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Multiple factors drive PCP decision to report child maltreatment to CPS
NEW ORLEANS — Primary care physicians’ decisions to file a report to Child Protective Services or to pursue alternative action is driven by numerous factors, according to a study presented at AAP National Conference & Exhibition.
“Among participating PCPs, this study found decision-making process is complex,” James G. Kaferly III, MD, assistant professor in pediatrics at the University of Colorado Denver, told Healio Primary Care. “When considering CPS report versus alternative actions, some PCPs weighed maltreatment concern and perceived likelihood of CPS response against possible negative relationship repercussions with family. While some providers pursue CPS report, others modified their report decision-making framework by incorporating alternative actions,” he continued.
To evaluate decision-making factors in these situations, researchers conducted a qualitative grounded theory study of 15 PCPs from two institutions. Participating PCPs completed individual semi-structured interviews about CPS reporting.
In their analysis, researchers identified four themes that characterized the factors of CPS report decision-making. The first centered around physicians’ feeling a duty to file a report when they were concerned for the safety of a child. Researchers found that the status of “mandated reporter” made some PCPs obligated to report any concern regardless of estimated outcomes.
Considering report impact and decision choice was another factor in physician decision-making. When there was no imminent danger to the child, physicians weighed their concerns about maltreatment and whether they felt a report would actually lead to a CPS response against possible repercussions of a damaged relationship with the family. For instance, if a PCP felt that CPS may not respond to a report and it could potentially cause a family to lose trust in the physician and stop seeking medical care, the physician might decide to pursue alternative action instead.
Another theme, what the researchers called “working before a report,” included efforts made by physicians to address family-specific barriers like inadequate resources or parent characteristics. For example, a physician might bring in a social worker to help parents address concerns instead of filling out a report.
Engaging CPS was the final factor in PCP decision-making; however, this varied based on the type maltreatment. For instance, if PCPs suspected that a child suffered physical or sexual abuse, their decision to file a report was undeterred. However, decision-making varied among PCPs who had previously reported neglect due to uncertainty that CPS would respond to the report.
Kaferly told Healio Primary Care that “increased report feedback to PCPs and efforts to increase transparency of CPS decision-making process,” would help to enhance collaboration between CPS and PCPs. – by Erin Michael
Reference:
Kaferly J, et al. Primary care providers: Perceived decision-making factors for Child Protective Service report. Presented at: AAP National Conference & Exhibition; Oct. 25-29; New Orleans.
Disclosures: Healio Primary Care was unable to confirm relevant financial disclosures prior to publication.