Navigating the grey zone in the response to child abuse and neglect in primary healthcare settings

Abstract

BackgroundChild abuse and neglect (child abuse) is a common issue that leads to significant health issues. Given the association between child abuse and health, mandatory reporting laws for doctors and nurses were introduced in jurisdictions such as the US, Canada and Australia. However, this legislation is not globally or nationally consistent. Thus, there is confusion surrounding the definition of abuse that should be reported and how to respond when suspicion does not meet the threshold of Child Protection. It is unclear as to how health professionals navigate the response to child abuse in light of this confusion. PurposeTo explore how Australian GPs and nurses navigate their response to child abuse and neglect in primary healthcare settings. MethodsTwenty-two Australian GPs and eight nurses were sampled from: private general practice and community health clinics; and Doctors in Secondary Schools, an initiative in the Australian state of Victoria that places GPs and nurses in high schools. We conducted 26 in-depth individual and group interviews. The interviews were audio-recorded, transcribed verbatim and analyzed thematically. Principal ResultsWe generated three themes: negotiating the threshold; mismatching expectations; and practising in the grey area. Participants engaged in a process of negotiating between their immediate colleagues, with families, and with statutory Child Protection authorities. When participants decided to make a report, they were met with a response from Child Protection that did not match their expectations. This led to feelings of distrust directed towards Child Protection authorities which left participants to manage patients within a ‘Grey Zone’. While practising in the Grey Zone, participants attempted to create an emotionally safe space for patients and engage in practical strategies that responded to patient vulnerabilities. Major ConclusionsWe recommend that training interventions be aimed at supporting practice within the Grey Zone and that threshold be made clearer in legal and occupational policy.