Management of child maltreatment suspicions in general practice: a mixed methods study

Abstract

Background

Maltreated children have many long-term consequences throughout their lives, but often maltreated children are not recognised in time by professionals. General practice could be central to the early recognition of child maltreatment due to the long-term relationship with families.

Objective

How do general practitioners (GPs) and practice nurses (PNs) deal with suspected maltreatment in children below 18 years of age, and which factors influence them to report cases to social authorities.

Design and setting

A mixed methods study set in general practice in Denmark.

Method and subjects

We combined data from a nationwide questionnaire with observations from five clinics and 20 interviews with GPs and PNs. We explored our data using the concept of uncertainty as a driver that shapes action and decision-making in general practice.

Results

Most GPs (94%) said they would discuss cases of suspected child maltreatment with social services, but in many cases they would prefer to discuss their suspicions with a colleague first (83%) – most likely where there are no clear-cut signs. The qualitative data added nuance to these findings by highlighting the difficulty of communicating across sectors, the importance of maintaining a connection with the child’s family, and practicing watchful waiting.

Conclusion

General practice has an opportunity to act early in cases of suspected child maltreatment if uncertainty is accepted as a critical part of the process of reaching a diagnosis. Communication across sectors is key, as is support for GPs with suspicions and for families in need of help.

Key points

• GPs are often thought to underreport child maltreatment but despite low levels of reporting, this does not mean they ignore it.

• Building on the connection with the family, making follow appointments, and discussing suspicions with colleagues are typical of how GPs manage suspicions of child abuse.

• Accepting uncertainty as a condition of raising the alarm could help GPs to act quickly to support children at risk of abuse.

Keywords:

• Primary care
• child health
• maltreatment
• abuse
• diagnostics

Acknowledgements

We would like to thank the GPs and PNs who participated in this study, by sharing their perspectives and experiences with us.

Ethical approval

This form of study, which is based on self-reported data, requires no ethical approval in Denmark where it was carried out.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

These materials have received financial support from The Danish Victims Fund. The execution, content, and results of the materials are the sole responsibility of the authors. The analysis and viewpoints that have been made evident form the materials belong to the authors and do not necessarily reflect the views of The Council of The Danish Victims Fund (grant number 1861000029).