The Importance of Being Earnest - Ethics and Child Abuse Reporting

The fame and glory of being a mandate reporter is not all it’s cracked up to be.  The massive mess and confusion of what and how to report can be daunting, even to the established therapist.  As one author stated, many clinicians feel that; “There is no way to do no harm” (1) when facing a potential child abuse report.  Further, sometimes what is best for the child (a child abuse report) is not what is best for the parent.  In addition, since treating mental illness decreases the risk for child abuse, clinicians certainly don’t want to derail the treatment of mental illness due to the mandated reporting of child abuse.  Nevertheless, therapists are mandated reporters and must report all child abuse regardless of the ramifications. 

The major conundrums fall into one of these four categories: 

  • What is often referred to as the gray areas of mandated reportable abuse.
  • Regarding sexual abuse of a teenager, what are the mandated guidelines when the victim says it’s consensual and the offender is a not a family member.
  • Determining whether to inform the family that there was a child abuse report made.
  • After reporting, how can a therapist move forward in a positive therapeutic manner?

Whether abuse is reported by a therapist is often determined by these three clinician characteristics:  experience, training and attitudes (2).  This article is aimed at increasing the training characteristics.  While the mandated reporter laws are easy to find in the MN state statutes, in Minnesota, specifics depend on the county where the abuse occurred, thus deciding whether to report can be a challenge.  How each county specifically defines child abuse varies significantly from county to county and the definitions can vary over time.  Due to these constantly changing particulars, it is best practice to call the county where the abuse has occurred and ask if the situation meets their current reporting guidelines. 

The broad brush approach for mandated reports of physical abuse includes all injuries (physical injury, mental injury, or threatened injury) caused by a caregiver or parent to a child that are non-accidental in nature.  An injury is usually defined by a mark (bruise, bump or reddened area) or other injury that is observable beyond a few hours.  Note that clinicians do not actually have to see the injury if a child reports that she or he has an injury.  Don’t let a child disrobe to show you!

Neglect is the often underestimated form of abuse.  It is cited by many as the most detrimental form of abuse yet gets less press and attention than physical or sexual abuse.  Neglect is defined by a lack of supervision, food, shelter, clothing, education, medical care, or protection from conditions that endanger the child. And it includes prenatal exposure to a controlled substance. However, one must keep in mind that a parent is required only to provide food regardless of taste.  And that being homeless does not automatically mean there is a lack of shelter. 

Supervision guidelines in regard to the reporting of neglect are vague. Minnesota statutes define supervision requirements as:  “Necessary supervision or child care arrangements appropriate for a child after considering factors as the child's age, mental ability, physical condition, length of absence, or environment, when the child is unable to care for the child's own basic needs or safety, or the basic needs or safety of another child in their care” (3). When deciding whether to report neglect due to inadequate supervision, the therapist must keep in mind the child’s developmental and emotional stability when determining supervision needs.  For example, a 13-year-old with severe ADHD may not be a safe babysitter for an active two-year-old.

Understanding what to report in the arena of sexual abuse brings up a myriad of questions.  The biggest area of confusion is in regards to the “consensual” sexual activity of a teen.  Most of the answers to what is a mandated report in these cases lies in the definition of a “significant relationship” according to Minnesota State statues.  A person who has a “significant relationship” with the child/teen includes a parent/step-parent/guardian, a person who is charged with caring for the child/teen, a first degree relative, or an adult who resides regularly in the child’s home.  This is a large category of adults and includes: aunts/uncles, father’s girlfriend, grandmother’s boyfriend, adult cousin, nanny, and many others.  When a “significant person” has sexual contact with a minor, they are committing child sexual abuse and that means all clinicians are mandated to report it.

Once a clinician has determined that a report needs to be made, the next question lies in how to manage the client-clinician relationship.  A report of child abuse could clearly impact the quality of your therapeutic relationship with your child client or the family members you are working with.  Of course, all therapists should inform their clients that they are mandated reporters and that even confidential material can be disclosed in cases of possible child abuse, but still, therapists may feel like a traitor if they report behind a family’s back. Child Protection workers want clinicians to keep reports in confidence from the family until their investigation is done. 

