A Matter of Professional Status: The Impact of Medical Hierarchies on Child Maltreatment Work

Abstract

Background: All health care professionals in Sweden are obliged to report children whom they suspect are subject to maltreatment to Social Services, but it has been shown that professional group affiliation is the most significant factor behind hospital personnel's decisions not to make reports. This article explores the differences between professional groups' work with child maltreatment and the different conditions under which they have to perform such work. Methods: 295 physicians, nurses, nurse assistants and hospital social workers at the four largest children's university hospitals in Sweden responded to a questionnaire. The data was analyzed using descriptive statistics, chi-square tests and binary logistic regressions. Results: The findings show great differences between the professional groups. Nurses and nurse assistants showed a lower level of knowledge of risk to children, the legalization and the available organizational support than physicians and hospital social workers. Nurses were characterized by feeling insecure in assessments and anxious about threats, while physicians tended to feel anxious about destroying the relationship with parents. Hospital social workers were characterized by feeling confident and trying to solve the situation themselves. It was unusual for nurses and nurse assistants to have experience of reporting, and hospital social workers were the group with the most such experience. The analysis shows that the differences between the professional groups are based on the traditional medical hierarchy, which is seen to have a strong influence on hospital staff 's work with child maltreatment. Conclusion:The study argues that all professional groups need training, with the opportunity to become more involved in the assessment and reporting processes. This would reduce the insecurity in assessments and support the professional autonomy of health care professional groups. Strengthening multidisciplinary structures at the clinical level would also help children who are subjected to maltreatment to be acknowledged and to receive support or protection.