Photo of tattered stuffed teddy bear left behind on the side walk. Text overlay

The Risks and Consequences of Failing to Report Child Abuse

Curt and Katie discuss the CA Board of Behavioral Sciences case against Barbara Dixon, LMFT who failed to report child abuse for Gabriel Fernandez and Anthony Avalos who both subsequently died from abuse by caregivers. We look at what this therapist missed as well as appropriate child abuse reporting, including the nuance of when to report. CW: details of child abuse discussed.

Transcript

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In this podcast episode we talk about the importance of child abuse reporting

We talk about the failure to report abuse by Barbara Dixon, LMFT that has recently been in the news related to the deaths of Gabriel Fernandez and Anthony Avalos.

The case related to the child abuse death of Gabriel Fernandez

  • Content Warning: Details of the case, including the actions taken (and not taken) by Barbara Dixon, LMFT
  • The decision-making process with child abuse reporting

Who is responsible to decide to report child abuse – the clinician or the supervisor?

“I hear [prelicensees] wrongly state that ‘I’m working under somebody else’s license; this falls on them’ … I cannot emphasize enough that decisions like this, in [Barbara Dixon’s] case, really do indicate that it is your responsibility, no matter what your agency says… People can and do get punished for not following through on their individual licensee or registration responsibilities as mandated reporters.” – Curt Widhalm

  • When supervisors or agencies tell clinicians under supervision not to report child abuse report
  • The individual responsibility that each clinician holds
  • The myth that you’re working “under” your supervisor’s license

How do you decide whether you should report child abuse?

“It’s these gray areas where there’s this nuance that I think feels really overwhelming. And for some folks, they’ll lean towards reporting or consulting to identify if it’s reportable. And for other folks, they use that as cover to not report when it feels too uncomfortable.” – Katie Vernoy

  • Clarity from child abuse reporting laws
  • Hesitation based on systemic response, the therapeutic relationship, and the paperwork hassle
  • Where there are gray areas and nuance

The consequences of failing to report child abuse or adequately document services or risks

  • Your agency or supervisor may not be held liable for your actions (especially if you don’t document what you did)
  • Incomplete documentation hurts – it doesn’t help you hide from liability

Appropriate Child Abuse Assessment and Reporting

  • Interviewing the child separately
  • Following up on what you’ve asked for
  • Understanding at what point it becomes our responsibility (i.e., having sufficient information)
  • Documenting each stage and make sure to appropriately close out treatment file when needed
  • Consultation and not making the decision on your own
  • Defining the injury and assess from there
  • Understanding normal childhood response to typical life events (and noting changes)

Navigating the gray areas in child abuse assessment

  • Looking at impact, intent, and injury
  • Using the context to help decide when there isn’t a definitive line
  • Adequately documenting, even when you aren’t sure you’re making the right decision, is important and necessary
  • Looking at what needs systemic intervention and what needs family therapy

Getting past the discomfort to report child abuse report

  • It is your responsibility
  • Taking a moment to understand the purpose of reporting
  • Reducing your own liability
  • Obtaining resources for families
  • Understanding the risk for families of systems getting involved

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

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OOTify. “OOT” or “uth” (उठ) means “lift up” in the Hindi language. OOTify is a digital health solution that acts as an evidence-based hub to unify relevant mental health resources. Community, Connection, and Collaboration are critical to OOTIFY.  As they lift the mental healthcare system, they ensure providers are part of the process. OOTIFY is a platform for providers, built by providers, and owned by providers. OOTIFY is the process of lifting up mental healthcare, while lifting each other up.

We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We’re going to go through trials and tribulations. But if we can work on our mental health, proactively, our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, “Hey, listen, I’m going through this too.” Do be you want to be a part of the solution by joining a new web three community focused on mental health and wellness? Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

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Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Los Angeles Times Article: Counselor who didn’t report abuse of Gabriel Fernandez, Anthony Avalos put on 4-year probation

Citation/Enforcement Decision on Barbara Dixon

LA Times Article: Charges dismissed against social workers linked to Gabriel Fernandez’s killing

Relevant Episodes of MTSG Podcast:

Now Modern Therapists Have to Document Every F*cking Thing in Our Progress Notes?

