It’s just a way to think of it. But no, in many states and certainly in mine, the nurse is not mandated to report a bruise unless he or she has some suspicion that a parent or other legally responsible person caused it by abusing the child. It’s not only a matter of what the child says. If the nurse has reason to believe that dad caused it- maybe the kid has constant bruises in uncommon places that a parent is attempting to hide by unseasonable clothing, then the nurse is mandated to report. If the nurse has no reason to disbelieve Billy that he got bruised playing baseball, then there is no mandated report. And if Billy got bruised when the kids who stole his bike punched him , it’s up to his parents to decide whether to file a police report.
Mandated reporters aren’t supposed to conduct their own investigation, but neither are they supposed to turn their brains off. No state wants every bruise reported and Kansas is one of the few that apparently wants every instance of underage sex reported.
It’s pretty hard to study people who haven’t been identified yet, so I was giving you the next best thing: people who were actively abusing children, and then were caught and placed in therapy. It turns out that therapy halves the chance that they will return to actively abusing children.
Moreover, that’s involuntary therapy: court- or prison-mandated mental health treatment that the offender has little ability to refuse. There is very little scientific research about the relative efficacy of voluntary versus involuntary treatment, but most therapists assert that patients who want to change (be it anorexia, alcohol abuse, whatever) have much more successful outcomes than those who don’t.
If being caught and placed in therapy significantly reduces the likelihood of stopping abuse, it’s at least reasonable to assume wanting to change and going to therapy voluntarily has at least the same likelihood.
I have no clue what kind of (ethical) test protocol could be developed to test that, however.
In almost every jurisdiction, the burden is on the therapist to determine if there is reasonable cause to believe imminent or ongoing abuse or neglect. That can be some tricky shit, and it opens the therapist up to a world of potential legal and ethical pain. That’s one reason (among many) there aren’t a whole lot of counselors interested in working with pedophiles.
There is generally no legal or ethical obligation to report past crimes. The therapist may feel a personal moral obligation to do so, but it’s generally held to be a violation of confidentiality. The exception to this is when the clinician believes that the past crimes indicate a clear and immediate danger to others right now.
Many, if not most, mental health professionals are deeply unsure about their duty to report. Some light reading on the subject if anyone’s interested.
In my jurisdiction (Kansas), that’s not true. The legal standard is: does the therapist have reason to suspect that a child has been harmed? It doesn’t matter how long ago, or where, or whether there is any immediate or ongoing abuse. If it ever happened, it must be reported, or the therapist can be charged with a misdemeanor or face professional disciplinary action. “Confidentiality” does not exist in that context here.
Yes, that means there are basically no therapists here wanting to work with pedophiles, at least outside the penal system. That also means that most therapists, when meeting a new patient, describe their office policies, HIPAA rules, and so forth, then explicitly state, “don’t tell me about anything you might have done that might trigger the mandatory reporting laws, which are thus and such.”
Reading over the KS statutes now. I’m not going to lay any bets on it, but they seem to be on the liberal end of the mandated reporting spectrum in the US. From the Kansas DCF:
Regardless, though, the statute applies to children…I’m not sure, even after reading the above link, if there exists a duty to report after the child in question turns 18. Any ideas, slash2k?
I’m noodling with some other stuff. AFAICT, Florida mandates reporting of suspected past abuse only if the child is still under 18. Same with Washington, which specifically states the mandate to report “does not apply to the discovery of abuse or neglect that occurred during childhood if it is discovered after the child has become an adult.” Minnesota says “within the preceding three years,” presumably extending past the age of majority if necessary.
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I’m not aware of any case law in Kansas on that question, so I don’t know how a prosecutor or court might interpret that. I would note that we don’t have the specific language about children who have become adults that is found in, e.g., Washington’s law, and certainly the statute of limitations on criminal prosecution does not expire that soon (generally, time doesn’t run out on a sex crime involving children until the kid is 28).
I suspect the answer to your question may depend more on the mood of the prosecutor and the individual circumstances than any bright-line rule. If the victim is now in their 50s or 60s and the perpetrator is long dead, the prosecutor’s interest level is going to be far different than if the victim is 19 and the perpetrator is still teaching at the local elementary.
