Skip to main content
Log in

Index of suspicion: feeling not believing

  • Published:
Theoretical Medicine and Bioethics Aims and scope Submit manuscript

Abstract

Throughout the U.S., state laws require professionals who work with children to report cases of suspected child abuse to child protection services. Both practically and conceptually, however, significant problems arise from a lack of clarity regarding the threshold that has been set for reporting. Specifically, there is no consensus as to what constitutes reasonable suspicion, and little direction for how mandated reporters should gauge their legal and professional responsibilities when they harbor suspicion. In this paper we outline the context of the problem, discuss the nature and scope of its conceptual underpinnings, and offer recommendations for moving towards a concrete, practical solution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Bacon, F. “Of Suspicion.” In The Essayes or Counsels: Civill and Morall. Edited y M. Kiernan. Cambridge: Harvard University Press, 1985.

    Google Scholar 

  • Badger, L. W. “Reporting of Child Abuse: Influence of Characteristics of Physicians, Practice, and Community.” Southern Medical Journal 82 (1989): 281–286.

    Google Scholar 

  • Baron, M. E. “Teaching Residents About Child Abuse and Neglect.” Academic Medicine 73(5) (1998): 573–574.

    Google Scholar 

  • Beck, K. A. and J. R. Coloff. “Child Abuse Reporting in British Columbia.” Research and Practice 26 (1995): 245–251.

    Google Scholar 

  • Bergler, E. “Predictions, Guesses and Hunches in Psychotherapy.” International Record of Medicine 165(1) (1952): 1–10.

    Google Scholar 

  • Blacker, D. M. “Reporting of Child Sexual Abuse: The Effects of Varying Definitions of Reasonable Suspicion on Psychologists’ Reporting Behavior.” Ph. D. diss., California School of Professional Psychology, Berkeley/Alameda, 1998.

  • Bonardi, D. J. “Teachers’ Decisions to Report Child Abuse: The Effects of Ethnicity, Attitudes, and Experiences.” Ph. D. diss., Pacific Graduate School of Psychology, 2000.

  • Brosig, C. L. and S. C. Kalichman. “Clinicians’ Reporting of Suspected Child Abuse: A Review of the Empirical Literature.” Clinical Psychology 12 (1992): 155–168.

    Google Scholar 

  • Cardini, F. and H. Weixin. “Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial.” Journal of the American Medical Association 280(18) (1998): 1580–1584.

    Google Scholar 

  • Carl E. Gray v. State of Florida, 520 So. 2d 584 (1988).

  • Child Abuse and Neglect Reporting Act, in California Penal Code, Article 2.5, Section 11166 (1963).

  • Commonwealth of Pennsylvania v. Benjamin R. Reppert, 383 A.2d (2001).

  • Connally v. General Construction Company, 269 United States 385 (1926).

  • Cote, A., P. Russo, and J. Michaud. “Sudden Unexpected Deaths in Infancy: What Are the Causes?” Journal of Pediatrics 135(4) (1999): 437–443.

    Google Scholar 

  • Crenshaw, W. B., L. M. Crenshaw, and J. W. Lichtenberg. “When Educators Confront Child Abuse: An Analysis of the Decision to Report.” Child Abuse & Neglect 19(9) (1995): 1095–1113.

    Google Scholar 

  • Davey, R. I. and J. Hill. “A Study of the Variability of Training and Beliefs among Professionals Who Interview Children to Investigate Suspected Sexual Abuse.” Child Abuse & Neglect 19(8) (1995): 933–942.

    Google Scholar 

  • Deisz, R., H. Doueck, and N. George. “Reasonable Cause: A Qualitative Study of Mandated Reporting.” Child Abuse & Neglect 20(4) (1996): 275–287.

    Google Scholar 

  • Delaronde, S., G. King, R. Bendel, and R. Reece. “Opinions among Mandated Reporters toward Child Maltreatment Reporting Policies.” Child Abuse & Neglect 24(7) (2000): 901–910.

    Google Scholar 

  • Deyoung, Y. and E. F. Zigler. “Machismo in Two Cultures: Relation to Punitive Child-Rearing Practices.” American Journal of Orthopsychiatry 64(3) (1994): 386–395.

    Google Scholar 

  • Diaz, A., E. Simantov, and V. I. Rickert. “Effect of Abuse on Health.” Archives of Pediatric and Adolescent Medicine 156 (2002): 811–817.

    Google Scholar 

  • Discala, C., R. Sege, G. Li, and R. M. Reece. “Child Abuse and Unintentional Injuries.” Archives of Pediatric and Adolescent Medicine 154 (2000): 16–22.

