GP's role in responding to child maltreatment: time for a rethink? An overview of policy, practice and research

Practitioner listening to a girlThere are increasing calls for a public health approach to child maltreatment.

A public health approach prioritises prevention and early intervention. In healthcare setting, this means identifying and responding to parental risk factors for maltreatment and harmful parent-child interaction.

This report looks not only at children who have obviously been abused but also those 'marginally maltreated' children (cases where it can be difficult to meet the threshold of significant harm).

It focuses on GPs because:

  • GP practices are a first and on-going point of contact for families
  • GPs have a view of family health needs over the life course, opportunities for building therapeutic relationships with families and are holders of the primary healthcare records which can act as an information repository about a family
  • GPs might be particularly well-placed to identify and respond to problems relating to child neglect and emotional abuse
  • GPs’ contact with families, which is often repeated over time, provides opportunity for direct responses to maltreatment-related concerns which might include on-going support and monitoring of children and wider family members
  • direct responses could occur in tandem with GPs’ participation in child protection systems and/or alongside services provided by other agencies, including children’s social care.

This research was conducted by the NSPCC, RCGP, UCL Institute of Child Health and the University of Surrey.

Authors: Jenny Woodman, Dawn Hodson, Ruth Gardner, Chris Cuthbert, Andrew Woolley, Janice Allister, Imran Rafi, Simon de Lusigan and Ruth Gilbert
Published: 2014

The report draws upon policy, practice and research to identify the ways that GPs can help reduce child maltreatment.

  • Recognise that they can contribute to a public health approach to child maltreatment through directly responding to families as well as participating in the statutory child protection system.
  • Use core skills of general practice to facilitate and enact direct responses to families with maltreatment-related concerns, including:
    • developing and maintaining a strong doctor-parent and doctor-child relationship
    • monitoring, coaching and advocating for families and providing opportune healthcare to children and parents.
  • Work sensitively to support parents caring for children and to encourage engagement with primary care and at the same time take action to keep children safe.
  • Have structures, such as regular primary care team meetings, to oversee direct responses by the primary care team and guide GPs’ participation in the statutory child protection system, including proactive and reactive information sharing.
  • Recognise that GPs can respond directly to families who prompt concerns about child maltreatment through the doctor-parent and child relationship and through monitoring, coaching and advocating for families and providing opportune healthcare.
  • Consider the relevance of GPs’ responsibility for family health care when responding to maltreatment-related concerns.
  • Support a public health approach to child maltreatment by facilitating GPs use of direct responses.
  • Promote the flow of meaningful information to and from the GP.
  • Some GPs use their core skills to respond directly to families who prompt professional concerns about child maltreatment. Direct responses use skills such as monitoring, coaching, advocating and providing opportune healthcare.
  • Facilitating direct responses to child maltreatment through policy will build on GPs’ existing practice and core skills and promote their contribution to a public health (or preventive) approach to child maltreatment.
  • Direct responses can be enacted through parents and other family members as well as their children and are likely to depend on maintaining a therapeutic relationship with parents and children and a strong doctor-family relationship.
  • Direct responses can occur before, during or after referral to children’s social care or early help services and in addition to GPs’ contribution to statutory child protection procedures.
  • Research is needed to determine the potential benefits and harms of wider use of direct responses in general practice in the UK.
Key messages for GPs, partner agencies and policy-makers 6
Executive summary 7
Abbreviations  10
Glossary 11
Background 13
Structure of report and methods 17
Why focus on GPs? 18
How far does policy and practice guidance support GPs’ direct responses to families? 25
Learning from practice and research: what do we know about direct responses by GPs 36
Parent, young person, adolescent and child view of the doctor-patient relationship in general practice 52
Key points, conclusions and the way forward 66
Appendices 68
References 78

Please cite as: Woodman, J. et al. (2014) The GP's role in responding to child maltreatment: time for a rethink?: an overview of policy, practice and research. London: NSPCC.

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