, they’ll be fearful that the family will find out they made a report. And, and really, you know, from where I sit, it seems like we’re missing an opportunity to provide support in that moment.

 Dr. James Metz (39:01):

I agree totally. And one of the things that we harp on in our program and to the medical providers who we interact with, is that if you’re gonna make a report and it’s possible to be transparent with the family, then by all means you should tell the family that you’re making a report. And why do we say that? Well, in large part, because of what Jill touched on already, is that the reaction of the family to the report is important to know that they understand why we are doing it. And what I tell our medical providers is that we have somewhat of a standardized script that we say anytime if there is an injury, anytime we see an injury like this on a child, we are mandated reporters. And when we’ve reached that threshold, an injury on a child that’s unexplained or that’s concerning for abuse, we make that report, but we tell the family unless it’s gonna put the child at more harm or risk of harm. And that’s sometimes hard to know. But there are situations where we might not want to tell the family because it would put the child at more significant harm, but to the degree that we can be transparent and open with a family, I think it’s hugely beneficial.

Cassie  (40:15):

Yeah. I would say in my own practice, there were a lot of times where the news that I was most hesitant to share with a family is the news that actually helped build the most trust in our relationship. You know,

 Dr. James Metz (40:28):

I think so.

Cassie  (40:28):

but it’s a real big hump to crawl over that those first couple times <Laugh>

 Dr. James Metz (40:32):

I think it, it allows the provider or the person making the report to share their concerns. Yeah. And, and it’s an opportunity for a discussion

Cassie  (40:39):

And maybe to hear from the family, you know, what’s going on from their perspective about X, Y, and Z.

 Dr. James Metz (40:43):

Right.

Cassie  (40:44):

Why kiddo doesn’t have a winter coat, or, you know, why so and so is watching them while they’re working, whatever it is. I, I do think we’re talking a lot about the, the medical kind of injury examples, which makes sense given your area of expertise. But I just wanna name, and Jill, I don’t know if you have thoughts on this, but some of the socioeconomic factors around the neglect cases sometimes make those ones really hard to know whether to report, because our sense of neglect is so caught up in our sense of, you know, values and our, our own kind of like, quote unquote home life and what’s normative.

Jill Richard (41:17):

Hmm. For sure, for sure. There’s a, there’s some data that we offer in the training related to neglect allegations relative to acceptance and intervention that I’m, that I don’t have in front of me right now, but is available in the training. I think that is a, that’s a really good pickup, Cassie, in that you know, a huge percentage of reports are based on, you know, an example Dr. Metz used earlier around the, the dirty clothes, the dirty child, the lack of bathing the dirty houses. And the State has very specific guidelines for those types of circumstances that do meet the threshold of being unsafe, once, once we’re at that stage. However, that generalized sort of value set around, you know, a white middle class heterosexual sort of,

Cassie  (42:16):

two parent.

Jill Richard (42:17):

Two parent household is, you know, not the norm and has never been the norm. But we’ve, we’ve liked to believe that it is the norm and it’s in fact , the standard on which we should base a desired upbringing for children. And, and anything less than that is, is not safe. And I’m certainly not suggesting that people are malicious in their intent to interpret that. But the history of our sort of moral compass and our moral values in, in anti-poverty work dictating the threshold by which we intervene in families who don’t have the resources to wash their clothes as, as frequently as they might like, or to eat as, as robustly and, and plentiful plentifully as they might like.

Cassie  (43:07):

Yeah. Yeah.

Jill Richard (43:08):

Right. So…

 Dr. James Metz (43:09):

You know, we, again, it, it comes to a threshold, you know, we have, there’s different types of neglect and unfortunately neglect gets put in this big basket. But there’s dental neglect, there’s educational neglect, there’s medical neglect.

Jill Richard (43:26):

And the first conversation in regards to those types of neglect doctor Metz, is what we were talking about a minute ago, which is how do you interact with that family in that regard? Because a medical dental neglect may not be active neglect. It might be a lack of resource or a lack of knowledge.

