The Behaviours and Perceptions of Paediatricians in Malta Relating to Child Protection Work: National and International Implications of a Mixed‐Methods Study

Abstract

Health professionals fulfil an essential role within the multiagency response to safeguarding concerns. This study explored the experiences, attitudes and perceptions of paediatricians relating to child protection (CP) work. A mixed‐methods approach was adopted, using the explanatory sequential design. The quantitative strand involved a population survey of paediatricians (N = 56). Data were analysed and used to inform a subsequent qualitative strand. Both strands indicated that CP work was perceived as complex, emotive and stressful. Paediatricians perceived themselves to be working within an unstructured system. Despite most reporting to have assessed CP cases, 77.4 per cent (n = 41) had never received training. The majority reported that response pathways and reporting procedures were unclear and that they were not involved in tasks beyond identification. These factors contributed to a lack of confidence and ambivalence towards CP, particularly child sexual abuse. Participants felt reassured by having a designated consultant, however, this role also enabled them to offload responsibility. Overall, CP work was not being fully owned. This study suggests that the lack of mandatory and statutory guidance results in significantly suboptimal practice. Investment in structured training and support systems is recommended to engage professionals. Designated professionals should complement, rather than minimise, the role and responsibility of other professionals. Key Practitioner Messages Child protection is the responsibility of every professional working with children. Developing child protection systems requires a strong national commitment reflected in legislation and statutory guidance in order to ensure that they are standardised, robust and sustainable. Engaging professionals in child protection work is essential and calls for structured training programmes, support systems and provisions in law that protect against legal liability. Designated professionals in child protection are essential, however, their role should complement, rather than minimise, the role and responsibility of other professionals. Child sexual abuse requires specialist input.

Safeguarding Children and Young People is Everyone's Responsibility

“…Additional data collection methods included interviews with 31 healthcare providers who attend to cases of sexual abuse, including nurses, physicians, social workers, pharmacists, counsellors, laboratory technologists and administrators, a health facility staff inventory, and 19 exit interviews with 14 child survivors and their caregivers. In a similar vein to the study by Borg and Barlow (), few providers (only 2 out of 581) had undertaken training specifically in the management of child survivors of sexual abuse, and only nine per cent had attended a three‐day training programme on the management of gender‐based violence using national guidance, thus lacking the knowledge of how to respond to the needs of child survivors of sexual abuse. While national guidance and protocols exist on the management of survivors of sexual violence, all the healthcare providers stated that these protocols were not child‐specific.…”

“…The second paper in this issue by Kevin Borg and Jane Barlow () reports on a study from Malta which explored the experiences, perceptions and attitudes of paediatricians about child protection work. This paper reinforces the important role that paediatricians have in the multiagency team response to an allegation or concern about child maltreatment.…”

“…This paper reinforces the important role that paediatricians have in the multiagency team response to an allegation or concern about child maltreatment. Borg and Barlow () conducted a mixed‐methods study, using an explanatory sequential design. An initial cross‐sectional survey was distributed to all paediatricians and paediatric trainees (56) employed in the Maltese NHS, which achieved an excellent response rate of 95 per cent ( n = 53).…”

“…Indeed, 72 per cent reported never having participated in interagency activities such as child protection conference meetings. While respondents appeared to be reassured by having a designated consultant to refer cases to, Borg and Barlow () suggest that this may result in paediatricians ‘using this role to offload responsibility’ (p. 462). Borg and Barlow () highlight the absence of mandatory and statutory guidelines within Malta, resulting in ‘suboptimal practice with regard to child protection’ (p. 464).…”

“…While respondents appeared to be reassured by having a designated consultant to refer cases to, Borg and Barlow () suggest that this may result in paediatricians ‘using this role to offload responsibility’ (p. 462). Borg and Barlow () highlight the absence of mandatory and statutory guidelines within Malta, resulting in ‘suboptimal practice with regard to child protection’ (p. 464). The study findings reinforce the need in Malta for ‘a robust structure that ensures that child protection is everybody's responsibility’ (Borg and Barlow, , p. 462) and the establishment of safeguarding teams of different professionals to work together in cases of child maltreatment.…”