Vincent J. Palusci, MD, MS, New York University, School of Medicine Frank E. Vandervort, JD, University of Michigan Law School

1. Universal and Clergy
Mandated Reporting Laws
and Child Maltreatment Report Rates
Vincent J. Palusci, MD, MS
New York University School of Medicine
Vincent.Palusci@nyumc.org
Frank E. Vandervort, JD
University of Michigan Law School
vort@umich.edu

2. Conflict of Interest Disclosures
Vincent J. Palusci, MD, MS and Frank Vandervort,
JD have no financial conflicts to disclose.
Unapproved or Off Label Disclosures
Vincent J. Palusci, MD, MS will not discuss
unapproved or off-label, experimental or
investigational use devices or pharmaceuticals.

3. Headlines in the U.S.

4. Background
• Recent events have propelled states and jurisdictions
to review their child maltreatment reporting laws in
efforts to better identify and prosecute alleged
abusers.
• A variety of changes have been proposed in state laws
regarding mandated reporting.
• These changes usually involve (1) “universal”
reporting, and (2) reporting by clergy.
• Little objective information is available regarding
whether such changes will result in meaningful
improvements or enhanced identification of child
maltreatment victims.

5. Reporting in the U.S.
• U.S. states have historically developed a variety of
definitions in mandated reporting laws to require reports
of suspected child abuse, neglect or maltreatment.
• 48 require certain professionals, such as physicians,
nurses, psychologists, law enforcement, teachers,
counselors, judges, etc., to report.
• 27 require members of the clergy to sometimes or
always report.
• 18 states require all adults to report (“Universal
reporting”)
• 4 include faculty, administrators, athletics staff, and other
employees and volunteers at institutions of higher
learning.
• Attorneys are generally specifically excluded for
privileged communications.

7. Other Things Affecting Reporting
• Actual child maltreatment rate:
– Child: gender, age, disability, school attendance
– Family: Race, education, ethnicity, poverty, size,
housing, marriage, religiosity, isolation, other family
violence
– Community: Size, crime, urbanity, congregations,
“child centeredness”, liquor stores
• Child welfare system:
– CM Definitions
– Policies & Procedures
– Capacity
– Central vs. decentralized
– Services & prevention

8. U.S. CM reports are fairly stable
during early 2000s
• Total confirmed reports near 900,000
• Neglect reports stable near 550,000
• Physical abuse down
• Sexual abuse stable near 95,000
• Medical neglect down slightly
• Psychological maltreatment stable

9. U.S. Child Maltreatment Reports (NCANDS)
0
10
20
30
40
50
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Rateper1,000
R-Rates

10. U.S. Child Maltreatment Victims (NCANDS)
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0 1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Rateper1,000
Overall
PA
SA
NEG
MN
PM
MULT
OTH

11. Today’s Objectives
• To evaluate the relationship of total and
confirmed child maltreatment report rates with
U.S. state universal and clergy reporting laws
• To determine whether demographic
characteristics modify these effts
• To assess whether these relationships hold
with confirmed CM types
• To evaluate the effects of changes in law on
these rates

12. Methods
• NCANDS Child File was used for year 2000 to
link with complete census data
• Frequency of total and confirmed CPS reports
was calculated by U.S. county
• Confirmed reports were calculated by
confirmed subtype (PA, Neglect, SA, PM)
• Population characteristics, social capital,
education, religion and crime rates were linked
by U.S. county
• State CM laws/policies were linked
• Cross-sectional design with linear regression
models used to compare factors

13. Sample states (213 counties)
• Arkansas
• Delaware
• Florida
• Kansas
• Kentucky
• Louisiana
• Maine
• Massachusett
s
• Minnesota
• Missouri
• Nebraska
• North Carolina
• Oklahoma
• Pennsylvania
• Rhode Island
• Texas
• Utah

15. Dataset Records
Total Reports, NCANDS, 2000 2,795,220
Total Reports, 18 States, 2000 1,024,419
Total Reports, 213 Counties ≥1000 reports 754,225
Confirmed Reports 252,390
- Physical Abuse 14.8%
- Sexual Abuse 5.9%
- Neglect 63.2%
- Medical Neglect 2.8%
- Psychological Maltreat 8.3%

16. Other Potential Factors affecting
CM reports
• Demographics: child age, gender, race,
ethnicity
• Social Capital: poverty, environment,
housing, marriage, religion, employment
• Education: level, school attendance
• Crime, other violence
• Community response, services
• Reporting laws, practices

17. Other County-Level Data
• U.S. Census [total and child population, gender, race,
ethnicity, unemployment, marriage, education,
school attendance, housing, poverty, disability,
linguistic isolation]
• Association of Religion Data Archives [congregations]
• U.S. Bureau of Labor Statistics [unemployment]
• FBI Uniform Crime Reports [crimes]

18. Today’s Objectives
• To evaluate the relationship of total andTo evaluate the relationship of total and
confirmed child maltreatment report rates withconfirmed child maltreatment report rates with
U.S. state universal and clergy reporting lawsU.S. state universal and clergy reporting laws
• To determine whether demographic characteristics
modify these effects
• To assess whether these relationships hold with
confirmed CM types
• To evaluate the effects of changes in law on these
rates

