Children's health needs filtered through legal priorities at Barnahus: A qualitative study

Child maltreatment is strongly associated with adverse physical and mental health outcomes. Yet, when authorities become aware of violence against children, addressing health needs has proven difficult, even within the Barnahus model, which explicitly aims to facilitate legal processes while providing care and support to children. The reasons for this imbalance remain unclear, particularly from the justice system's perspective. A clinical feasibility study at Barnahus Stockholm, Europe's largest facility, examined routine voluntary health examinations through collaboration with police investigators. In practice, however, investigators rarely offered these examinations despite explicit instructions to invite every child. This study explored investigators' experiences of informing children and caregivers about health examinations and their organizational, professional, and personal reasons for refraining from doing so. Ten forensic child abuse investigators were interviewed. Reflexive thematic analysis, informed by institutional logics theory, showed that legal processes consistently outweighed health priorities. Children were regarded primarily as evidence-bearers rather than rights-holders, their health needs filtered through investigative priorities. Organizational agendas shaped interpretations of children's best interests, encouraging medical examinations when serving prosecutorial aims but dismissing them when focused solely on health. Concerns for suspects' integrity and anticipated reactions from adult stakeholders further constrained health-oriented responses. Findings suggest that despite multidisciplinary intentions, criminal law logic dominates Barnahus practice, systematically subordinating children's health needs to investigative requirements. This institutional prioritization undermines the model's stated child-centered approach, highlighting the need for structural and legislative reforms to better integrate health and welfare considerations into child protection responses.