Vulnerable Family Meetings: A Way of Promoting Team Working in GPs’ Everyday Responses to Child Maltreatment?

Jenny Woodman,Ruth Gilbert,Danya Glaser,Marian Brandon,Janice Allister

doi:10.3390/socsci3030341

Abstract

This study uses observations of team meetings and interviews with 17 primary care professionals in four GP practices in England to generate hypotheses about how “vulnerable family” team meetings might support responses by GPs to maltreatment-related concerns and joint working with other professionals. These meetings are also called “safeguarding meetings”. The study found that vulnerable family meetings were used as a way of monitoring children or young people and their families and supporting risk assessment by information gathering. Four factors facilitated the meetings: meaningful information flow into the meetings from other agencies, systematic ways of identifying cases for discussion, limiting attendance to core members of the primary care team and locating the meeting as part of routine clinical practice. Our results generate hypotheses about a model of care that can be tested for effectiveness in terms of service measures, child and family outcomes, and as a potential mechanism for other professionals to engage and support GPs in their everyday responses to vulnerable and maltreated children. The potential for adverse as well as beneficial effects should be considered from involving professionals outside the core primary care team (e.g., police, children’s social care, education and mental health services).

Highlights

One practice allocated an hour every fortnight to discuss problems in adults and, for the second half of the meeting, discussed children and young people: It could be anything, from a child that’s constipated to a child who’s got a serious medical diagnosis to a child who is a cause for concern, and we’ll discuss all the children who have child in need plans or child protection plan (GP, interview data)
There was no evidence in our study that vulnerable family meetings were used for peer supervision and learning in this difficult area or to support joint decision making about how GPs and the primary care team should manage the family in their everyday contact with them
We suggest an opportunity was being missed for peer supervision in this difficult area and joint decision making about how to manage everyday contact with specific vulnerable children, young people and their families in primary care

Summary

Introduction

It is widely acknowledged that scarce resources and high demand mean that children’s social care in England is functioning as “an emergency service [1]” which prioritises reactive child protection responses over earlier help and prevention, despite policies which have ambitions to the contrary [1,2,3,4,5].Qualitative studies report that some families and professionals have encountered a lack of early help or child in need services for families who are below the very high thresholds for child protection services [6,7,8,9,10,11].In this context, the spotlight has been thrown on the role of other services which have routine contact with all children and families, such as GPs. There is evidence from qualitative studies that some GPs in England are already using their core skills and opportunities as family doctors to identify and respond to maltreatment-related concerns 1, for children with problems related to neglect and emotional abuse [12] In these studies, GPs were responding directly to families by “keeping a watchful eye” on them, “standing up and shouting” for families (e.g., advocating for better housing), talking to parents to help them realise “that there was a problem with the children” or that “stopping drinking was a good thing”, and providing immediate and opportune healthcare for children when parents came to the surgery for other reasons [12,16]. These responses relied on GPs building a therapeutic relationship with parents and/or older children and good links with health visitors [12]

Methods

Results

Discussion

Conclusion