Consequences of introducing mandatory reporting legislation for child sexual abuse Associate Professor Ben Mathews Health Law Research Centre Faculty of Law, Queensland University of Technology Brisbane, Australia

Context in Ireland Policy-based obligations have existed since 1999 for various professionals to report suspected child abuse - Children First: National Guidance for the Protection and Welfare of Children (2011) To be put on statutory footing via Children First legislation (bill in drafting stages) My presentation: What might be the consequences of this new ‘mandatory reporting legislation’ for child sexual abuse reporting? 1. Defining child sexual abuse 2. Defining mandatory reporting laws 3. Some indications from Australia (esp WA) Does introducing MR enhance detection of CSA? Do different reporter groups have different reporting patterns? What do patterns of reporting numbers and outcomes indicate for children, child protection systems and communities?

1. Defining sexual abuse Sexual activity between a child and an adult (or older person, usu >5 years older) for the sexual gratification of the older/more powerful person, where the child cannot consent and/or is not developmentally capable of understanding the acts. Acts include: oral, vaginal or anal penetration fondling breasts/genitals; other sexual touching masturbation voyeurism and exhibitionism exposure to/involvement in pornography Clearly a different kind of maltreatment than, eg, neglect: criminally and civilly actionable; effects not obvious; acts occur in private; can last months, years; offenders may have multiple victims; gross abuse of power

High CSA prevalence is shown by rigorous population studies UK: 10% reported CSA involving sexual contact, with a further 6% reporting non-contact CSA (May-Chahal & Cawson, 2005) Australia : 1.1% experienced parent-inflicted CSA < 16 (Rosenman et al, 2004) 20% of women reported CSA involving genital contact (Fleming 1997) Dunne et al (2003) re sexual abuse < age 16: 12% of girls and 4% of boys experienced penetrative abuse 33.6% of girls and 15.9% of boys experienced non-penetrative abuse NZ: 23.5% in an urban region; 28.2% in a rural region (Fanslow et al, 2007) 18.5% (Fergusson et al, 2000) 32% (Anderson et al, 1993). USA: 27% girls; 16% boys (Finkelhor et al, 1990)

Basic features indicating sexual abuse (contextual) Sexual abuse often (but not always) characterised by (Putnam, 2003) : child is female nearly always inflicted by someone known to the child marital conflict / low parental attachment parental alcohol abuse absence of a parent presence of a stepfather Note frequent age of onset approx 9-10 (Finkelhor’s 1990 study found of 416 women and 169 men reporting CSA, 78% and 69% were aged 12 or under at onset, and median ages were 9.6 and 9.9) Some offenders have multiple victims Note frequent nondisclosure by the child (fear; guilt; embarrassment; shame; preverbal)

Basic features indicating sexual abuse (behavioral) Behavioral (nb case-by-case; age; circumstances) Note: frequently no physical evidence due to nature of acts Frequent failure to disclose (fear; guilt; embarrassment; shame; preverbal) Situational anxiety/distress (fear of being with particular person) Inappropriate dress (eg coverage even in warm weather) Unwillingness to expose body eg gym/fear of being touched Unexplained gifts/money Sexual knowledge not congruent with development Difficulty concentrating at school; sudden performance decline Protection of siblings Internalising behavior: PTSD, depression, low self-esteem, anxiety, withdrawal, self-harm Externalising behavior: aggression, anger, running away from home, sexual acting out beyond developmental norm, alcohol/substance abuse

Basic features indicating sexual abuse (physical manifestations: Hudson et al in Jenny 2011; Finkel 2009) Abuse STIs (gonhorrea, syphilis, HIV, chlamydia) Injury to hymen Extra-genital trauma (although physical force often ‘slight’) Other injuries to genitalia consistent with accounts or suspected abuse Genital pain Dysuria Fondling: erythema, edema, contusions, abrasions to fondled areas Oral-genital contact: bite marks/dental injury Penetrative: depending on force, may be signs of trauma, scar tissue, lacerations, abrasions, transections Not abuse Accounts of accidental injury plausible, consistent, with veracity (eg straddle falls on bicycle crossbar, gym equipment) Dermatitis esp nappy rash Infections Erythema Labial adhesions Foreign bodies Skin tags

2. Defining mandatory reporting laws Laws requiring selected professionals to report suspected child abuse Usually – but not always – the laws apply to require reports of all four classical forms of suspected child maltreatment ie sexual abuse, physical abuse, psychological abuse and neglect Selected professionals are those frequently working with children: eg t eachers; nurses; doctors; police, etc Laws provide protections to reporters (confidentiality; immunity from suit)

