Identifying Child Physical Abuse: Who Is Reporting, and How Accurate Are Their Reports?

Purpose: Child physical abuse (CPA) is one of the most lethal forms of child maltreatment; being reported for suspected CPA alone substantially heightens the child’s risk for sustaining future fatal injuries (Putnam-Hornstein, Cleves, Licht, & Needell, 2013). Therefore, early and accurate identification of CPA is imperative to the protection and timely provision of services to children in need. In the U.S., professionals who are mandated to report suspected child maltreatment initiate the majority of child maltreatment reports (62%; U.S. Department of Health and Human Services, 2015). However, few studies have been conducted to describe the distribution of report source for CPA or how report sources may associate with the outcomes of these reports. Further, these relationships have only been investigated using reports made for children under age five (King, Lawson, & Putnam-Hornstein, 2013). This study addressed these gaps by (1) describing the distribution of report sources for CPA reports investigated by Child Protective Services; (2) examining the likelihood of CPA report substantiation by reporter type (i.e. professionals and nonprofessionals) and report source (i.e. occupation of the professional reporter); and (3) fully investigating the impact of the child's age on the relationships between report outcomes and report source.

Methods: In a national sample of 204,414 children birth to age 17 years who were reported and investigated for suspected CPA in 2013, the distribution of reporter type and report source were described. Multilevel logistic regression was used to predict report outcome (i.e. substantiated or unsubstantiated) based on the reporter type or report source, controlling for child, caregiver, and state-level characteristics. A report source x child age interaction term was added to assess the differential impact of child age on report outcome by source of report. Marginal effects using mean predicted probabilities were calculated to predict the probabilities of report substantiation based on reporter type and occupation.

Results: Approximately 13% of children reported for CPA were later confirmed to be victims of abuse. Professional reporters initiated 84% of all CPA reports, of which 20% were made by a healthcare provider or mental health professional. The odds of report substantiation were 1.6 times higher when initiated by a professional versus a nonprofessional. Compared to nonprofessionals, reports made by healthcare providers and legal/law enforcement personnel have a 2.6 and 3.3 times higher odds of being substantiated, respectively. However, reports made by even the best reporters (i.e. legal/law enforcement) only have a 26% chance of substantiation. Moreover, mental health professionals appeared to be less accurate reporters than nonprofessionals (OR=0.67; 95%CI=0.62, 0.73). Overall, the difference in likelihood of CPA report substantiation among professional and nonprofessional reporters diminish as the age of the reported child increases.

Conclusion: In 2013, fewer than 1 in 7 children reported for CPA were found to be victims of abuse. Although there are many reasons for an unsubstantiated report, reports that cannot be confirmed due to weak or insufficient evidence may add undue stress onto a child protection system that is already stretched thin. Importantly, reports made without sufficient cause may threaten family well-being and further endanger families that are already vulnerable. Because professional reporters initiate the vast majority of CPA reports, strategies that promote accurate reporting among professionals are warranted. Some of these strategies that are pertinent to the nursing profession will be described.