Posted: September 8th, 2022

Child Abuse Reporting

Child Abuse Reporting – 1 Reports of Abuse of Children
In Pennsylvania, PMHNPs are required to report suspected child abuse to Childline, a system run by the Department of Public Welfare. This means that if a provider thinks a child they are treating is being abused, they must report it. At first, I thought wrongly that reporting child abuse was easy, but it became clear quickly that it wasn’t as easy as it seemed. As I looked into this topic, I had some questions: Is using drugs while pregnant considered child abuse, and if so, what would my role be as a PMHNP?
The Guttmacher Institute, a research and policy organization that works on sexual and reproductive rights, put out the first article we’ll talk about. Each state is different in two main ways: whether or not drug use during pregnancy is considered child abuse and how hard it is for clinicians to deal with the law. In the United States, 24 states and the District of Columbia consider it child abuse for a woman to use drugs while she is pregnant (Substance use during pregnancy, 2022). Only in Indiana is it illegal for doctors to talk about a patient’s drug use without getting permission from the patient. Some states changed their child welfare laws so that prenatal drug exposure is now considered abuse or neglect. This means that if a child is born exposed to drugs, the state can take away the parents’ rights (Substance use during pregnancy, 2022). In Pennsylvania, using drugs while pregnant is not considered child abuse. However, providers in this state are required to report diagnosed or suspected drug use during pregnancy. Aside from what the law says about reporting, providers should be careful with pregnant clients who use drugs. Research has shown that women who use drugs during pregnancy are afraid of the consequences and don’t get help (Atkins & Durrance, 2020). Avoiding prenatal care raises concerns for the well-being of the mother and fetus. There isn’t much evidence that more punitive policies about drug use during pregnancy work because the number of babies born with neonatal abstinence syndrome (NAS) hasn’t gone down in those states.
McTavish et al. (2019) wrote an article about the ethical side of reporting child abuse that looked at how children and caregivers felt about the mandatory reporting process. One important thing that this article showed was that the mother’s experience with Child Protective Services (CPS) could be traumatic and add to the stress or stressors that caused the potentially dangerous behavior and led to CPS’s involvement (McTavish et al., 2019). The same question comes up as in the first article: Does mandatory reporting do more harm than good? It seems silly to wonder if reporting suspected child abuse would hurt more, but the mother’s views are also important. Like when a pregnant woman uses drugs, avoiding care out of fear of the consequences means less access to good care, which puts the child’s health at risk. McTavish et al. (2019) say that there isn’t much evidence to show that mandatory reporting reduces the number of times a child is abused or improves their health.
Both articles about reporting child abuse have implications for how PMHNPs work with their clients. When building a therapeutic relationship, it’s important to talk about any duties to report right away. Early disclosure and preventive measures should help moms instead of punishing them. If mothers and children feel safe telling important information, the results are better than if they don’t get care.