How does it work if a therapist learns of abuse that was perpetuated outside the state? Does it depend on whether the victim and/or abuser is currently in the state, domiciled in the state, etc.? E.g. if a perp now living in Kansas states that they abused a 12 year old child in Pennsylvania and that the child is now living in Florida, which authorities are called? Kansas? Pennsylvania? Florida? All of them? What happens if the abuse allegedly took place not only outside the state, but outside the country? E.g. would a Kansas therapist pick up the phone and call the child protective agency of Balochistan Province, Pakistan to report an incident that allegedly happened in 1972? Would they report the alleged Pakistani incident to Kansas authorities and the Kansas authorities would handle relaying it to the Pakistani Embassy in DC?
Mandatory reporting laws do not require the reporter to take matters into his or her own hands beyond reporting; if there is reasonable cause to suspect abuse or neglect, every jurisdiction has a single reporting process in place, regardless of the specifics of the case. In Kansas, for example, reports are made to DCF by default, or to local law enforcement if not during DCF business hours or if there is reason to believe danger to a child is imminent.
After that, it’s up to DCF or local law enforcement, or both, to determine the next steps, and the clinician is more or less out of the loop.
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What hope is there, then, for people who have committed acts against children and who really and truly-o want to stop but who don’t want to cause trouble for themselves in the criminal justice system?
Is prison, the sex offender registry, strict probation conditions, etc. really an essential part of recovery for someone who already recognizes that they have a problem? It’s my understanding that a lot of criminal justice interventions are intended to forcefully make a person realize they have a problem, something that isn’t the case here.
One thought I had was that a wannabe ex-perp could walk into a therapist’s office and say something like, “I want some of that old-fashioned, high strength sex offender treatment, stat. I’m not ready to tell you why, uhh yeah, but go ahead and start.” Does a therapist really need to know the details of who, how old, how often, etc., or can they effectuate some level of general therapy to examine a person’s current general sexual disposition, presence of sexual hangups, impulse control tendencies,etc. to reduce their potential dangerousness in the future?
Another thought I had was that our wannabe ex-perp could dance around the thresholds for disclosure and/or withhold enough to make reporting it meaningless, while still informing the therapist of the scope of the problem. E.g. the patient could say, “I diddled a 13 year old a few times when I was in my 20’s, then when I was 30 I did a 16 year old once consensually, then later raped her forcefully when she wouldn’t put out again. I’m not going to give any names or places, for all you know all this took place in a sheep-herder’s town in Mongolia.” Even if the therapist figures that the abuse probably took place somewhere within a hundred miles of where the patient lives now, that’s not much for child protection agencies to go on. What are they going to do, interview half a million kids from ten different jurisdictions?
Fair point- and I’m not trying to give you a hard time here. That data is probably the best thing we’re going to get on the subject; I’m just not sure how much weight it deserves.
In other words, what about people who break the law and don’t feel like being punished? The words “tough shit” come to mind.
In most cases, they wouldn’t need to interview half a million kids. If law enforcement chose to investigate thoroughly, the first questions are “where was this guy living in his 20s, and what 13-year-olds were around him?” For most people, it’s not really that hard to figure out their previous addresses and then start asking landlords, neighbors, family members, co-workers, etc.
Technically, the Kansas statute mentions only “a child” (not “an identifiable child”); how seriously DCF or law enforcement would take a case where little or no identifying information is available is a question I can’t answer. Again, I suspect it would depend on circumstances. If a quick inquiry determines the alleged perpetrator has lived in the same smallish community all his/her life, the response is likely to be different than in a case where the perp has lived in seven states and three foreign countries during the time period under investigation, for example.
The dilemma robert_columbia is presenting, however, is that the lawbreaker hasn’t been caught yet, and presents an ongoing danger to other children. With treatment, the risk that he/she will abuse others is substantially less, but without treatment, others will likely suffer. Is punishment or prevention more important?
The Germans have an experimental program in Berlin called Prevention Project Dunkelfeld, trying to get pedophiles who either have not offended yet or are as yet unknown to the legal system into therapy; it’s a pretty new program, so it will be interesting to see what the outcomes are over a period of years.