Enhancing Counselor Trainee Preparedness for Treating Eating Disorders: Recommendations for Counselor Educators

Taylor J. Irvine, Adriana C. Labarta

Eating disorders (EDs) are increasingly prevalent and pose significant public health challenges. Yet, deficits exist in counselor education programs regarding ED assessment, conceptualization, and treatment. Consequently, counselors report feeling incompetent and distressed when working with ED clients. We propose a conceptual framework, the 3 Cs of ED Education and Training, to enhance trainee development. The 3 Cs are: (a) cultivating trainee self-awareness through reflexivity and deliberate skill practice, (b) capturing contextual and sociocultural factors with culturally responsive approaches, and (c) collaborating with interdisciplinary ED professionals while strengthening counselor professional identity. Implications for counselor educators include incorporating activities aligned with this framework into curriculum and experiential training in order to facilitate trainee competence in ED assessment and treatment.

Keywords: eating disorders, 3 Cs of ED Education and Training, framework, counselor education, trainee development

Eating disorders (EDs) remain one of the most lethal mental health illnesses, contributing to roughly 3 million deaths globally each year (van Hoeken & Hoek, 2020) and impacting 29 million or 9% of Americans over their lifetime (Deloitte Consumer Report, 2020). In the United States alone, EDs directly result in 10,200 deaths annually, averaging one death every hour (Deloitte Access Economics, 2020). The steady rise of EDs across genders and countries is of increasing concern, with scholars noting in their systematic literature review that rates have doubled from 3.5% in 2000–2006 to 7.8% in 2013–2018 (Galmiche et al., 2019). EDs also exact a significant economic toll in the United States. In the 2018–2019 fiscal year, Streatfeild et al. (2021) found that EDs generated financial costs of nearly $65 billion, averaging about $11,000 per affected individual. Moreover, their study estimated an additional $326.5 billion in non-financial costs due to reduced well-being among those with EDs. Given their associated comorbidities with other mental health illnesses (Ulfvebrand et al., 2015), enduring somatic issues (Galmiche et al., 2019), and facilitation of psychological distress (Kärkkäinen et al., 2018), EDs pose significant public health and economic threats that necessitate further consideration. However, the literature lacks meaningful attention to ED prevention and treatment (van Hoeken & Hoek, 2020), an oversight that needs to be redressed within counselor education (CE) graduate training programs. A failure to examine this clinical issue threatens the maintenance of quality assurance and ethical standards within the profession, enabling short- and long-term client harm.

Challenges and Gaps in ED Education and Training
     Given the steady rise in the prevalence of EDs and their associated consequences, counseling trainees must be equipped with comprehensive training in order to effectively conceptualize and treat these complex conditions. However, across the decades, research has illuminated ED education and training deficits, particularly in graduate programs (Biang et al., 2024; Labarta et al., 2023; Levitt, 2006; Thompson-Brenner et al., 2012). For instance, Labarta et al.’s (2023) recent study examined clinician attitudes toward treating EDs, revealing challenges related to the lack of specialized graduate training. Among surveyed respondents, only 25.7% reported that their programs offered a specialized course on EDs, while approximately half of the sample (41.3%) divulged that their program dedicated only 1–5 hours of ED-related instruction throughout the curricula. Furthermore, one participant indicated that ED education is “rarely more than one lecture at the master’s level” (Labarta et al., 2023, p. 21). This is particularly concerning as research shows that trainees are not only very likely to encounter a client battling an ED at some point in their professional career (Levitt, 2006) but are also going to be less prepared and effective in treating such clients without specialized ED training in graduate programs (Biang et al., 2024; Labarta et al., 2023).

As a result of this lack of ED education, scholars have noted negative implications for helping professions, contributing to clinician incompetence, increased burnout, and diminished self-efficacy when working with ED clients (Labarta et al., 2023; Levitt, 2006; Thompson-Brenner et al., 2012). Clinician competence is a necessary vehicle to not only promote individual accountability but to also ensure the integrity of the broader counseling profession. However, holistic competency development is threatened without adequate, targeted ED training, increasing the likelihood that counselors-in-training (CITs) will encounter recurring treatment failures when working with clients struggling with an ED (Williams & Haverkamp, 2010). Williams and Haverkamp (2010) echoed this sentiment, stating that the field risks the occurrence of “iatrogenesis . . . particularly when the practitioner has a poor understanding of EDs, the negative reactions that eating disordered clients can evoke in the clinician are not managed, and/or there are specific types of process and relationship errors made in therapy” (p. 92). For example, although a school counselor may not serve as the primary treatment provider for an adolescent with bulimia nervosa, their understanding of warning signs and symptoms, supportive collaboration with students and families, and knowledge of specialized community referrals are invaluable to the counseling process (Carney & Scott, 2012). As such, counselor educators must assist CITs with developing essential competencies for treating EDs during graduate training programs, ultimately working toward bridging this gap and improving the quality of care.

Addressing the deficit of multicultural research in the field of EDs is of paramount importance, as it directly impacts the practice and education of counselors. Accrediting and professional bodies expect counselor educators to impart multicultural knowledge and skills to CITs, including a focus on diverse cultural and social identities (American Counseling Association [ACA], 2014; Council for the Accreditation of Counseling and Related Educational Programs [CACREP], 2023). Furthermore, Levitt (2006) emphasized that the significant consequences and growing prevalence of EDs across diverse cultural groups necessitate that clinicians “gain exposure to the etiology, manifestation, and treatment of eating disorders within multiple contexts” (p. 95). This assertion underscores the critical need for a more inclusive and culturally competent approach to assessing, treating, and educating about EDs, emphasizing the urgency of addressing the existing gaps in research. Ultimately, the absence of targeted ED research and training, notably conceptualization and assessment strategies, poses ethical concerns for safeguarding clients’ welfare, rendering trainees ill-equipped to address milder presentations of these disorders, let alone complex cases with more severe symptoms, such as heightened suicidality, enduring medical complications, and acute psychological distress (Kärkkäinen et al., 2018).

Research concerning client experiences is also imperative when assessing education and training needs for effective ED treatment. Babb et al. (2022) conducted a meta-synthesis of qualitative research on ED clients’ experiences in ED treatment, illuminating important themes on clinicians’ roles in supporting clients. Several clients reported that some staff perpetuated stereotypes about EDs (e.g., viewing the client as an illness versus a person) and tried to fit clients into specific theoretical frameworks. Clients attributed this lack of awareness and sensitivity to the providers’ lack of specialized training in EDs. Conversely, clients in this study felt empowered when providers were empathic and provided individualized approaches to treatment. These participants noted that “being seen as an individual” facilitated motivation for treatment, with the therapeutic alliance as an essential factor in this process (Babb et al., 2022, p. 1289). These client perspectives provide valuable insights that should inform the development of CE training programs to better prepare CITs for working with individuals with EDs.

Training Recommendations for Counselor Education Programs

Collectively, the findings cited above underscore the importance of comprehensive ED training for counselors to be able to effectively and compassionately serve diverse clients with EDs. However, accessibility to such education and training remains a challenge to both the graduate students and practitioners (Biang et al., 2024; Labarta et al., 2023). Furthermore, despite the efficiency of manualized approaches, Babb et al.’s (2022) study emphasized the need for both flexibility and avoiding a one-size-fits-all approach to ED treatment, particularly given the diversity of clients with EDs, including those from traditionally underrepresented backgrounds (Schaumberg et al., 2017). Clients’ lived experiences corroborate these gaps, reporting instances of stereotyping, rigid adherence to theoretical frameworks, and a lack of empathy stemming from inadequate specialized training (Babb et al., 2022). These findings highlight the pressing need for training strategies that ensure competence and uphold ethical standards within the treatment of EDs, including ongoing education for new practitioners entering the field.

