Native American women and children suffer from domestic violence at an alarming rate on and off Indian reservations in the United States. Often these families that are impacted by domestic violence are involved in the state/county child welfare system. This study was to gain knowledge about Native American tribal child social workers experiences and challenges with co-occurrences of domestic violence and child maltreatment cases. This study used an exploratory, qualitative design with a phenomenological approach by collecting data through face-to-face and over the phone interviews with four Native American tribal child social workers from four different tribes across the nation. This design allowed participants the opportunity to provide a more in-depth explanation from their own personal experiences regarding their experiences and challenges working with domestic violence and child maltreatment cases. The study found that there is a need for state/county social workers to have a better understanding of the historic and current experiences of Native people from a cultural, spiritual, and socioeconomic perspective through effective and consistent training on the Indian Child Welfare Act (ICWA). The study also found, that there is a need for state/county administration and social workers to build relationships with tribal child social workers in order to provide culturally competent and effective policies and services to serve Native American communities.

This study examined the association between poverty and child neglect. The existence of a general association has been established for some time. However, there is much debate, and little detailed research, on the specific processes that create this association. This study focused on the form of neglect that involves the most health risk for children—physical neglect. It was hypothesized that poverty should increase the likelihood of a specific type of physical neglect, neglect of safety and basic needs, occurring more than other types. Using official child protective services data from a national data set three types of physical neglect were examined: abandonment, lack of safety or basic needs, and inadequate supervision. Hypothesis 1 was that poverty increases the odds of safety/basic needs neglect more than it influences the odds of either abandonment neglect or inadequate supervision neglect, controlling for prior neglect. Hypothesis 2 focused on a test of whether the link between poverty and physical neglect is not direct, but is instead mediated by caregiver stress. Three waves of longitudinal data were used for this test to establish causal time order between poverty and stress, and between stress and physical neglect. This study analyzed data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), Assessments 0-3 from the National Data Archive on Child Abuse and Neglect at Cornell University. The data was analyzed using multinominal logistic regression for both models. The results did not confirm Hypothesis 1, though the analysis was limited somewhat due to low frequencies of some physical neglect types in certain age groups. Hypothesis 2 was confirmed showing that the effect of poverty on physical neglect was completely mediated by caregiver stress for the abandonment and safety/basic needs types of physical neglect. Implications of the results for research on the effects of poverty on child neglect, and for preventing child neglect are discussed. / Graduation date: 2012

Most children exposed to interpersonal violence experience multiple forms of victimizations that are more predictive of trauma symptomatology than single traumatic incidents. This exploratory study seeks to extend research that suggests a child’s intrinsic strengths may help mitigate the development of serious psychiatric symptoms for children experiencing multiple interfamilial victimizations. Utilizing a diverse clinical sample (N= 106) of children 7 to 18 years of age who were exposed to multiple family traumas or to non-interpersonal traumas, path analysis models (moderation, mediational, and moderated mediational) were employed across potential explanatory or attenuating demographic factors (age, ethnicity, and gender) to ascertain the associations between multiple interpersonal maltreatment types experienced, childs’ behavioral and emotional strengths, and their posttraumatic stress symptomatology and/or behavioral and emotional difficulty symptoms. / text

Les populations autochtones canadiennes ont un passé difficile qui influence leur vécu actuel. Les recherches canadiennes et ailleurs dans le monde s’entendent sur la surreprésentation des enfants autochtones en protection de l’enfance. Au Canada, la surreprésentation s’explique présentement par la présence de conditions de vie dégradées plutôt qu’en raison d’un traitement différentiel des services de protection à l’égard des enfants autochtones. La présente étude ajoute aux connaissances sur les mauvais traitements et la réponse des services de protection de la jeunesse aux enfants autochtones québécois en s’intéressant à trois questions : leur surreprésentation, leurs différences par rapport aux autres enfants et les prédicteurs du placement. D’abord, à partir des données administratives de la protection de la jeunesse, la surreprésentation des enfants autochtones est évaluée à trois étapes des services : les signalements retenus, les situations fondées et les placements. Les enfants autochtones et les autres enfants sont comparés sur un ensemble de caractéristiques personnelles, familiales, parentales des signalements et des services rendus. Les prédicteurs du placement des enfants desservis par la protection de la jeunesse sont enfin vérifiés, en portant une attention particulière à l’importance du statut autochtone dans cette prédiction. Les résultats révèlent une augmentation de la surreprésentation des enfants autochtones d’une étape à l’autre des services de protection considérés. Ces enfants ont plus souvent des conditions de vie difficiles et sont confrontés à davantage de facteurs de risque que les autres enfants. Le statut autochtone est important dans la prédiction du placement, même après l’ajout d’un ensemble de caractéristiques pouvant contribuer à la prédiction. La complexité d’accès aux services de première ligne dans les communautés autochtones ou l’influence d’une variable non considérée, telle la pauvreté matérielle et économique, constituent de possibles explications. Les implications pour la recherche et la pratique sont discutées. / Canadian Aboriginal populations have for a while experienced difficulties that influence their actual lives. Research in Canada and elsewhere in the world acknowledges the overrepresentation of aboriginal children in child welfare services. In Canada, the overrepresentation of aboriginal children in child welfare services is mostly explained by the existence of risky life conditions rather than by the hypothesis of differential treatment of aboriginal children by child welfare. The actual study adds knowledge concerning child maltreatment in the aboriginal children population and the way Québec child welfare responds to aboriginal children by an examination of their overrepresentation, their differences with other children and the predictors of out-of-home placement. Using administrative data of Québec child welfare services, the overrepresentation of aboriginal children is first verified at three steps of the child welfare trajectory: the retained reports, the substantiated cases and the out-of-home placements. Aboriginal children are compared with other children on personal, family, parental and services characteristics. Predictors of out-of-home placement for children receiving child welfare services are finally investigated, with a specific attention to the aboriginal status in that prediction. Results reveal an increase in the overrepresentation of aboriginal children as they progress in the different steps of child protective services trajectory. These children live more often with hard life conditions and have to face more risk factors than other children. The importance of aboriginal status in out-of-home placement decisions remains substantial, even when many other characteristics increasing out-of-home placement risks are added. The complexities to access primary care in aboriginal communities or the influence of an unmeasured variable, such as material or economic poverty are possible explanations. Implications for research and practice are discussed.