Do Therapists Curse in Session?

Toxic Work Environments

Giving and Getting Good Supervision

Make Your Paperwork Meaningful: An interview with Dr. Maelisa McCaffrey Hall

Noteworthy Documentation: An interview with Dr. Ben Caldwell, LMFT

CYA for Court: An interview with Nicol Stolar-Peterson, LCSW

Who we are:

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

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Modern Therapist’s Survival Guide Creative Credits:

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Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm 0:00
This episode is brought to you by OOTify.

Katie Vernoy 0:03
OOTify is an immersive digital mental health ecosystem. It’s designed to help minimize the fragmentation, trial and error and overwhelm felt by both patients and providers in the process of giving and receiving care. Modify is the process of lifting up mental health care while lifting each other up.

Curt Widhalm 0:20
Listen at the end of the episode for more information.

Katie Vernoy 0:23
This episode is also brought to you by Turning Point.

Curt Widhalm 0:26
Turning Point Financial Life Planning help surface stop worrying about money. confidently navigate every aspect of your financial life from practice financials and personal budgeting to investing taxes and student loans.

Katie Vernoy 0:39
Visit turningpointhq.com to learn more and enter the promo code modern therapist for $200 off any service.

Announcer 0:47
You’re listening to The Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 1:00
Welcome back modern therapists. This is The Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about the things going on in our fields, the things that we do in our practices. We dabbled quite a bit into law and ethics as we talk about these things. And the very top of this episode, I’m gonna give a little bit of a content warning that we’re going to discuss some child abuse stuff. And today we are discussing a case out of California that has a therapist facing some disciplinary actions. The California Board of Behavioral Sciences had a decision that took effect on March 31 2022, about Barbara Dixon, Licensed Marriage and Family therapist who’s now on probation. And this is due in large part to not reporting child abuse, not doing record keeping and having not one but two child clients ultimately die. So we are going to talk about in this episode, our responsibilities as therapists, the interactions between the clients that we see, ourselves, the agencies that we work for, and our mandated reporting duties. Now normally, when we talk about situations like this, we do offer some privacy to accused therapists. This is a little bit different because this has been in the news, we have some stuff that we’ll post in our show notes over at mtsgpodcast.com, where this therapist is named by name, specifically in an LA Times article here. So if this does seem to deviate from some of our other podcasts in the past by naming a therapist, the reason why is that this seems to be part of the public news cycle at this point. Katie, when did you first start hearing about this case?

Katie Vernoy 3:06
I’m not quite sure. With LA County, oftentimes, there are DCFS, or therapist stuff that show up in the news because children die. And I think part of it and this is something where beyond the scope of this podcast, LA County Department of Child and Family Services has been historically underfunded and/or overworked. And I think also inefficient. I think there’s just a lot of stuff going on there. I think that there have been great social workers I’ve worked with there and social workers I joke there’s like drunk guy that’s on the phone, answering the child abuse hotline that refuses to take anything and thinks that parents should be able to beat their kids. So I think there’s a wide array of things that I’ve been aware of over time. I think I had heard about these child deaths around the time that they happened. But on April 13, within when this article about Barbara Dixon came out, I saw it, forwarded it to you and that’s why we’re talking about it. I think the the part of this that I feel hardest to really grapple with is just the it’s just such a shame that these kids were in these situations. There was a therapist who had a little bit of an eye into the situation and did not act. I don’t think that’s the only thing that would have changed things. Certainly and even had in one of the cases I was looking at the timeline even had the report happened with the timelines for the DCFS it’s questionable whether they would have been able to save him but I just to me the fact that this is part of our work, I think is hard to take in sometimes.

