Identifying children suspected for maltreatment: The assessment process taken by healthcare professionals working in community healthcare services

Healthcare professionals working in community settings are well-placed to detect suspected child maltreatment cases. Yet, child maltreatment presents particular diagnostic challenges given that the assessment has to be made fast due to the potential harm to the child and under conditions of great uncertainty. The purpose of this article is to examine how healthcare professionals working in community health services clinics make judgments about the likelihood that a child's clinical condition was caused by maltreatment. The study was conducted in the largest health-management organization in Israel, across fourteen clinics in the north of the country. Semi-structured interviews were conducted with 21 healthcare professionals from six occupational branches, including pediatrics, nursing, social work, physiotherapy, speech-therapy and occupational-therapy. It was found that healthcare professionals' assessment of possible child maltreatment involves the recognition of emerging vulnerability about the child's condition, interpretation of suspicions as the outcome of maltreatment, and looking for accountable, after the fact, justifications. The participants' assessment was guided by explicit knowledge and intuitive judgment, and was influenced by individual characteristics and factors in the organizational environment. According to the participants, efforts to advance practice should focus on alerting them to consider maltreatment as a possible explanation for a child's condition. Strategies such as focused training sessions, opportunities for rapid consultation, and nudges were proposed as helpful ways to achieve this function. The authors also emphasize the importance of providing healthcare professionals with a reliable and regular supply of feedback and opportunities for reflection.