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School nurse's screening for child maltreatment facilitates disclosure – A Swedish intervention study

02 April 2024
Research
02 April 2024
Volume 5 | British Journal of Child health · Issue 2

Abstract

Early identification of child maltreatment (CM) is essential for children to receive support. The aim was to develop and evaluate a screening instrument for CM to be used by the school nurse in the health dialogue. The research questions included if victimisation could be disclosed by screening, if disclosure led to support measures, and the pupils' and the school nurses' experiences of the screening. A screening instrument to identify CM was developed. A total of 140 pupils and eleven school nurses participated. Mixed methods were used for analysis. Results showed that 29.7% of the participants disclosed CM victimisation and support was given when needed. Girls disclosed exposure to all types of maltreatment to a greater extent than boys. Pupils expressed the importance of screening and it created a trustful relation with the school nurse. No school nurses or pupils were distressed by the screening. Screening for CM facilitated disclosure.

Child maltreatment (CM) is a global public health problem with negative consequences on the child, the family and society (Gilbert et al, 2009). In 1979, Sweden was the first country in the world to ban CM which has led to a decrease in violence (Lucas and Janson, 2022). CM prevalence is difficult to estimate due to underreporting. Studies have shown that 5% of the pupils were exposed to systematic physical CM and many of them to polyvictimisation (Jernbro and Janson, 2017; Hafstad and Augusti, 2019). Early identification is essential for children to get the support they need and is cost-effective (Shonkoff, 2016). It prevents ill health during childhood and the need of health care in adulthood. Swedish legislation requires professionals who suspect CM to report immediately to social services. This requirement is unconditional but is not always fulfilled (Engh and Eriksson, 2015). One recent Swedish study showed that almost all school nurses have had experiences of pupils exposed to child abuse, but they do not always report to social services when they suspect abuse (Sundler et al, 2021).

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Child maltreatment
intervention
school nurse
screening
disclosure
mixed methods