Broad context, aims of mandatory reporting laws Key goal: child protection (ie from physical, sexual, psychological abuse, and neglect) / social justice First MR laws a product of Kempe, Battered Child Syndrome, gaze aversion, serious physical abuse, and the right of access to society Plus: early intervention for health promotion / public health – to minimise lifelong costs of abuse to individuals, families, community Using expertise of professionals regularly dealing with children (eg teachers/nurses/doctors, police) to detect cases Recognising that without reports made by these professionals, many cases will not come to the attention of helping agencies (this applies especially to sexual abuse) The laws do not require reporters to investigate, or expect them to be always accurate (hard even for doctors, who may examine) Purpose: government assistance, not punishment; but greater intervention/response if necessary

General approach under MR laws across Australia A mandated reporter must report: a belief / suspicion… based on reasonable grounds… that a child has been, is being or is likely to be abused… where the suspicion arises in the course of the person’s work. ‘Abuse’ defined to limit reportable cases to those involving significant harm (sexual abuse will always be seen as involving significant harm) Protections: immunity from suit; confidentiality MR laws introduced since the 1970s in different States, at different times, in different forms In Western Australia, MR introduced 1 Jan 2009, for sexual abuse only

3. Indications from Australian jurisdictions (esp WA) Does introducing MR enhance detection of CSA? Yes (and nb 75% of identified CSA cases in USA, Canada result from MR) Do different groups have different reporting patterns? Yes What do patterns of reporting numbers and outcomes indicate for child protection systems and communities? caveats re report numbers (vs distinct children), investigations and ‘substantiations’ while improvements appear possible, from many perspectives (including victims’), enhanced detection of CSA via MR a major social policy success Ongoing high quality education and support is required for reporters (including feedback about outcomes of reports) Support (training, resourcing) for agency staff (intake, investigation, response) and associated personnel is essential Ongoing monitoring of how the system is functioning; improvements

Context of these findings Western Australia introduced MR on 1 January 2009, for sexual abuse only Mandatory reporter groups: doctors, nurses, midwives, teachers, police This preliminary analysis of report numbers & outcomes for 12 month period before (2008) and after the law (2009) shows interesting findings; part of a larger project Findings indicate: higher numbers of reports, esp for some reporter groups (2.5 x in short term) higher numbers of detected cases (152 to 218: 43% increase) similar overall ‘substantiation’ rate, but differs by group

12 months before MR law compared with 12 months after MR law Total Child Sexual Abuse Reports by mandated reporters 2008 vs 2009 Total reports 2008:2009 increased by a factor of ~ : 1773 Highest numerical increase: police Highest proportional increase: nurses Total Reports by professional group

12 months before MR law compared with 12 months after MR law Substantiated CSA Reports by mandated reporters 2008 vs 2009 Total substantiated reports 2008:2009 increased by a factor of ~ 0.43: 152:218 (66 distinct cases) Highest numerical increase: police Highest proportional increase: doctors Total Substantiated Reports by professional group

Investigations and substantiation rates (nb caveat) BEFORE MR LAW: 2008 Total Reported Total Investigated Investigated – Substantiated (of total reports) Investig’d – Substant’d (of investigated reports) Medical Practitioners % 4 9.5% 4 16% Nurses % % % Police % % % Teachers / Principals % % 41 31%

Investigations and substantiation rates AFTER MR LAW: 2009 Total Reported Total Investigated Investigated – Substantiated (of total reports) Investig’d – Substant’d (of investigated reports) Medical Practitioners % % % Nurses % % % Police % % % Teachers / Principals % % 33 22%

NSW data: 1987 MR by teachers of sexual abuse Teachers’ reports in 3 month period before mandatory reporting, by type and outcome Reports Substantiated (same; or different, type as suspected: subtotal) Not substantiated Substantiation rate Sexual abuse 98(62;7): % Teachers’ reports in 3 month period after mandatory reporting, by type and outcome Reports Substantiated (same; or different, type as suspected: subtotal) Not substantiated Substantiation rate Sexual abuse 286(165;23): %

Reports, outcomes in Australia overall (all sources): trend in last 3 years (AIHW 2013) 2008/092011/12 Total notifications:339,454252,962 Total children in notifications:207,462173,502 (106,754 investigations) Total substantiations:54,62148,420 Total children in substantiations:32,64137,781 Emotional abuse14,024 (37.2%) Neglect10,936 (29.0%) Physical abuse7980 (21.1%) Sexual abuse4801 (12.7%)