The following section offers competency-based recommendations for CE programs to incorporate into their curricula and experiential training. We propose a conceptual model that we call the 3 Cs of ED Education and Training. The 3 Cs are: (a) cultivating trainee self-awareness, (b) capturing contextual and sociocultural factors, and (c) collaborating with interdisciplinary professionals (see Figure 1). We also provide an overview of recommended activities and associated reflective prompts that can be used in a special topics course on EDs (see Appendix A), as well as suggested adaptations for integration across counseling curricula. By integrating these teaching strategies, CE programs can enhance competency-based education for EDs (Williams & Haverkamp, 2010), which may empower CITs to provide compassionate, empirically supported services to this vulnerable population.

Figure 1
The 3 Cs of ED Education and Training
 


Cultivating Trainee Self-Awareness
     Cultivating trainee self-awareness is essential to ethical and multiculturally competent ED treatment. As espoused in our ethical codes (ACA, 2014), counselors are expected to examine their own beliefs, attitudes, and emotional responses when working with clients. Without such conscious examination, clinicians risk projecting their personal biases onto their clients or responding in ways that might inadvertently cause harm. For instance, the pervasive weight stigma embedded in our society can unconsciously influence counselors and may result in microaggressions, victim blaming, or the dismissal of symptoms, particularly when working with clients in larger bodies (Veillette et al., 2018). Counselors may also experience countertransference reactions triggered by ED behaviors or other challenging treatment components, such as high relapse rates, resistance to treatment, or insurance coverage issues (Labarta et al., 2023; Warren et al., 2013), negatively influencing the therapeutic relationship (Graham et al., 2020). Reflexive exercises, paired with targeted deliberate skill practice, are valuable mechanisms for facilitating conscious self-examination and building relevant knowledge and skills for effective ED treatment. 

Encouraging Reflexivity and Deliberate Practice
     Reflexivity, defined as “a practice of observing and locating one’s self as a knower within certain cultural and socio-historical contexts,” allows CITs to engage with courses on cognitive, affective, and experiential levels (Sinacore et al., 1999, p. 267). The integration of reflexive exercises and critical discussions into ED curricula is essential for cultivating self-awareness and, in effect, mitigating potential client harm. Such practices create opportunities for trainees to identify and address any unconscious biases or beliefs, which, if unaddressed, can undermine the quality of care provided. By establishing a habit of mindful self-inquiry, educators can take the first critical step in preparing ethically conscientious counselors attuned to ED clients’ diverse needs (Labarta et al., 2023).

This intentional practice of reflexivity should be paired with deliberate practice strategies focused specifically on promoting skill development for treating EDs. Deliberate practice is a systematic and intentional training method that targets skill development in order to attain expert performance in a given area or domain (Ericsson, 2006; Irvine et al., 2021). Research shows that integrating deliberate practice strategies early in CE training promotes competency development (Chow et al., 2015). Ericsson (2006) developed five crucial tasks of deliberate practice: self-assessment, skill repetition, formative feedback, stretch goals, and progress monitoring. The first task is a necessary step in increasing trainee self-awareness, which is particularly crucial when working with vulnerable populations, such as those struggling with EDs. Deliberate practice empowers trainees to refine their skills and continuously evolve as competent, empathic, and effective counselors. Thus, deliberate self-reflection on personal assumptions is key, as examining one’s relationship with food and body is imperative to prevent issues like value imposition and orient the focus of treatment to the client’s healing process.

Integrating reflexivity and deliberate skill practice early in CE training is vital to promoting lasting competency. CITs often overestimate their competence at the end of their training, necessitating that CE programs systematically monitor the congruence between CITs’ self-assessments and counselor educators’ assessments of CITs’ competency and skill development (Gonsalvez et al., 2023). Routine reflexive exercises can illuminate areas for growth, while deliberate practice strategies provide structured mechanisms for targeted skill refinement. As trainees embark on their professional journeys, ongoing and intentional efforts to self-reflect and evolve through skill refinement will empower them to provide safe, ethical, and effective ED treatment.

Capturing Contextual and Sociocultural Factors
     It has been well-documented that EDs impact individuals across social and cultural identities despite the misconception that only thin, White, affluent, cisgender women are affected (Schaumberg et al., 2017). Indeed, scholars have pointed to the need for intersectional, social justice–informed research that addresses the unique ways that context and culture influence EDs and body image concerns (Burke et al., 2020; Halbeisen et al., 2022). The prevalence of EDs and pervasive body image issues is alarming in today’s sociocultural landscape. For instance, the recent increase in gender-affirming care bans and anti-LGBTQ+ legislation poses profound and detrimental effects on individuals battling an ED (Arcelus et al., 2017), as these restrictive policies exacerbate the mental and emotional distress already experienced by LGBTQ+ individuals, further isolating them and undermining their access to critical health care services (Canady, 2023). As a result, members of this community are more apt to experience intensified body dysphoria, heightening the risk of developing or worsening an ED in an attempt to conform to societal norms (Arcelus et al., 2017).

In the wake of the COVID-19 pandemic, the world has experienced a collective trauma that triggered a series of physical and mental health consequences that will linger for years to come, including rising rates of disordered eating and body-related concerns. Termorshuizen et al. (2020) surveyed 1,021 individuals across the United States and the Netherlands, revealing that ED diagnoses increased at a rate of roughly 60%, with respondents noting increased binge episodes (30%) and restriction behaviors (62%) during this time. Scholars have also shown the deleterious effects of the pandemic on body image perception. For instance, in one study of 7,878 respondents, 61% of surveyed adults and 66% of surveyed children (17 and under) disclosed frequent negative feelings regarding their body image, with 53% of adults and 58% of children reporting that the pandemic has significantly exacerbated these feelings (House of Commons, 2021). Unfortunately, weight stigma was also pervasive in the media, with concerns regarding quarantine weight gain (e.g., “Quarantine-15”) contributing to eating and body image challenges (Schneider et al., 2023). Amidst the multifaceted challenges presented by recent sociopolitical events and the intersecting struggles faced by diverse individuals with EDs, it is essential that counselors implement culturally responsive approaches to treatment and advocacy efforts.

Centering Culturally Responsive Approaches
     Given the diversity of clients who struggle with eating and body image concerns (Schaumberg et al., 2017), CE programs must integrate culturally sensitive theories into the curriculum to ensure that CITs possess the necessary competencies to explore relevant cultural factors and effectively treat diverse clients with EDs (Williams & Haverkamp, 2010). Two theories that fostered the development of the Multicultural and Social Justice Counseling Competencies (MSJCC; Ratts et al., 2016) are intersectionality theory and relational–cultural theory (Singh et al., 2020). Intersectionality is a framework for comprehensively understanding the interaction of systemic inequalities and oppression that significantly affect marginalized community members (Burke et al., 2020; Crenshaw, 1991). This theoretical paradigm deepens our understanding of factors such as age, race, ethnicity, sexual orientation, ability status, body size, and gender identity and how these factors influence an individual’s lived experience. Intersectionality is vital for promoting social justice and culturally responsive treatment while also serving as a tool to dismantle oppression and colonizing practices within the profession (Chan et al., 2018; Singh et al., 2020). Intersectionality-informed practice may assist researchers and counselors with considering risk and protective factors for EDs; however, the lack of attention to the intersecting roles and identities of ED clients (e.g., a Catholic, bisexual, Latina) remains a concern, which is crucial for informing culturally competent counseling and training practices (Burke et al., 2020).

Relational–cultural therapy (RCT; Jordan, 2009) is another promising theory that may decolonize dominant counseling approaches (Singh et al., 2020). Due to its emphasis on relational connection, social justice, and empowerment, RCT has been applied to the treatment of EDs (Labarta & Bendit, 2024; Trepal et al., 2015). Infusing RCT into practice may help counselors understand sociocultural influences that maintain ED (e.g., diet culture, weight stigma, acculturation) and perpetuate feelings of disconnection for individuals who do not conform to prevailing body or appearance standards. RCT also aligns well with counseling’s wellness orientation due to its relational and strengths-based focus, emphasizing resilience over pathology in the treatment of ED (Labarta & Bendit, 2024). Counselor educators can expand beyond traditional ED treatment approaches by integrating culturally responsive theories like intersectionality and RCT into course curricula, thus highlighting the intrapersonal, interpersonal, and systemic components that impact clients with EDs.

