Mandatory reporting of abusive behavior
After reading this article, you will be able to:
- Discuss mandatory reporting of individuals who require special protection
- Describe the forms of domestic violence
Editor's note: The following is an excerpt from the Discharge Planning Guide: Tools for Compliance, Third Edition, by Jackie Birmingham, RN, BSN, MS. For more information on this title or to order your copy, visit www.hcmarketplace.com/prod-8732.
The National Center for Injury Prevention and Control is part of the Centers for Disease Control and Prevention. Its website describes its mission as preventing injuries and violence and reducing their consequences. The website provides information about violence and injury that discharge planners may find useful in a variety of circumstances. Access the website at www.cdc.gov/injury/index.html.
Various state requirements are related to reporting instances where there is concern that protected classes of individuals, such as children, the elderly, or others who require special protection, are being harmed or may be harmed. The laws vary by state regarding the types of individuals, such as healthcare workers and educators, who are mandated to report instances of concern. Discharge planners are strongly advised to check their own state requirements.
In most states, healthcare professionals who work with patients and families are mandatory reporters. This requires them to report suspected abuse if circumstances make its occurrence evident to them.
Reporting abuse can be problematic for clinicians who work with patients and families while the patient is in the protected environment of a hospital. Discharge planners, along with nurses or physicians, don't have the benefit of evaluating patients in their usual environment, so determining the need to report is difficult. However, this does not exempt discharge planning clinicians from reporting questionable circumstances that they observe.
In the course of daily work in a hospital, it is not unusual for a discharge planner to become aware of certain behavior by patients and/or those involved in their care that is suggestive of abuse. Mandatory reporting of suspected abuse is a serious matter that requires collaboration with the physician and other healthcare professionals involved in the discharge process. Because discharge planners are working with patients on planning for care after discharge, they are in a position to question, and they need to act on, situations that may put patients at risk.
When evaluating a family's ability, willingness, and availability to provide needed care to patients, discharge planners may become aware of scenarios that are not reasonable or safe for the patient.
For example, discharge planners often work closely with patients who have suffered a stroke or congestive heart failure and they may discover behaviors associated with these patients.
However, one important point to remember is that hospitalization is a major stressor for patients and their families and that not all seemingly unusual behavior indicates abuse. Often behaviors are based on cultural and ethnic values that drive family dynamics and must be viewed in this manner. Individuals from diverse cultural and ethnic backgrounds may have never been in a U.S. hospital and may be overwhelmed; this is understandable. In this situation, counseling-a requirement in the Conditions of Participation for discharge planning-is essential.
Clinicians should investigate medically relevant cultural practices, belief, and behaviors of individuals from diverse ethnic groups. They should begin with ethnic groups that have a large presence in the hospital; understanding their practices and beliefs can facilitate development of a discharge plan that fits the patients' ongoing needs. Such understanding also helps clinicians identify culturally based behaviors that may appear to be abuse or neglect.
Reporting behavior that raises concern is mandatory regardless of the reason it occurs. However, knowing as much as possible about patients' ethnic and cultural beliefs will go a long way in protecting them.
Discharge planners who suspect behavior that puts a patient in a potentially risky and reportable situation should consult a social worker and the patient's hospital-based PCPs to obtain insight about factors that require consideration. However, discharge planners should never hesitate to make a report based on their own judgment.
The unique circumstance of domestic and family violence may not be directly observable by a discharge planner, but circumstances may raise concerns that a discharge planner must address.
Many, if not most, hospitals have teams of professionals who address this very serious issue, and discharge planners should use internal and external resources to address an individual's needs.
Domestic violence is also known as domestic abuse, spousal abuse, child abuse, or intimate partner violence. It can be broadly defined as a pattern of abusive behavior by one or both partners in an intimate relationship such as marriage, dating, family, friendship, or cohabitation. Domestic violence has many forms including:
- Physical aggression (e.g., hitting, kicking, biting, shoving, restraining, throwing objects)
- Sexual abuse
- Being controlling or domineering
- Passive/covert abuse (e.g., neglect)
- Economic deprivation
Domestic violence may not always constitute a crime, depending on local statutes, severity and duration of specific acts, and other factors.
Discharge planners should review relevant state law with hospital legal counsel to determine necessary action when a crime is suspected.
Access the National Center for Injury Prevention and Control fact sheet on intimate partner violence at www.cdc.gov/ncipc/dvp/ipv_factsheet.pdf.
You can find additional information about intimate partner violence available at www.cdc.gov/ViolencePrevention/intimatepartnerviolence/index.html.
The federal Child Welfare Information Gateway website provides links to state laws pertaining to child abuse and neglect. Access information to help protect children and strengthen families at www.childwelfare.gov/systemwide/law_policies/statutes/manda.cfm.