Posted: June 11th, 2022

DISCUSSION POSTDue today at 6/9/2022 at 7 pm

nursingweek 2
ATTACHED FILE(S)
Week 2 Discussion Post
NRNP 6665
Holly Bowling
Child and Elder Abuse Reporting
The topic I chose to discuss is “Child and Elder Abuse Reporting”. Elder abuse is a
common form of violence against older people often committed by relatives or institutional
caregivers known to the victim and can be defined as “a single or repeated act, or lack of
appropriate action occurring within any relationship where there is an expectation of trust which
causes harm or distress to an older person’’ (Donovan & Regehr, 2010). However, elder abuse
can come in many different forms such as physical abuse, sexual abuse, emotional abuse,
financial/material exploitation, neglect, abandonment, and self-neglect. Approximately 1-2
million Americans have been a victim of some sort of abuse, and it is typically someone close to
them, such as their adult child or family member (APA, 2008). However, institutional abuse has
become a major concern lately with the COVID pandemic, as family members are not able to see
their loved ones or care for them at home (APA, 2008).
Child abuse “includes all types of abuse and neglect against a child under the age of 18
by a parent, caregiver, or another person in a custodial role that results in harm, the potential for
harm, or threat of harm to a child” (CDC, 2020). As with elderly abuse, child abuse can come in
many different forms, including physical, sexual, emotional abuse, and neglect. According to the
CDC (2020), approximately 1 in 7 children experience some form of abuse each year, with over
1700 dying of abuse in 2018. Children of abuse can not only suffer physical problems, but
psychological problems as well, including anxiety, depression, and PTSD, and can result in many
other psychological and health problems later in life (CDC, 2020).
The following will discuss four article summaries related to the legal and ethical issues
related to reporting child and elder abuse, as well as how the information could be applied to my
clinical practice.
Article 1- Ethical Considerations for Adults
The purpose of the article “Examining the Ethical Challenges in Managing Elder Abuse:
A Systematic Review” (Saghafi, Bahramnezhad, Poormollamirza, Dadgari, & Navab, 2019) is to
examine existing ethical challenges regarding elderly abuse. In the research conducted, the
results revealed no common definition and no legislation about elder abuse and also showed that
health care providers’ observance of ethical principles depends on the ethical and legal
conditions of the community (Saghafi et al., 2019). Cultural and religious differences are shown
to be the reasons for the lack of a common definition and legislation, which comprises the
biggest obstacle to protecting the rights of elderly people, and that ethical principles should be
respected as far as a person has competency. The article suggests that the care team and nurses
as the first line of treatment are responsible to identify and report mistreatments and support
vulnerable populations such as the elderly (Saghafi et al., 2019). Abuse by a family member or
intimate partner is complex, because the elderly may be struggling against social, cultural, and
religious aspects of life to live with abusive people, therefore it can be difficult for members of
the care team to perform a successful intervention for an elderly who is willing to stay in the
abusive situation. Two main issues that can be seen with the care team are job burnout and
ethical distress even though they have a thorough and accurate understanding of the ethical
concepts and challenges involved in elder abuse and decide on the best intervention (Saghafi et
al., 2019). The article brings out that when it comes to comprehensive ethical principles about
elder abuse that if the elderly suffer from cognitive disorders, psychologists should try to
maintain the confidentiality of their information and contact legal authorities, however, they are
allowed to disclose information in suspected abuse cases even without the patient’s consent, and
are also allowed to share the private information of patients with the latter’s families or with
other experts to protect patients against harm (Saghafi et al., 2019). In the question of reporting
and sharing information about elder abuse, respect for confidentiality and trust is one of the most
important ethical principles that have to be taken into consideration by caregivers, however,in
cases where serious harm is caused, the care team can disclose information without obtaining
consent. In the U.S., if a therapist is suspicious about abuse, they should report it to authorities
despite concerns over the patient’s privacy, as well as disclosing the patients’ private information
to protect them against harm (Saghafi et al., 2019). Lack of legislation is the biggest obstacle to
protecting the rights of elderly people in many countries, however, the availability of ethical
principles and laws helps the care team deal with abuse, as ethical principles are laid down by
experts to protect the profession (Saghafi et al., 2019).
“Indiana is a mandatory report state, meaning everyone is required by law to report cases
of suspected neglect, battery or exploitation of an endangered adult to an APS unit or law
enforcement. All reports are secured and kept confidential” (IN.gov, 2021).
