Child maltreatment in a tribal setting: Evaluation experiences of medical providers

Native American children suffer one of the highest rates of child maltreatment (CM) compared to other racial groups. Medical providers working in tribal settings may offer unique insight into the response to CM concerns in... [ view full abstract ]

Native American children suffer one of the highest rates of child maltreatment (CM) compared to other racial groups. Medical providers working in tribal settings may offer unique insight into the response to CM concerns in this setting.
Objective: To explore successes, limitations, and clinical knowledge related to CM among medical providers working within a US tribal healthcare system.
Methods: Through tribal collaboration, 22 Native and non-Native medical providers were interviewed. Grounded theory methods were used to construct an understanding of the ways in which providers perceived and experienced CM identification and reporting.
Results: Five themes describing obstacles and facilitators to decision making, medical management, reporting and follow up were identified by medical providers.
-Black Box: confusion with the process of CM reporting was common.
-Traditional values/ practices: Native cultural practices were NOT contributory to CM with the exception of perceived neglect around child care practices within extended families.
-Barriers: tribal specific barriers were identified such as poor understanding of local vs. state CPS processes, remoteness of family residence, hospital staff potentially being family and/or same tribe as suspected perpetrators, as well as other general barriers such as lack of set procedures, time costs and training deficits.
-Collaboration: key staff having inside knowledge of CM processes described as much needed and may help alleviate the Black Box feeling. Absence of key staff produced challenges in CM management.
-Success specific to tribal facility: working in tribal health setting described as a benefit to providers/ families experiencing CM. Perceived facilitating factors included more time spent with patients, less concerns for reimbursement, ability to secure needed services through tribal health resources, and support from tribal health system leadership.

Conclusions: identified successes and barriers in the tribal setting may serve as a springboard for CM service delivery improvement and fostering continued collaborations in CM response.