Dental health personals experience with mandatory reporting to child welfare authorities

Norway has as most other western countries mandatory reporting requirements for health personnel and other public personnel. This law requires any individual who suspects serious child maltreatment to report to child welfare... [ view full abstract ]

Norway has as most other western countries mandatory reporting requirements for health personnel and other public personnel. This law requires any individual who suspects serious child maltreatment to report to child welfare authorities. Each year the child welfare authorities receive more than 50 000 notifications and, in 2014 hospital/doctor/dentist accounted for six percent of these messages. All children have the right to free dental care until they are 18 years old and are called in to their local public dental health clinic regularly through their childhood. During the last few years mandatory reporting has received increased public attention and many counties have implemented new routines for public dental health personnel on what and when to report to child welfare authorities. Signs of child abuse and neglect may often be difficult to understand, reporters must therefore make decisions under uncertainty just as social workers in child welfare authorities often have to do. According to an ecological decision model, such decision is not only influenced by the characteristics of the case but also the knowledge and attitudes of the professional, the organization and external factors like policy.
The purpose of the present project was to investigate dental health personnel’s experience with mandatory reporting to child welfare authorities.
Individual qualitative interviews were carried out with four dentist and three dental hygienists in 2014. The informants had from four to 30 years’ experience and were employed at four different dental health clinics in Hordaland County, Norway. The interviews were audiotaped and then transcribed verbatim and analysed.
The informants had all sent notifications to child welfare authorities and experienced situations with their patients that had made then concerned such as patients that did not show up, poor dental health, signs of neglect, signs of psychological abuse and patients showing strong resistance to treatment. However, in many cases the signs were vague and the informants found it difficult to reach a decision to send notification to child welfare authorities or not. Since they often experienced a “gut-feeling” they were afraid to make a mistake if they had no objective proofs, they were uncertain regarding ethnic minorities and different cultural practices, and they were also uncertain whether sending a notification would help the child. The informants felt the need to have someone to discuss their worries and concerns with and they also needed more training and competence. They wanted a closer collaboration with the child welfare service which they perceived as a “closed” service.