19. Report Rates by State Reporting
Law
Reporting Law #States #Counties Total
Report
Rate
Confirmed
Report Rate
Universal Reporting
Yes 9 151 60.6 19.9*
No 9 62 51.8 13.9
Clergymen Required
to Report?
Yes 7 91 55.7 15.4*
Sometimes 7 37 44.5 8.8*
No 4 83 66.8 25.4

20. Today’s Objectives
• To evaluate the relationship of total and confirmed
child maltreatment report rates with U.S. state
universal and clergy reporting laws
• To determine whether demographicTo determine whether demographic
characteristics modify these effectscharacteristics modify these effects
• To assess whether these relationships hold with
confirmed CM types
• To evaluate the effects of changes in law on these
rates

21. Adjusted Reports by County Population <18y,
2000
y = 0.0337x -571.9
R2
= 0.7025
0
10,000
20,000
30,000
40,000
50,000
60,000
0 200,000 400,000 600,000 800,000 1,000,000
County Population < 18Y
EstimatedNumberof
CMReports

22. Significant Factors for Total Report
Rate
• State Law: Universal reporting
• Population <18y: Percent males, Black, American
Indian/Alaskan native
• Child Poverty: Percent at 100% poverty level
• Children in married families
• Children ages 10-14y in school
• Congregation number and rate per 1,000
• Index Crimes, Rape
• r2
= 0.2831-0.3364

23. Changes in Total Report rates
per 1,000 (mean=58.1)
Increases
12-16 in states with mandated universal reporting
23 for each percent increase in males
4 for each increase in those living at poverty level
78 for each unit increase in rate of congregations per 1,000
population
8 for each increase in index crime per 1,000
Decreases
2 for each percent increase in AIAN
23 for each percent increase in children ages 10-14y in school
3-7 for each percent increase in rapes

24. Significant Factors for
Confirmed Report Rate
• State Law: Universal reporting
• Total Population <18y : Percent males, Black, American
Indian/Alaskan native
• Child Poverty: Percent at poverty level
• Percent of children in school: Ages 3-4y, 10-14
• Linguistic Isolation
• Index crimes
• Aggravated assault rate per 1,000
• r2
= 0.3401-0.3833

25. Changes in Confirmed Report
rates per 1,000 (mean=18.1)
Increases
7-9 for universal reporting
10 for each unit increase in % males
1 for each unit increase in children ages 3-4y in school
1-10 for each unit increase in aggravated assaults
Decreases
1 for each percent increase in Blacks or AI/AN
6 for each percent increase in children ages 10-14y in school
2 for each increase in index crimes per 1,000

26. Today’s Objectives
• To evaluate the relationship of total and confirmed
child maltreatment report rates with U.S. state
universal and clergy reporting laws
• To determine whether demographic characteristics
modify these effects
• To assess whether these relationships hold withTo assess whether these relationships hold with
confirmed CM typesconfirmed CM types
• To evaluate the effects of changes in law on these
rates

27. CM Type Confirmation Rates by
Reporting Law
Reporting Law Physical
Abuse
Sexual
Abuse
Neglect Psychological
Maltreatment
Universal Reporting
Yes 6.9 2.5 11.3 1.9
No 7.3 4.0 7.9 1.4
Clergymen Required
to Report?
Yes 4.4* 2.1 9.3 1.4*
Sometimes 3.6* 1.7 7.3* 1.6
No 11.6 4.5 17.3 2.2

28. Multivariable Models for CM
Type Confirmation Rates
• Physical Abuse: Sometimes-Yes Clergy
Reporting (↓4-5)
• Sexual Abuse: Not significantly related to
law
• Neglect: Universal reporting (↑8-10)
• Psychological Maltreatment: Not
significantly related to law

29. Today’s Objectives
• To evaluate the relationship of total and confirmed
child maltreatment report rates with U.S. state
universal and clergy reporting laws
• To determine whether demographic characteristics
modify these effects
• To assess whether these relationships hold with
confirmed CM types
• To evaluate the effects of changes in law on theseTo evaluate the effects of changes in law on these
ratesrates

30. Changes from 2000 to 2010
• Universal Reporting
– None of the study states changed their laws
• Clergy Reporting
– 1 state changed from ‘no’ reporting to ‘yes’
reporting
– 1 state changed from ‘sometimes’ reporting to
‘yes’ reporting

31. Report Rates by Changes in State
Clergy Reporting Law, 2000-2010
Reporting Law #States #Counties Δ Total
Report
Rate
Δ Confirmed
Report Rate
Change in Clergy
Reporting Law
Yes 2 23 13.4 0.71*
No 15 169 7.5 -3.7
1 state removed for
inadequate data in 2010
*P<0.05