Elder Abuse Reporting
Each state has a different law about how to report abuse of older people. The way each state defines elder abuse, who is required to report it, what the reporter’s role is if the victim is competent and able to act on their own, and how to report if the victim lives in a nursing home or their own home are all different. The Pennsylvania Department of Aging says that PMHNPs are “mandated reporters” and must tell the local Area Agency on Aging about any suspected elder abuse. If the alleged abuse is sexual, a serious injury happened, or the death seemed suspicious, the clinician must also tell local police.
The article I chose to read about the legal side of elder abuse is mostly about how complicated elder abuse is. It is hard to do research on elder abuse because there is no one definition of elder abuse that is used everywhere. As was already said, it varies from state to state (Roberto, 2016). Elder abuse is often underreported because the victims are embarrassed, afraid it will happen again, afraid of being sent to a nursing home, or just used to being abused. Clinicians are required to report abuse or neglect of an older person, so they must do so when they have a good reason to think it is happening (Roberto, 2016). Reporting the abuse is a required breach of confidentiality, but if the suspected victim denies the abuse, it makes reporting and investigating harder. For example, let’s say that Adult Protective Services (APS) gets a non-emergency report and starts an investigation. If the older person or their legal guardian don’t agree, a court order or search warrant would be needed. For the court to help, APS needs to show that there is a good reason to do so. Even if the clinician isn’t sure how to keep the client’s dignity and sense of self-determination, it is their job to protect the client’s health. Once the report is made, providers don’t have to fix the problem or reduce the risk. Some tools, like the Conflict Tactics Scale (CTS), can help clinicians find elder abuse when it’s hard to tell (Roberto, 2016).
When someone hurts an older person, the issue of autonomy comes up. Saghafi et al. (2019) talk about how people who are against mandatory reporting of elder abuse say that it violates the client’s autonomy and privacy. Older people who are mentally capable have the right to make their own decisions. However, they should only be allowed to stay independent if it is ethically and reasonably possible for the provider. Even though the concern about violating autonomy is real, letting psychological abuse go on violates respect, and letting physical, financial, or neglectful abuse go on violates non-maleficence (Saghafi et al., 2019). The biggest problem with protecting the rights of the elderly is that different providers have different cultural and religious backgrounds, and there is no one law or definition for elder abuse.
When it comes to reporting elder abuse in clinical practice, legal and ethical concerns about autonomy and privacy are the most important ones. Even though mandated reporters have a duty to report suspected abuse, by doing so, are they taking away an older adult’s freedom and putting their privacy at risk? If a PMHNP isn’t sure what their role is when it comes to reporting elder abuse, they can work with a colleague or talk to a lawyer.

References
Atkins, D. N., and C. P. Durrance (2020). State policies that look at drug use during pregnancy as child abuse or neglect don’t reach their goals. Health Affairs, 39(5), pp. 756–763. https://doi.org/10.1377/hlthaff.2019.00785
Mandatory abuse reporting. Department of Aging of Pennsylvania (2022). Get the page at https://www.aging.pa.gov/organization/advocacy-and-protection/Pages/Mandatory-Abuse-Reporting.aspx on August 31, 2022.
McTavish, J. R., Kimber, M., Devries, K., Colombini, M., MacGregor, J. C., Wathen, N., and MacMillan, H. L. (2019). A meta-synthesis of qualitative studies on how children and their caretakers feel about having to report child abuse. BMJ Open, 9(4), 1–13. https://doi.org/10.1136/bmjopen-2018-025741
Roberto, K. A. (2016). How hard it is to abuse an older person. American Psychologist, vol. 71, no. 4, pp. 302–311. https://doi.org/10.1037/a0040259
Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). (2019). A systematic review of the ethical problems that come up when dealing with elder abuse. Journal of the History and Ethics of Medicine. https://doi.org/10.18502/jmehm.v12i7.1115
Substance use during pregnancy. Guttmacher Institute (2022, August 3). From https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy on August 30, 2022.

