Association of child abuse and neglect training with filing reports of concern to child welfare services: a cross-sectional study.

BACKGROUND: The aptitude, knowledge, and competence of dental health personnel on child abuse and neglect (CAN) is not optimal for deciding when to file a report of concern to child welfare services (CWS). OBJECTIVES: The aim of this study was, firstly, to assess the association of the public dental health personnel 's (PDHP) training on CAN received in the last three work years, i.e., in 2016 through 2018 with filing reports to the CWS in the same period and secondly to assess the association of expressed need of training on CAN with filing reports to the CWS. METHODS: This cross-sectional study uses data from an electronic survey census of PDHP from Norway (n = 1791) conducted in 2019. The Pearson chi-square test, non-parametric tests, logistic, and negative binomial regression were used for unadjusted and adjusted analysis. Data was reported with proportions, odds ratios (OR), incidence rate ratios and 95% confidence intervals (CIs). RESULTS: From 2016 to 2018, the prevalence estimate of filing reports to CWS was 50%, with a mean (standard deviation) of 1.39 (2.11) reports sent. The logistic regression analysis showed an association between filing reports of concern and CAN training in the last three years. Compared to those that had not received CAN training during the three previous years, the ORs (95% CI) for filing reports to the CWS during the same period was 2.5 (1.6-4.0) for one day CAN work training, 3.2 (2.0-5.1) for 2-4 days CAN training and 4.9 (2.6-9.4) for five or more days CAN training. Compared to workers who did not need training in reporting (routines of CAN), those who expressed the need for a little more and more training were less likely to file a report. The corresponding OR were 0.6 (0.4-0.9) and 0.6 (0.3-0.9), respectively. CONCLUSION: CAN training during the last three years is associated with filing reports of concern to CWS in the same period among PDHP in Norway. The likelihood of filing CAN reports increased with the number of days of CAN training received. Secondly, the PDHP with an expressed need for training on CAN routines were less likely to report suspicions to CWS.

Information sharing between the dental healthcare and child welfare services regarding child maltreatment-A repeated cross-sectional study in Norway.

BACKGROUND: Little is known about dental healthcare workers reported suspected child maltreatment to and received inquiry from the child welfare services (CWS). AIM: Assess time lag differences in public dental healthcare workers' information sharing with CWS and identify sociodemographic and attitudinal covariates of information sharing with CWS in 2014 and 2019. DESIGN: In 2014 and 2019, a national census of 1542 and 1791 Norwegian dental health care workers, respectively, were invited to participate in an electronic survey. Of them, 1200 (77.8%) and 1270 (70.9%) replied to the questionnaires. Time trends of reported child maltreatment and received inquiries were estimated and adjusted for sociodemographics, attitudes, trust, and collaborative routines in logistic regression analyses. RESULTS: The likelihood of reported child maltreatment to and received inquiry from CWS was higher in 2019 than in 2014 (OR 1.4 [95% CI 1.2-1.7] and OR 1.1 [95% CI 0.9-1.4]). Significant associations occurred with sociodemographic characteristics, attitudes, and collaborative routines. The likelihood of receiving inquiry about whether being employed long versus short term was higher in 2019 than in 2014. CONCLUSION: Information sharing between dental healthcare workers and CWS improved across time and might promote beneficial outcomes.

Reporting suspicion of child maltreatment - a 5 yr follow-up of public dental health care workers in Norway.

OBJECTIVE: This study examined stability and change of Norwegian dental health care workers' mandated reporting of suspected child maltreatment from 2014 to 2019 as well as the influence on reporting practices from regional, sociodemographic- and attitudinal factors. It was hypothesised that those factors associate independently with reporting practices across the survey period. METHODS: In 2014 a census of 1542 dental health care workers employed in the public dental health care service (PDHS) were invited to participate in an electronic survey and 1200 (response 77.8%) consented to participation. Corresponding figures in 2019 were 1791 and 1270 (response 70.9%). Of the 1200 participants in 2014, 591 participated in 2019 (follow up 49.3%). RESULTS: A total of 58% and 25.7% of the dental health care workers confirmed ever reporting and avoidance of reporting in both survey years whereas 24.6% and 17.2% changed the status of ever- and avoiding reporting across time. The likelihood of being a stable reporter was greatest in experienced participants, those living in eastern parts of Norway and confirming professional obligations to report. At the population level, 59.6% and 79.5% confirmed ever reporting of suspected maltreatment in 2014 and 2019. Corresponding figures for confirmed avoidance of reporting were 33.9% and 37.9%. CONCLUSION: Reporting of suspected child maltreatment is maintained at a relatively high level and varies by socio-demographic and attitudinal concerns.

Dental health personnel's experience with receiving inquiries from child welfare services: a national cross-sectional study.

OBJECTIVES: To assess if and to what extent public dental health personnel (PDHP) receive inquiries from child welfare services (CWS), and to assess whether PDHP's experience of receiving inquiries is associated with PDHP's characteristics and whether the associations are influenced by PDHP's experience of reporting to CWS. MATERIAL AND METHODS: Questionnaires were distributed to 1542 PDHP in Norway. Descriptive statistics were used for analysis. Negative-binominal-regression analyses with incidence rate ratios (IRRs) and confidence intervals (CIs) were used to estimate the association between received inquiries from CWS and PDHP characteristics. RESULTS: From a total of 1074 respondents, 52.4% had received inquiries from CWS (2012-2014) with a mean number of 3.9 (SD = 4.5). PDHP's likelihood of receiving inquiries was significantly associated with having many patients, working in small municipalities, working in eastern Norway, having good knowledge of the Health Personnel Act, and having experience reporting to CWS. Regional differences were the only association that varied according to PDHP reporting activity. CONCLUSIONS: PDHP receive inquiries from the CWS. The likelihood of receiving inquiries is associated with several characteristics of PDHP. To increase PDHP's likelihood of receiving inquiries, it is important to establish contact between the CWS and PDHS and ensure that the PDHP has good knowledge of the Health Personnel Act.