32. CM Type Confirmation Rates by Changes in
State Clergy Reporting Law, 2000-2010
Reporting Law Physical
Abuse
Sexual
Abuse
Neglect Psychological
Maltreatment
Change in Clergy
Reporting Law
Yes -16.2* -3.8* -28.7* -1.5
No -3.2 -1.1 -5.4 -1.3
1 state removed for
inadequate data in 2010
*P<0.05

33. Changes in Total Report rates
per 1,000 for 2000-2010
Increases
14 in states with new clergy reporting requirements
2 for Black, AI/AN, Asian, and Hispanic population changes
1 for each percent increase living in married families
1 for each increase in index crime per 1,000
Decreases
Small decreases for child population changes
2 for each percent increase in poor English
1 for each percent increase in unemployment

34. Changes in Confirmed Report
rates per 1,000 for 2000-2010
Increases
6 for states with new clergy reporting requirements
1 for each % increase in White or Black families
1 for each % increase in families below 1000%FPL
1 for each change in aggravated assaults
Decreases
1 for each % increase in Blacks or AI/AN
2 for each % increase in unemployment

35. Multivariable Models for Changes in
CM Type Confirmation Rates
• Physical Abuse: New Clergy Reporting
Requirement (↓13)
• Sexual Abuse: New Clergy Reporting
Requirement (↓7)
• Neglect: New Clergy Reporting
Requirement (↓24)
• Psychological Maltreatment: Not
significantly related to law

36. Limitations-1
While NCANDS is a large dataset covering many U.S.
states, there are several limitations in its use for
secondary analysis:
– While there are exhaustive efforts to assure data can be
combined, different states use different definitions and
policies for what is entered
– No attempts have been made to make the data
representative of the U.S. child population or the
population of maltreated children
– Large states can bias the analyses
– Some states did not submit data for certain years or for
certain fields

37. Limitations-2
• This research is preliminary and hypothesis-
generating
• Cross-sectional statistical comparisons cannot
be used to infer causation
• We cannot know definitively from this research
whether changing state law or policy will result
in changes in report or confirmation rates

38. Summary of Results
• States with laws mandating that all adults must report
suspected child maltreatment have higher rates of
total and confirmed reports (+25%).
• States with laws mandating that clergy must at least
sometimes report suspected child maltreatment have
lower rates (-10-20%).
• Some child and community characteristics modified
the association with report rates, and there were
varying effects on report rates for specific types of
child maltreatment.
• Effects have been noted after changes in state clergy
reporting laws, but it is unclear whether they are
significant.

39. For additional information
Palusci VJ, Vandervort FE. Universal reporting laws and child
maltreatment report rates. Children and Youth Services Review
2014;38:20-28. Epub 29 Jan 2014 doi:
10.1016/j.childyouth.2013.12.010
Vandervort FE, Palusci VJ. Effects of clergy reporting laws on child
maltreatment report rates. APSAC Advisor 2014;26(1):16-26.
Data Sources
Association of Religion Data Archives. (2002, 2012). Religious congregations and membership
study, 2000, 2010. (www.thearda.com/archive/files/downloads/RCMSCY_DL.sp), Accessed
7/12/2014.
National Data Archive on Child Abuse and Neglect. (2002, 2012). National Child Abuse and
Neglect Data System (NCANDS): Child Files 2000, 2010. Ithaca, NY: Cornell University Family
Life Development Center.
U.S. Census Bureau, Census 2000 Summary Files 1, 3. (
www.census.gov/prod/cen2000/doc/sf1.pdf), Accessed 2/1/2012.
U.S. Census Bureau (2011-2013a). 2010 Decennial Census [Data file and code book]. Retrieved
July 12, 2014 from http://factfinder2.census.gov/
U.S. Department of Justice (2001, 2011). Crime in the United States, 2000, 2010. Uniform Crime
Reports. Washington, DC: U.S. Government Printing Office. (www.ucrdatatool.gov).
Accessed 7/12/2014.

40. Many thanks to John Eckenrode, Elliott
Smith, and Michael Dineen at Cornell’s
National Data Archive on Child Abuse and
Neglect
The data utilized in this publication were made available by the National Data Archive on Child
Abuse and Neglect, Cornell University, Ithaca, NY, and have been used by permission. Data
from the National Child Abuse and Neglect Data System were supplied by state child
protective services agencies to the Children's Bureau, the Administration on Children, Youth
and Families, U.S. Department of Health and Human Services. Funding for NCANDS was
provided by the Children's Bureau, U.S. Department of Health and Human Services.
Technical support on NCANDS is provided under contract to the Children's Bureau by Walter
R. MacDonald & Associates, Inc. The authors are solely responsible for its content and
analyses; neither the participating state agencies, Walter R. MacDonald & Associates, Inc.,
the Children's Bureau, the Archive, Cornell University, or its agents or employees bear any
responsibility for the analyses, opinions, or interpretations presented here.
Acknowledgements

41. Thank you!
Questions?
Vincent J. Palusci, MD, MS
New York University School of Medicine
Vincent.Palusci@nyumc.org
Frank E. Vandervort, JD
University of Michigan Law School
vort@umich.edu