 Dr. James Metz (43:43):

Exactly. And, you know, I, I think we need to look beyond what we’re seeing and see why we have gotten to where we are in terms of the, the neglect or the dental neglect that we’re seeing, or the, you know, what pushes it over to, you know, something that is concerning and making it report is, you know, but making the report without trying to intervene and help the family get to the medical appointment, have the resources to buy the, the, the shampoo that will help with the lice,

Cassie  (44:14):

right.

 Dr. James Metz (44:14):

. Or something like that,

Cassie  (44:15):

or get the winter coat.

 Dr. James Metz (44:16):

or get the winter coat, that doesn’t yet rise to the level of, of making a report.

Cassie  (44:23):

I think that’s really helpful. Go ahead

Jill Richard (44:24):

I wanted to just address the anonymous reporting comment that you had made earlier, because I think that is a really important consideration for reporters to be thinking about. And one of the things that we should be attentive to in terms of like our personal accountability as providers and practitioners anonymous reports really only serve to alert the system surveil the families, and there is no, there’s confidentiality parameters and information sharing parameters that protect reporters from possible consequences. So anonymous reports are a bit of a red flag for the system to wonder what the intent behind the report is. So as a mandated reporter, we really wanna just, I just wanna put a pitch in here to, if you’re concerned about making a report, that’s definitely something to talk with a colleague about and to think through before you’re making that report, because it does end up making a track record, and it doesn’t give the state or the system enough information or often the right information to be able to follow up on and provide a helpful intervention.

Cassie  (45:33):

Yeah, that is such a great point and really, really well said. So this always comes too soon, but we’re pretty much out of our time here. I’m gonna do, you know, what we always do to close, which is I’d like to ask each of you you know, if our listeners today only walk away with one thing, what what’s the thing you want them to take away with you?

 Dr. James Metz (45:52):

You know, I, I hate to harp on it, it just is so rings true to me, is that reporting is not benign and our intentions are good we wanna protect children and I think that that’s a lofty goal. I feel like we just need to be aware and think about all the ways that we can protect children and think about all the different resources we can bring to bear to help children be safe.

Cassie  (46:20):

That’s, that’s a really good one.

Jill Richard (46:21):

It is a really good one. I’m gonna jump right off from there and say, the one thing that I would love to walk away from this with people grabbing is there’s not just one way to provide safety and support to children. We, we all want children to be safe. We all want families to be supported. So, let’s be accountable to our community, to the families that need the system to be accountable to them. What is my part, what is your part in evolving our child safety response as, as a, as a state and as a community to a place where our policies actually can have an impact on what families are experiencing? And I was wanting to offer the hotline.

Cassie  (47:05):

Oh, yeah.

Jill Richard (47:05):

The abuse reporting line. It seems apropos

Cassie  (47:09):

I think so <Laugh>

Jill Richard (47:10):

to say when you do think that there is a report that meets the threshold of a child safety being threatened, you can call 1-800-649-5285, 24 hours a day, seven days a week. And as a caveat, if someone is in immediate danger, of course, always call 911. Do not make a report first call 911 and then follow that with a report. The last thing I’ll say Cassie, is that we are excited, Dr. Metz will be featured on our training and the Child Welfare Training Partnership in partnership with the State of Vermont. We will be launching our new mandatory training for mandatory reporters in the coming probably two to three months. So stay tuned and…

Cassie  (48:02):

And we can link to that right on the website. So…

Jill Richard (48:04):

Perfect.

Cassie  (48:05):

You know, if as you’re listening if we have met our goal and peaked your interest, go ahead and click on the show notes page. There’ll be a bunch there to keep, keep you learning. Alright. Thank you so much.

 Dr. James Metz (48:16):

Thanks, Cassie.

Jill Richard (48:17):

Yay. Thank you.

Cassie  (48:18):

Thank you,

Jill Richard (48:19):

<laugh>.Thank you.

Speaker 2 (48:22):

The Social Work lens is produced by the University of Vermont’s Child Welfare Training Partnership and the State of Vermont. Our theme music is composed and performed by local band Brick Drop, and our sound production and engineering has been brought to you by Egan Media Productions. We’d also like to give a special thank you to our in-House administrative production assistant Emma Baird. For the Social Work Lens, I’m Cassie Gillespie and we’ll see you next time.

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