Collaborating With Interdisciplinary Professionals
     The counseling profession has recognized the importance of interdisciplinary practice, encouraging counselors to participate in “decisions that affect the well-being of clients by drawing on the perspectives, values, and experiences of the counseling profession and those of colleagues from other disciplines” (ACA, 2014, Code D.1.c, p. 10). The CACREP Standards (2023) also emphasize the need for counseling students to learn about collaboration, consultation, and community outreach as part of interprofessional teams (Section 3.A.3). Indeed, interdisciplinary collaboration provides an opportunity for individual and systems-level advocacy (Myers et al., 2002). The challenge remains in how counselors can balance establishing a distinct professional identity while simultaneously fostering a sense of community among various helping professions (Klein & Beeson, 2022). Researchers have underscored common experiences of counselors within interdisciplinary teams, including challenges with building legitimacy and credibility, especially among more well-established helping professions such as psychiatry or psychology (Klein & Beeson, 2022; Ng et al., 2023). Given that multidisciplinary collaboration is also crucial to ED treatment (Crone et al., 2023; Williams & Haverkamp, 2010), counselor educators must prepare CITs to effectively work within interdisciplinary treatment teams while utilizing their counseling values and training to best serve their clients and advocate for the inclusion of counselors across ED treatment settings (Labarta et al., 2023).

Strengthening Counselor Professional Identity
     Given that EDs are biopsychosocial in nature, effective treatment commonly involves collaboration among various health professions (e.g., medicine, psychiatry, counseling, psychology, dietetics) to ensure holistic, comprehensive client care (Crone et al., 2023). Counselors’ developmental, preventive, and wellness-based perspectives can help provide a strengths-based approach to interdisciplinary collaborations (Labarta et al., 2023). For example, a psychiatrist at a residential facility may focus on assessing a client’s pathology, comorbidity, and changes in symptoms throughout treatment. Although counselors can also focus on assessing client symptoms, their training allows them to provide insight into protective factors that foster client resilience in their recovery process (e.g., social support and cognitive flexibility). Both professionals bring unique expertise, knowledge, and skill sets that provide a distinct conceptualization of the client’s concerns with food or with their body. However, the ultimate goal of the treatment team is to ensure ethical and competent care for the client.

Outside of intensive ED treatment, counselors in school settings and community agencies can offer prevention-based approaches to mitigate risk factors leading to the development of EDs. Prevention-based efforts, such as community programs and workshops, are essential to the field of ED, given the alarmingly low rates of help-seeking in adults with lifetime EDs (34.5% for anorexia nervosa, 62.6% for bulimia nervosa, and 49.0% for binge eating disorder), which are even more pronounced among marginalized communities (Coffino et al., 2019). As such, counselors and other helping professionals can collaborate on ways to increase accessibility to mental health services for underserved groups with increased risk of eating or body image concerns (e.g., LGBTQ+; Nagata et al., 2020). Regardless of the settings within which CITs will work, students can benefit from developing teamwork, leadership, and advocacy skills, as well as a systemic conceptualization of client care (Ng et al., 2023). Ultimately, counselor educators can encourage the exploration of shared goals across helping professions and the utilization of counseling values and training to enhance interdisciplinary work for diverse clients and communities recovering from EDs (Klein & Beeson, 2022; Labarta et al., 2023; Ng et al., 2023).

Implications for Counselor Educators

The 3 Cs for ED Education and Training pose several implications for counselor educators and counseling programs. Although intended for ED treatment, this framework captures essential competencies across counseling specialties, such as counselor self-awareness, cultural and diversity issues, and interdisciplinary practice (CACREP, 2023). As such, integrating these foci into the counseling curriculum can help reinforce competencies regardless of the settings within which students will work. Counselor educators teaching about EDs should also consider ways to incorporate other ED counseling competencies, such as relevant ethical issues, assessment and screening, and evidence-based treatments into coursework (Williams & Haverkamp, 2010). These topics can be integrated into the 3 Cs for ED Education and Training in several ways. For instance, ethical issues and scenarios, such as determining when a client may need a higher level of care, can be presented to students as a standard component of collaborating with interdisciplinary professionals. Counselor educators can also review common ED assessments and encourage students to critically evaluate gaps in the diagnostic process that impact underrepresented populations (e.g., men with EDs), capturing contextual and sociocultural factors and enhancing culturally responsive care (see Appendix B for more examples.)

We also recognize the potential challenges of implementing the 3 Cs of ED Education and Training, as a stand-alone, special topics course on EDs may not be possible for all counseling programs. However, counselor educators can adapt and incorporate the suggested activities in Appendix A into various CACREP core courses to enhance ED education across the curriculum. CE programs can also utilize their Chi Sigma Iota chapters to host events on EDs, such as an interdisciplinary panel discussion followed by a group discussion on professional counseling identity and advocacy (Labarta et al., 2023). Opening these events to the local community could encourage continuing education, collaboration, and advocacy.

Directions for Future Research
     Given that the 3 Cs of ED Education and Training is a conceptual framework, there are several directions for future research. Counselor educators and researchers may consider developing a stand-alone course to test the effects of this framework on CITs’ competence in treating EDs. To our knowledge, limited ED competency measures exist, especially for counselors. As such, researchers could explore developing an instrument that measures ED competency areas that include the 3 Cs of ED Education and Training. Such a tool would be helpful for research, clinical, and teaching purposes. An ED competency tool may also enhance CITs’ and counselors’ deliberate practice efforts, promoting quality care for clients across ED treatment settings. Additionally, one theoretical framework educators can modify to help enhance trainees’ clinical competencies in treating EDs is Irvine and colleagues’ (2021) Deliberate Practice Coaching Framework (DPCF), given its structured guidance for skill refinement through individualized coaching and feedback. The development and future testing of an adapted DPCF for EDs may further enhance reflexive and deliberate practice efforts for CITs and counselors working with this population.

Conclusion

In this article, we have proposed our 3 Cs of ED Education and Training to address current gaps in ED education and enhance trainee preparedness across CE programs. Informed by existing literature, this framework incorporates essential elements of comprehensive ED treatment, including counselor self-awareness, cultural and contextual factors, and interdisciplinary practice. The flexibility of this framework allows educators to adapt current curricula to strengthen ED training in CE programs and to meet the needs of their students. Further research that tests a stand-alone course incorporating this framework is needed. The 3 Cs of ED Education and Training offer a path forward in remedying the salient gaps in ED education, ultimately advocating for more compassionate, ethical, and inclusive care across counseling settings.

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.

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Appendix A

The 3 Cs of ED Education and Training: Suggested Activities and Reflective Prompts

 

3 Cs of ED Education & Training Suggested

Activities

Activity Sample

Reflective Prompts

Adaptations for Integration Across Counseling Curricula
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cultivating Trainee

Self-Awareness

Reflexive Journaling:

Have CITs maintain a journal, reflecting on their experiences (e.g., biases, assumptions, insights, challenges) throughout the course.

Instructors can provide suggested weekly prompts based on the content or topic area discussed.

Deliberate Practice:

During the first week, CITs will read Williams and Haverkamp’s (2010) article on ED counseling competencies.

CITs then write a reflection paper identifying 2–3 targeted, actionable areas for development and growth.

Revisit these competencies at the end of the course to assess CIT growth and ongoing development areas.

Reflexive Journaling Prompts:

Reflect on your beliefs, values, and attitudes about counseling ED clients. What would you like to learn? What challenges do you anticipate?

How might cultural factors impact how counselors work with ED clients? Consider how your cultural and social identities shape your relationship with food and body image.