Curt Widhalm 4:46
I had first seen an LA Times article 2019 about Barbara Dickson when she first testified that she didn’t report the suspected abuse to authorities and this has been a case that’s kind of been on my radar for a while here, and have kind of periodically checked in on this. And in the sometimes slow wheels of investigations and reaching conclusions on these kinds of things, it does take several years for evidence to mount up for the appropriate defenses to be tried to be made in these kinds of accusations and stuff. And seeing this kind of fully come to fruition here puts a end note on this, but to speak to some of the details of this case. And to kind of put things into perspective as to why this is so important for us. We’re going to go through some of the details here. And this is from the stipulated settlement available on the California Board of Behavioral Sciences disciplinary actions. And we’ll also include a link to this in our show notes as well. But the therapist Barbara Dixon had been working for a nonprofit organization, Hathaway-Sycamore Child and Family Services who had a contract with the Los Angeles County Department of Child and Family Services. And as an associate, the therapist would go in and see children in their homes. And she had provided in home therapy for an eight year old child in 2013. And this child was originally referred to DCFS by the child’s teacher, and seems like a pretty quick response and getting into therapeutic services. About a month or two into treatment this child according to the case notes had visible injuries on his body and the therapist had observed that he was limping and had a black eye, he spoken a low pitch and when questioned about it in front of his mother, the child’s repeated his mother’s account that he had fallen off of a bicycle. The session notes did not indicate that the respondent question the mother and child separately. And the mother, according to the respondent was supposed to provide a doctor’s note of treatment with the client’s injuries at the next scheduled session. But the mother missed the next session, and there was no treatment notes of receiving a doctor’s note, no follow up about asking about it. No follow up discussion with the minor or the mother regarding the injuries. About two to three weeks after that was the last in home session. A week or so after that was a telephone conversation with a mother to schedule a termination session. And less than a week after that the child was beaten by the mother and her boyfriend and died two days later. Katie and I have both worked with children and Katie more so within the Department of Mental Health System. I’ve worked largely with kids, both in agencies and in my private practice for years afterwards. But what stands out to you amongst all of this as things that really needed to happen here. Like just give me kind of first responses here.

Katie Vernoy 8:27
I think there’s a lot of pieces to it. And I’ll and there’s some understanding of what happened from Barbara Dixon’s side as well as what was missed. And so just to add a couple more details, according to Barbara Dixon’s testimony, I think in 2019, she was told by a supervisor, at least she claims she was told by a supervisor not to report abuse in either case. So we’re talking about the first one. The second one, I think, has a similar flavor. So we’ll see if we’ll have time to talk about them both. But I think this is there’s enough here to have, I think a reasonable conversation. When I look at the account of this kid coming in with these injuries, said it was a bike injury or bike, you know, fell off his bike, and there was there was some injuries that didn’t seem to quite align with that. You and I talked beforehand and said I’ve had a lot of bike accidents and never did I have a black eye. And I think that’s fair to say. And I think in the article aparently later, she went on a walk with this child and after initially believing that it was a kind of a fallen off the bike kind of injury she was a little bit concerned but didn’t follow up and didn’t report because the agency told her not to. I think it’s one of those things where there’s that yucky feeling in your gut at the pit of your stomach where you’re like, This just doesn’t feel right. It’s clear from how she’s described it that that probably was there. And there was also this element as permission not to report by a supervisor or at least according to that account. And so, unfortunately, this feels very familiar. Because I think there’s been a lot of times where I’ve had supervisees, or even supervisors who are coming to discuss, you know, this was when I was working in community mental health, but would come to discuss these things. And there was there was a threshold point where it was like, okay, absolutely everybody knows to report but there’s some, some gray areas where people weren’t sure, like injuries that theoretically could have been someone falling off their bike or things like that. I think the difficulty with this one is this feels like it really goes beyond that threshold of being reportable. And I think people have a fear of reporting. And and I think some of these fears are well founded because of how systems can be very harmful to marginalize communities or typically marginalized communities. But I think this fear of reporting, whether it’s the hassle, or the discomfort or the impact on the relationship with a family, I think, keep people from reporting stuff that fall in that gray area. But the fact that that this was beyond that, where there was physical injuries, he was limping. He had a black eye, like, it’s something where there was this would be on that point. And that’s really worrisome. And I think we can feel completely vindicated. Say like, of course, it’s worrisome this child died. And you know, like a month later, I tried to put myself in, in Barbara’s shoes, and I can understand the hesitance, especially as a pre licensed individual, saying, like, I just don’t know, and I’m getting guidance that I shouldn’t. And so to me, it feels I can’t think of a better word, it feels yucky.