Article 2-Ethical Considerations for Children
The purpose of the article Child Abuse: Is there a mandate for researchers to report (Liss,
1994) is to understand the legal-ethical conflict for the researcher in the field of child abuse and
neglect, as well as examining the tension between state laws that mandate the report of child
abuse. One main question of focus is whether researchers are to report child abuse or if they are
considereddiscretionaryreporters,meaningtheyhavetheoptiontoreportchildabuseand
neglect or not (Liss, 1994). The article brings out how the Child abuse prevention and treatment
ACT of1974requiresstatestoenactstatutesthatmandatethereportingofchildabuseand
neglect.However,allfiftystatesdifferduetohavingnospecificindividualsasmandated
reporters,therefore,somestateshavemandatedreporters,whileothershavediscretionary
reporters. It is up to each state to decide who is qualified to be a reporter of child abuse (Liss,
1994).Manystateshaveenactedpsychotherapist-patientprivilegestatutesthatcoverspecial
communications.Thepsychotherapist-patientprivilegeisreservedforsituationswherea
therapist-patientrelationshiphasbeenestablishedandwheredisclosuresaremadewiththe
expectation that they will remain confidential and private (Liss, 1994). However, in most states,
thereportingofchildabuseandneglectisanexceptiontothecustomarycircumstancesof
confidentiality and privilege. Just like a psychotherapist, researchers have authorized certificates
of confidentiality that shield individual data from subpoena, however, they do not address the
disclosure of child abuse and neglect, which, therefore, leavesthe researcher in a situation to
decideiftheyshoulddiscloseinformationinthebestinterestofthechild(Liss,1994).The
dilemma for the researcher under the discretionary reporting laws is the struggle between the
moral or ethical dilemma of protecting children and safeguarding their welfare which may be
partof the profession’sethical codeof behavior versusthe contractual agreement to maintain
confidentiality and anonymityaslaid out in the informedconsentsigned by thesubject. The
main point that must be taken from this article is that each researcher needs to determine their
responsibilities in terms of the reporting of child abuse and neglect. The decision will depend on
the individual state’s laws, the definition of the scope of practice of the investigator’s discipline,
and the type of disclosure made by the subject (Liss, 1994).
“Indiana is a mandatory reporting state, therefore, anyone who suspects a child has been
neglected or abused must by state law make a report” (IN.gov, 2021).
Article 3- Legal Considerations for Adults
The purpose of the article “Elder Abuse: Clinical, Ethical, and Legal Considerations in
Social Work Practice” (Donovan & Regehr, 2010) is to investigate challenges that arise with the
complexity of elder abuse cases and reviews clinical, ethical, and legal obligations to inform
clinical decision-making, as well as to address the problem, scope, and consequences of elder
abuse while focusing on alerting social work practitioners to the challenges which arise from the
ambiguity of current laws and guidelines (Donovan & Regehr, 2010). The article talks about
legislative changes that focus on issues of elder abuse and have moved towards mandatory
reporting and intervention in many jurisdictions. The issue that is posed with these changes is the
right of elderly individuals for self-determination and understandable resistance to the notion of
treating elderly individuals as essentially equivalent to children in need of protection. The article
helps those as healthcare workers to consider at what point does a person no longer has the right
to determine how they will live, and when is a person incapacitated to the point that mandatory
reporting of suspected abuse is warranted? (Donovan & Regehr, 2010). Social work practitioners
need to understand characteristics of the older adult’s cognitive abilities, mental health, and
physical health to assist in the understanding of the client’s capacity to make decisions and
vulnerability to abuse, otherwise, the social worker may misinterpret elder abuse in certain
situations (Donovan & Regehr, 2010). In regards to the legal aspect of reporting elderly abuse,
the article mentions how social workers should know the laws in their jurisdiction as they apply
to their clients and it is the legal duty of the practitioner to report abuse if their jurisdiction has
mandatory reporting laws. Federal laws and legislation do not necessarily protect or fund elder
abuse in the United States as it does for child abuse (Donovan & Regehr, 2010). However, the
article points out that all US states have enacted legislation authorizing the use of adult
protective services (APS) in cases of elder abuse, which help to establish a system for reporting
and investigating abuse and for the provision of social services to help the victim, as well as
requiring mandatory reporting from certain groups of people, such as healthcare workers to
report suspected cases of abuse to the appropriate social service (Donovan & Regehr, 2010).
However, statutes vary widely depending on the state and type of abuse committed. Therefore, it
is important for the healthcare professional to understand the laws of abuse reporting in their
state of employment, and to collaborate with the client and prospective parties in devising the
best option plan in keeping the client safe.
In the state of Indiana, “a person who believes or has reason to believe an endangered
adult is the victim of battery, neglect or exploitation is required to report the facts to Adult
Protective Services or a law enforcement agency having jurisdiction over the endangered adult”
(IN.gov, 2021).