Complete the Anti-fat Attitudes Questionnaire (Crandall, 1994) and interpret your score. What insights did you gain? Why might self-assessment in this domain be an important tool for counselors? (Kerl-McClain et al., 2022)

Deliberate Practice Prompts:

Using a Likert scale of 1 (not confident) to 5 (very confident), how confident do you feel to treat clients with EDs?

Using a Likert scale of 1 (not prepared) to 5 (very prepared), how prepared do you feel to treat clients with EDs?

Identify 2–3 areas of personal or professional development and growth.

Identify 2–3 actionable steps for this semester and beyond.

 

Psychopathology and Diagnosis Courses:

Before teaching ED diagnoses, facilitate a brief activity to promote reflexive practice (see suggested prompts).

Follow up with a class discussion on CITs’ reflections, reactions, insights, and the possible impact of biases or assumptions on the diagnosis and treatment process for ED clients.

Practicum and Internship Courses:

CITs working in ED treatment settings can use the deliberate practice prompts to continually assess strengths and growth areas.

Encourage CITs to complete the self-assessment on ED knowledge and skills. Based on the identified gaps, campus instructors can invite guest lecturers to discuss topics of interest.

3 Cs of ED Education & Training Suggested

Activities

Activity Sample

Reflective Prompts

Adaptations for Integration Across Counseling Curricula
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Capturing Contextual

and

Sociocultural Factors

Media Critique:

Have CITs select and analyze a form of media (e.g., movies, TV series, social media).

CITs can then consider the messages conveyed about EDs and body image.

Class Discussion:

Engage in a class discussion on CITs’ observations, noted themes, and implications for counseling practice.

Educators may also initiate a discussion on media literacy and how to broach similar discussions with clients and colleagues.

 

Individual Reflection Prompts:

How were EDs and/or body image concerns portrayed explicitly and implicitly?

How do sociocultural factors (e.g., race, ethnicity, gender, etc.) influence media portrayals and messages about EDs/body image?

How might these portrayals or messages influence one’s beliefs about EDs?

Class Discussion Prompts:

What were the overarching themes or messages across the various media?

How can culturally responsive theories (e.g., RCT, intersectionality) inform how we conceptualize the impact of media on EDs and body image concerns?

How can counselors work with clients impacted by harmful media ideals?

How can counselors advocate for more culturally inclusive and responsible ED portrayals in media?

Social and Cultural Diversity Course:

Facilitate a discussion on CITs’ observations of ED media portrayals, considering the impact of limited representation on mental health access.

Provide a case study of a client with intersecting minoritized identities and encourage CITs to identify culturally responsive treatment approaches and theories that can benefit the client’s recovery.

3 Cs of ED Education & Training Suggested

Activities

Activity Sample

Reflective Prompts

Adaptations for Integration Across Counseling Curricula
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Collaborating with Interdisciplinary Professionals

ED Expert Panel:

Invite professionals across disciplines specializing in treating EDs (e.g., M.D., psychiatrist, psychologist, dietician).

Engage the panelists in a discussion on their respective training, roles, responsibilities, and experiences working in interdisciplinary treatment teams.

Reserve Q&A time for CITs to share any thoughts, questions, and insights (Labarta et al., 2023).


Professional Identity Reflection Paper:

After the ED expert panel discussion, have CITs write a reflection paper on what they learned from the panelists.

CITs can reflect on how counselors contribute to interdisciplinary teams using their developmental, prevention-focused, and wellness-based training.

Facilitate a broader discussion with CITs during the subsequent class meeting.

Expert Panel Discussion Prompts:

Briefly discuss your ED treatment experiences and describe your main roles and responsibilities.

Discuss the benefits and challenges of working in interdisciplinary treatment teams.

What would you say are the most prevalent issues faced by ED professionals today?

What words of wisdom can you share with CITs considering working with ED clients?

Professional Identity
Paper Prompts:

·      What challenges and opportunities do you foresee as a counselor working in an interdisciplinary treatment team?

·      How can counseling values inform an interdisciplinary perspective on ED treatment?

·      What personal strengths could you contribute as an interdisciplinary treatment team member?

·      Reflect on the MJSCC (Ratts et al., 2016), discussing how they can inform a counselor’s work with diverse clients struggling with eating and/or body image concerns.

Introduction to Mental Health Counseling Course:

If coordinating an ED expert panel is not feasible, consider inviting other professionals across specialty areas (e.g., EDs, addictions, integrated behavioral health) to share their experiences

CITs can complete a reflection paper on their insights and reactions to the guest panelists using the professional identity paper prompts as a guide.

 


Appendix B

Educator Checklist for Integrating the 3 Cs of Eating Disorder (ED) Education and Training Into Counselor Education Curricula

Cultivating Trainee Self-Awareness
Increase trainee awareness by incorporating ED warning signs, risk factors, and conceptualization strategies into assessment and treatment approaches.
Routinely assess student competency on ED-related knowledge and skills, evaluating for any incongruence between the students’ and educators’ scores. Additionally, assess multicultural counseling competencies related to EDs during student evaluations. Provide feedback for growth.
Encourage student attendance at ED-focused workshops, webinars, and conferences to enhance deliberate practice efforts, promoting professional growth and development.
Promote student exploration of their own cultural identities, values, and biases related to appearance, health, and eating behaviors.
Capturing Contextual and Sociocultural Factors
Incorporate diverse ED case examples and vignettes that reflect a range of intersecting cultural identities and experiences.
Provide training on culturally responsive ED treatment approaches like RCT and intersectionality. Be sure to cover strategies for adapting evidence-based ED treatment approaches to be culturally relevant for diverse clients.
Emphasize the importance of cultivating cultural humility and client empowerment, particularly when working with ED clients from diverse or marginalized backgrounds.
Collaborating With Interdisciplinary Professionals
Critically examine course syllabi to identify where ED content and scholarship could be incorporated or expanded (e.g., textbooks, media, articles). Include resources from interdisciplinary helping professionals.
Compile a list of interdisciplinary community referrals and resources to support students working with ED clients.
Provide opportunities (e.g., guest lecture, course assignment) for students to learn from ED experts in various helping disciplines. Encourage students to reflect on ways to utilize their counseling values and training within interdisciplinary treatment collaborations.

Note. This checklist is a framework for integrating ED education into CE graduate training. Consider modifying components to align with your specific curriculum, resources, and student population. The goal is to integrate ED education in a way that provides students with foundational knowledge, skills, and practical experience to effectively support clients struggling with EDs and body image issues in their future counseling practice.

Taylor J. Irvine, PhD, NCC, ACS, LMHC, is an assistant professor at Nova Southeastern University. Adriana C. Labarta, PhD, NCC, ACS, LMHC, is an assistant professor at Florida Atlantic University. Correspondence may be addressed to Taylor J. Irvine, Department of Counseling, Nova Southeastern University, 3300 S. University Dr., Maltz Bldg., Rm. 2041, Fort Lauderdale, FL 33328-2004, ti48@nova.edu.

A Child Abuse Reporting Framework for Early Career School Counselors

Malti Tuttle, Lacey Ricks, Margie Taylor

School counselors experience various emotions, such as anxiety, when in the role of mandated reporter of child abuse. This manuscript addresses how early career school counselors might experience distress because of the lack of established child abuse reporting procedures, fear of repercussions for the school counselor or student, and limited training in identifying types of abuse. Based on the previous literature, the authors discuss the imperative role early career school counselors have as mandated reporters and provide a framework to assist in the child abuse reporting process. The framework, specifically designed for school counselors, is collaborative in nature and emphasizes maintaining ethical and legal standards, obtaining continual professional development, and following best practices for mandated child abuse reporting.

