Programme no. 348-OP
Quality Improvement
Facing suspected child abuse - what keeps Swedish general practitioners from reporting to child protective services?
Marijke Talsma*1, Anna-Lena Östberg2, Kristina Bengtsson Boström3
1Närhälsan Billingen Health Care Centre,Skövde,Sweden, 2R&D Centre, Skaraborg Primary Care,Skövde,Sweden;Public Dental Service,Region Västra Götaland,Sweden;Dept of Behavioral and Community Dentistry,Institute of Odontology, Sahlgrenska Academy, University of Gothenburg,Göteborg,Sweden, 3R&D Centre, Skaraborg Primary Care,Skövde,Sweden
* = Presenting author
Objectives: The aim of this study was to examine the reporting of suspected child abuse among Swedish general practitioners (GPs), and to investigate factors influencing them in their decision whether or not to report to child protective services (CPS).
Background: The reporting of child abuse by Swedish general practitioners (GPs) at health care centres has so far not been investigated.
Results: Despite mandatory reporting, 20% of all physicians had at some point suspected but not reported child abuse. Main reasons for non-reporting were uncertainty about the suspicion and use of alternative strategies; for instance, referral to other health care providers or follow-up of the family by the treating physician. Only 30% of all physicians trusted CPS’ methods of investigating and acting in cases of suspected child abuse, and 44% of all physicians would have wanted access to expert consultation. There were no differences in the failure to report suspected child abuse that could be attributed to GP characteristics. However, GPs educated abroad reported less frequently to CPS than GPs educated in Sweden.
Material/Methods: A cross-sectional questionnaire study among 177 GPs and GP trainees at primary health care centres in western Sweden. Main outcome measures: demographic and educational background, education about child abuse, attitudes to reporting and CPS, previous experience of reporting suspected child abuse and need of support.
Conclusion: This study showed that GPs see a need for support from experts and that the communication and cooperation between GPs and CPS needs to be improved. The low frequency of reporting indicates a need for continued education of GPs and for updated guidelines including practical advice on how to manage child abuse.
Points for discussion: The low response rate resulted in small numbers in some subgroups; hence, true statistically significant differences may not be found. Self-reporting entails a risk of memory bias and social desirability. The GPs’ ability to recognise and report child abuse might differ between countries, depending on education, possibilities of multidisciplinary cooperation and expert consultants. GPs’ cultural and religious background may influence the assessment of suspected child abuse. We need to further explore which factors cause the child abuse suspicion to arise. None of the most experienced GPs in our study had reported suspected child abuse to CPS during the past year. Our data indicate that experienced GPs participated less frequently in continued education on child abuse. Peer support might facilitate the discussion on and awareness of child abuse. Better communication and collaboration with CPS and possibilities of consultation may lower the threshold for reporting.