Parental substance misuse and compliance as factors determining child removal: A sample from the Victorian Children's Court in Australia

Purpose

The current study explores the role of parental substance misuse in child protection cases and examines its impact as a factor in decisions on child removal in court orders.

Methods

A cohort of 273 child protection cases from the Victorian Children's Court was reviewed. This sample consisted of cases where children have been removed (Custody to Secretary Order, n = 142 cases) or remained with parents (Supervision Order, n = 131 cases). Data was extracted on parental substance misuse in single and two parent households as well as compliance with court-based and child protection directives.

Principle results

Parental substance misuse (PSM) was present in 51% of child protection cases sampled and among those, poly-substance abuse was common (67%). PSM was associated with Indigenous status; younger age of child at court appearance; having a court-proven case of emotional abuse, less compliance with child protection services and a longer time between notification to authorities and final court decision. In one parent households, only parental compliance is the primary factor underlying decisions of child removal. In two parent households, the decision to remove a child from the family home was ultimately driven by parental compliance, and to a lesser extent by PSM of illicit drugs and the number of parents misusing drugs.

Conclusion

PSM and non-compliance appear to be significant factors in delaying stability for the child through the granting of court orders which may involve child removal. There is a need, by child protection professionals, for prompt recognition of PSM and associated compliance/engagement issues in order to refer appropriate cases for further assessment and treatment in specialist drug treatment services. Early involvement with specialist drug treatment services provides the Court with an indication of compliance which is an important factor for making decisions that assist with achieving stability for the child.     

Intention to leave in social workers and educators employed in voluntary child welfare agencies

Introduction

Individuals employed in child welfare settings can have a profound impact on children in care. Research shows that direct care staff can have an effect on emotional and physical outcomes for children with whom they work. This paper seeks to expand knowledge of the child welfare workforce by studying educators employed in child welfare settings and comparing their job satisfaction and intent to leave with that of prevention workers employed in similar settings.

Materials and methods

Data for prevention workers (n = 538) were obtained from workers employed at all preventive service programs under contract with a large municipality. Data for educators were obtained from voluntary agencies located elsewhere in the state (n = 139). The instrument was a modified version of a survey developed to examine job satisfaction and potential turnover among public child welfare workers. Domains measured included various aspects of job satisfaction, intention to leave, and whether workers regretted taking their jobs. Data were analyzed using bivariate analysis and structural equation modeling (SEM).

Results

While both educators and prevention workers varied on different domains of job satisfaction, their overall satisfaction did not differ nor did their intention to leave their jobs. Satisfaction with contingent rewards, the nature of the work and opportunities for promotion along with not regretting taking one's job were predictive of thinking about leaving one's job. Thinking about leaving was predictive of taking concrete steps towards actual leaving.

Discussion

While people both prevention workers and educators report different levels of job satisfaction and work conditions in their agencies, job title itself has less to do with a worker's intention to leave, as measured by both thinking about leaving and taking steps towards actively looking for a new job, than other factors. Larger contextual factors may be at play in workers' decisions to stay employed. Suggestions are made for reducing turnover intentions along with suggestions for further study to clarify the role of organizational factors in workers' intention to leave.     

Actuarial risk assessment in child protective services: Construction methodology and performance criteria

Purpose

To prevent the recurrence of child maltreatment, actuarial risk assessment can help child protective services (CPS) workers make more accurate and consistent decisions. However, there are few published articles describing construction methodologies and performance criteria to evaluate how well actuarial risk assessments perform in CPS. This article describes methodology to construct and revise an actuarial risk assessment, reviews criteria to evaluate the performance of actuarial tools, and applies a methodology and performance criteria in one state.

Methods

The sample included 6832 families who were followed for two years to determine whether they were re-reported and re-substantiated for maltreatment.

Results

Both the adopted and the revised tools had adequate separation and good predictive accuracy for all families and for the state's three largest ethnic/racial groups (White, Latino, and African American). The adopted tool classified relatively few families in the low-risk category; the revised tool distributed families across risk categories.

Conclusions

The revised tool classified more families as low-risk, allowing CPS to allocate more resources to higher-risk families, but at the cost of more false negatives.     