Keywords: child abuse, mandated reporter, early career, school counselors, framework

School counselors often experience anxiousness regarding child abuse reporting (Lambie, 2005; Sikes, 2008). Early career school counselors in particular can experience this because of the lack of established reporting procedures (Lambie, 2005), fear of repercussions for the school counselor or student (Bryant & Milsom, 2005; Kenny, 2001), and limited training on identifying types of abuse (Alvarez, Kenny, Donohue, & Carpin, 2004; Kenny, 2001). Because of these factors, early career school counselors seek and request support to assist them with the child abuse reporting process and clarification on these procedures (Bryant & Baldwin, 2010; Ricks, Tuttle, Land, & Chibbaro, 2019). Therefore, we propose a child abuse reporting framework designed to assist early career school counselors, who are ethically and legally mandated to report child abuse, in the child abuse reporting process (American School Counselor Association, 2016; Sikes, Remley, & Hays, 2010). This manuscript is different from previous literature (e.g., Alvarez et al., 2004; Bryant & Milsom, 2005; Kenny, 2001; Lambie, 2005; Sikes, 2008) because it focuses specifically on the concerns and needs of early career school counselors, as well as expands on previous literature. For the purpose of this article, child abuse and neglect are defined by the Child Abuse Prevention and Treatment Act Reauthorization Act of 2010 (2010) as “any recent act or failure to act on the part of a parent or caretaker which results in death, serious harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm” (p. 6).

Child maltreatment can have lasting harmful effects on victims. Maltreatment includes “medical neglect, neglect or deprivation of necessities, physical abuse, psychological or emotional maltreatment, sexual abuse, and other forms included in state law” (U.S. Department of Health & Human Services [USDHHS], Administration for Children, Youth and Families, & Children’s Bureau, 2019, p. 108). Minimum standards for what constitutes child abuse are defined by federal law and further stipulated under state law (ASCA, 2015; Stone, 2013). Laws and definitions of child abuse can vary across each state, and ASCA (2019b) provides information on Child Protective Services (CPS), laws, and statutes for different states. Furthermore, ASCA’s (2015) position statement, The School Counselor and Child Abuse and Neglect Prevention, states: “It is the school counselor’s legal, ethical and moral responsibility to report suspected cases of child abuse and neglect to the proper authorities” (p. 7).

Mandated reporting is among the many responsibilities school counselors perform within the school setting. School counselors are required by the Child Abuse Prevention and Treatment Act (CAPTA) of 1974 to report suspected cases of child abuse to the appropriate authorities. School counselors need to become familiar with federal guidelines, their state laws, and school policies regarding child abuse and mandated reporting laws and procedures. ASCA (2016) speaks to the role of the school counselor in child abuse reporting by stating that school counselors are ethically and legally responsible for reporting suspected cases of child abuse to appropriate agencies. These agencies include, but are not limited to, CPS, law enforcement agencies, attorneys, social workers, and case managers assigned to open cases (Bryant, 2009; Hinkelman & Bruno, 2008).

It is essential for school counselors to have knowledge and an understanding of the ethical standards and legal statutes that apply to child abuse reporting (Corey, Corey, & Callanan, 2011). Two sections from the ASCA Ethical Standards for School Counselors (2016) specifically address child abuse reporting. The “Serious and Foreseeable Harm to Self and Others” (A.9.) section speaks to ensuring the welfare and safety of students by making appropriate reports to CPS, parents and guardians, and agencies and authorities regarding the abuse. The “Bullying, Harassment and Child Abuse” section (A.11.) highlights the ethical mandates school counselors must follow when reporting suspected child abuse (ASCA, 2016).

Froeschle and Crews (2010) echoed the vital role ethics and legalities play as well as the challenges presented in working with students. Because school counselors serve as an integral part of protecting the health and well-being of children by performing in the role of responsible mandated reporters, it is imperative that school counselors recognize the importance of maintaining student welfare when making decisions pertaining to suspected child abuse. Research regarding school counselors’ ethical and legal competency is limited; however, it has been noted that knowledge of ethical and legal parameters around child abuse reporting has increased in coursework and trainings (Lambie, Ieva, & Mullen, 2013). This necessitates the call for school counselors to have additional knowledge and training in detecting signs and symptoms of abuse and a general understanding of how to report child abuse.

Although the ethical and legal responsibilities of school counselors in the role of reporting child abuse and maltreatment has been recognized (Kenny & Abreu, 2016), counselors might not have received adequate training in identifying and reporting child abuse. Therefore, the authors of this article further recognized the dutiful call to provide a framework for early career school counselors to assist with the process of reporting child abuse. The purpose of this manuscript is to develop an effective mandated reporting framework for school counselors. The development of the framework within this manuscript was guided by the ASCA Ethical Standards for School Counselors (2016), recommendations by early career school counselors (Ricks et al., 2019), previous literature and research studies (Bryant & Baldwin, 2010; Lambie, 2005; Sikes, 2008), and current mandated reporter procedures (Hogelin, 2013). However, it is imperative to acknowledge that within any such framework, state and school policy must be followed and considered.

 

Child Abuse Trends

Mandated reporting is increasingly needed because of the extent of child abuse and neglect in the United States. In 2015, CPS agencies received approximately 4.1 million referrals for potential child abuse or neglect, which involved roughly 7.5 million children (USDHSS et al., 2019). Gullatt (1999) published a manuscript that reported the number of abused children to be astonishing. Despite decades passing since the 1990s, the number of children abused today is still considered shocking. In 2017 it was reported that 674,000 children were victims of abuse and neglect (USDHHS et al., 2019). The number of children abused increased by 2.7% from 2013 to 2017, and it is estimated that 1,720 children died from abuse and neglect in 2017, a rate of 2.32 per 100,000 children (USDHSS et al., 2019). These staggering statistics attest to the need for school counselors to become more educated and confident in reporting child abuse.

“Abuse is encountered in all socioeconomic groups, races, and religions” (Lambie, 2005, p. 250). The racial distribution for all children within the United States who experience abuse is 50.7% Caucasian, 13.7% African American, and 25.2% Hispanic (USDHHS et al., 2019). The percentages of victims are similar for both boys (48.6%) and girls (51.0%; USDHHS et al, 2019); however, rates of abuse seem to vary by socioeconomic status. According to Sedlak et al. (2010), children from households of low socioeconomic status experience some type of maltreatment at a rate more than five times higher than other children; they also were more than three times as likely to experience abuse and about seven times more likely to experience neglect. Bias has been suggested as a cause of differentiation in demographics of reported child abuse cases. When looking at school counseling reporting trends, a recent study specifically examining school counselors’ decisions found school counselors were not statistically more likely to report students based on race but were more likely to suspect abuse when students were from a middle or lower socioeconomic class (Tillman et al., 2015). However, research data suggest that the variation in the overrepresentation of low-income children is driven by the presence of increased risk factors among this population (Jonson-Reid, Drake, & Kohl, 2009).

Despite the increased need for school counselors to be proficiently trained in mandated reporting, many school counselors experience challenges with the reporting process. School counselors are frontline workers who develop trusting relationships with children, which in turn leaves school counselors with a much higher reporting rate than other professionals within the school (Bryant, 2009). A study by Bryant and Milsom (2005) found the second most reported legal issue experienced by school counselors was whether to report alleged sexual abuse. However, there are some laws that no longer give school counselors the choice. Furthermore, according to Davis (1995) and Sikes (2008), the reporting of child and sexual abuse cases are the second highest reasons for school counselors to attend court. The increase in reports of child abuse, legal issues experienced by school counselors, and the frequency of court appearances by school counselors also are valid reasons for developing a better, more effective, and easily understood framework for mandated reporting.

 

Challenges in Reporting Child Abuse

Reporting child abuse and neglect can often be a challenging and stressful experience for school counselors. This might be due to difficulty in collaborating with reporting agencies; the lack of training in child abuse symptomology (Alvarez et al., 2004; Kenny, 2001); unclear guidelines for reporting child abuse (Lambie, 2005), including what defines reasonable suspicion to report (Levi & Brown, 2005); and the fear of repercussions from parents and school officials (Bryant & Milsom, 2005; Kenny, 2001). A recent research study (Ricks et al., 2019) identified challenges faced by early career school counselors, which provided the impetus to further consult the literature to seek what circumstances led to these challenges and how to mitigate potential barriers to reporting child abuse. Each of these challenges are discussed in further detail.

