Factors Affecting Healthcare Professionals' and Non-Professionals Judgments in Relation to Child Maltreatment Mandatory Reporting

Background and Purpose: A broader look at international child maltreatment mandatory reporting laws shows that the Israeli law can be characterized as significantly harsh and wide-ranging. This approach is manifested, among others, by defining mandated reporters as all citizens rather than some occupational groups that work regularly with children, and in defining sanctions for non-compliance as 3 months imprisonment for a citizen and 6 months for a caregiver or professional, rather than financial penalties. Of note, reporting practices of citizen mandate reporters is generally under-researched. In this study, we investigated this issue via comparisons between non-professionals and healthcare professionals, all working in community-health-services, in their child maltreatment reporting decision-making. We experimentally examined the effect of heuristics in non-professionals and professionals' judgments as affected by the child’s ethnicity, gender, and family socioeconomic status. We examined how these variables influence assessments regarding suspected maltreatment, and intentions to consult and report child maltreatment.

Methods: The study used an experimental design within a cross-sectional survey framework. A series of vignettes were constructed, describing a child at risk. Three factors were randomly manipulated: child’s ethnic background (Jewish/Arab), child's socio-economical background (Middle-Class/Low-Class), and child’s gender (Male/Female). Each participant was asked to respond to five randomly selected vignettes (from a pull of nine vignettes). Participants were asked to assess the likelihood of suspected child maltreatment, their intentions to consult on the case, and their reporting intention for the case. The sample was a purposive convenience sample, intended to maximize variation, consisting of 517 participants: 80 non-professionals and 437 healthcare-professionals working in community-based HMO clinics, in Israel. Linear and logistic regression-analyses were carried at the vignette level, controlling statistically for within participant clustering using robust-standard-errors within a Generalized Estimating Equations (GEE) model.

Results: Findings show that whether participants were civilians or healthcare professionals had significant effect on the assessment of child maltreatment; being a professional increased the likelihood that child's condition will be identified as resulting from maltreatment. The experimental manipulations had significant effect on the assessment of suspected child maltreatment; being a girl, Jew, and belonging to low socio-economic class increased the likelihood that case will be suspected for child maltreatment. Finally, it was found that the assessment of suspected child maltreatment appears as a significant predictor of later decisions regarding consultation and reporting.

Conclusions and Implications: This study shows that heuristics effect both non-professionals and healthcare-professionals' ability to identify child maltreatment correctly, and that, in general, professionals tend to suspect child maltreatment in greater likelihood. The results are discussed in terms of their implications on service delivery, including the perceived danger of intervening in the lives of innocent families and investing scares resources at the wrong place.