Managing child abuse or suspected child abuse in primary care: Results from a qualitative study of general practitioners trained in detecting child abuse Managing child abuse or suspected child abuse in primary care

Introduction: Identifying and alerting suspected child abuse enables its investigation and management. In France, anyone can report the situation to child services when child abuse is suspected. However, the number of reports of concern received from physicians is low, and lack of knowledge is a frequent obstacle. This study aimed to explore the practices of trained general practitioners (GPs) regarding the identification and management of suspected child abuse. Method: We led a qualitative study from February to November 2021 based on a grounded theory approach. We conducted semi-structured interviews with GPs working in the south of France who had received training in identifying child abuse. We performed an inductive analysis using NVivo software. Results: We interviewed 10 GPs (data saturation with seventh GP). Despite the training, obstacles seemed to persist, such as apprehension of the parents' reaction, the technical difficulties of the process, and the lack of feedback after making a report. Being accompanied by a professional who can be directly contacted would facilitate the communication of worrying information. Without direct links to a single referent, doctors would prefer alternative ways of referring their patients to organizations they were familiar with. Discussion and conclusion: GPs expressed a need for easy access to childcare professionals to support them in the decision to file a report of suspected child abuse. A multidisciplinary approach and a dedicated point of contact seemed to help the process. Nominating a child protection referent doctor per department and creating specific units in hospitals for children at risk would help GPs get effectual contacts for reporting worrying information and better care for children at risk of abuse.