 

     Collaboration with reporting agencies. A review of literature on school counselors’ relationships with reporting agencies found that the relationships are disconnected and misunderstood (Bryant & Baldwin, 2010). A study conducted by Sikes et al. (2010) indicated most school counselors had negative experiences when making reports to reporting agencies. Participants in the study reported high levels of anxiety because of the concern that the report would not be investigated. Consistent with findings from the research study conducted by Ricks et al. (2019), Bryant and Baldwin (2010) found that school counselors experience frustration and irritation when the school counselor’s report did not result in an investigation from CPS. Furthermore, a study conducted by Behun, Cerrito, Delmonico, and Kolbert (2019) found that school counselors chose not to report suspected child abuse because of the belief CPS would not intervene effectively.

Furthermore, school counselors experience concern when CPS does not provide follow-up information regarding the report of alleged abuse. A study conducted by Bryant (2009) found school counselors reported 77% of alleged cases of child abuse to CPS, and only 66% of those cases were investigated by CPS. Some school counselors believe they are entitled to information about the ongoing investigation of the report made; however, because of confidentiality, CPS is not legally obligated to provide school counselors with detailed information about an ongoing investigation (Child Welfare Information Gateway, 2003; Minnesota Department of Human Services, 2016). After the initial assessment, the CPS caseworker will determine the disposition of the reported case based on state laws, agency guidelines, and gathered information (Child Welfare Information Gateway, 2003).

According to the Child Welfare Information Gateway (2003), CPS agencies use different terminology for this decision. Most states use a two-tiered system of substantiated–unsubstantiated or founded–unfounded. Some states use a three-tiered system of substantiated, indicated, or unsubstantiated. The indicated classification means evidence of abuse has been found, but not enough to substantiate the case. A school counselor can be provided information on whether the case was indicated or not indicated by CPS (Minnesota Department of Human Services, 2016; Washington State Department of Social & Health Services, 2018).

To resolve this issue, further education and collaboration with CPS and other agencies can aid school counselors’ understanding of policies, leading to less frustration for school counselors. Bryant (2009) recommended CPS provide additional training for school counselors on mandated reporting and recognition of child abuse. This training conducted by CPS with schools can improve the working relationship between CPS and school counselors.

Likewise, Hinkelman and Bruno (2008) recommended attorneys, CPS, and mental health professionals gather to discuss child abuse through in-service trainings. During such time, school administrators can review their written policies to be certain they correspond with state laws, ensuring the reporting process is both ethical and legal for school counselors. This practice would mitigate challenges to communication, consultation, and collaboration between school counselors and reporting agencies, which would be helpful.

 

     School counselors’ knowledge of child abuse symptomology. Previous research studies indicated the most significant hindrance to reporting child abuse is the lack of knowledge in recognizing signs of child maltreatment (Kenny & Abreu, 2016). A study conducted by Bryant (2009) evaluated school counselors’ perceived ability to recognize different types of child abuse. Generally, most school counselors felt confident in their knowledge to recognize physical abuse; however, fewer counselors reported certainty in identifying sexual as well as emotional abuse (Bryant, 2009; Bryant & Baldwin, 2010; Bryant & Milsom, 2005; Kenny & Abreu, 2016).

More experienced counselors believe themselves to be competent in recognizing and reporting child abuse, while beginning school counselors with less experience perceive themselves to be less knowledgeable and in need of additional training (Tillman et al., 2015). Bryant and Baldwin (2010) also found most experienced school counselors reported more confidence in recognizing signs of physical abuse in children. Certain physical and behavioral concerns in children can serve as indicators of physical abuse (Mayo Clinic, 2015; Sikes, 2008). Behavioral changes can include isolation, change in school performance, depressed affect, sudden weight loss or gain, or inability to control emotions (Lambie, 2005; Mayo Clinic, 2015; Minnesota Department of Human Services, 2016; Sikes, 2008). School counselors spend a significant amount of time with children and can be alert to the changes in behavior of a student, or teachers can notify the school counselor of their concerns for a child (Brown, Brack, & Mullis, 2008).

Conversely, certain forms of abuse, such as sexual and emotional abuse, are not as easily recognized by school counselors (Bryant & Baldwin, 2010). Emotional abuse can be defined as the continuous use of abusive language that hurts the child’s self-esteem or well-being (Mayo Clinic, 2015). Emotional abuse includes verbal and emotional assault, and isolating, ignoring, or rejecting a child (Mayo Clinic, 2015). Lack of empathy, warmth, and understanding also are associated with emotional abuse (McEachern, Aluede, & Kenny, 2008). A study conducted by Bryant and Milsom (2005) stated three-quarters of school counselors in the study felt sure of their ability to identify child physical abuse, but less so in their ability to recognize sexual and emotional abuse. The difficulty in determining emotional abuse can lead to school counselors feeling less qualified to make a report of suspected child abuse (Valkyrie, Creamer, & Vaughn, 2008).

Further training and education on the signs and symptoms of different types of abuse are necessary for school counselors to feel more confident in making a report of suspected child abuse (Herlihy & Corey, 2015). Awareness and instruction on the symptomology of the various forms of child abuse can increase early reporting from school counselors, resulting in improved chances of children recovering from the negative effects of child abuse (Valkyrie et al., 2008).

 

     Unclear guidelines for reporting child abuse. Although school counselors are in the role to report suspected child abuse, many still struggle to determine if a report is warranted. School counselors have voiced the issue of needing evidence to make a report of child abuse (Valkyrie et al., 2008). Past studies indicated school counselors felt more comfortable reporting abuse when they had solid evidence the abuse occurred and were more likely to hesitate to report if less evidence was present in the case (Bryant & Milsom, 2005; Tillman et al., 2015). Moreover, a study conducted by Bryant (2009) indicated that the lack of evidence was the main reason school counselors decided not to report the suspicion of abuse.

Despite these findings, it is important that school counselors recognize that it is not their responsibility to investigate the case or determine the truth of the allegation of abuse. In fact, it is not in the best interest of the child for school counselors to investigate the alleged abuse because they do not have the proper resources and it could lead to further issues for the child (Hinkelman & Bruno, 2008; Lambie, 2005; Miller, Dove, & Miller, 2007). The school counselor’s responsibility is to follow legal and ethical obligations as a mandated reporter (ASCA, 2016) by reporting all suspected child abuse. It is important for school counselors to be aware of their state laws because it can be a felony if child abuse is not reported (Child Welfare Information Gateway, 2019).

Additional education on the school counselor’s role in reporting child abuse could elevate their understanding of their role in mandated reporting. Being aware that the law does not require school counselors to investigate cases and that they will not be held liable if a report is false (Hinkelman & Bruno, 2008) may increase the reports made by school counselors. It is important for school counselors to report suspected child abuse to the appropriate agencies and authorities by following state laws and school district protocol to ensure the safety of all children.

 

     Fear of Repercussions. Numerous studies have suggested school counselors fear the repercussions that can result from reporting suspected child abuse (Bryant, 2009; Bryant & Baldwin, 2010; Bryant & Milsom, 2005; Sikes et al., 2010). These repercussions may originate from school administration, colleagues (Bell & Singh, 2017; Kenny, 2001; Sikes et al., 2010), or the family of the student (Bryant & Baldwin, 2010; Kenny, 2001; Valkyrie et al., 2008), or impact the relationship with the student (Alvarez et al., 2004; Bryant & Baldwin, 2010; Sikes et al., 2010). Moreover, school counselors may be afraid the family of the child will file a lawsuit against the school and the counselor for making a report of suspected child abuse (Valkyrie et al., 2008). Conversely, a study conducted by Kenny, Abreu, Helpingstine, Lopez, and Mathews (2018) found that all 50 states give immunity to professionals who report alleged child abuse. The purpose of the immunity is to encourage professionals to report suspected abuse, knowing they do not have to fear the repercussions of disgruntled family members (Kenny et al., 2018). Further exposure to the law of mandated reporting can in fact reduce the anxiety of reporting and encourage more reporting of alleged abuse.