    Google Scholar 

  • Drake, B. and S. Zuravin. “Bias in Child Maltreatment Reporting: Revisiting the Myth of Classlessness.” American Journal of Orthopsychiatry 68(2) (1998): 295–304.

    Google Scholar 

  • Dubowitz, H. and M. Black. “Teaching Pediatric Residents About Child Maltreatment.” Journal of Behavioral Pediatrics 12(5) (1991): 305–307.

    Google Scholar 

  • Dubowitz, H., A. Klockner Jr., R. H. Starr, and M. M. Black. “Community and Professional Definitions of Child Neglect.” Child Maltreatment 3(3) (1998): 235–243.

    Google Scholar 

  • Dukes, R. L. and R. B. Kean. “An Experimental Study of Gender and Situation in the Perception and Reporting of Child Abuse.” Child Abuse & Neglect 13 (1989): 351–360.

    Google Scholar 

  • Edwards, V. J., R. F. Anda, D. F. Nordenberg, V. J. Gellitti, D. F. Williamson, and J. A. Wright. “Bias Assessment for Child Abuse Survey: Factors Affecting Probability of Response to a Survey About Child Abuse.” Child Abuse & Neglect 25(1) (2001): 307–312.

    Google Scholar 

  • Erickson, M. J., T. D. Hill, and R. M. Siegel. “Barriers to Domestic Violence Screening in the Pediatric Setting.” Pediatrics 108(1) (2001): 98–102.

    Google Scholar 

  • Fargason, C. A., R. G. Chernoff, and R. R. S. Socolar. “Attitudes of Academic Pediatricians with a Specific Interest in Child Abuse Toward the Spanking of Children.” Archives of Pediatric and Adolescent Medicine 150 (1996): 1049–1053.

    Google Scholar 

  • Fein, J. A., N. Kassam-Adams, M. Gavin, R. Huang, D. Blanchard, and E. M. Datner. “Persistence of Posttraumatic Stress in Violently Injured Youth Seen in the Emergency Department.” Archives of Pediatric and Adolescent Medicine 156 (2002): 836–840.

    Google Scholar 

  • Fein, S. “Effects of Suspicion on Attributional Thinking and the Correspondence Bias.” Journal of Personality and Social Psychology 70(6) (1996): 1164–1184.

    Google Scholar 

  • Fein, S., and J. L. Hilton. “Judging Others in the Shadow of Suspicion.” Motivation and Emotion 18(2) (1994): 167–198.

    Google Scholar 

  • Finkelhor, D. “Is Child Abuse over-Reported? The Data Rebut Arguments for Less Intervention.” Public Welfare 48 (1990): 22–29.

    Google Scholar 

  • Fisher, L. “Hermeneutics of Suspicion.” Philosophy and Literature 16(1) (1992): 106–114.

    Google Scholar 

  • Flaherty, E. G., R. Sege, H. J. Binns, C. L. Mattson, and K. K. Christoffel. “Health Care Providers’ Experience Reporting Child Abuse in the Primary Care Setting.” Archives of Pediatric and Adolescent Medicine 154 (2000): 489–493.

    Google Scholar 

  • Flaherty, E. G., R. Sege, C. L. Mattson, and H. J. Binns. “Assessement of Suspicion of Abuse in the Primary Care Setting.” Ambulatory Pediatrics 2(2) (2002): 120–126.

    Google Scholar 

  • Flieger, C. L. “Reporting Child Physical Abuse: The Effects of Varying Legal Defi-nitions of Reasonable Suspicion on Psychologists’ Child Abuse Reporting.” Doctoral, The California School of Professional Psychology, 1998.

  • Foreman, T., and W. Bernet. “A Misunderstanding Regarding the Duty to Report Suspected Abuse.” Child Maltreatment 5(2) (2000): 190–196.

    Google Scholar 

  • Haeringen, A. R. V., M. Dadds, and K. L. Armstrong. “The Child Abuse Lottery – Will the Doctor Suspect and Report? Physician Attitudes Towards and Reporting of Suspected Child Abuse and Neglect.” Child Abuse & Neglect 22(3) (1998): 159–169.

    Google Scholar 

  • Hampton, R. L. and E. Newberger. “Child Abuse Incidence and Reporting by Hospitals: Significance of Severity, Class, and Race.” American Journal of Public Health 75 (1985): 56–68.

    Google Scholar 

  • Hansen, K. K. “Folk Remedies and Child Abuse: A Review with Emphasis on Caida De Mollera and Its Relationship to Shaken Baby Syndrome.” Child Abuse & Neglect 22(2) (1997): 117–127.

