Florida—limit reporting to data collection purposes, by mandating that reports be made only to local agencies responsible for maintaining elder abuse registries.

Most of the states require physicians, dentists, mental health professionals, nurses, social workers, and allied health workers to report, with a few exceptions. In Alaska, California, Nebraska, and Oregon, dentists are not required to report; in Idaho, mental health professionals are not required to report.

Impact

Research on health professionals’ typical practice in cases of maltreatment and its divergence from optimal practice has focused in large part on clinicians’ decisions about whether to report suspected maltreatment to authorities (Melton et al., 1995; Kalichman and Brosig, 1993; Kalichman, 1999). It is not uncommon for health professionals to refrain from reporting suspected child maltreatment that they do not regard as serious or clear-cut (Finlayson and Koocher, 1991; Kalichman and Brosig, 1993; Kalichman and Craig, 1991; Kalichman et al., 1988, 1989; Watson and Levine, 1989; Zellman, 1990a). Studies on elder abuse indicate that some health professionals do not report due to questions about the usefulness of reporting (i.e., repeated reports about the same patient do not appear to improve the situation; Clarke-Daniels et al., 1989, 1990) and beliefs that community resources are insufficient for appropriate responses (Jones et al., 1997). The tendency to ignore or bypass reporting mandates appears to be most prevalent among mental health professionals (Kalichman et al., 1988).

Although requirements for reporting suspected maltreatment are commonly recognized by health care professionals (Zellman, 1990a), many express concerns that reporting can be as harmful as helpful. Potential advantages of mandatory reporting, particularly for intimate partner violence, that have been cited include improvement of the health care response to family violence, aid in victim referral, and assistance with perpetrator prosecution (Rodriguez et al., 1999; Tilden et al., 1994). Concerns include beliefs that mandatory reporting may (1) breach confidentiality and so undermine autonomy, trust, and privacy in the health care setting (Kalichman and Craig, 1991; Kalichman et al., 1989; NRC and IOM, 1998; Rodriguez et al., 1998, 1999; Vulliamy and Sullivan, 2000; Warshaw and Ganley, 1998); (2) interfere with efforts to enhance patient safety (Levine and Doueck, 1995; NRC and IOM, 1998; Rodriguez et al., 1998, 1999; Tilden et al., 1994; Warshaw and Ganley, 1998; Zellman, 1990b); (3) serve as a deterrent to perpetrators obtaining treatment (Berlin et al., 1991; Kalichman et al., 1994); (4) precipitate violent retaliation by perpetrators against victims or health care professionals (Gerbert et al., 1999; Rodriguez et al., 1999); (5) decrease the utilization of health care services by abuse victims (Gerbert et al., 1999; Rodriguez et al., 1999); and (6) discourage inquiries by health care professionals who believe that if they do not ask, they have nothing to report (Gerbert et al., 1999).



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