As the Roman Catholic church’s sex abuse scandal grows ever wider in scope in the U.S., bishops convene for a national meeting in Baltimore on Tuesday under heavy pressure to acknowledge their oversight failures and give a larger role to lay Catholics and secular authorities in confronting the crisis.

The pressure comes not only from longtime critics of the church’s response to clergy sex abuse, but also from insiders who now voice doubts that the bishops are capable of handling the crisis on their own. Among them is Francesco Cesareo, chairman of a national sex-abuse review board set up by the bishops.

Sex-abuse scandals have beset the Catholic church worldwide for decades, but events of the past year have created unprecedented challenges for the U.S. bishops

“My biggest concern is that it’s going to end up being bishops overseeing bishops,” Cesareo told Catholic News Service, the news agency of the U.S. bishops’ conference. “If that’s the case, it’s going to be very difficult for the laity to feel any sense of confidence that anything has truly changed.”

Sex-abuse scandals have beset the Catholic church worldwide for decades, but events of the past year have created unprecedented challenges for the U.S. bishops. Many dioceses have become targets of state investigations since a Pennsylvania grand jury report in August detailed hundreds of cases of alleged abuse. In February, former Cardinal Theodore McCarrick was expelled from the priesthood for sexually abusing minors and seminarians, and investigators are seeking to determine if some Catholic VIPs covered up his transgressions. Another investigative team recently concluded that Michael Bransfield , a former bishop in West Virginia, engaged in sexual harassment and financial misconduct over many years.

Even the president of the bishop’s conference, Cardinal Daniel DiNardo of the Galveston-Houston archdiocese, has been entangled in controversies. On June 4, The Associated Press reported on a Houston woman’s allegations that DiNardo mishandled her case alleging sexual and financial misconduct by his deputy.

The archdiocese said it “categorically rejects” the story as biased and one-sided. However, the archdiocese later said it would review the married woman’s allegations that the monsignor, Frank Rossi, continued to hear her confessions after luring her into a sexual relationship, a potentially serious crime under church law.

SNAP, a national advocacy group for clergy abuse victims, has called on DiNardo to resign his post or at least recuse himself from presiding over the Baltimore meeting.

The bishops had drafted some new accountability policies for their previous national meeting in November, but deferred action due to a last-minute request from the Vatican. One of those proposals would have established a new code of conduct for individual bishops; another would have created a special commission, including lay experts and clergy, to review complaints against the bishops.

In Baltimore, the bishops will be guided by a groundbreaking new law issued by Pope Francis on May 9.

It requires priests and nuns worldwide to report clergy sexual abuse and cover-ups by their superiors to church authorities. It also calls for any claim of sexual misconduct or cover-up against a bishop to be reported to the Vatican and a supervisory bishop in the U.S.

SNAP said the pope’s edict was a step forward, but urged the U.S. bishops to go further by requiring that church staff report their suspicions to police and prosecutors in addition to reporting internally. SNAP also said the bishops should turn over any files and records related to sex abuse to their state attorneys general for investigation, and it urged the bishops to ensure that all U.S. dioceses release lists of priests, nuns and other church staff alleged to have committed sexual abuse.

Beyond the pope’s edict, the bishops will consider creating an independent, third-party reporting system to which allegations of abuse could be filed.

John Gehring, Catholic program director at a Washington-based clergy network called Faith in Public Life, said many bishops now realize they need lay leadership as decisions on anti-abuse policies are made.

“But the disagreement comes when you get down to deciding what that actually looks like in practice,” Gehring said. “Some bishops are still uncomfortable with conceding power and there will be inevitable tensions.”

Catholic leaders argue, with some statistical backing, that instances of clergy sex abuse have declined sharply with the adoption in 2002 of a charter establishing guidelines for dealing with clergy sex-abuse of minors.

“The Church is a far safer place today than when we launched the Charter,” DiNardo contended in a recently released report on abuse. “Programs of background checks, safe environment trainings, review boards enforcing zero tolerance policies, and victims assistance require hundreds of dedicated, professional teams with child safety as their highest priority.”

However, Professor Margaret McGuiness, who teaches courses on Catholicism at La Salle University, doubted that any steps taken in Baltimore would win back the trust of many lay Catholics dismayed by the multiple scandals.

“I think they have a deeper problem, which is a rapid decline in Mass attendance and church membership in general,” McGuinness said. “Individual bishops can blame the decline on feminism, ‘loose morals,’ or anything else, but the fact is that the sex abuse crisis has driven many Catholics away.”

According to the Center for Applied Research in the Apostolate, an authoritative source of Catholic-related data , 45% of U.S. Catholics attended Mass at least once a month in 2018, down from 57% in 1990.

While Catholic leaders have faced criticism for many years over their response to abuse, one potentially momentous new development is the degree of pressure the church now faces from state investigators and legislators.

In addition to the investigations underway by attorneys general in at least 15 states, several legislatures have approved statute-of-limitation revisions this year giving victims of long-ago child sex-abuse new windows for litigation against the Catholic church, the Boy Scouts and other institutions. California is considering such a bill, as well as a measure that would require priests to report suspected abuse even in cases where they heard about it during confession.

The California Catholic Conference decried the confession bill as “a clear violation of religious liberty” and noted that priests violating the confidentiality of confession faced excommunication.

University of Pennsylvania professor Marci Hamilton, an expert on child-abuse prevention, said the surge of legislative action is due in part to “the dawning reality for many Americans — including lawmakers — that bishops cannot and will not solve this problem themselves.”