Establishing a mental health service for young children in out-of-home care: The Gumnut Clinic for 0 to 5 year olds in Western Sydney

Objective

Children aged 0 to 5 years in out-of-home care represent a vulnerable population at high risk of social, emotional and developmental problems, yet there are few services specifically addressing their psychological needs. This paper is the first of two concerning the establishment of The Gumnut Clinic, a specialist mental health assessment clinic in Western Sydney for this population. The current paper provides the rationale for the development of the clinic and detail of the referral and assessment processes.

Method

The paper describes the establishment of The Gumnut Clinic at Redbank House in Sydney, Australia, the approach to assessment of these young children and their carers, and the challenges encountered.

Conclusions

Young children are overrepresented in child protection and out-of-home care services. Their social, emotional and developmental needs are under-recognized. Development of a specialist mental health service is a step towards improving health outcomes for these children.     

Reducing turnover is not enough: The need for proficient organizational cultures to support positive youth outcomes in child welfare

Objective

High caseworker turnover has been identified as a factor in the poor outcomes of child welfare services. However, almost no empirical research has examined the relationship between caseworker turnover and youth outcomes in child welfare systems and there is an important knowledge gap regarding whether, and how, caseworker turnover relates to outcomes for youth. We hypothesized that the effects of caseworker turnover are moderated by organizational culture such that reduced caseworker turnover is only associated with improved youth outcomes in organizations with proficient cultures.

Methods

The study applied hierarchical linear models (HLM) analysis to the second National Survey of Child and Adolescent Well-being (NSCAW II) with a U.S. nationwide sample of 2346 youth aged 1.5- to 18-years-old and 1544 caseworkers in 73 child welfare agencies. Proficient organizational culture was measured by caseworkers' responses to the Organizational Social Context (OSC) measure; staff turnover was reported by the agencies' directors; and youth outcomes were measured as total problems in psychosocial functioning with the Child Behavior Checklist (CBCL) completed by the youths' caregivers at intake and at 18-month follow-up.

Results

The association between caseworker turnover and youth outcomes was moderated by organizational culture. Youth outcomes were improved with lower staff turnover in proficient organizational cultures and the best outcomes occurred in organizations with low turnover and high proficiency.

Conclusions

To be successful, efforts to improve child welfare services by lowering staff turnover must also create proficient cultures that expect caseworkers to be competent and responsive to the needs of the youth and families they serve.     

Public attitudes toward the identification and reporting of alleged maltreatment cases among social groups in Israel

Objectives

To identify what types of behaviors are defined as child maltreatment by the Israeli public, and which types of incidences are seen as justifying reporting to the authorities. The study examines to what extent these views are different among social groups in the Israeli society (e.g., Arabs and ultra-Orthodox).

Methods

A telephone survey was conducted among a representative sample of 812 adults in Israel, with an oversampling of additional 50 ultra-Orthodox Jews. A series of 12 scenarios was presented to respondents who indicated whether each of them was a case of maltreatment and whether it justified reporting to authorities.

Results

There was strong consensus among the participants that some scenarios indicate maltreatment. These scenarios related to all types of maltreatment and were associated with potentially severe harm. The tendency to justify reporting is weaker than the tendency to see them as cases of maltreatment. Further, there is a correspondence (although not a perfect one) between to what extent scenarios are judged as more indicative of maltreatment and the extent to which they are seen as justifying reporting. Both Arabs and ultra-Orthodox Jews tend to see more maltreatment than Jews in general and non ultra-Orthodox Jews in particular, except for using corporal punishment to “educate” an insolent child. No consistent differences were found between these groups in their justification for reporting.

Conclusions

There are indications that the underlying dimension which determines the identification of cases as maltreatment and justifies reporting is the severity of the potential harm to child, rather than the type of maltreatment (i.e., physical, sexual, neglect or emotional). The authors suggest that public campaigns should be tailored to address the different attitudes and perspectives of different social-cultural groups.     

The surprisingly weak evidence base for supervision: Findings from a systematic review of research in child welfare practice (2000–2012)

Objective

The objective of this study is to ascertain what is known about the effectiveness and cost-effectiveness of supervision in child welfare in relation to outcomes for consumers/service users, staff and organizations.

Method

This is a systematic review of the English language literature (2000–2012). Scoping study is followed by database searches of indexes and abstracts including Campbell Collaboration, CINAHL, the Cochrane Library, Medline, PsycInfo and Social Work Abstracts, journal hosts (EBSCO and IngentaConnect) plus specialist journals. Inclusion criteria: studies that reported on the associations between the provision of supervision and outcomes for service users/consumers, workers and organizations as well as intervention studies. Potentially relevant studies were independently screened by two reviewers (Stage 1) and if meeting the eligibility criteria proceed to full text review and data extraction (Stage 2). Studies were subject to critical appraisal by three reviewers using the Weight of Evidence approach (Stage 3). An analysis of included study characteristics is followed by a narrative synthesis of findings structured to answer the research objective.

