Citation

Cowley LE, Maguire S, Farewell DM, Quinn-Scoggins HD, Flynn MO, Kemp AM. Child Abuse Negl. 2018; 82: 178-191.

Affiliation

Division of Population Medicine, School of Medicine, Cardiff University, Wales, United Kingdom. Electronic address: KempAM@cardiff.ac.uk.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.chiabu.2018.06.009

PMID

29913434

Abstract

Clinicians face unique challenges when assessing suspected child abuse cases. The majority of the literature exploring diagnostic decision-making in this field is anecdotal or survey-based and there is a lack of studies exploring decision-making around suspected abusive head trauma (AHT). We aimed to determine factors influencing decision-making and multidisciplinary collaboration in suspected AHT cases, amongst 56 child protection professionals. Semi-structured interviews were conducted with clinicians (25), child protection social workers (10), legal practitioners (9, including 4 judges), police officers (8), and pathologists (4), purposively sampled across southwest United Kingdom. Interviews were recorded, transcribed and imported into NVivo for thematic analysis (38% double-coded). We identified six themes influencing decision-making: 'professional', 'medical', 'circumstantial', 'family', 'psychological' and 'legal' factors. Participants diagnose AHT based on clinical features, the history, and the social history, after excluding potential differential diagnoses. Participants find these cases emotionally challenging but are aware of potential biases in their evaluations and strive to overcome these. Barriers to decision-making include lack of experience, uncertainty, the impact on the family, the pressure of making the correct diagnosis, and disagreements between professionals. Legal barriers include alternative theories of causation proposed in court. Facilitators include support from colleagues and knowledge of the evidence-base. Participants' experiences with multidisciplinary collaboration are generally positive, however child protection social workers and police officers are heavily reliant on clinicians to guide their decision-making, suggesting the need for training on the medical aspects of physical abuse for these professionals and multidisciplinary training that provides knowledge about the roles of each agency.

Copyright © 2018 Elsevier Ltd. All rights reserved.

Language: en

Keywords

Abusive head trauma; Child physical abuse; Child protection; Qualitative research