Understanding the roles of the healthcare and child welfare systems in promoting the safety and well-being of children

Nicolette Joh-Carnella; Eliza Livingston; Miya Kagan-Cassidy; Ashley Vandermorris; Jennifer N Smith; Daniel M Lindberg; Barbara Fallon

doi:10.3389/fpsyt.2023.1195440

Understanding the roles of the healthcare and child welfare systems in promoting the safety and well-being of children

Front Psychiatry. 2023 May 30:14:1195440. doi: 10.3389/fpsyt.2023.1195440. eCollection 2023.

Authors

Nicolette Joh-Carnella¹, Eliza Livingston¹, Miya Kagan-Cassidy¹, Ashley Vandermorris^{2

3}, Jennifer N Smith^{2

3}, Daniel M Lindberg⁴, Barbara Fallon¹

Affiliations

¹ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
² The Hospital for Sick Children, Toronto, ON, Canada.
³ Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
⁴ Departments of Emergency Medicine and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.

Abstract

Introduction: The accurate identification and appropriate investigation of child maltreatment is a key priority for promoting the optimal health and development of children. Healthcare providers are often well-positioned professionals to report suspected child abuse and neglect, and, therefore, interact regularly with child welfare workers. Little research has examined the relationship between these two groups of professionals.

Methods: We interviewed healthcare providers and child welfare workers in order to examine the referral and child welfare investigation processes to understand strengths and identify areas of improvement for future collaboration. Thirteen child welfare workers from child welfare agencies and eight healthcare providers from a pediatric tertiary care hospital in Ontario, Canada were interviewed to meet the study's objectives.

Results: Healthcare providers spoke about positive experiences making reports, factors impacting reporting decisions, areas for improvement (e.g., difficulties communicating, lack of collaboration, and disruption of therapeutic alliance), training, and professional roles. For interviews with child welfare workers, identified themes included healthcare professionals' perceived expertise and understanding the role of child welfare. Both groups brought up the need for increased collaboration as well as systemic barriers and legacies of harm.

Discussion: Our core finding was a reported lack of communication between the groups of professionals. Other identified barriers in collaboration included a lack of understanding of each other's roles, hesitation for healthcare providers making reports, as well as legacies of harm and systemic inequities in both institutions. Future research should build on this examination by including the voices of healthcare providers and child welfare workers to identify sustainable solutions for increased collaboration.

Keywords: Canada; child abuse and neglect; child welfare; healthcare; pediatrics; reporting.