Results

690 unique studies were identified at Stage 1, 35 proceeded to Stage 2 and, following quality appraisal, 21 were included in the review. Almost all of the studies were cross-sectional, providing evidence of associations between the provision of supervision and a variety of outcomes for workers, including job satisfaction, self-efficacy and stress and for organizations, including workload management, case analysis and retention. There was only one, poorly reported, intervention study and no studies of outcomes for consumers. No economic evaluations were found.

Conclusions

The evidence base for the effectiveness of supervision in child welfare is surprisingly weak. An agenda for research based on a framework for the development and evaluation of complex interventions is proposed.     

Temporal stability of entries and predictors for entry into out-of-home care before the third birthday: A Danish population-based study of entries from 1981 to 2008

Objective

Placing a child in out-of-home care is one of the most radical measures a child protection system can decide to take. There is an essential interest in understanding the probability of entering care and what circumstances are related to the decision to place a child in out-of-home care. This study investigates the temporal stability of rates and predictors for entry into care.

Method

Data were obtained by linking several registration systems. The study population was defined as all children entering care before their third birthday from birth cohorts 1981–2008 (N = 11,034). Furthermore, a control population consisting of a randomly assigned quarter of the Danish child population from the same birth cohorts was used (N = 515,773). Rates of entry and Cox regression models from six periods from 1981 to 2008 were used to model co-variates associated with entry into out-of-home care.

Results

The overall likelihood for entering care is found to be decreasing over time. Furthermore, results reveal two trends: relative rates of entry are significantly decreasing for children whose mother has a psychiatric history prior to the child's birth; relative rates are significantly increasing for children whose mother or father was unemployed in the year prior to the child's birth.     

Case Reading as a Practice and Training Intervention in Domestic Violence and Child Protection

This article explores the role of a case-reading tool, developed by the Safe and Together Institute, deployed across five Australian states, and which engaged workers from child protection (CP) and specialist domestic and family violence (DFV) services. It aimed to assess the extent to which DFV is identified in CP case files and to assess the quality of case practice from a DFV-informed perspective, as documented in the case file. The Safe and Together approach to child welfare provides a robust foundation upon which practitioners from statutory and nonstatutory backgrounds can work collaboratively and reach consensus about how best to ensure the safety and wellbeing of children living with DFV. The case reading is both a process of transformative working for practitioners and an analytical tool through which their agencies can affect systemic change.

IMPLICATIONS

• A national audit of 20 child protection case files using the Safe and Together case-reading process indicated that documented child protection practice sits at the lower end of a domestic and family violence-informed Continuum of Practice.

• Analysis indicates a need to improve: child protection engagement with fathers who use DFV, assessments of their parenting role and its impact on children and family functioning; identification of adult survivors’ protective capacities and their impact on children.

• Research in this area may have broader implications for other professions and government policy both nationally and internationally.

     

The relationship of placement experience to school absenteeism and changing schools in young,school-aged children in foster care

Background

Chronic school absenteeism and frequent school changes, particularly among younger children, may be antecedents for the high rates of school failure and subsequent dropout among youth in foster care. However, the relationship of foster care experience to absenteeism and school change has not been well studied.

Objective

This study examined the association of placement experience with absenteeism and changing schools among 209 urban children in foster care enrolled in public elementary schools.

Methods

A cohort of children aged 5 to 8 years who entered non-relative or kinship foster care from 2006–2008 were followed longitudinally for 2 years from entry into foster care. Children residing in foster care were categorized at the end of the study as early stable, late stable, or unstable, if they achieved a permanent placement prior to 45 days, between 45 days and 9 months, or failed to do so within 9 months, respectively. Children who reunified home were classified as a fourth category. Poisson regression, controlling for baseline factors, was used to compare days absent and number of schools attended across categories of placement experience.