    Google Scholar 

  • Harrington, D., M. M. Black Jr. R. H. Starr, and H. Dubowitz. “Child Neglect: Relation to Child Temperament and Family Context.” American Journal of Orthopsychiatry 68(1) (1998): 108–116.

    Google Scholar 

  • Hawkins, R. and C. McCallum. “Effects of Mandatory Notification Training on the Tendency to Report Hypothetical Cases of Child Abuse and Neglect.” Child Abuse Review 10(5) (2001): 301–322.

    Google Scholar 

  • Hettler, J. and D. S. Greenes. “Can the Initial History Predict Whether a Child with a Head Injury Has Been Abused?” Pediatrics 111(3) (2003): 602–607.

    Google Scholar 

  • Hickson, G. B., W. O. Cooper, P. W. Campbell, and W. A. Altemeier. “Effects of Pediatrician Characteristics on Management Decisions in Simulated Cases Involving Apparent Life-Threatening Events.” Archives of Pediatric and Adolescent Medicine 152 (1998): 383–387.

    Google Scholar 

  • Hilton, J. L., S. Fein, and D. T. Miller. “Suspicion and Dispositional Inference.” Personality & Social Psychology Bulletin 19(5) (1993): 501–512.

    Google Scholar 

  • Howe, A. C., S. Herzberger, and H. Tennen. “The Influence of Personal History of Abuse and Gender on Clinicians’ Judgments of Child Abuse.” Journal of Family Violence 3 (1988): 105–119.

    Google Scholar 

  • Hutchinson, E. D. “Mandatory Reporting Laws: Child Protective Cases Gone Awry.” Social Work 38 (1993): 56–63.

    Google Scholar 

  • Hymel, K. P., and C. Jenny. “Child Sexual Abuse.” Pediatrics in Review 17(7) (1996): 236–250.

    Google Scholar 

  • Illinois v. Gates et ux., United States Supreme Court. 2317 (1982).In the Matter of Kimberly S. M., an Infant, by Her Parents and Legal Guardians, Mariann D. M. Et Al. v. Bradford Central School, 649 N. Y. S.2d 588 (1996).

  • Kalichman, S. C. Mandated Reporting of Suspected Child Abuse: Ethics, Law, & Policy. 2nd edition Washington, D. C.: American Psychological Association, 1999.

    Google Scholar 

  • Kee, H. W., and R. E. Knox. “Conceptual and Methodological Considerations in the Study of Trust and Suspicion.” Journal of Conflict Resolution 14(3) (1970): 357–366.

    Google Scholar 

  • Kempe, C. H., F. N. Silverman, B. F. Steele, W. Droegemueller, and H. K. Silver. ''The Battered Child Syndrome.'' Journal of the American Medical Association 181(1) (1962): 17-24.

    Google Scholar 

  • Korbin, J. E. ''Child Abuse and Neglect: The Cultural Context.'' In The Battered Child. Edited by R. E. Helfer and R. S. Dempe. 23-41. Chicago: University of Chicago Press, 1987.

    Google Scholar 

  • Lansford, J. E., K. A. Dodge, G. S. Pettit, J. E. Bates, J. Crozier, and J. Kaplow. ''A 12-Year Prospective Study of the Long-Term Effects of Early Child Physical Maltreatment on Psychological, Behavioral, and Academic Problems in Adolescence.'' Archives of Pediatric and Adolescent Medicine 156 (2002): 824-830.

    Google Scholar 

  • Leventhal, J. M. ''Thinking Clearly About Evaluations of Suspected Child Abuse.'' Clinical Child Psychology and Psychiatry 5(1) (2000): 139-147.

    Google Scholar 

  • Levine, M., H. J. Doueck, J. B Freeman, and C. Compaan. ''Rush to Judgment? Child Protective Services and Allegations of Sexual Abuse.'' American Journal of Orthopsychiatry 68(1) (1998): 101-106.

    Google Scholar 

  • MacLeod, J., and G. Nelson. ''Programs for the Promotion of Family Wellness and the Prevention of Child Maltreatment: A Meta-Analytic Review.'' Child Abuse & Neglect 24(9) (2000): 1127-1149.

    Google Scholar 

  • Marshall, W. N., and C. Locke Jr. ''Statewide Survey of Physicians Attitudes to Controversies About Child Abuse.'' Child Abuse & Neglect 21(2) (1997): 171-179.