The safest choice is to keep your report in confidence and not inform the family.  Letting a family member know about an abuse report could potentially put a child in danger.  That is especially true if the offender becomes angry or wants to intimidate the child.  If a therapist decides to veer from the safe choice, and inform the family about the child abuse report, that therapist must delineate some very good reasons.  Good reasons could include those cases where the parent knows they have committed abuse and they recognize they need intervention.  It could involve a situation where a clinician may be empowering a teen to report the abuse themselves (and your report is simply a verification that they have done it).  These good reasons should be documented in the client’s medical record.  In the best case scenario, consultation with other clinicians has occurred and can be documented in the client’s medical record.

Even if the therapist does not tell the family at the time of a report, they may be mopping up the fallout afterwards.  Families may have figured out who reported them to child protection and avoid future therapy sessions.  In those cases, follow up with the family can result in re-engagement, if handled well.  Standing your ground as a caring and concerned therapist who must follow the law and wants the best outcome for their family is the ideal way to navigate this.  It is best to communicate clearly that you want to keep children safe.  But, also communicate that you know parenting is hard, complicated and sometimes leads parents to actions that are not safe.  If you feel unsafe going through this with a parent, ask a colleague to join you in the session, or ask to meet when administrative staff are available and can monitor the tenor of your session.   

Parents that learn of a child abuse report, may rant and rave about the child abuse report to their therapist, unaware that the report came from that same therapist.  Threats or aggression are uncommon but not unheard of.  Again, walking that line between hearing the parent’s concern about the impact of the report and also sharing with them the reasons that child abuse reporting can be a helpful intervention is optimum. 

While this is but a brief and truncated primer, please know that the best way to negotiate most of these challenges is to stay informed by contact with your county child protection agency and make sure you consult with other clinicians. Often child protection agencies are happy to speak with you about specific situations and will give advice about the need to report.  The other tool to sharpen is the willingness to consult with clinician colleagues on cases when child abuse reporting is in question.  If making a difficult decision about child abuse reporting or informing family members about a report, it is essential to consult with other clinicians and get their ideas and thoughts on the situation.  And then of course, document!

Libby Bergman, LICSW, was one of three co-founders of the Family Enhancement Center and has served as the Executive Director since 2000. Libby has worked with youth and families for over 25 years and is a sought after expert and speaker on the subject of child abuse and neglect.


  1. Feng, J. Y., Chen, Y. W., Fetzer, S., Feng, M. C., & Lin, C. L. (2012). Ethical and legal challenges of mandated child abuse reporters. Children and Youth Services Review34(1), 276-280.
  2. Schultz, LeRoy G. (1990) “Confidentiality, Privilege, and Child Abuse Reporting,” Issues In Child Abuse Accusations, Journal of the Institute for Psychological Therapies 2(4). Available at: (accessed 31 October 2016)
  3. Reporting Of Maltreatment Of Minors, 2016, 626.556
  4. Davis, K. J., & Yonkers, K. A. (2012). Case Report: Making Lemonade Out of Lemons: A Case Report and Literature Review of External Pressure as an Intervention With Pregnant and Parenting Substance-Using Women. The Journal of Clinical Psychiatry73(1), 51-56.
  5. Donohue, B., Alvarez, K. M., & Schubert, K. N. (2015). An Evidence-Supported Approach to Reporting Child Maltreatment. In Mandatory Reporting Laws and the Identification of Severe Child Abuse and Neglect (pp. 347-379). Springer Netherlands.
  6. Sonkin, Daniel Jay, and Douglas Scott Liebert. "Legal and ethical issues in the treatment of multiple victimization child maltreatment." Multiple victimization child maltreatment: Clinical and research perspectives (1999): 297-316.
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