The Full Informed Consent: Mandated Reporting to Child Protective Services (CPS) in Child Mental Health
“Regulating and destroying black, brown and indigenous families in the name of child protection has been essential to the “ongoing white supremacist nation building project” as much as prisons and police. Like the prison industrial complex, the foster industrial complex is a multi-billion-dollar government apparatus that regulates millions of marginalized people through intrusive investigations, monitoring and forcible removal of children from their homes to be placed in foster care, group homes and “therapeutic” detention facilities. The vast majority of child welfare investigations and removals involve allegations of neglect related to poverty, and black families are targeted the most for state disruption. . . . CPS affirmatively harms children and their families while failing to address the structural causes for their hardships. Residents of black neighborhoods live in fear of state agents entering their homes, interrogating them, and taking their children as much as they fear police harassing them in the streets.”
Dorothy Roberts, The Imprint, (2020)
Child mental health providers typically require parents initiating care to sign a “Notice of Privacy Practices” indicating that providers are mandated reporters legally required to report actual or suspected instances of abuse and neglect of a minor. Some providers might also explain the reporting mandate during an opening session. What is not often discussed, however, is what the reporting process looks like, how families and children are notified, and what if any responsibility providers take to protect families of color from reporting’s endemic racism.
When I received training about mandated reporting during my postgraduate medical training, I was taught that it was the law and I could lose my medical license if I didn't do it. I was also trained to believe that it was a form of child protection meant to keep children safe. It was only through my own antiracism teaching and writing that I developed a more nuanced understanding of this process, its racism, and related harm to children and families of color. This activist scholarship has since informed the way I provide the full informed consent to the children and families I see and why I consider this disclosure to be a requirement of my oath to first do no harm.
I begin by reviewing who is a mandated reporter (for example, doctors, healthcare providers, and teachers) and what mandated reporting entails. I make it clear that mandated reporters call CPS based on suspicion and perception and face no consequences for misreporting or reporting because of their own racism, white saviorism, or clinical coercion. This lack of accountability is concerning because physicians, teachers, and other mandated reporters have pro-white implicit biases that impact how they treat people of color. They are in no way immune to anti-Black racist tropes pertaining to criminality, welfare queens, and broken families, and research has shown they treat white people better. The chronic and criminal undertreatment and neglect of Black pain is but one of many examples. I have also witnessed a number of healthcare providers who weaponize mandated reporting against minoritized families who do not “comply” with care. Similarly, I have seen white children’s parents get a pass when abusive or negligent because they are, per my colleagues, “a good family.” I, therefore, warn families to protect themselves against other mandated reporters. I also warn them that reporters are not required to inform families when they do make a report, so it can come as quite a shock if CPS shows up knocking at their doors.
Most parents, especially those of color, are terrified their children will be taken away from them, a legitimate concern given this country’s long history of state-sanctioned separation of Black and Brown families.To addres this concern, I explain how widespread CPS investigations are, noting that more than one-third of all US children are the subjects of investigated child maltreatment reports before their 18th birthday. The majority of cases pertain to neglect, only a small percentage of cases are substantiated, and an even smaller percentage of these cases involve family separation. Therefore, the likelihood of removal from the home is quite low.
Because more than half of Black children (twice that of white children) are reported during their lifetimes, I consider this a lifelong risk that I am responsible for addressing, for example, by documenting clearly how engaged, supportive, and receptive parents are to care. I also note that because child welfare relies on racist algorithms that use race to determine which families to investigate, whenever I do call CPS, I do not report the race (instead I saw “I do not know.”). However, I almost always let families know I have made the call. Finally, for families assailed by poverty and other forms of structural violence that can manifest as neglect, I ensure we involve other family members and community supports in their care to decrease the likelihood of reporting. I do this in order to take good care of families but also because I know how devastating family separation stemming from child welfare can be for parents and children alike. At the very least, I will call the closest family members, chosen or biological (neighbors, cousins, grandparents, etc) during appointments or invite them to attend, and I document the interventions we come up with together to ensure children have food on the table, roofss over their heads, and smiles on their faces.
Several years ago I was working with a delightful family who brought their teenaged child in to see me. The child, who came into my care with an autism diagnosis, reported that their older sister had aggressively thrown a book at her. When I checked in with their parents, both of whom had witnessed the incident, they clarified that their older child had tossed the book to my patient to catch. I had no concern about abuse or neglect but worried that if another mandated reporter–particularly one of the schoolteachers at the child’s majority-white school, heard this account, they might have just enough suspicion (rooted in anti-Black racism) to call CPS. I, therefore, provided the full informed consent about mandated reporting to the parents and my concern about its likelihood. They were a bit puzzled but many months later, the father called to say “that thing you said might happen–it happened.” CPS showed up at their home unexpected. I offered sympathy and support and reminded the father that I had been documenting their child’s progress carefully. Fortunately, the case was not substantiated and instead it was closed. I wish the teacher who made the report had understood all of the unnecessary harm involved. I certainly ensured the family did.
Parenting Tip: When commencing a child's mental healthcare journey, ask your provider: “Can you please tell me about how you do mandated reporting? Will you let me know if you contact CPS? If I am fearful of CPS being involved, how will you support me with this? What is your understanding of the role of racism in CPS reporting? When you call CPS will you give my race? Why or why not?”
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