Results

Among the 209 children, 51% were male, 79% were African American, and 55% were initially placed with kin. One third of children reunified home; among children who did not reunify, one half was early stable, and a third was unstable. Adjusted rates of school absenteeism increased in stepwise fashion as children's placements became more unstable; children with unstable placements were 37% more likely to be absent than those with early placement stability (p = 0.029). Children who reunified during the study demonstrated the highest rates of absenteeism; however, there was no significant difference in absenteeism before or after reunification. Number of schools attended increased as stability worsened, with the standardized rate of schools attended reaching 3.6 schools (95% CI 3.1–4.1) over a two year period among children in unstable placements.

Conclusions

The relationship between placement experience and school absenteeism and school change illustrates the need to better coordinate the educational experience of high-risk children in foster care. The secondary finding of high absenteeism among children in the process of returning home illustrates that educational challenges for youth may be equally if not more concerning among the greater majority of youth in child welfare who remain home with birth parents.     

Predictors of out-of-home placement following residential treatment

Objective

There is a lack of research examining predictors of out-of-home placement (OOHP) following residential treatment (RT). The current study examined how various child and family factors predict OOHP at discharge and 6-months post-discharge for a RT sample.

Methods

Three hundred and eighty-three children (11.92 years, SD = 2.63, 293 boys) with serious mental health disorders were assessed using the Brief Child and Family Phone Interview (BCFPI) and placement information forms at admission, discharge, and 6-months post-discharge from RT.

Results

OOHP at discharge was predicted by older age, OOHP at admission, child welfare involvement, deliberate self-harm, a history of physical abuse, neglect, witnessed domestic violence, and a poor family situation (p < .05). At 6-months post-discharge, OOHP was predicted by dual diagnosis, OOHP at admission, child welfare involvement, neglect, and witnessed domestic violence (p < .05).

Conclusions

Pre-treatment factors are predictive of OOHP following RT. Identifying these key predictors and developing permanency planning options for children to promote stability and consistency is essential. A systemic evidence-based approach is imperative in promoting resilience for children at risk of OOHP, including family intervention and collaboration with the community.     

Initial assessment: A key stage in social work intervention

Abstract

This paper examines the intake practices in child protection in the New South Wales Department of Community Services as a case study of initial assessment in social work intervention. Data was collected in three Department of Community Services local offices where 39 practitioners were interviewed about their child protection work practices. An observational study of the workers' intake practices was also undertaken for a period of approximately 110 days. While official Department of Community Services policy and procedures provided the basis for intake practice, this research found that other important factors relating to the informant, the characteristics of the frontline worker, the workplace environment and the context of child protection practice influenced the intake process. The implications of the research findings for other social work practice settings are considered.     

The transition from in-home services to out-of-home care: A Danish register-based study

Objective

This register-based study describes the transition from in home-based care to placements in out-of-home care. It also describes whether children who enter care directly differ from children who enter care after episodes of in home-based care.

Method

The study includes all children who entered the child protection system of a larger regional social service system in Denmark from 1993 to 2006 (N = 9961). Graphs of cumulative incidences were used to describe transitions into out-of-home care within two years after in home-based care started. Cox regression models are used to estimate the impacts of child and parental characteristics. In addition, Chi² tests are used to identify differences between children who enter care directly and children who receive in home-based care.

Results

Results indicate that the majority of children do not enter out-of-home care but that risks differ among age groups. Covariates did not predict transitions into out-of-home care for those who entered in-home care after becoming teenagers. Especially for those who entered in-home care before entering their teens, the psychiatric histories of the mothers and the children predicted the transitions into out-of-home care. Immigration background was a protective factor for those who entered in-home care as pre-scholars. Depending on the age group, low birth weight, children's fathers' and mothers' psychiatric histories, and single parentship were all characteristics more likely to be associated with children who entered care directly. Children who entered care directly differed from children who entered care within two years after an in home-based service had been initiated on covariates that described psychiatric history.     

Externalizing problems in young foster children: Prevalence rates,predictors and service use

Objective

Examining the prevalence of externalizing problems, their predictors and mental health service use for these problems by foster children and foster parents in a representative group of foster children aged 3 to 12 in Flanders.

Method

Survey data were collected on 212 foster children, who had been in the foster family for approximately four months. Foster parents filled out a Child Behavior Checklist to measure foster children's externalizing problems. Foster care workers reported on several potential risk variables for externalizing problems and on foster children's and foster parent's mental health service use. Predictors of externalizing problems were identified from a large number of variables using the method of purposeful selection of variables in linear regression.

Results

40.6% of the foster children had externalizing problems. Foster children who were placed because of behavioral problems had more externalizing problems. Only 20.9% of the foster children with externalizing problems and only 13.9% of their foster parents received professional help.

