Mandatory Reporting of Abuse and Neglect

Mandatory reporting refers to the obligation of certain community members or professionals to report signs of abuse or neglect in children, the elderly, or other adults who are dependent on others for basic care. While there are many community members responsible for mandatory reporting, including healthcare workers, emergency medical workers, teachers, coaches, childcare workers, state employees, home care workers, and clergy members, healthcare workers are often the first to note signs of abuse or neglect in patients.¹ It is a heavy burden to bear, however, because healthcare workers, and specifically Medical Assistants, engage with patients over the phone as well as before/during/after appointments; each exchange has the potential for abuse reports to be made by patients or for staff to note symptomatic behaviors.  

It is important to note that it is not only children who can be abused; there is domestic abuse, child abuse, and elderly abuse. According to the article “Child Physical Abuse and Neglect,” 1 in 4 children are abused in their lifetime, 18% are abused physically, 78% are neglected, and 9% are abused sexually.² According to the National Domestic Violence Hotline, 1 in 4 women and 1 in 9 men are abused in domestic relationships.³ Lastly, according to the National Council on Aging, 1 in 10 Americans aged 60+ has experienced some form of elder abuse.⁴ It is important to understand that there are so many different types of abuse; not all abuse can be visually seen. 

Because there are several different forms of abuse, it is important to know them all. The first type of abuse is physical abuse. Some examples of physical abuse include, but are not limited to, assault, physical punishment, involuntary isolation/confinement, and any restraints.⁵ A second form of abuse is sexual; sexual abuse is any unwanted, non-consensual touching, looking, or sexually driven verbal harassment. This includes but is not limited to rape, inappropriate touching, photography, or filming of sexual acts.⁵ A third type of abuse is psychological or emotional abuse, which is classified as someone doing or saying something that makes one feel bad. Some examples of psychological/emotional abuse include, but are not limited to, social isolation, not respecting privacy, cyberbullying, and intimidation.⁵ Financial/material abuse is also common; this type of abuse occurs when someone prevents the use of or the misuse of someone else’s finances. A few examples of financial/material abuse include, but are not limited to, theft, fraud, use of another's bank account without consent, and the use of someone else’s vehicle without consent.⁵  Lastly, elder abuse affects elderly or handicapped individuals and frequently originates from an organization or institution. Some examples of organizational or institutional abuse include, but are not limited to, discouraging/not allowing visits from family or friends, not offering choices or independence, and abusive and disrespectful attitudes towards people using the service.⁵

As a Medical Assistant, it is important to recognize the signs and symptoms of abuse. Physical abuse is typically the easiest to spot, as visible marks can often be observed. Some examples of signs of physical abuse include, but are not limited to, bruises, frequent injuries, injuries without explanations, not seeing their provider regularly, and changed behavior around a specific person.⁵ Sexual abuse can be difficult to identify. Signs of sexual abuse in adults can include low self-esteem, feeling that the abuse is their fault, fear of outside intervention and others knowing, and physical and mental isolation.⁵ For children, signs of sexual abuse can present a little differently; some physical signs of sexual abuse in children are STIs, which are not something regularly found in children, as well as trauma to the genital area, like bleeding or bruising.⁶ Some emotional signs of sexual abuse in children include keeping secrets, not talking as much as usual, avoidance of removing clothing, covering up, being afraid of being left alone, or being uncomfortable with specific people, and regression in behaviors.⁶ Some signs of psychological or emotional abuse include an air of silence when a specific person is nearby, withdrawal or change in the way someone acts, low self-esteem, a change of appetite, weight loss or weight gain, making excuses for the other person, and blaming themselves.⁵ Some signs of financial or material abuse include missing possessions, missing money, others showing unusual interest in assets, and unexplained withdrawal of funds from accounts.⁷ Lastly, some signs of organizational or institutional abuse include poor record-keeping and missing documents, lack of flexibility, and absence of visitors.⁸ 

As the first person the patient talks to, the Medical Assistant has a vital role; they should be able to pick up on signs and be approachable if the patient wants to discuss their abuse. If a patient says something to the Medical Assistant (or if the Medical Assistant sees signs), the Medical Assistant should be receptive, empathic, and supportive of the patient. Once the rooming of the patient is complete, the Medical Assistant should immediately find the patient's provider and relay the information. This will aid the provider in addressing the patient’s needs. According to office protocol, the Medical Assistant may be asked to begin the call with their state's Department of Human Services. Overall, the Medical Assistant must be empathic and appropriately confidential in these difficult situations, only disclosing their concerns to the provider and following through with the appropriate authorities, relaying only the minimum necessary information for the report.

 

References

1. Children's Bureau and Child Welfare Information Gateway (n.d.). Mandatory Reporting of Child Abuse and Neglect - Oregon. Child Welfare Information Gateway. Retrieved January 28, 2024, from https://www.childwelfare.gov/resources/mandatory-reporting-child-abuse-and-neglect-oregon/
2. National Library of Medicine (2023, May 29). Child Physical Abuse and Neglect. National Center for Biotechnology Information. Retrieved January 28, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK470337/
3. National Coalition Against Domestic Violence (n.d.). National Statistics. Retrieved January 28, 2024, from https://ncadv.org/STATISTICS
4. National Council on Aging (2021, February 23). Get the Facts on Elder Abuse. Retrieved January 28, 2024, from https://www.ncoa.org/article/get-the-facts-on-elder-abuse
5. Social Care Institute for Excellence. (n.d.). Types and indicators of abuse. Retrieved January 28, 2024, from https://www.scie.org.uk/safeguarding/adults/introduction/types-and-indicators-of-abuse
6. Rape, Abuse & Incest National Network (n.d.). Warning Signs for Young Children. RAINN. Retrieved January 28, 2024, from https://www.rainn.org/articles/warning-signs-young-children
7. Coventry City Council (n.d.). Abuse and neglect of adults with care and support needs - Financial Abuse. Coventry. Retrieved January 28, 2024, from https://www.coventry.gov.uk/coventry-safeguarding-adults-board/safeguarding-adults-life-stories/5
8. Coventry City Council (n.d.). Abuse and neglect of adults with care and support needs - Organizational Abuse. Coventry. Retrieved January 28, 2024, from https://www.coventry.gov.uk/coventry-safeguarding-adults-board/safeguarding-adults-life-stories/9