Article 4-Legal Considerations for Children
The purpose of the article “Legal and Clinical Guidelines for Making a Child
Maltreatment Report” (Kenny, Abreu, Marchena, Helpingstine, Lopez-Griman, & Mathews,
2017).) is to help psychologists to interpret state laws related to abuse reporting, as well as
providing practical and clinical guidance for psychologists when confronted with making a
report of child abuse. Psychologists are in a distinctive role to report child maltreatment,
however, they often face barriers and challenges to reporting abuse, including a lack of
knowledge of the process of initiating a report were mandated by law. Many healthcare providers
are included as mandated reporters of child abuse, as this allows for secondary and tertiary
prevention such as intervening during an occurrence and rehabilitation after abuse occurs (Kenny
et al., 2017). The benefits of reporting child abuse include decreasing the likelihood of
reoccurrence of abuse for the victim and provision of services to the family. The standard for
most states when it comes to mandated reporting by mental health practitioners is that they are
permitted to disclose confidential information without the consent of the individual only as
mandated by law or to protect the client from harm. This standard covers the issue of making a
mandated report of child abuse as it is both covered by the law and intended to protect the victim
from harm (Kenny et al., 2017). The article points out how most states encourage reporting child
abuse immediately, while others have a timeframe of when to report. It is also brought out that
reporting can be made upon suspicion or belief as opposed to actual evidence. Results of the
study conducted showed that all 50 U.S. states have statutes set in place to protect mandatory
reporters from civil and criminal liabilities when abuse reports are filed in good faith, or in the
absence of malicious intent, regardless of whether the report results in a substantiated report
(Kenny et al., 2017). However, someone who fails to report or falsely reports child abuse is
subject to a penalty, such as a misdemeanor, although some states classify it as a felony and even
jail time. When unsure of whether or not to report child abuse, the practitioner can consult with
other colleagues or child protective services (CPS) for whether the report is acceptable or not
(Kenny et al., 2017).
In the state of Indiana “failure to report suspected abuse or neglect is a Class B
misdemeanor and nothing relieves an individual from his/her responsibility to report unless a
report has already been made to the best of the individual’s belief” (IN.gov, 2021).
Applying Information to Clinical Practice
As brought out previously, Indiana is a mandatory reporting state for child and elder
abuse (IN.gov, 2021). As an advanced practitioner, I need to make it a priority to understand the
laws and ethical dilemmas that might be brought about when treating such clients with potential
abuse in the state of Indiana. Every citizen has an equal responsibility to report child and elder
abuse and neglect, however, when it comes to making important decisions, such as in the
courtroom, individuals with special training and experience are usually expected to meet a
higher standard of care and responsibility, within any profession (Liss, 1994). As an advanced
mental health practitioner, I must be aware of any type of child or elder abuse and be able to
devise a treatment plan and report as appropriate to the correct agency. When assessing a child or
elder abuse, it is important to assess the client’s level of risk, presenting problem, and the goals
that have the greatest priority and impact of an intervention on the client (Saghafi et al., 2019).
Each case of suspected child and elder abuse and/or neglect presents unique challenges to
professionals and the worker must understand their roles and responsibilities to the client. Due to
the absence of clear guidelines, the sensitive nature of the work of the mental health provider
leaves the responsibility on the practitioner to be well versed in clinical, legal, and ethical
considerations to come to a professional and responsible resolution for their client.
References
American Psychological Association. (2008). Elder abuse. Retrieved from
https://www.apa.org/pi/prevent-violence/resources/elder-abuse
IN.gov. (2021). Indiana child abuse and neglect hotline. Retrieved from
https://www.in.gov/dcs/2971.htm
IN.gov. (2021). Adult protective services. Retrieved from https://www.in.gov/fssa/da/adult-
protective-services/
IN.gov. (2021). Department of Education Reporting Child Abuse Frequently Asked Questions.
Retrieved from https://www.doe.in.gov/sites/default/files/safety/faq-child-abuse.pdf
IN.gov. (2021). Elder abuse. Retrieved from https://www.in.gov/ipac/3248.htm
Donovan, K., & Regehr, C. (2010). Elder Abuse: Clinical, Ethical, and Legal Considerations in
Social Work Practice. Clinical Social Work Journal, 38(2), 174–182. https://doi-
org.ezp.waldenulibrary.org/10.1007/s10615-010-0269-2
Kenny, M. C., Abreu, R. L., Marchena, M. T., Helpingstine, C., Lopez-Griman, A., & Mathews,
B. (2017). Legal and clinical guidelines for making a child maltreatment
report. Professional Psychology: Research & Practice, 48(6), 469–480. https://doi-
org.ezp.waldenulibrary.org/10.1037/pro0000166
Liss, M. B. (1994). Child Abuse: Is There a Mandate for Researchers to Report? Ethics &
Behavior, 4(2), 133. https://doi-org.ezp.waldenulibrary.org/10.1207/s15327019eb0402_6
Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining
the ethical challenges in managing elder abuse: a systematic review. Journal of Medical
Ethics & History of Medicine, 12(1), 1–18.

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