Additional education on mandated reporting and a specific plan for mandated reporting can help to alleviate the fears school counselors have when reporting abuse. If the school policy includes a specific model for mandated reporting, then school counselors may be less likely to fear repercussions and follow appropriate guidelines (Committee for Children, 2014; Oloumi-Johnson, 2016; Sinanan, 2011). If faced with disgruntled parents, school counselors can refer to their school policy within the mandated reporting model to verify to the concerned individual that school policy and procedures were followed.

 

Challenges of the Early Career School Counselor

Early career school counselors are often faced with tremendous challenges as they enter their new work environment. These challenges include differing expectations from site to site and district to district (Hatch, 2008). Although school counselors are designated as mandated reporters, many may struggle with identifying different types of abuse, understanding reporting procedures, and understanding their district and state policies (Bryant, 2009; Ricks et al., 2019). New school counselors may be especially vulnerable to challenges because they are still defining their roles within their new school system and learning what the expectations are for their site. Past research also has shown that school counselors’ understanding of child abuse reporting is related to past professional experiences (Bryant, 2009), and early career school counselors can be deficient in this knowledge. Additional training in child abuse reporting is needed to help school counselors become more proficient and knowledgeable in these procedures (Tillman et al., 2015). Currently, there is a lack of research and resources for early career school counselors on child abuse reporting. This proposed framework aims to aid early career school counselors in developing their understanding of child abuse reporting procedures and expectations.

 

Framework Foundation

The purpose of this article is to develop an effective mandated reporting framework for school counselors based on the ASCA Ethical Standards for School Counselors (2016), the research from Ricks et al. (2019), and previous literature reviews and research studies. Even though previous recommendations for collaboration have been made, we recognized the need for school counselors to have a specific framework for reporting child abuse that is collaborative and specific to school counseling.

 

Ricks et al. (2019) examined the experiences of child abuse reporting by early career school counselors (0 to 5 years of experience as a school counselor) in the Southeastern United States. Early career school counselors were targeted because they can be confused and frustrated regarding their roles within the school as mandated reporters (Slaten, Scalise, Gutting, & Baskin, 2013). Participants responded to a survey allowing them to share their experiences and suggestions regarding child abuse reporting using two open-ended questions (Ricks et al., 2019). The two open-ended questions asked: (1) What types of additional training do you need regarding child abuse reporting? and (2) What challenges did you or are you facing as a new SC (0–5 years) regarding mandated reporting? (Ricks et al., 2019). Findings revealed the need for help identifying types and signs of abuse; staff and faculty training; information on reporting procedures; and additional mandated report training. Additionally, the findings found challenges with mandated reporting including fear of repercussions, agency concern and collaboration, reporting policies, identifying types of abuse, and school counselor responsibilities. The responses to the open-ended questions informed the direction and development of this framework to assist early career school counselors as they navigate the child abuse reporting process.

 

Child Abuse Reporting Framework for Early Career School Counselors

 

     The purpose of this framework is to provide steps for early career school counselors to ensure their school counseling program is following best practices in mandated reporting. The steps are designed based on the recommendations by the participants in the study by Ricks et al. (2019) to provide clarity in the informed decision-making process when child abuse is suspected. School counselors should adhere to all the steps identified to ensure they are knowledgeable of current research and best practices on child abuse reporting. This information is considered vital for reviewing mandated reporter guidelines and identifying resources to assist students. Additionally, early career school counselors are encouraged to continuously review guidelines and procedures to ensure execution of streamlined services; however, keeping resources is not enough. School counselors should continually update their collected information by participating in ongoing professional development to ensure they remain abreast of changes in laws, policies, agencies, and personnel.

The authors recognize that reporting child abuse is a collaborative effort within the school setting, which includes faculty, administrators, school counselors, and other mandated reporters. Therefore, a collaborative approach was deemed appropriate, especially when seeking support and understanding the gravity of reporting child abuse to the appropriate agencies and authorities. A collaborative approach is substantiated based on previous literature by Gullatt (1999), Bell and Singh (2017), and Ricks et al. (2019). Gullatt called for a collaborative approach to child abuse reporting and recommended school principals be aware and know how to identify child abuse as well as the laws for reporting.

Eight steps have been outlined in the Child Abuse Reporting Framework for Early Career School Counselors to guide early career school counselors in their role as mandated reporters: (1) become familiar with and follow state laws and district/school child abuse reporting policies, (2) become familiar with and follow the ASCA ethical standards, (3) obtain training to identify and recognize signs of child abuse, (4) identify stakeholders, (5) build collaborative partnerships, (6) provide school-based training, (7) report child abuse, and (8) perform post-reporting procedures. Each of these steps includes recommendations and considerations to assist in increasing self-efficacy for early career school counselors in the child abuse reporting process.

 

Step I: Become Familiar With and Follow State Laws and District/School Child Abuse Reporting Policies

     State laws define the role of community members, helpers, and school officials as mandated reporters. Therefore, it is in the best interest of early career school counselors to review the laws on mandated reporting within their state of employment to understand what is expected for mandated reporters, the timeframe to report, and contact information. Knowledge and awareness of state laws is particularly imperative because state requirements to report child abuse vary for each state (Hogelin, 2013; Lambie, 2005). Not only do state laws differ, but schools within the same district can vary in their child abuse reporting policies. Early career school counselors must make familiarizing themselves with state laws and district/school child abuse reporting policies a priority. This should be done during the pre-planning period and first days on the job in order to be knowledgeable and aware of what the laws and policies state. Areas in particular to be aware of include who is to be contacted when knowledge of suspected child abuse has been identified; who officially makes the report; what the procedures are; how to make a report (e.g., electronically, phone call, in person, website); where and how to file documentation of the report; and who to inform once the report has been made.

Some schools and states require everyone who has knowledge of suspected child abuse to file a report. This would include school counselors, administrators, teachers, and school personnel. In some school districts, a designated school official is the individual to make the report. This generally is the school counselor. Therefore, it is incumbent on early career school counselors to be aware of what their role is and how it meets the legal and ethical requirements. School counselors should be aware that if the school has designated only a specific individual to file a report, this may go against the law and possibly jeopardize the school counselor’s licensure and certification. Therefore, it is important that all stakeholders in the school setting be aware of their respective state’s laws.

 

Step II: Become Familiar With and Follow the 2016 ASCA Ethical Standards

ASCA ethical standards A.9. and A.11. highlight the responsibilities school counselors have in reporting child abuse (ASCA, 2016). Early career school counselors have received training in their master’s programs regarding ethics; however, it is especially imperative to review the ethical standards pertaining to child abuse reporting on a regular basis. This will aid in maintaining ethical dispositions at the forefront, while leveraging the ASCA ethical decision-making process as a guide (ASCA, 2016). Additionally, the ASCA ethical standards can be used as a tool to advocate for school counseling services in reporting child abuse. This is especially useful in circumstances when there might be role confusion by administrators, school personnel, authorities, and agencies. By referencing the ethical standards, school counselors can advocate for their role in reporting child abuse and working to keep students safe.

 

Step III. Obtain Training to Identify and Recognize Signs of Child Abuse

It is recommended that educators consistently receive training to identify and recognize signs of child abuse (Hogelin, 2013). Kenny and Abreu (2016) recommended counselors seek continued education on child abuse reporting by attending workshops that will help them remain abreast of the changes to reporting laws and requirements. Therefore, school counselors should advocate to receive opportunities to attend professional development conferences and trainings by the district and/or local agencies (Hogelin, 2013). Advocacy is considered an integral component of the ASCA National Model (ASCA, 2012; 2019a). Although regular training is recommended, it is not guaranteed this practice occurs across states and school districts. Furthermore, it would be beneficial for early career school counselors to seek and participate in professional development because of varying types of training they have or have not received on identifying and reporting child abuse during their master’s-level school counseling programs.