Conclusions

This study showed that externalizing problems are prevalent in this young foster care population, that it is hard to predict which foster children had externalizing problems, and that foster children and their foster parents rarely receive services for these problems. These findings call for a standard protocol of assessment of foster children's externalizing problems. Moreover, from a preventive viewpoint, guidelines are needed to systematically link young foster children with externalizing problems and their foster parents to appropriate services.     

Examining the equivalence of fidelity over two generations of KEEP implementation: A preliminary analysis

Problem

In order to obtain and maintain positive outcomes garnered from evidence-based practice (EBP) models, it is necessary to implement them effectively in “real world” settings, to continually monitor intervention fidelity to prevent drift, and to train new staff due to turnover. The fidelity monitoring processes that are commonly employed in research settings are labor intensive and probably unrealistic to employ in community agencies given the additional burden and cost that they represent over and above the cost of implementing the EBP. Efficient strategies for implementing fidelity monitoring and staff training procedures within the inner context of agency settings are needed to promote agency self-sufficiency and program sustainability.

Method

A cascading implementation model was used whereby agencies who achieved proficiency in KEEP, an EBP designed to prevent placement disruptions in foster and kinship child welfare homes, were trained to take on fidelity management roles to improve the likelihood of program sustainability. Agency staff were trained to self-monitor fidelity and to train internal staff to achieve model fidelity. A web-based system for conducting fidelity assessments and for onsite/internal and remote program quality monitoring was utilized.

Results

Scores on fidelity ratings from streamed observations of intervention sessions showed no differences for foster parents treated by first generation interventionists trained by model developers compared to a second generation of interventionists trained by the first generation.

Conclusion and relevance to child welfare

Development of the local intra-agency capacity to manage quality intervention delivery is an important feature of successful EBP implementation. Use of the cascading implementation model appears to support the development of methods for effective monitoring of fidelity of the KEEP intervention, for training new staff, and ultimately for the development of internal methods for maintaining program sustainability and effectiveness.     

Delinquent and aggressive behaviors in early-adopted adolescents: Longitudinal predictions from child temperament and maternal sensitivity

Background

160 early-adopted children were followed from infancy to adolescence. Central question was whether early and concurrent parenting and child temperament predicted adolescent delinquent and aggressive behaviors.

Methods

Structural equation modeling was used to test the relations between early and concurrent observed maternal sensitivity, mother reported effortful control and teacher reported delinquent and aggressive behaviors.

Results

This longitudinal adoption study showed that lower effortful control, concurrent as well as 7 years earlier, predicted higher levels of delinquency in adolescence and aggression in middle childhood and in adolescence. Lower levels of effortful control in infancy predicted higher levels of maternal sensitivity in adolescence which in its turn predicted less adolescent delinquent behavior.

Conclusions

The findings suggest that effortful control is an important predictor of both aggressive and delinquent behaviors. Maternal sensitivity also plays a role in the development of delinquent behavior, buffering a lack of effortful control, but is not related to aggression at age 14. It is important to note that these relations were found in a sample of parents and their genetically unrelated adopted children.     

Reflections on citizen-state child welfare partnerships: Listening to citizen review panel volunteers and agency liaisons

Objective

Previous research pertaining to the citizen review panel (CRP) initiative indicates that discrepancies exist between panel member and state agency liaison perceptions of CRP effectiveness in fulfilling the CAPTA CRP mandate. This study explores the impressions of both CRP members and liaisons involving barriers to effective CRP-state child welfare partnerships and recommendations to improve the relationship, provided through narrative survey responses from CRP liaisons from 30 states and D.C. and panel members from 32 states and D.C. Thematic categories which emerged from analyses of these responses are discussed, and a conceptual model and substantive-level theory of the CRP-child protective services (CPS) relationship developed from the results are presented.

Results

The complex nature of CRP-CPS relationships emerged as the central theme among CRP members' and liaisons' responses. Liaisons and CRP members identified a need for CRP members to become more educated globally on child welfare despite the relatively high level of education and experience of much of the sample. Difficulties encountered by panel members in the effort to partner surfaced in themes of mistrust and skepticism about the worth of citizen participation in child protection. Negative agency attitudes, lack of role clarity, and lack of commitment to authentic partnership were cited as negative influences upon the relationship by both liaisons and CRP members. The most important preferred outcome of the partnership was that citizen volunteers would become more knowledgeable partners who could meaningfully contribute to child welfare efforts. A second desired outcome important to CRP members was to form a shared vision with CPS.

