Recently, several influencers and articles have brought attention to the potential overuse of child protective services (CPS), casting a spotlight on the complexity of this issue.
Healthcare practitioners are tasked with reporting potential abuse to CPS. While many do so honestly, some doctors have been accused of falsely reporting abuse.
Experts say that MDs need to watch out for and report red flags indicating potential child abuse. However, MDs should also be aware of the trauma caused by removing a child from their home.
Recently, several news articles and social media videos have addressed instances in which potential issues of child abuse were reported to Child Protective Services (CPS).
For example, one TikTok influencer said that CPS was called to investigate potential child abuse after she posted a video of her 18-month-old son “playing” with his father while swaddled in plastic wrap. Another TikToker, followed by nearly 800,000 people, made a video about refusing to blindly trust the medical field after an HCP allegedly called CPS and falsified his son’s medical records because the father of the child left a bad review online. Recent films like Take Care of Maya also put the question of how we determine child abuse under the spotlight.
That the system is flawed—or even downright problematic—is undeniable. Consider, for example, a recent Texas case in which CPS investigated a family simply for having a trans child—or the fact that many children are abused even after they are placed into foster care by CPS.
On the other hand, CPS is needed. Nearly 600,000 children (1,820 of whom died of abuse and neglect) were listed as “unique victims” of abuse in 2012, according to a report from the U.S. Department of Health & Human Services Administration for Children and Families Administration on Children, Youth, and Families Children’s Bureau.
A closer look at CPS
The child welfare system in America does not consist of one agency; rather, it’s composed of multiple organizations across states and communities. In each state, CPS is designed to address child maltreatment, including physical abuse, sexual abuse, emotional abuse, and neglect—particularly when it comes to a child’s own family or network, including parents or primary caregivers, such as extended family members or babysitters.
Unfortunately, the use of CPS isn’t rare. According to PLOS One, it’s estimated that one in three U.S. children will, at some point, be the subject of a CPS investigation, typically for allegations of neglect. Nearly 16% of these children are removed from their homes.
The same research finds, "Four out of five (79% to 83%) of children initially investigated as infants had one or more subsequent CPS referrals during childhood.” The researchers state that this “indicat[es] that abuse risk was either missed during the initial CPS investigation or escalated afterward.” That said, they summarize, “The failure to address maltreatment risks when children first present to the system is a complex problem with no easy solution.”
When should MDs call CPS?
First, you likely know that many HCPs are mandated reporters, meaning they must report child abuse according to state laws in accordance with the Federal Child Abuse Prevention and Treatment Act (CAPTA).
Dr. Daniel Ganjian, MD, FAAP, a pediatrician at Providence Saint John’s Health Center in Santa Monica, CA, says that his loyalty “is first to the children—to making sure they’re safe and not being abused or neglected. It’s not about getting parents in trouble. It’s about saying, ‘There’s something fishy going on; I don’t know for sure if something is wrong. Is CPS able to go and do an investigation? CPS often helps MDs get more information,” he says.
Put simply, Dr. Ganjian says that he thinks it’s better to overuse CPS than to underuse it, though he disparages feuding parents who call CPS in a bid for custody.
In one instance, he called CPS after discovering bruises on a patient’s body. While the bruises turned out to be caused by an insect that had bitten the patient, Dr. Ganjian says that he wouldn’t have known that without CPS’s intervention. He then worried, “How am I gonna face the parents?” after he’d made the call. However, he goes on, “The parents were so thankful to me for thinking about their child.”
Dr. Mohsen Saidinejad, MD, Professor of Emergency Medicine and Pediatrics at the David Geffen School of Medicine at UCLA and a leader within the Pediatric Pandemic Network, also says that the decision to call CPS does not come lightly.
“For some pediatric clinicians, resources exist within our system, such as a social worker who can help with better screening of a child who may be at a safety risk…but sometimes, the pediatrician has to make that decision on their own,” Dr. Saidinejad says. “The bottom line is that you don't have to be sure or correct; a concern for the child is enough.” He goes on to say that pediatricians, as mandated reporters, “are not held liable for calling CPS when there is no certainty of harm.”
Dr. Saidinejad clarifies that it’s appropriate to call CPS “anytime that suspicion of safety risk is present. Children who are in a group home [or] foster care, those with any disability, and any child who cannot tell their story (like babies) are at higher risk.”
He says it’s also important to consider both the urgency of the situation and whether there is a feasible alternative explanation to abuse. “The doctor may consider if there is prior history of CPS involvement or other unexplained injuries or illnesses. Additionally, the provider may consider the number of healthcare encounters the child or their siblings have had,” Dr. Saidinejad adds.
But what happens when you’re unsure? “Sometimes the decision is easy due to enough evidence and suspicion. Other times, it is a tough decision, especially if the caregiver seems nice and the suspicion is not high. But there is a bigger downside to not expressing concern and not contacting CPS,” Dr. Saidinejad says.
Dr. Ganjian adds an important piece of advice for HCPs—particularly new pediatricians: Find a mentor you can bounce your thoughts off of. “It’s always a good idea to say, ‘What do you think?’ so the person with more experience can guide you and shed more light on the situation.”
Why the issue is so complex
An article in the American Medical Association’s Journal of Ethics explores the complexity of CPS involvement, particularly for healthcare providers, saying, “Alongside the slideshows of the physical evidence of child abuse, medical students should be taught about the personal and social toll of surveillance, investigation, and child removal by CPS.”
According to Joel Touchet, PhD, LMFT, Clinical Director, deciding to call CPS could result in the child’s removal from home—a trauma that compounds already-existing trauma. “In our less-than-perfect-world, sometimes the cost-benefit ratio is marginal,” he says. “On the one hand, we do save children from neglect or abuse, but on the other hand, we place the child in a foster or group home that is often unprepared to really meet their emotional needs. In a case of significant abuse, the benefit is clear, but in cases of neglect, we only trade one problem for another in all but the most severe cases.”
Touchet believes that the answer lies in offering families more in-home support services so they can “get the intensive support they need without causing additional trauma and trading one problem for another.”