Discussion#2 Week 2 discussion
The Health Insurance Portability and Accountability Act of 1996 (HIPAA), a federal law, called for the creation of national standards to keep sensitive health information about patients from being shared without their knowledge or consent. It aims to provide a strong legal protection to make sure that private health information stays private. It makes it easy for patients to get information about their care and treatment (Center for Disease Control and Prevention, 2022).
Article One
This article talks about the role of blocking information and how patients can get to their health information. It says that under HIPAA, patients must be able to get access to their health information, except when some covered entities are allowed to stop them from doing so. The Cures Act addresses the problem of patients not being able to see their health records. It stresses that patients can ask for their health records in any way they want. Entities have a responsibility to keep patients’ data private, accessible, and accurate (Rose,2021).
The moral and legal problems with HIPAA that have to do with psychiatric and mental health care for children, teens, and adults
When a child has a mental health problem, his or her parents are told about it. Parents show proof that they are in charge of their child’s health care. However, if the provider thinks that treating the parent as a personal representative could put the child’s safety at risk, he or she can choose not to treat the parent as a personal representative (Murzl et al., 2017).
All protected health information is covered by the privacy rule, but psychotherapy notes get extra protections. The Privacy Rule says that a therapist’s notes on psychotherapy are separate from the rest of a patient’s medical records because they are written during a session. So, the privacy rule says that the Patient’s permission must be gotten before the psychotherapy note is given to anyone, even for treatment (HHS.gov, 2022).
Part Two:
This article talks about how patients’ legal rights to change their health records are limited to those who get care at federally run health care facilities.
People have the right to access and change their PHI through organizations like healthcare plans, clearinghouses, and providers who do some transactions electronically, as well as the business partners of these organizations. However, the patient’s right to access must be granted within 30 days of a request, no matter where the record is or what format it is in (Burton et al., 2017).
When it comes to psychiatric and mental health care for children or teens and adults, changing health records raises both moral and legal questions.
Parents or other legal representatives of a minor patient must ask for changes to their records. At the same time, if the request is granted, the original document won’t be changed or taken away. Instead, the changed document will be linked to the original. An adult patient can ask for their healthcare record to be changed if something is wrong with it, and the provider must change the information that the patient disagrees with. If the provider does not agree with the request, the patient must send the provider a statement of disagreement.
The third article
This article talks about the ethical arguments for and against online psychotherapy. It talks about the benefits of online psychotherapy, such as the fact that services are available and flexible, communication is better, there are benefits for clients who are in remote areas, it’s easy to get to, and it’s cheaper. The article also talks about the problems with online psychotherapy, such as privacy concerns, the need for special training, communication problems caused by technology, gaps in research, and problems with getting help in an emergency (Stoll et al., 2020).
The moral and legal problems with online psychotherapy as they relate to psychiatry and mental health care for children, teens, and adults.
Teletherapy is growing quickly, and there are ethical concerns that make it hard to protect the privacy of clients. Therapists who work with both adults and children must know the rules and laws and follow best practices to avoid breaking HIPAA (Stoll et al., 2020).
Article Four
The article talks about HIPAA and gives rules about when it’s okay for a health care provider to share protected health information about a patient who is being treated for a mental disorder. It talks about HIPAA’s rules on privacy and how to share information about mental health. It also talks about when HIPAA lets healthcare information be shared with the parents of minor patients and whether or not they are able to agree to treatment. It says when HIPAA lets doctors share information with the family members of people with mental health problems. Lastly, the article talks about when HIPAA lets the clinician talk to law enforcement about patients with mental health problems who are in the emergency room.
The moral and legal problems with telling others about psychiatric and mental health care for children, teens, and adults.
Parents usually have access to their children’s protected health information as personal representatives. But there are times when parents might not be the best people to speak for their minor children. Patients who are too young to be adults are still people in this situation, and they have the right to say yes or no to care.
(U.S. Department of Health and Human Services Office for Civil Rights, n.d.) Healthcare providers can share health information with family members and friends who are involved in a patient’s care if the patient does not object.
How Does This Information Help in the Clinic?
Information blocking affects clinical practice by making patient health records less usable, safe, and of good quality. This causes tasks to take longer to finish and makes the provider, who is the end user, more frustrated (American Medical Association, 2022).
Changing a patient’s record affects clinical practice because it raises questions about the quality of care the patient is getting. Regulatory authorities may also look down on this. Changing documents could make it hard to defend claims of malpractice. In Illinois, changing medical records makes it hard for providers to get paid for services because it raises questions (Paszkowska, 2018).
Online psychotherapy makes it easier for people who don’t get enough care to get care that is based on evidence. In clinical practice, it brings in more money and makes it possible for patients with busy schedules to get psychotherapy. Online psychotherapy gives people in Illinois an option besides traditional psychotherapy settings (American Psychological Association, 2022)
Disclosure of protected health information in clinical practice improves the quality of care given to patients because it helps to secure the exchange of patient information with other members of an interdisciplinary team. This reduces legal risks or liabilities that could arise from not sharing information. In Illinois, clinicians who want to share patient information must protect patients’ privacy and get their written and signed permission first (Levy et al., 2018).
Conclusion
HIPAA tries to keep important information about patients from getting out to the public. It also gives patients control over their health information, which protects the public’s interest. But it has a big effect on the money hospitals, health care facilities, and medical research spend.

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