    Google Scholar 

  • McMahon, P., W. Grossman, M. Gaffney, and C. Stanitski. ''Soft-Tissue Injury as an Indication of Child Abuse.'' The Journal of Bone and Joint Surgery 77-A(8) (1995): 1179-1183.

    Google Scholar 

  • Meriwether, M. H. ''Child Abuse Reporting Laws: Time for a Change.'' Family Law Quarterly 20(2) (1986): 141-171.

    Google Scholar 

  • Morris, J. L., C. F. Johnson, and M. Clasen. ''To Report or Not to Report: Physician's Attitudes Toward Discipline and Child Abuse.'' American Journal of Diseases in Childhood 139 (1985): 194-197.

    Google Scholar 

  • Myers, J. E. B. ''Medicolegal Aspects of Child Abuse.'' In Treatment of Child Abuse: Common Ground for Mental Health, Medical, and Legal Practitioners. Edited by R. M. Reece. 319-338. Baltimore: The Johns Hopkins University Press, 2000.

    Google Scholar 

  • Myers, J. E. B. ''Medicolegal Aspects of Suspected Child Abuse.'' In Child Abuse: Medical Diagnosis and Treatment. Edited by R. M. Reece and S. Ludwig. 545-563. Philadelphia: Lippincott, Williams, & Wilkins, 2001.

    Google Scholar 

  • National Clearinghouse on Child Abuse and Neglect Information. ''Child Abuse and Neglect State Statute Elements: Number 2, Mandatory Reporters of Child Abuse and Neglect.'' 50. Washington, D. C.: United States Department of Health and Human Resources, 2001.

  • National Clearinghouse on Child Abuse and Neglect Information. ''Current Trends in Child Maltreatment Reporting Laws.'' 25. Washington, D. C.: United States Department of Health and Human Services, 1999.

  • National Clearinghouse on Child Abuse and Neglect Information. ''Statutes at a Glance: Mandatory Reporters of Child Abuse and Neglect.'' 9. Washington: United States Department of Health and Human Services, 2002.

  • Overpeck, M. D., R. A. Brenner, A. C. Trumble, L. B. Trifiletti, and H. W. Berendes.''Risk Factors for Infant Homicide in the United States.'' New England Journal of Medicine 339(17) (1998): 1211-1216.

    Google Scholar 

  • Paradise, J. E., M. R. Winter, M. A. Finkel, A. B. Berenson, and A. S. Beiser. ''Influence of the History on Physicians' Interpretations of Girls' Genital Findings.'' Pediatrics 103(5) (1999): 980-986.

    Google Scholar 

  • People of the State of Michigan v. Alfred Cavaiani, 172 Michigan Appeals Court 706 (1988).

  • Pitetti, R. D., F. Maffei, K. Chang, R. Hickey, R. Berger, and M. C. Pierce. ''Prevalence of Retinal Hemorrhages and Child Abuse in Children Who Present with an Apparent Life-Threatening Event.'' Pediatrics 110(3) (2002): 557-562.

    Google Scholar 

  • Rao, N., and E. Eckert. Dominic James: Special Report. http://springfield.newsleader. com/specialreports/dominicjames/.

  • Reece, R. M. and S. Ludwig, eds. Child Abuse: Medical Diagnosis and Treatment. Philadelphia: Lippincott, Williams, & Wilkins, 2001.

    Google Scholar 

  • Rosen, C. H. ''Factors Relating to Clinicians' Decisions to Report Child Abuse.'' P h. D. diss., Loyola University of Chicago, 1998.

  • Ruppel, R. A., P. M. Kochanek, P. David Adelson, M. E. Rose, S. R. Wisniewski, M. J. Bell, R. S. B. Clark, D. W. Marion, and S. H. Graham. ''Excitatory Amino Acid Concentrations in Ventricular Cerebrospinal Fluid after Severe Traumatic Brain Injury in Infants and Children: The Role of Child Abuse.'' Journal of Pediatrics 138(1) (2001): 18-25.

    Google Scholar 

  • Saluja, G., J. Kotch, and L. C. Lee. ''Effects of Child Abuse and Neglect: Does Social Capital Really Matter?'' Archives of Pediatric and Adolescent Medicine 157(7) (2003): 681-686.

    Google Scholar 

  • Saul Ornelas and Ismael Ornelas-Ledesma v. United States, 517 United States 690 (1996).

  • Scheid, J. M. ''Recognizing and Managing Long-Term Sequelae of Childhood Maltreatment.'' Pediatric Annals 32(6) (2003): 391-401.

