Reasonable suspicion in reporting child maltreatment: a survey among German healthcare professionals

Abstract

Background With regular contacts to the general child population, healthcare professionals could play an important role in the detection of child maltreatment. However, a majority of child maltreatment cases go unnoticed by the healthcare system. Child protection legislations usually offer terms like “reasonable suspicion” to corner a threshold that warrants reporting to child protection services (CPS) is defined as. The indistinct legal terminology leads to marked differences in the interpretation of this threshold. Therefore, we aimed to systematically assess the understanding of reasonable suspicion and subsequent handling of cases in the German context. Methods A cross-sectional online survey was conducted among 2485 physicians and psychotherapists working with children and adolescents. Field access was gained by German professional associations. Via case vignettes, predictors of thresholds for reporting were assessed. Results The probability of a report to CPS increased positively with the degree of suspicion for maltreatment. However, even if participants were certain that child maltreatment occurred, 20% did not chose to report to CPS. Training in child protection lowered the professionals’ threshold for reasonable suspicion; experience with child protection cases and good knowledge of the legal framework increased the likelihood to report an alleged situation of child maltreatment to CPS. Conclusion Our data show that a significant proportion of health care professionals are uncertain about estimating reasonable suspicion and on how to proceed when there are strong indications for child maltreatment Therefore, data point towards the relevance of training in child protection among healthcare professionals in order to improve detection and adequate handling of cases of child maltreatment.

Herausforderungen der Kostenschätzung von Kindeswohlgefährdung in unterschiedlichen Versorgungsbereichen und eine Annäherung an Kosten in der Gesundheitsversorgung

“…Mangelndes Wissen zu Hinweiszeichen, zum Erkennen von Kindesmisshandlung ist ein möglicher Faktor. Auch wenn davon ausgegangen wird, dass nicht alle Formen von Gewalt an Kindern und Jugendlichen durch Fachkräfte im Gesundheitswesen erkannt werden können, ist dennoch davon auszugehen, dass verbesserte Schulung und mehr Kenntnisse zum Kinderschutz zu verbessertem Erkennen beitragen können [31,32]. Weiter deuten aber Aussagen von Experten darauf hin, dass nicht in allen Fällen, wo Kindesmisshandlung durch Fachpersonen im Gesundheitswesen erkannt wird, diese auch dokumentiert wird [6].…”

Medical Institutions’ Response to Child Abuse: Survey across Japan

“…Previous studies included reports from Germany, Sweden, and Australia, which can be compared with the results of this study. Berthold et al (2021) reported a survey of 2485 physicians and psychotherapists treating children and adolescents in Germany regarding suspicion of child abuse and notification to the CPS [12]. The probability of reporting to the CPS increased positively with the degree of suspected abuse.…”

“…However, even when participants had a high degree of certainty that child abuse had occurred, approximately 20% did not choose to notify the CPS. When that certainty was medium, approximately 35% did not choose to report to the CPS [12]. Talsma et al (2015) surveyed general practitioners in Sweden regarding notification of child abuse cases to the CPS.…”

“…Although physicians nationally in Belgium, Germany, Malta, the Netherlands, Ireland, and the UK are not obliged to notify, the response in some cases differs at the state level [9], making a uniform understanding difficult. There have been several previous studies on the gap between compliance with notification obligations and actual notifications made by health care providers and institutions [10][11][12]. Among others, a survey of 2485 German healthcare professionals found that 20% of study participants did not choose to notify the child protection system (CPS) even if they were certain that child maltreatment had occurred [12].…”

“…There have been several previous studies on the gap between compliance with notification obligations and actual notifications made by health care providers and institutions [10][11][12]. Among others, a survey of 2485 German healthcare professionals found that 20% of study participants did not choose to notify the child protection system (CPS) even if they were certain that child maltreatment had occurred [12]. This indicated that distress regarding the obligation to notify and report child abuse among healthcare professionals can be a problem in many countries.…”