Laws, protocols, procedures, and staff are continuously changing; therefore, early career school counselors should remain cognizant and aware of these changes. In order for knowledge to remain relevant, school counselors should engage in continued professional development on recognizing child abuse indicators and child abuse reporting. This practice allows the school counselor to remain informed while increasing their self-efficacy in reporting suspected child abuse. Additionally, each year school counselors must continue to update administration and school personnel on procedures and protocol for identifying and reporting child abuse.

 

Step IV. Identify Stakeholders

School counselors who seek to strengthen partnerships with administrators (e.g., principals and assistant principals) are in a position to initiate discussion on child abuse reporting procedures and protocols to ensure an understanding of the role of the school counselor as a mandated reporter. Particularly building a partnership with principals is vital to identify the key role school counselors play in the school setting. A study conducted by Bringman, Mueller, and Lee (2010) shed light on the perception principals have on the role of the school counselor. This research indicated that principals have not received prior education on the role of the school counselor; therefore, it would be beneficial to discuss the role of the school counselor with administration. This step is deemed significant because school counselors generally see themselves as more informed in recognizing and reporting child abuse than principals (Tillman et al., 2015).

Nevertheless, a study conducted by Kenny and McEachern (2002) mentioned that both school counselors and school principals report child abuse, although school counselors reported child abuse at a higher percentage than school principals. Still, it is imperative to recognize that both professions—school counselors and administrators—share the common goal of protecting children by reporting suspected child abuse (Kenny & McEachern, 2002; Tillman et al., 2015).

Early career school counselors can leverage this insight by approaching their administrators through a collaborative stance, highlighting this shared goal, and discussing how to ethically and legally report suspected child abuse. This discussion can include, but is not limited to, state laws, district policies, and district/school child abuse reporting procedures. Furthermore, school counselors and school principals who keep the safety of students at the forefront and work together need to reduce role confusion.

 

Step V. Build Collaborative Partnerships

     CPS. This step has been included to encourage partnerships between school counselors and CPS. District school counseling supervisors can support this endeavor by extending an invitation to CPS supervisors to attend a meeting with school counselors. This meeting would be utilized as a rapport-building opportunity as well as a way to share each other’s roles, challenges, and strengths. Additionally, this would be an opportunity for CPS to provide updates, contact information, and any other pertinent information.

It also has been recommended that joint training be done with local CPS members and school counselors (Bryant & Baldwin, 2010) to ensure collaboration between agencies and to ensure all participants are exposed to consistent training. Additionally, CPS may be able to provide training to the school system and not only school counselors. “When school counselors understand the limitations inherent in receiving a report, they might, in turn, be more efficacious in their reporting of child abuse” (Bryant & Milsom, 2005, p. 70). This training should include information on the reporting process, but also on the investigative process so that school counselors develop an understanding of the reactions and behaviors of the investigators (Bryant & Baldwin, 2010). Other stakeholders, such as school psychologists, social workers, and nurses, would benefit from this training as well.

     Law enforcement. Public safety is the mission of law enforcement officers. Within the school system, police officers and especially school resource officers (SROs) engage in numerous activities and perform numerous duties. One of the duties can include being a member of the school’s crisis response team (Cowan, Vaillancourt, Rossen, & Pollitt, 2013). School counselors should work to build a positive working relationship with their SRO and local law enforcement. These individuals can help assist school counselors in providing services when students are a danger to themselves or when the student is in danger. Additionally, SROs have been provided specific training on “student needs and characteristics, and the educational and custodial interests of school personnel” (Cowan et al., 2013, p. 10). Law enforcement and SROs also can help ensure the safety of everyone in the building when a threat arises.

     Attorneys. School counselors should consider consulting with the school district’s attorney to ensure that their rights and the rights of their students and others are being maintained. Most schools have a school attorney that school counselors can communicate with when issues or questions arise. School counselors also must make sure they are aware of legal and ethical guidelines on confidentiality and privacy of student information. Nonetheless, if school counselors find themselves in situations where discrepancies arise, they should call their local department of children’s services or attorney (Mitchell & Rogers, 2003). Participants from a study conducted by DeCino, Waalkes, and Matos (2017) reported positive experiences with legal counsel. An attorney not only provides guidance on ethical dilemmas but also legal advice for potential court hearings.

 

Step VI. Provide School-Based Training

     Stakeholders in the school setting, such as teachers, school nurses, coaches, paraprofessionals, custodians, lunchroom staff, and other support staff in the building, should be provided with training to identify and report child abuse (Hogelin, 2013; Lambie, 2005). It is recommended that training on child abuse identification and reporting procedures be conducted each year; this is mandatory in some states. These individuals interact with students daily and are able to recognize if a student is in distress. Despite their daily interactions with students, many teachers struggle to identify signs of abuse and have a lack of knowledge of reporting procedures (Greytak, 2009). Therefore, school counselors are in the position to schedule dates and times at the beginning of the school year, such as during pre-planning, and mid-year as a refresher to provide school personnel with the training to identify and recognize child abuse as well as inform them of their mandated reporter obligations. This involves addressing state laws, ethical requirements, and district/school policies for child abuse reporting as well as providing the procedures and contact information to make a report.

 

Step VII. Report Child Abuse

Child abuse reporting involves several crucial details. These details include, but are not limited to, the name of the child, name of family members (e.g., parents, siblings), individuals who reside in the home, phone number, address, previous history of abuse, academic performance, child dispositions, and concern leading to the report (Sikes, 2008). It would behoove early career school counselors to determine if their school districts have a specific form to complete while filing an abuse report. This resource would guide the process of obtaining all the details for filing a complete report. If no such resource is available, school counselors should work with key personnel to create a standardized form for abuse reporting. Furthermore, knowledge of the method to make a report is necessary. Reporting procedures for CPS vary by state. Most states prefer an oral report be made to CPS; however, some states require a written report be completed after the oral report has been made (Child Information Gateway, 2017). Because there may be a timeframe in which to call according to state policy, early career school counselors who are aware of the specific method to report will not only report in a timely manner but be more prepared and self-efficacious in their reporting skills and capabilities.

 

Step VIII. Perform Post-Reporting Procedures

After the child abuse report has been made, questions often arise about how to support the student who needs to be aware of the child abuse report, and how to respond to parents who inquire about the report. Early career school counselors can reach out to the caseworker to inquire as to what supports might be provided at the school, check in with the student to ensure they are safe, and seek what procedures the district has in place to address parents. When approached by parents, early career school counselors can maintain the disposition of informing parents that all child abuse reports are confidential and that they may contact the caseworker with their questions. Additionally, pamphlets on the role of mandated reporting and resources can be made available in the school counselor’s office to provide the parents with assistance in identifying supports. School counselors also can provide parents with referrals to outside agencies, such as counseling or family supports, when asked by parents who are seeking interventions.

 

Conclusion

Reporting child abuse is recognized as a crucial element in the role of a school counselor. Early career school counselors often are anxious about reporting child abuse because of the fear of repercussions from parents, lack of self-efficacy in identifying abuse, limited knowledge of child abuse reporting procedures, unclear reporting procedures for school counselors, and lack of collaboration with outside agencies. This article has addressed the challenges faced by early career school counselors and provides a framework to alleviate their anxiety while increasing their self-efficacy as mandated reporters.  

 

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest or funding contributions for the development of this manuscript.

 

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Malti Tuttle is an assistant professor and School Counseling Program Coordinator at Auburn University. Lacey Ricks is an assistant professor at Liberty University. Margie Taylor is a visiting assistant professor at Auburn University. Correspondence can be addressed to Malti Tuttle, 2084 Haley Center, Auburn, AL 36849, mst0022@auburn.edu.