“She can’t come today. I’m actually not really sure where she is.”

Little did I know, this would be the opening line to a new chapter in my nascent counseling career. Every therapist remembers their first child abuse report, and on an overcast day in central Massachusetts, this was about to be mine.

As the phone call continued, I learned that during a particularly heated argument, this mother had struck her daughter, and the teen had run away as a result. Although it was clear to me that mom’s blow to her daughter’s head constituted child abuse, when I consulted with my supervisor, his questioning was along an entirely different line. How long had my client been missing? Had her mother filed a missing person’s report with the police? 

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I informed him that my client had been missing for over two days, and during a second, very awkward phone call, we learned that although she had called the homes of several of her daughter’s friends, my client’s mother had not contacted the police. To my surprise, my supervisor informed me that the mother’s failure to make timely and reasonable efforts to locate her child also constituted child abuse, because being missing put my client at risk of imminent harm.

For new and seasoned clinicians alike, the line between what is and is not legally considered child maltreatment can be difficult to distinguish. Laws vary widely from state to state, and are frequently updated to reflect new findings in abuse and neglect research. The best way to familiarize yourself with your state’s laws is to read the relevant statutes yourself from beginning to end. The U.S. Department of Health and Human Services maintains an excellent search engine through which you can look up your home state’s child maltreatment laws in a matter of seconds.

Although some behaviors clearly constitute child abuse or neglect, other instances of child maltreatment are not as obvious. For example, making believable threats to kill, disfigure, or severely harm a child is considered child abuse in many states, even if the caregiver never acts on them. And many forms of punishment that may not leave physical injuries—such as excessive physical restraint and extended periods of isolation—also fall under legal definitions of child abuse. Additionally, a wide variety of parental inactions are considered child maltreatment, such as failing to establish a significant relationship with a child, failing to seek assistance with school refusal, or engaging in sexual activity with reckless disregard as to whether or not a child is present. Other unconventional forms of child maltreatment include encouraging a child to engage in criminal activity, knowingly exposing a child to sex offenders, and driving under the influence with a child in the car.

The criteria for neglect can also be difficult to navigate, as laws vary significantly from state to state. In some states, a caregiver is not considered neglectful if they are unable to meet their child’s basic needs due to financial inability, unless that caregiver has previously declined public assistance that would have allowed them to meet those needs. In other states, however, a caregiver’s failure to meet a child’s basic needs is considered neglectful regardless of the caregiver’s financial ability to meet those needs.

Similarly, there is wide variation among states in laws related to children’s exposure to illegal drug use. In some states, the issue is not directly addressed in current law, leaving mandated reporters to simply report the emotional or physical injury caused by parental substance abuse. Other states, however, have extensive and detailed legislation on this topic. For example, many states specify that child maltreatment includes knowingly exposing a child to drug paraphernalia, bringing a child to a location where drugs are manufactured, allowing a child to witness a drug sale, placing a child in a vehicle where drugs are being stored, and exposing a child to the materials necessary to manufacture drugs, even if no illicit substances are actually used or manufactured at the time the child is present.

Additionally, increased awareness about abuse to elderly, intellectually disabled, and physically disabled persons has resulted in mandatory reporting laws for these populations in several states. If it has been years since you read your state laws, I encourage you to review them the next time a client no-shows and you find yourself with an unexpected hour. You may be surprised at what has changed!

When in doubt, consult your supervisor and err on the side of caution. It’s always better to report an incident and weather the damage to your therapeutic alliance than to not report one and go home with an uneasy conscience.

In my client’s case, I was surprised at how little changed between her mother and me following my call to the Department of Children and Families. Mom was fully aware that I would be required to report her physical altercation with her daughter, so it made very little difference that her limited attempts to locate her child would also have to be reported. In fact, my call improved my client’s outcomes because being involved with DCF allowed the family to access in-home therapy resources that had been previously unavailable. Although I was terrified of alienating a family in need, reporting this mother’s struggle to discipline her teen turned out to be my most helpful intervention. 


File under: Law & Ethics, The Art of Psychotherapy, Family Therapy