Through Occupation's Lens: Comparison of Child-Maltreatment Mandatory Reporting Judgement and Intentions of Social Workers, Nurses, and Physicians in Community Clinics

Background and Purpose: States' commitment to guarantee children's protection from maltreatment had been realized from the 1960's by governments worldwide, endorsing mandatory reporting laws. Since then, a considerable emphasis in the literature is put on ascertaining whether mandatory reporting rules and guidelines are being followed by particular occupations, and on ways to enhance fidelity with legislation. In this study, we investigated reporting practices across professional groups. Furthermore, the force here was on professionals working in community health services, a setting which is still under-researched. We examined how the profession, being a physician, a nurse, or a social-worker, influences assessments regarding suspected child-maltreatment, intentions to consult on the case, and intentions to report the case. We further investigated the effects of heuristics such as child’s ethnicity, gender, and family socioeconomic-status on professionals' judgments.

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 ethnicity (Jewish/Arab), child's socio-economics (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 357 participants: 143 medical doctors, 168 nurses and 46 social-workers 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 profession had significant effect on the suspected child maltreatment assessment and intention to consult on the case. Being a nurse decreased the likelihood that child's condition will be identified as the result of maltreatment and being a physician decreased consultation intentions. Manipulated factors had differential effects for each profession. Physicians' assessment of child maltreatment was significantly affected by the child's ethnicity, gender, and socioeconomic-status; nurses' assessment was effected by child's gender and socioeconomic-status; social workers' assessment was only affected by the child's gender. Being a girl, Jewish, and belonging to low socio-economic class increased the likelihood that case will be suspected for child maltreatment. In addition, child being a girl significantly increased physician's intention to report the case.

Conclusions and Implications: This study shows that heuristics effect professionals' construction of child maltreatment, yet in a differential way according to profession and type of decision. The results are discussed in terms of their implications for professional socialization and qualification. It is recommended that future research will address the efficacy of multi-professional child protection training programs.