Conclusions

Findings imply that when key components of mutual respect, legitimacy, CPS knowledge, shared vision, authenticity, citizen engagement, honest communication, and a serious, deliberative process are in any way impeded, the partnership is vulnerable to breakdown, and intended outcomes may be compromised.

Implications

Important relational difficulties that have formed barriers between volunteers and CPS agencies have been identified, and results suggest specific issues to target for improvement. These findings can prompt a more informed discourse about the challenges and opportunities presented when attempting to engage citizens in child welfare practice and policy-making, and can lead to new research paths. Suggestions for such efforts are offered.     

Is program structure related to stigma and community acceptance of justice-involved adolescents?

Objective

The aim of the study is to examine the impact of diversion program characteristics on social stigma of delinquent adolescents in Jordan.

Method

A street survey of adults was conducted in Amman, Jordan. Respondents were randomly assigned to read one of four vignettes involving a delinquent adolescent who participated successfully in one of four types of juvenile justice interventions: detention center placement; diversion with counseling; diversion with counseling plus victim apology and restitution; and diversion with counseling plus family-based apology and restitution. Respondents reported their willingness to accept the adolescent as a member of their child's school, as a friend of their child, as a spouse for their child, and as a future employee. Seventy seven percent of adults approached participated (N = 137).

Results

Respondents reported greater willingness to accept the adolescent when he participated in any of the three diversion programs compared to the detention center condition (β = .80, p < .05). However, there were no differences among the diversion program types (i.e., counseling only, counseling plus individual restorative justice, counseling plus tribal restorative justice) in acceptance levels. Regardless of intervention type, the perception that the adolescent had ‘learned his lesson’ was associated with greater acceptance and with heightened expectations of future success.

Conclusion

Intervention characteristics can influence public stigma in the Middle East. For justice involved youths, interventions that increase perceptions that youth have learned their lesson is a crucial ingredient to stigma reduction efforts. Social work interventions with delinquent adolescents and their families need to incorporate stigma management strategies that convey lesson-learning as a key intervention outcome.     

Are maternal and community risk factors associated with the presence of asthma among children placed in foster care?

Objective

The occurrence of pediatric asthma has been associated with exposure to chronic stress. This study examined the relationship between maternal and community risk factors and asthma in a sample of maltreated children in foster care.

Method

Interviews were conducted with 365 maltreated children in foster care. Measures included youth/caregiver reports of asthma, an index of maternal risk based on data abstracted from child welfare records and community violence exposure.

Results

After controlling for demographic variables, maternal risk was associated with the presence of asthma (OR = 1.314, 95% CI = 1.09–1.58). Community violence exposure, however, was not related to the presence of asthma.

Conclusion

Maternal risk factors were significantly associated with the presence of asthma in a foster care population. Physicians who care for maltreated children in foster care should be particularly attuned to the presence of these additional risk factors that may place high-risk children at increased risk for chronic health problems.     

Ethical and legal challenges of mandated child abuse reporters

Background

Mandated reporters inconsistently report child abuse cases. Ethical dilemmas and legal challenges to reporting arise creating barriers to assist abused children and their families.

Purpose

The purpose of this study was to describe professionals' ethical dilemmas and legal challenges to reporting child abuse.

Method

A qualitative study was conducted to explore the ethical and legal challenges of mandated reporters when reporting child abuse. Individual interviews between 60 and 100 min were conducted with a purposive sample of 18 mandated reporters including physicians, nurses, social workers, and teachers. Grounded theory methodology was used to develop categorical themes that reflected mandated reporters' experiences and challenges.

Result

Three themes emerged from the data: conflicts, time, and law as refuge. Professionals described challenges in balancing autonomy, beneficence, nonmaleficence, and justice. There was no best solution to do no harm. The associated stigma and pressure of cultural and secular norms of child abuse inhibit professionals' action based on legal and ethical requirements. The theme of time included limited time and an uncertain future. The law provides security and refuge for professionals to find a solution to the challenges of reporting child abuse.

Conclusion

The ethical and legal challenges of reporting child abuse create complex dilemmas for mandated reporters. Ethical principles are in constant opposition when negotiating rights of children and rights of parents. Supportive structures and education are needed to assist professionals in meeting their reporting obligation and solving their dilemmas.