Curt Widhalm 11:46
As many of our listeners know, I am a professor of law and ethics at California State University, Northridge. I also sit on the California Association of Marriage and Family Therapists ethics committee, I am speaking for neither of those organizations. But framing this within some of the background knowledge that comes with being in those positions. I hear from a lot of pre licensed people in our line of work are putting ourselves out there are connecting with people in the community, and I hear them wrongly state that I’m working under somebody else’s license, this falls on them. And in law and ethics classes that are typically taught first semester where there is a focus on child abuse assessment and reporting. I cannot emphasize enough that decisions like this, in this case, really do indicate that it is your responsibility, no matter what your agency says. That it and that is part of why this emphasis is on the individual so much is you are the frontlines ones who are responding. And people can and do get punished for not following through on their individual licensee or registration responsibilities as mandated reporters.

Katie Vernoy 13:16
Yeah.

Curt Widhalm 13:16
And unfortunately, it has taken children dying, to bring this emphasis up, to really put the onus back onto you as the individual. And, yeah, there should be, you know, some sort of responsibility of agencies that have policies like this in place of not reporting. I have quit working at agencies, I have stopped working at agencies when I found out that their policy is don’t report unless the child is bleeding. I have worked at agencies and this speaks to a huge part of this other thing that’s going on in this case is agencies that are document as little as possible to absolve us of responsibility, and I have long held that is the agency’s way of putting the responsibility on you as the individual. And in this case, that seems to really be holding true.

Katie Vernoy 14:13
Sure, and to me, there’s no mention of the agency in the official BBS document with the decision and the agency and I had training at Hathaway-Sycamores, I guess it’s now called Sycamores, like I had no negative interactions with Sycamores. I didn’t hear a negative reputation of Sycamores. So I can’t speak to whether or not that was their policy. It was not something that I had heard but so many agencies have had that policy of don’t report unless they’re actively bleeding or report if there’s anything more than an open hand on the bottom, it seems like it’s we’ve got black and white tactics for different agencies on how they decide what people report but to me, the fact that this clinician at first said, hey, it was the agency, they told me not to report. And then the agency said, that’s not the case, I have to look back to see exactly how that was responded to. But to me, it is very easy as a pre-licensed clinician to think that you are not going to be held responsible for what’s yours, but you absolutely will be. And I think it’s something for supervisors too, I mean, the supervisor is not mentioned and this, I don’t know that there’s a way to figure out who the supervisor was.

Curt Widhalm 15:35
We’ll post a another article here about the supervisors were dismissed from criminal charges in this case, and this is an article from July of 2020. So they were dismissed in this case.

Katie Vernoy 15:51
Okay. So the supervisors, even though people tell supervisors, this person’s working under your license, you’re responsible. Well, maybe not as much as we thought. So I think all folks should be holding on to the responsibility to do what needs to be done. But to to finish up this first point, if you are a clinician, pre-licensed or not, it is your responsibility to manage those those mandates.

Curt Widhalm 16:23
The other big piece of this is documentation.

Katie Vernoy 16:28
Yes.

