Child Maltreatment: To Report or Not to Report? It’s More Complex than That

Abstract

Child maltreatment (CM) is a widespread problem, contributing to health and societal difficulties often throughout the lifespan. Healthcare professionals (HCPs) who see potential warning signs for CM are responsible for protecting the child from future harm, which may involve alerting the authorities. The decision-making is challenging as unwarranted reporting may lead to mistrust and not benefit the child. We sought to explore what factors might influence HCPs’ decisions to report suspected CM in a Norwegian sample. Using a cross-sectional survey among HCPs in Norwegian hospitals with pediatric wards, we presented five case vignettes describing different probabilities of CM and variables assessing experience, knowledge, and confidence. A total of 382 HCPs completed the survey. Despite recognizing warning signs for CM in the case vignettes, a large proportion were reluctant to report to authorities. Recognition of CM and expressed willingness to report four or all five of the case vignettes (high reporters) was associated with the profession, knowledge, experience, and confidence in handling CM cases. Expressed confidence in performing physical examinations for physical or sexual abuse and talking with parents about abuse was significantly associated with high reporting (OR 2.3 to 17.8). Qualitative data further supported the role of self-efficacy. In summary, reporting to the authorities is an important but complex aspect in cases of suspected CM, but many HCPs relate that they fail to do so. This study indicates reporting suspicion of CM is correlated with self-efficacy and knowledge among HCPs, which should inform educational, social, and policy decisions.