Child maltreatment is not a new issue. It has existed in various forms in every society since the early days in history. However, it is only in the past four decades that abuse and neglect of children has attracted widespread interest among health professionals and the general public. There is now a large body of evidence that identifies four main maltreatment forms: physical, sexual, emotional maltreatment and neglect. Child maltreatment is a substantial public health problem, as it is associated with immediate and long-term health problems. Most research into child maltreatment has been conducted in English-speaking, developed countries. Although there has been a small but steady increase in the number of studies from less developed countries over the past decade, there remains a relative dearth of research in these populations, especially in Asia. Over the years, most research projects around the world tend to be focused on only one type of child maltreatment (usually either child sexual abuse or child physical maltreatment), and many studies do not examine risk factors in depth, or address the possible outcomes of various forms of maltreatment. Children have always held a very important place in the culture and traditions in Vietnam. In 1989, Vietnam was the first Asian country and the second country in the world to sign and ratify the United Nations Convention on the Rights of the Child. Since then Vietnam has adopted various measures to promote children's rights and particularly children's rights to be protected from abuse and exploitation. Despite strong political support for the rights of children, there is little formal research into child maltreatment. From the small amount of available evidence and media reports, it appears that children in Vietnam are vulnerable to maltreatment, just as they are all over the world. It is clear that information about the extent and health consequences of different forms of child maltreatment from scientifically sound studies is still far from sufficient. Thus, more research is essential to ensure effective and culturally appropriate responses to protect children from maltreatment. The primary aim of this research was to examine the nature and co-occurrence of four forms of child maltreatment including sexual, physical, emotional maltreatment and neglect among Vietnamese secondary and high school adolescents in both urban and rural settings, and determine the extent to which such adverse experiences impact on self-reported health risk behaviours and physical and mental health. A mixed methods design including qualitative interviews and focus group discussions, and a cross-sectional survey was employed in this study. Incorporation of qualitative inquiry added a cultural dimension on child maltreatment and informed to develop appropriate quantitative measures. Following 8 focus group discussions and 16 in-depth interviews as well as a pilot study of 299 adolescents in Vietnamese schools, a cross-sectional survey of 2,591 adolescents randomly selected from eight secondary and high schools in one urban district and one rural district was undertaken between 2004 and 2005. Data were collected by self-administered questionnaires in class rooms. Key information included demographics, family characteristics and environment, and four scales measuring sexual abuse, emotional and physical maltreatment and neglect as well as standard brief assessments of health related risk behaviours, mental and general physical health. The study clearly revealed that experiences of different forms and co-occurrence of child maltreatment among school adolescents were prevalent in Vietnam. The prevalence estimates of at least one type of physical and emotional maltreatment, neglect and sexual abuse were 47.5%, 39.5%, 29.3% and 19.7% respectively. A significant proportion of respondents (41.6%) was exposed to more than one form of child maltreatment, of which 14.5% and 6.3% experienced three or four maltreatment forms. Results from multivariate logistic regression analyses showed that the prevalence of child physical and emotional maltreatment and neglect among adolescents was not statistically different between urban and rural districts. However, children from rural schools were more likely to report unwanted sexual experiences than their counterparts in urban schools. There was no significant gender difference in reports of adverse sexual experiences. In contrast, girls were more likely to report emotional maltreatment and neglect whereas boys were more likely to experience physical maltreatment. Furthermore, family environment assessed by parental quarrelling, fighting, perceived quality of parental relationship and emotional support appeared to be the most consistent factors significantly predicting each form of child maltreatment. After controlling for a wide range of potential confounding factors, many significant correlates between each type of maltreatment, each level of maltreatment co-occurrence and each health risk behaviour were found. In general, the pattern of correlations between child maltreatment and health risk behaviours was similar for females and males. Emotional maltreatment significantly correlated with most behaviours examined. Physical maltreatment seems more likely to be associated with involvement in physical fights and being threatened. Sexual abuse was significantly related to smoking, drinking, being drunk, and involvement in fighting. Statistically significant associations between neglect and self-harm such as involvement in fighting, feeling sad and hopeless, suicidal thoughts and attempts were found. Clearly, co-occurrence of child maltreatment was significantly associated with almost all examined health risk behaviours and a dose-response relationship was observed in most of the dependent variables. Regarding continuous measures of mental and physical health, multivariate regression analyses revealed that presence of four types of child maltreatment explained a small but significant proportion of variance (from 5% to 9%), controlling for a wide range of background variables. Additionally, while each form of child maltreatment had independent effects on depression, anxiety problems, low self-esteem and poor physical health emotional maltreatment appeared to be the strongest influence on mental and physical health of both female and male adolescents. Analysis of variance also clearly suggested that exposure to increasing numbers of maltreatment forms significantly increased the risk of mental and physical health problems in a dose-response fashion. The present study extends a small body of previous research examining poly-victimization in developed nations to an Asian country. The data contribute new knowledge on cross-cultural child maltreatment problems. Considerable commonalities as well as some differences in the findings in Vietnam compared with earlier research were found. One important conclusion concerns the significant independent associations between various types of child maltreatment, as well as the cumulative effects of poly-victimization on a wide range of health risk behaviours, depression, anxiety, self-esteem, and general physical health. This pioneering research in Vietnam provides timely and substantial evidence that can be used to raise public awareness of the nature of child maltreatment and the harmful effects of not only sexual and physical abuse but also other forms of emotional maltreatment and neglect which have not received attention before. These results from a community-based sample have demonstrated the urgent need for prevention programs. The current study provides an impetus for more comprehensive research in this sensitive area in the near future so that culturally and politically relevant evidence-based responses to child maltreatment can be developed in Vietnam.