Curt Widhalm 16:28
Everybody’s favorite part of this, but so many aspects of this, you know, there’s a failure to do an appropriate child abuse assessment here. And it was documented that it was done in an incomplete way that does not reflect the standards of care of working with children. And, you know, as Katie, you were mentioning earlier that when you work with kids, you kind of get a sense of what normal injuries are and what know what abnormal ones are. Scrapes, and bruises on elbows and knees, those are consistent with falling off of a bike, as you said, black eyes very much not so. And I’ve got children myself at home, there’s just bruises that show up just for being like a 6-7-8-9 year old kid that, you know, even they can’t really explain. But it’s why we spend so much time of here’s what an appropriate an abuse assessment actually is. Because it’s not only looking at what the injuries are, but also how the child talks about them. And that seems to really be missing in this case, at least as far as the documentation that was provided of these case sessions. Also emphasizing here, that when you put that things need to be followed up on, you should follow up on them and document them because, lo and behold, people can and do get into major trouble. And I can’t stress this enough. People die.

Katie Vernoy 18:10
Yeah. Yeah. In my reading of the timeline for this this case, it seems possible that this clinician started digging a little bit, required, requested required a doctor’s note said that in the notes. And so the documentation is both more than maybe, if you’re wanting to hide it didn’t do that. Well. But if you’re wanting to fully document it wasn’t sufficient. But it seems like that clinician was trying to take some more steps to follow through, and then did not and the and the family failed out of treatment. And so that I think this other piece, and this is the part that I find difficult because I think we do have a responsibility. And the child abuse report would have would have followed through on that responsibility. But I think when we don’t have sufficient information and a family fails out of treatment, we can still feel responsible, but it may not be possible for us to actually go through and edit and make a report if there’s not sufficient information. And so I think, to me, I go back to what I talked about in you know, are now clinicians have to document every fucking thing. And then also the previous one where we were talking about a different citation. I think that when we see that clinicians are overworked, have really high caseloads and are not potentially timely with their documentation, potentially don’t remember they’re supposed to be following through on things if they’re, you know, there’s there’s a lot of times where, yeah, it’s like, oh, yeah, that sucks. But like, as you mentioned, like there are times when us not being able to be on the ball means that kids die because we’ve missed something or we didn’t follow up on something So to me, I guess there’s three different points I was making. So I’ll start with I’ll dive into one, which is this notion of, at what point does it become a responsibility? Because if families fail out of treatment, if we don’t have enough information, we can’t be held responsible for that.

Curt Widhalm 20:17
If you’re following through on what you’re supposed to be following through on.

Katie Vernoy 20:21
Of course, of course, I’m not saying that this applies in this case, necessarily, it looks like it doesn’t. But I think there’s there’s folks that are gonna go to like, oh, well, I’m totally fine and aren’t. And I think there’s going to be the those of us that I say, like me, where I’m like, oh, no, you know, there was, there was a kid I had a slight, slight worry about, and I started digging in and the family failed out. And I don’t know, I don’t know, what happened, am I responsible?

Curt Widhalm 20:48
You’re responsible, in my teachings to all of my law and ethics students on this, you as an individual holds, and especially in private practice, you as an individual holds very little control over a family?

Katie Vernoy 21:05
Yes.

Curt Widhalm 21:06
Your responsibility is in those escalating situations is, if they’re bouncing out of treatment, if they’re doing things that weren’t mandated reports towards abuse, your job is to report them into the system that does have more control over them. And that’s why those systems are in place. And that is where your responsibility is.

Katie Vernoy 21:25
Sure. I think it’s those gray areas where there was something that was a wild notion, you ask about it, you don’t get enough information to report but now the family’s scared, and off they go.

Curt Widhalm 21:39
Then you document it and close out your treatment notes, which is one of the things that seems to be missing here is these are the attempts that were made to continue to contact the family. This is the follow up on these sessions. This is where this kind of questionable behavior may warrant actually filing an abuse report even if that is not a mandated report, because this is that cya cover your ass sort of aspects that I think a lot of us are either scared of, don’t want to put the extra work into or don’t want to be liable for making a call that might seem overboard for situations. But don’t let that be your, as an individual, decision. That’s the benefit of consultation or making a phone call let Child and Family Services be the ones who say no to this, don’t make that decision on your own.

