On the first day of a high-pressure meeting for the Catholic Church in the United States, the bishops who lead the church debated questions about whether the church’s approach to combating sexual abuse will be adequate.

“We find ourselves at a turning point, a critical moment in our history which will determine in many ways the future vibrancy of the church and whether or not trust in your leadership can be restored,” Francesco Cesareo, chair of the church’s National Review Board appointed to oversee abuse complaints, told the bishops as their meeting began. After listening to the opening hours of discussion, Cesareo said in an interview that these bishops face a steep climb to reform the church. “You can have all the policies you want, but without that culture change — there has to be a recognition of co-responsibility ... not a sense of opposition,” he warned.

The bishops are reeling from a difficult year for the church, with sex scandals involving high-up bishops revealed and criminal investigations opened in states nationwide.

Their first efforts to respond to the problem were thwarted in November, when all the bishops in the country met with plans to enact several new polices but were stunned on the first morning of their gathering by a message from the Vatican: Don’t do anything about sexual abuse.

Now the leaders of the 196 U.S. dioceses are trying again at a three-day meeting in Baltimore. Over the next two days, the bishops will vote on 10 action items. Those items include adapting the U.S. catechism to match Pope Francis’s 2018 change in church teaching on the death penalty and other subjects, but most deal with the subject of abuse.

The Vatican this time has encouraged all bishops worldwide to enact abuse plans in the next year, but oversight from Rome is still hampering many American leaders’ desires. A frequent question echoed among the bishops Tuesday morning as they began discussion boiled down to: What can we do while remaining within the constraints that Francis has imposed?

Francis published a document last month called a “motu proprio,” which “establishes universal law for the Catholic church,” said Bishop Robert P. Deeley of Portland, Maine, who led the American committee on how to implement the instructions. “Nothing we propose for the United States can deviate from universal law, contradict it.”

Francis directed that any bishop, worldwide, who is accused of abuse or of mishandling an abuse case should be investigated by a fellow bishop known as a “metropolitan” who leads a large diocese in his region. In November, that metropolitan model was proposed by some American bishops as an alternative to a national lay commission to investigate complaints against bishops.

At the time, the model of bishops investigating bishops was fiercely criticized by victims’ advocates, who prefer lay people as empowered investigators rather than the clergy themselves. Now, under Francis’s new rules, it seems to be the worldwide rule.

“Any reform that leaves the ultimate authority for investigating abuse and cover up in the hands of Church officials instead of secular law enforcement is no reform at all,” the Survivors Network of Those Abused by Priests, or SNAP, said in a statement as the meeting began. “Rather, it is the continuation of how bishops have responded to cases of sex abuse since 2002, just updated and codified as a new policy.”

That left U.S. bishops on Tuesday morning debating among themselves about how much of a role they can give to lay people while staying within Francis’s framework.

Cardinal Blase Cupich of Chicago, for instance, proposed establishing offices staffed by lay people who would handle cases in conjunction with the metropolitan. “We institutionalize lay involvement from the very beginning, and that’s an important message to send,” Cupich said. Deeley suggested that Cupich was misinterpreting Francis’s instructions.

Among the meeting’s 10 action items, a code of conduct for bishops, proposed in November and hotly debated, has been edited and reintroduced, with the new softer-sounding title “Acknowledging Our Episcopal Commitments.” That document calls for the bishops to commit to the standards of the 2002 Dallas Charter, in which the church introduced zero-tolerance standards for priests accused of abusing children but did not address misconduct by bishops.

The bishops debated Tuesday what it might mean to apply the 2002 charter to themselves. Bishop Shawn McKnight of Jefferson City, Mo., pointed out that the charter calls for lay-led review boards to investigate cases of alleged abuse by priests and asked whether bishops could be investigated by those boards, as well, which seemed to contradict the metropolitan plan. Bishop Michael Barber of Oakland, Calif., pointed out that the charter calls for priests to step aside while they are under investigation, and he wondered who would run a diocese if a bishop had to remove himself temporarily.

Cardinal Joseph Tobin of Newark, who led the committee spearheading the bishops’ code, seemed disinclined to provide specific answers. “Is it basically the principles in the charter,” asked Archbishop Salvatore Cordileone of San Francisco. “Or is it actually every requirement in the charter?”

The former, Tobin said, “is a correct understanding of the mind of the committee.”

The bishops turned midday to another subject, a discussion about why millennials are leaving the church in large numbers. On the morning that the meeting began, the Pew Research Center released a poll suggesting the sex abuse scandals and the dropping membership in all age groups are related — about one-quarter of Catholics told Pew that they attend Mass less frequently because of the abuse scandal, and about the same number said they have reduced their donations to the church.

Hannah Natanson contributed to this report.