    Google Scholar 

  • Schwartz, A. J. and L. R. Ricci. ''How Accurately Can Bruises Be Aged in Abused Children? Literature Review and Synthesis.'' Pediatrics 97(2) (1996): 254-257.

    Google Scholar 

  • Shand, A. F. ''Suspicion.'' British Journal of Psychology 13 (1922): 195-214.

    Google Scholar 

  • Singley, S. J. ''Failure to Report Suspect Child Abuse: Civil Liability of Mandated Reporters.'' Journal of Juvenile Law 19 (1998): 236-270.

    Google Scholar 

  • State of Minnesota v. Curtis Lowell Grover, 437 N. W.2d 60 (1989).

  • State of Wisconsin v. Richard Hurd, 400 N. W.2d 42 (1986).

  • Steinberg, K. L., M. Levine, and H. J. Doueck. ''Effects of Legally Mandated Child Abuse Reports on the Therapeutic Relationship.'' American Journal of Orthopsychiatry 67(1) (1997): 112-122.

    Google Scholar 

  • Telden, V. P., T. A. Schmidt, B. J. Limandri, G. T. Chiodo, M. J. Garland, and P. A. Loveless. ''Factors That Influence Clinicians' Assessment and Management of Family Violence.'' American Journal of Public Health 84(4) (1994): 628-633.

    Google Scholar 

  • Ten Bensel, R. W. and M. Wilcox. ''Facilitating Physician Reporting of Child Abuse.'' Minnesota Medicine 79 (1986): 651-653.

    Google Scholar 

  • Terry v. Ohio, 88 United States Supreme Court 1868 (1968).

  • Thompson-Cooper, I., R. Fugere, and B. M. Cormier. ''The Child Abuse Reporting Laws: An Ethical Problem for Professionals.'' Canadian Journal of Psychiatry 38 (1993): 557-562.

    Google Scholar 

  • Trost, C. ''Chilling Child Abuse Reporting: Rethinking the CAPTA Amendments.'' Vanderbilt Law Review 51 (1998): 183-215.

    Google Scholar 

  • United States v. Ragen, 314 US 513 (1942).

  • Vulliamy, A. P., and R. Sullivan. ''Reporting Child Abuse: Pediatricians' Experiences with the Child Protection System.'' Child Abuse & Neglect 24(11) (2000): 1461-1470.

    Google Scholar 

  • Walker, E. A., J. Unutzer, C. Rutter, A. Gelfand, K. Saunders, M. VonKorff, M. P. Koss, and W. Katon. ''Costs of Health Care Use by Women HMO Members with a History of Childhood Abuse and Neglect.'' Archives of General Psychiatry 56 (1999): 609-613.

    Google Scholar 

  • Warner, J. E. and D. J. Hansen. ''The Identification and Reporting of Physical Abuse by Physicians: A Review and Implications for Research.'' Child Abuse & Neglect 18 (1994): 11-25.

    Google Scholar 

  • White, A. R. ''Suspicion.'' In Wittgenstein's Intentions. Edited by J. V. Canfield. 81-85. Hamden: Garland, 1993.

  • Widom, C. S. ''Posttraumatic Stress Disorder in Abused and Neglected Children Grown Up.'' American Journal of Psychiatry 156(8) (1999): 1223-1229.

    Google Scholar 

  • Wissow, L. S. ''Child Abuse and Neglect.'' New England Journal of Medicine 332(21) (1995): 1425-1431.

    Google Scholar 

  • Wissow, L. S. and M. E. H. Wilson. ''Use of Epidemiological Data in the Diagnosis of Physical Child Abuse: Variations in Response to Hypothetical Cases.'' Child Abuse & Neglect 16 (1992): 49-55.

    Google Scholar 

  • Wright, R. J., R. O. Wright, L. Farnan, and N. E. saac. ''Response to Child Abuse in the Pediatric Emergency Department: Need for Continued Education.'' Pediatric Emergency Care 15(6) (1999): 376-382.

    Google Scholar 

  • Wyatt, G. E., T. B. Loeb, B. Solis, and J. V. Carmona. ''The Prevalence and Circumstances of Child Sexual Abuse: Changes across a Decade.'' Child Abuse & Neglect 23(1) (1999): 45-60.

    Google Scholar 

  • Zellman, G. L. ''Report Decision-Making Patterns among Mandated Child Abuse Reporters.'' Child Abuse & Neglect 14 (1990): 325-336.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Levi, B., Loeben, G. Index of suspicion: feeling not believing. Theor Med Bioeth 25, 277–310 (2004). https://doi.org/10.1007/s11017-004-3136-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11017-004-3136-8

Navigation