Tackling Child Neglect by Ruth Gardner

Author:Ruth Gardner [Gardner, Ruth]
Language: eng
Format: epub
ISBN: 9781784501655
Barnesnoble:
Publisher: Kingsley, Jessica Publishers
Published: 2016-08-18T00:00:00+00:00

Potential challenges and benefits of direct responses by GPs

Although these are the most detailed descriptions available of direct therapeutic responses by GPs to vulnerable and maltreated children, young people and their families, the four responses described in this chapter only scratch the surface of what we want to know about how GPs might best intervene directly with families. First, they are probably not exhaustive; more research may find other types of direct and potentially therapeutic responses. Second, we do not know whether these responses work, or whether GPs make things worse for some children and young people when they try to respond in these direct ways. For example, there is a danger that building relationships with parents to facilitate coaching can become an ‘accommodative strategy’ (Strong 2001) towards the parent that ends up affirming patterns of ‘bad’ behaviour (Chew-Graham, May and Roland 2004). Such a strategy could encourage professionals to focus on parents and overlook the needs of children, resulting in inadequately protecting them from abuse or neglect. On the other hand, developing a trusting relationship with parents can also be seen as a ‘containment’ strategy, which, alongside close monitoring of children’s health and wellbeing, has been put forward as an appropriate approach within social work for keeping children safe (Howe 2010). As Brigid Daniel argues in her review of the evidence about professional responses to child neglect, relationships between parents and professionals need to be supportive yet challenging (Daniel, Taylor and Scott 2011).

Many would argue that GPs do not have the inclination, time or expertise to maintain this kind of supportive yet challenging relationship with parents, and are limited by not having access to the whole picture of a child or family’s life. Even GPs themselves question whether they have time to address child maltreatment in a ten-minute consultation, whether they are still family doctors who know their patients and can offer continuity of care, and whether they see maltreatment frequently enough to give it a primary focus (Fitzpatrick 2011; Masters 2012). Coaching parents relies on repeated contact between the parents and a specific GP, and monitoring is much more difficult if patients cannot get appointments easily. Repeated contact between a GP and a parent was seen as a key facilitator of direct responses by GPs to neglectful families; the implications of this are discussed at length later in the chapter. On the other side of the argument, GPs maintain that child safeguarding and building relationships with challenging families encapsulates the nature of general practice as a holistic service and is an integral part of GP work (Allister 2011; Ford 2011). From this perspective, continuity of care and patient access are still possible in general practice but cannot be taken for granted; GPs and practices need to work a bit harder to ensure they happen (Freeman and Hughes 2010).

In addition, if these strategies by GPs do indeed work to help children and young people and it is possible for GPs to deliver them in the current system, this is unlikely to be the case universally.

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