Katie Vernoy 22:40
Pushing back just a little, because I think that this case is so obvious. And so as a jumping off point, it’s something where it’s like, yes, this should have been reported. This kid was clearly very injured. The family didn’t follow up appropriately and fell out of treatment like this was a this was a child abuse report, cut and dry. I think there are those times when there are I’m going to call them gray areas. You know, I think before the episode I mentioned that, I had a family where, you know, I was actually doing a home visit and the mom grabbed a house slipper and patted the kid on the bottom and said get out of here, I got a session with Katie. And they looked at me because I had described that child abuse reporting was anything besides an open hand on the bottom. And I looked at her, I was like, you’re fine. Because there was no injury, there was nothing. It was it was not ill intended. It was something that she immediately recognized, like, Oh, someone from a different culture, or a different family might see this as potentially violent, which it was not at all. But I think that there are those types of things where we’re in truth, as clinicians, we are doing assessments of what is happening here. And whether it aligns with my agency’s idea of what has to be reported or not. What is my decision because they’re, you know, an open hand on the bottom, depending on the age of the kid and the strength of the adult could be way more harmful, is actually way more harmful than what I witnessed. And so I think it’s that thing of when we’re in that space, where we’re assessing some of these things that fall in a gray area, a kid that has a black eye because the they were fighting with their sibling, and it’s a known thing that’s going on and that’s why they’re in treatment. I mean, it’s it’s those types of things where it’s like, well, mutual affray among minors is not reportable, at least in California. It wasn’t at the time. And so it’s it’s it’s these gray areas where there’s this nuance that I think feels really overwhelming. And for some folks, they’ll lean towards reporting or consulting to identify if it’s reportable. And for other folks, they use that as cover to not report when it feels too uncomfortable. And so I want to talk a little bit about that because I think that this case I think is pretty obvious. But I think, you know, when we veer a little bit to the right, so to speak, I think people can start falling into some of these traps.

Curt Widhalm 25:11
Oh what you’re talking about, even in describing it is you’re putting it into a context, you’re, you’re taking it out of gray, and you’re moving it back into black and white, because of the context. And that is proper child abuse assessments is what many people struggle with in this conversation is we want a definitive line. And even though the very same actions between two different client households, maybe exactly the same, the outcomes of them might be extremely different. And that’s where our role as clinicians and as mandated reporters is to ask the evaluative questions in in the appropriate ways to determine what makes it definitive in one situation as a mandated report and what makes it definitively not. And that you are documenting that as as your process, because good documentation on a good process, even if it’s wrong, provides you a level of protection rather than doing, frankly, bad assessments and bad documentation. That’s, and this is shown in the stipulation of Barbara Dixon here as it’s not just the failure to report it’s also about bad documentation. It’s also about gross negligence and incompetence in the documentation and response to this, that you have a responsibility to do all parts, not just come up with a decision.

Katie Vernoy 26:50
So taking a couple of moments on assessment, because you said we need to do a good assessment, the scope of this conversation, it does not lead to what constitutes child abuse, because there’s a lot of nuance from different states. And so we don’t go there. But I think when you’re looking at assessment, I think the first piece is what is the injury? Right?

Curt Widhalm 27:14
That’s what I was taught is start by defining the injury. If there’s an injury, proceed, that you are going to be reporting. You may not ultimately, but really, if you can’t define an injury, you’re gonna have a lot harder time making it into this is abuse.

Katie Vernoy 27:35
And physical injuries, I think are a little bit easier to define, I think emotional injuries for emotional abuse, which I think is a permitted versus mandated.

Curt Widhalm 27:44
In California, it’s permitted. Yeah.

