The failure of victims to report abuse depends on the type of abuse i.e. physical, psychological, sexual, neglect, human rights and/or substandard care.

There are many great, mentor coaches in the United States, who often do not get the credit they deserve. But, like any profession, there are a few bad apples that spoil the bunch. Several will spoil the orchard.

The failure for adult and children amateur athletes to report might be due to the victim’s feeling, emotions, family, relationships, time, who, what, when, where, psychodynamics and other factors. The failures are multifactorial. The following are many of the factors:

• Adult and Child Athletes and SRE Participants are susceptible and vulnerable to abnormal Coaching Behaviors.
• An enormous Power Gap exists between a Coach and Athletes and Participants.
• Zabernism is the misuse of power by an authority such as a coach. Bullying is another form of zabernism. Some Coaches misuse their authority and endanger athletes with physical and emotional injuries that result from inadequate coaching supervision and protection and some sexually abuse their athletes and some are bullies.
• Youth and Children have a reliance and dependency on Adult Coaches.
• Because of the Child Victims’ age, innocence, smaller physical size, immaturity, inability to defend themselves, fear, guilt and shame after Child Sexual Abuse and the Power Gap they seldom self-Report SRE Child Sexual Abuse.
• Each year, hospital emergency rooms treat more than 775,000 boys and girls ages 5 to 14 for sports injuries.
• There are 8,000 sports related injuries children less than 18 treated daily in U.S. emergency departments
• About 4,000 of those daily injuries are Preventable and Not-Accidental, or Child Athlete Abuse Syndrome.
• Machoness: the “Macho Man or Woman” Coach, who has probably been abused and bullied themselves, abuses and bullies and creates “Macho Athletes”, who will deny they are abused and bullied and, in turn abuse and bully others. This is an abuse and bully cavalcade and pathologic layer of abnormal masculinity and feminity. Coaches don’t have to abuse and bully to be tough, competitive men and women.

• Athletes often manifest the ‘Code of Silence’ and ‘take one for the team’
• Some participants feel that no one out there really cares
• Fear repercussions, have shame, guilt, embarrassment
• Feel somehow responsible, perpetrator betrayal
• Become terrified, threatened
• Anticipates gift and reward termination for misconduct with the Coach
• Adults disbelieve the child, child fears potential punishment
• Deeply respects the perpetrator, has been ‘groomed to love’ the perpetrator
• Fears the legal process and/or is demonized as a ‘trouble maker’
• Feels unworthy and themselves might be “publically prosecuted”
•‘Currently, the judicial system favors the presumption of the defendant’s (offender) innocence, presupposing that the victim has falsely accused her attacker. 3 Therefore, the victim must not only overcome their fears of facing the attacker in court, the victim must also deal with the underlying presumption in society that the sexual assault was consensual.” [The Existing Confidentiality Privileges as Applied to Rape Victims, 5 J.L. & Health 101 (1990-1991)]
• The Power Gap will be dramatically reduced and neutralized when Child and Adult Athletes and SRE Participants are educated, realize and fully understand that their Coach is a “Substitute Caretaker” when less than 18 years old and is responsible and has a duty for the Care of every Child during the Coach’s custody and control throughout SRE Participation
• Child Athletes and Participants in SRE will most likley Self-Report Sexual Abuse when they are educated, realize and fully understand the Duty of the “Coach-Substitute-Caretaker”

• Shamefully, Doctors and Health Care personnel manifest similar Non-Reporting and only a small percentage of Child Abuse to authorities after treating and attending to Child Abuse Injuries and Deaths.
• Dr. Steven Kairys, a professor of pediatrics at Robert Wood Johnson Medical School in New Brunswick, N.J., and then director of the American Academy of Pediatrics, said there were concerns of pediatricians with reporting abuse.
• “One of the most powerful mechanisms for protecting children from abuse is a law that designates school teachers, day care operators, doctors, nurses, and others “mandatory reporters” of child abuse and neglect.”
• “Kairys said abuse cases are inadequately reported by pediatricians and investigated, because of untrained social workers, fear of the doctor for disruption of the parent-doctor relationships, paper work, poor communication, and mistrust between CPS and the medical community and unqualified judges.”
• “The doctors who are most likely to observe physical abuse only account for two to three percent of abuse reports filed. The majority comes from school teachers and other mandatory reporters.” [106]
• But hold on, Doctor and Healthcare Reporting is the Law!
• Because the new ICD-10 diagnostic codes have been significantly improved since the ICD-9 codes and published Oct 1, 2016 for everyone’s use worldwide, Doctor and Healthcare Worker reporting should improve dramatically.

Our responsible agencies have not determined how to solve this dilemma i.e. ‘Why Children Don’t Report Abuse.’ The crimes from cruelty, maltreatment and abuse of Children are rapidly increasing. So how do our governmental, judicial, child protective services, community based services, U.S. Dept. of Health and Human Services and medical systems remedy these failures by Children to report?

When children or child (<18) and youth (16-24 UN definition) athletes sustain sexual abuse, physical and/or psychological maltreatment and/or negligence injuries, they should seek Doctor or Nurse consultations.

We must educate the public. Nowadays the best mechanism for spreading the word is to trend on twitter with hash tag: #WhyChildrenDontReportAbuse #TellTheDoctor/Nurse
Doctors, nurses and other healthcare workers are supportive, careful, confidential, and administer private actions and their results can be trusted.

The system for Doctors, nurses and health care workers, child abuse mandated reporting, has been established by the U.S. federal government and followed by state governments.

Children and Child and Youth Athletes should tell the Doctor and/or the Nurse, who might be a personal, school, team, church, health department, neighbor Doctor and/or Nurse, whether on or off duty, about their adverse experiences, because the Doctor and/or the Nurse are supportive experts, and are careful and confidential.

They are experienced in private examinations, treatments and actions. Children’s justice can be trusted and children’s human rights protected after confidential communication with a Doctor and/or Nurse.

Children will confide in their Doctor and/or Nurse. Both are usually good communicators. “TRUST is key to confidential communication” 34

“Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of the patient-Doctor relationship.” 1

With experienced Doctor and/or Nurse communication, children and youth are “more likely to be satisfied with care and share pertinent information for accurate diagnoses, follow advice, adhere to the suggested treatment” 1,6,7,9,14,16,18,19,20,21,22,23

“Doctor-patient communication is a major component health care” 24, 25, 26 “Doctors are in a unique position of respect, power and confidentiality. Effective Doctor-patient communication is a source of patient motivation, incentive, reassurance and patient support 19, 24, 25, 26

Good Doctor-children patient relationships increase Doctor job satisfaction and reinforce children’s self-confidence, motivation, and positive view of their health status and health outcomes.”19, 24, 25, 26

Hippocrates offered that Doctors improve patients’ health with just good communication. 19

A suggestion is that federal legislation should provide that children, who report Child Abuse, are allowed special medical insurance coverage provided by the U.S. Department of Health and Human Services so that children’s privacy can be maintained and their examinations, treatments and laboratory services are covered and no explanation of benefits (commonly referred to as an EOB form) are forwarded to the parents or guardians and no notifications and contacts with the parents, guardians and other non-investigated parties are implemented until approved by the county attorney, child protective services (CPS) and/or investigative agencies.

For example, the discrete professional services rendered might be covered by Medicaid and flagged appropriately by Medicaid for privacy if an incident occurs.

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