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Variation in recorded child maltreatment concerns in UK primary care records: a cohort study using The Health
Jenny Woodman1, Nick Freemantle, Janice Allister
1MRC (Medical Research Council)-Centre of Epidemiology for Child Health, University College London (UCL)-Institute of Child Health, London, United Kingdom.
Insights
General Practitioners (GPs) in the UK are increasingly recording child maltreatment concerns, with annual incidence rising by 10.8%. This highlights significant engagement in child safeguarding, though recording likely underestimates the true prevalence.
Area of Science:
- Pediatrics
- Public Health
- General Practice
Background:
- Child maltreatment is a significant public health concern requiring accurate identification within healthcare systems.
- Primary care records are crucial for documenting child welfare concerns and informing safeguarding interventions.
Observation:
- A retrospective cohort study analyzed 1,548,972 children registered in 448 UK General Practices between 1995 and 2010.
- Annual incidence of coded maltreatment concerns increased by 10.8% yearly, reaching 9.5 per 1000 child-years in 2010.
- Practice-level prevalence varied, with a median of 0.9% of children having maltreatment codes recorded between 2008-2010.
Findings:
- General Practitioners (GPs) demonstrate consistent and increasing recording of child maltreatment concerns over time.
- The observed rise in recording suggests active engagement in child safeguarding by primary care.
- Despite the increase, current recording rates likely underestimate the full burden of child maltreatment encountered in primary care.
Implications:
- Findings support the need for continued and enhanced child safeguarding training and resources for GPs.
- Increased and accurate recording of maltreatment concerns can improve resource allocation for child protection services.
- Policies and interventions should acknowledge and build upon the demonstrated engagement of UK GPs in child safeguarding activities.
Objectives:
To determine variation over time and between practices in recording of concerns related to abuse and neglect (maltreatment) in children's primary care records.
Design:
Retrospective cohort study using a United Kingdom representative primary care database.
Setting:
448 General Practices.
Participants:
In total 1,548, 972 children (<18 y) registered between 1995 and 2010.
Main Outcome Measures:
Change in annual incidence of one or more maltreatment-related codes per child year of registration. Variation between general practices measured as the proportion of registered children with one or more maltreatment-related codes during 3 years (2008-2010).
Results:
From 1995-2010, annual incidence rates of any coded maltreatment-related concerns rose by 10.8% each year (95% confidence interval 10.5, 11.2; adjusted for sex, age and deprivation). In 2010 the rate was 9.5 per 1000 child years (95%CI: 9.3, 9.8), equivalent to a prevalence of 0.8% of all registered children in 2010. Across all practices, the median prevalence of children with any maltreatment-related codes in three years (2008 to 2010) was 0.9% (range 0%-13.4%; 11 practices (2.5%) had zero children with relevant codes in the same period). Once we accounted for sex, age, and deprivation, the prevalence for each practice was within two standard errors of the grand mean.
Conclusions:
General Practitioners (GPs) are far from disengaged from safeguarding children; they are consistently and increasingly recording maltreatment concerns. As these results are likely to underestimate the burden of maltreatment known to primary care, there is much scope for increasing recording in primary care records with implications for resources to respond to concerns about maltreatment. Interventions and policies should build on this evidence that the average GP in the UK is engaged in child safeguarding activity.
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