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Child protection referral issues for general practitioners/family physicians Cole, Carol Diane

Abstract

The purpose of this research was to investigate why GPs/FPs are having difficulty collaborating with other health and human service professionals on matters of child protection. Since the symptoms of a child in need of protection are often hidden and can easily be minimized or attributed to something else, an assertiveness to rigorously investigate ambiguous symptoms is required. This research applied Organizational Citizenship Behaviour theory to understand some of the barriers and facilitators to assertive collaboration. The research survey of 190 GPs/FPs in Vancouver B C , showed that the referral process in child protection cases is lengthy (often a few hours over several weeks), and the GP/FP is rarely remunerated for this time. Most GPs/FPs believe that it takes longer to refer to non-MDs than to MDs. GPs/FPs who refer to non-MDs have more interprofessional education (mentoring, CCFP certification), and work in group practices more often than in solo practices. GPs/FPs who are paid by fee-for-service refer to non- MDs less often than those who are paid by other methods (e.g., salary). Abundant additional information was collected beyond the basic research question, mainly for future research. Some of these data are striking: many GPs/FPs have never referred a child/family for a child protection concern; most child protection referrals are to pediatricians and then to psychiatrists; the GPs/FPs who stated that non-MD referrals take longer than M D referrals referred more to pediatricians and psychiatrists than to non- MDs; the GPs/FPs who refer to non-MDs stated that it took the same amount of time to refer to non-MDs or MDs. Another distinctive finding was that the survey comments showed strong GP/FP frustration with the lack of help for children and their families, including some alarming examples. The work reported here provides data about MD/non-MD collaboration, discusses practice implications, and offers suggestions about how to encourage child protection referrals from GPs/FPs particularly to non-MD health and human service professionals. GPs/FPs may be the province's most accessible, powerful professional resource for children and their families, and the least motivated to take action.

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