Katie Vernoy 27:45
Yeah. I think that’s where it starts getting a little bit, I guess, kind of iffy for me is there’s a lot of stuff that can emotionally harm children that I think, as a society, we, we typically don’t call child abuse. And so, to me, I think there’s that element of okay, how do we, how do we dig into that? How do we make sure that we’re protecting the kids because something that’s egregious and overwhelming and, and truly abusive needs external intervention from an organization that can control the family, so to speak. I think things that are within the realm of this is an unhealthy household, and they need family therapy, I think there’s going to be some some places there were folks are going to struggle to determine what goes over the level of abuse versus this family needs family therapy.So what do you think?

Curt Widhalm 28:46
Do you have a question in that?

Katie Vernoy 28:48
I’m saying, What are your thoughts on that? Because I feel strongly that I as an individual, I feel like I’ve had a lot of experience with this. And I feel like I can, I can navigate through the nuance, but I you’re teaching new clinicians on this. And so when we’re looking at this gray area, where we’re looking at really fine gradations to determine when is it reportable? When is it a cause for family therapy? Do you have advice? Maybe that’s the question I was trying to get to.

Curt Widhalm 29:19
My advice is start with defining what the emotional injury is. Is it a change in behavior, a change in mood, a change in responsiveness, withdrawal from the parent or the alleged abuser in these situations that you’re going to want to define what the abuse is, what that injury is, and then start working from there as far as this is what makes this an abuse situation. Child was responding this way before said event. Child’s was responding this way after the event, a marked behavioral change, a marked change in how they are grooming themselves. All of the things that we go through in proper education in our child abuse assessment sort of things of knowing what normal child behavior is in response to a parent getting mad at them and putting them in timeout, yeah, kids going to have a marked change of behavior from being loud or crying or noxious, or whatever it is that led to the timeout to afterwards. But if it gets pushed into, you know, shaming and, you know, withdrawal from the parents, we’re not wanting to talk with them at all, these are more and more signs of moving into that abuse end of a spectrum of child responses.

Katie Vernoy 30:50
And that speaks to the second case. And I think that this is really telling, because I think that there’s two kids that this happened with, and it was the same clinician. And so I think that that speaks to a dynamic for this clinician, whether it was the agency’s interaction with her or her own stuff. But regardless, in the second case, there was a clear change in behavior after a visit with an uncle who had theoretically sexually abused him, there was I didn’t catch all of it, it seemed like it was very complicated. But there was the key elements for this behavior change that were clear from the description, I’m assuming in the documentation, that it was a big concern. And so I think we I think we know when something needs to be reported, and I always describe it as that pit of the stomach yucky feeling. I think it’s, I think the last piece, and we’re running a little bit low on time here. But I think that the last piece is really getting past that yucky feeling and just doing the thing, because I think a lot of people get caught there. I had a supervisor who her outgoing message was, you know, like, Hi, this is so and so dadada and to my clinicians, if you’re calling about suspected child abuse, you should report it. Because we know it, I think we instinctually know, like, this feels really bad. This feels really wrong. And I may be missing that there are folks that that’s not the case, whether they’ve had their own abuse, and it feels normal to them. And so there’s there’s different things that we want to assess. Or maybe they’re more sensitive to it. I think there’s there’s elements of this where I feel like we have a good sense or many of us have a good sense of what should be reported. But it can be very hard on the relationship with a family, it can be very work intensive, you know, hours on the phone or writing up the reports or at this point, I think it’s mostly just typing it up and shooting it off to the interwebs. But I think there’s there’s it is a decision that has an impact every time someone decides to do a child a suspected child abuse report.

Curt Widhalm 33:12
And, you know, wrapping this up, you know, not only is this child’s, these two children dead, this therapist who was an associate at the time, taking the responsibility, the California applet court overturned charges against the supervisors in the situation saying that they had no responsibility for this child’s welfare, no direct responsibility. I am emphasizing to all of our listeners, you as the individual have the responsibilities in these situations, your agency’s rules do not matter. You have to follow the law. You have to keep people alive. Do your jobs.

