The Experiences, Attitudes and Perceptions of Paediatricians in Malta Relating to Child Protection Work: Implications of a Mixed-methods Study

Health professionals fulfil an essential role within the multiagency response to safeguarding concerns. This study aimed to explore the behaviours and perceptions of paediatricians relating to Child Protection (CP) work in a country characterised by the absence of mandatory and statutory guidance. 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 phase, in which data were collected using one-to-one interviews and analyzed using thematic analysis. The response rate was at 95% (n=53). Paediatricians perceived themselves to be working within an unstructured system. Despite the majority reporting to have assessed CP cases, 77.4% (n=41) had never received specific CP training. Furthermore, the majority reported that response pathways and reporting procedures were unclear and that they were not involved in CP related tasks beyond identification. Both quantitative and qualitative data indicated that CP work was perceived as complex, emotive and stressful, and that this, together with lack of experience, resulted in ambivalence and lack of confidence particularly in child sexual abuse. Although participants felt reassured by having a designated consultant, this role also enabled them to offload responsibility, with CP work not being fully owned. Trainees appeared more willing to be involved than specialists. This study suggests that the lack of mandatory and statutory guidance results in significantly suboptimal practice with regard to CP. Investment in formalised structured training and support systems that enhance reflective practices, are recommended to engage professionals in CP work. Designated professionals in CP should complement, rather than minimise, the role and responsibility of professionals working with children. Such measures will help create a cognitivie change to making CP everybody`s responsibility and that ensure a more robust and sustainable CP system that is child-centred and more cost-effective.