Explaining the intention of dental health personnel to report suspected child maltreatment using a reasoned action approach.

BACKGROUND: This study provides an empirical test of the reasoned action approach (RAA) socio-cognitive theory with the aim of 1) predicting the intention of public dental health personnel (PDHP) to report suspected child-maltreatment to child welfare services (CWS); 2) estimating the effects of the theoretical constructs of RAA, including experiential and instrumental attitudes, injunctive and descriptive norms, and perceived capacity and autonomy regarding PDHP's behavioural intentions; and 3) exploring whether the RAA operates equivalently (i.e., is invariant) in male and female providers. METHODS: This national cross-sectional study was conducted in Norway. An electronic survey was distributed to 1542 dentists and dental hygienists working in the public dental health service. The survey included RAA items constructed in accordance with the recommendations for the RAA model. Structural equation modelling (SEM) was used to identify factors derived from the theory of RAA to predict PDHP reporting intentions. RESULTS: A total of 77.8% (1200) of those surveyed responded to the survey. The present study provided support for the utility of the RAA across both male and female providers in predicting their intention to report suspected child-maltreatment to the CWS. The final modified SEM model revealed that instrumental attitudes and perceived behavioural control (based on merged capacity and autonomy parameters) were the strongest predictors of intention to report, followed by the reporting of descriptive norms, injunctive norms and experiential attitudes. These factors explained 63.6% of the observed variance in the reporting intention. CONCLUSIONS: The large amount of explained variance suggests that RAA is a well-functioning theory that predicts PDHP's reporting intentions to CWS across gender, and gives an understanding of the socio-cognitive factors involved. To strengthen reporting intention among dental personnel, this study suggests educators should focus on the value and positive consequences of reporting, the resources available and how to overcome obstacles; attention to normative expectations and individuals' feelings about reporting may also be helpful.

Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel.

BACKGROUND: To prevent child maltreatment, the identification of vulnerable children is essential. In Norway, public dental health personnel (PDHP) report suspicion of child maltreatment to child welfare services (CWS) at a relatively high rate. However, their reasons for reporting and the response from CWS have not been investigated. The objectives of this study were to (1) explore the reasons that PDHP send reports of concern, (2) examine how CWS responds to PDHP reports, and (3) assess whether different reasons for concern are associated with a given response from CWS. METHODS: A national cross-sectional study was conducted by an electronic survey distributed to public dental hygienists and dentists in Norway. Descriptive statistics were calculated in terms of mean (SD) distributions and frequency, expressed as % (n). To account for clustering of responses among respondents, binomial generalized estimating equation analysis was used to estimate odds ratios (ORs) and confidence intervals (CIs) of CWS responses across number of reports with different reasons for concern. RESULTS: Of a total of 1542 questionnaire recipients, 1200 (77.8%) responded to the survey. From 2012 to 2014, 42.5% of the respondents sent 1214 reports to CWS, with a mean number of 2.7 (SD = 2.0) reports per respondent. The PDHP sent the reports due to suspicion of neglect or physical, sexual and/or psychological abuse. Non-attendance at dental appointments and grave caries were reported most frequently. Among the reports, 24.5% resulted in measures being taken by CWS, 20.7% were dropped, and 29.4% lacked information from CWS on the outcome. Reports due to suspicion of sexual abuse, (OR 1.979, 95% CI (1.047-3.742), P = 0.036), grave caries (OR 1.628, 95% CI (1.148-2.309), P = 0.006), and suspicion of neglect (OR 1.649, 95% CI (1.190-2.285), P = 0.003) had the highest association with the implementation of measures. CONCLUSIONS: PDHP report on several forms of child maltreatment and contributes in detection of victimized children. However, the relatively low number of measures being taken by CWS and the number of reports that lack a response to reporters reveal a need for a closer cooperation between the services, as this would benefit both the children at risk and the services.

Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey.

OBJECTIVE: Detecting and responding to child-maltreatment is a serious challenge and public health concern. In Norway, public dental health personnel (PDHP) have a mandatory obligation to report to child welfare services (CWS) if they suspect child-maltreatment. This study aimed to assess PDHP's frequency of reporting and failing to report to CWS and whether the frequencies varied according to personal, organizational and external characteristics. MATERIAL AND METHODS: An electronic questionnaire was sent to 1542 public dental hygienists and dentists in Norway, 1200 of who responded (77.8%). RESULTS: The majority 60.0%, reported having sent reports of concern to CWS throughout their career, 32.6% had suspected child-maltreatment but failed to report it in their career and 42.5% had sent reports during the three-year period from 2012 to 2014. The reporting frequency to CWS was influenced by PDHP's personal, organizational and external characteristics, while failure to report was influenced by personal characteristics. CONCLUSIONS: Compared to international studies, PDHP in Norway sends reports of concern and fails to report to CWS at relatively high rates. PDHP's likelihood of reporting was influenced by age, working experience, number of patients treated, size of the municipality and geographical region, while failure to report to CWS was influenced by working experience.