Katie Vernoy 34:01
So you’re saying buck up and deal with the discomfort because you got to do your job?

Curt Widhalm 34:05
Yes,

Katie Vernoy 34:07
I will. I will take that. And I want to add a little bit more. I think whenever I feel that discomfort and the hesitation or the pushback around this is a report. And this happens across the board, whether it’s for child abuse reporting dependent adult or elder abuse, obviously outside the scope of this conversation. I sit with it for a minute and I think about what what is the purpose of this report. And if you’ve done a good assessment, you’ve identified a real injury. You’ve identified a pattern of abuse or even a an incident of abuse that is reportable by contacting the appropriate agencies. First off, you’re covering your own behind which isn’t the the most, I guess, compelling for some folks, but I think it is a compelling reason to do it. But hopefully, you’re also getting resources for these families, to avoid killing kids to avoid kids being severely harmed or traumatized for the rest of their lives. Child abuse reports can trigger resources, additional resources they wouldn’t have access to and it can, it can, it can really be a helpful tool. As we know, it can also be very harmful for systems to go in and to tear families apart. And I know that that’s that’s hard to try to figure out where this lands, but for me, in my experience, with my families is working in all different places across the Southland, but South Los Angeles included. I think it’s been something where in being able to work with the families and talk with them about why I’m making the report, what’s happening with the report, working together with them on this. There’s been healing for the families and healing of generational trauma, which is a big thing to ask, of a single day of making a report, but I think there is a pathway forward for some families when it’s actually called out. And so getting getting to that space can be helpful with the caveat that I recognize there are systems that harm families. I think it’s it’s a hard line sometimes.

Curt Widhalm 36:33
We will include links to the news articles that we used for this in our show notes. You can find those over at mtsgpodcast.com. You can also join our Facebook group Modern Therapist group, follow us on our social media. And until next time, I’m Curt Widhalm with Katie Vernoy.

Katie Vernoy 36:52
Thanks again to our sponsor, OOtify.

Curt Widhalm 36:54
“OOT” or “uth” (उठ) means “lift up” in the Hindi language. OOTify is a digital health solution that acts as an evidence based hub to unify relevant mental health resources. Community, Connection and Collaboration are critical to OOTify. As they lift the mental health care system, they ensure providers are part of the process. OOTify is a platform for providers, built by providers and owned by providers. OOTify in the process of lifting up mental health care while lifting each other up.

OOTify 37:27
We need to talk about our mental health. We need to make our mental health stronger so we can withstand the things that happen in our life. We’re gonna go through trials and tribulations. But if we can work on our mental health, proactively our wellness, we can handle all that as a community and come together. People are more open to talk about these stories and say, Hey, listen, I’m going through this too. Do you want to be a part of the solution by joining a new web three community focused on mental health and wellness. Join the OOTify community as an investor or mental health provider by visiting ootify.com/contact. You can also give us a follow on social media to stay tuned on exciting updates.

Curt Widhalm 38:09
This episode is also brought to you by Turning Point.

Katie Vernoy 38:13
We wanted to tell you a little bit more about our sponsor Turning Point. Turning Point is a financial planning and coaching firm that helps therapists stop worrying about money. Dave, our good buddy over at Turning Point will help you navigate every aspect of your financial life from practice financials and personal budgeting to investing taxes and student loans. He’ll help you move through that feeling of being stuck, frustrated and overwhelmed, and arrive at a place where you feel relief, validation, motivation and hope.

Curt Widhalm 38:45
And for listeners of MTSG you’ll receive $200 off the price of any service. Just enter the promo code modern therapist, be sure and visit turningpointhq.com and download the free white papers 7 Money Mindset Shifts to Reduce Financial Anxiety. That’s turningpointhq.com

Announcer 39:03
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