The co-occurrence of domestic violence (DV) and child maltreatment is high. Response to both problems has historically been via two different systems. However, child protection workers are increasingly asked to respond to this co-occurrence since research has identified that exposure to DV can negatively impact on children and that child maltreatment often co-occurs with DV. This study looks at child protection systems response to families affected by DV by using two research methods. First, a systematic review was conducted using research papers focusing on child protection workers response to families experiencing DV. Second, a critical discourse analysis of current Australian child protection policies was conducted. Findings from the systematic review show that child protection workers' response to abused mothers went from treating them as 'mad' in the 1980s, to labelling them 'failure to protect' in the 1990s and early 2000. These findings showed continued focus on abused mothers rather than on perpetrators of DV. Some contradictions were found around child removal data. However, important links were found between re-notification of children and subsequent removal. Findings from the Australian policy analysis revealed that most policies referred to DV as a child protection issue and used a feminist definition of DV. However, not all states had detailed guidelines on how to intervene safely and effectively with families affected by DV. Discussions and recommendations focus around the pressing need for more DV expertise within child protection systems. It also discusses the issue of responsibility placed on abused mothers while perpetrators of DV remain invisible. Finally, it discusses the response to children exposed to DV compared to the response to children exposed to DV who are also victim of direct child maltreatment. The key recommendations of this study are to have DV expertise within the child protection systems, to empower abused mothers rather than blaming them, which implies putting the responsibility back on the perpetrator of DV and to have resources and systems in place before responding to child exposure to DV as child maltreatment per se.

Made available in DSpace on 2016-06-02T20:30:55Z (GMT). No. of bitstreams: 1 4979.pdf: 1038551 bytes, checksum: 709a439c826b0d6630ae64c9c4187eb8 (MD5) Previous issue date: 2013-02-07 / Universidade Federal de Sao Carlos / This dissertation is a compendium of four scientific papers. Each paper describes a stage of the study, with the final goal of evaluating the effectiveness of different materials to increase parents knowledge on abusive head trauma. The first paper describes a review of national and international literature, which aimed to give a current overview of abusive head trauma (AHT). According to the review, AHT can be defined as injury to the skull and intracranial contents to a child due to a sudden unintentional impact and/or a violent shaking. It occurs mainly with babies and children under 1 year of age and can result in serious consequences for children's development, including death. Although there are specific signs for this type of abuse, it can be mistaken for common child illnesses or accidental head trauma. Thus, it is essential that health professionals are trained for the correct diagnosis. One of the main factors associated with its occurrence is the baby crying, which highlights the need for intervention with parents in order to teach them about child development and safe strategies to deal with the baby. The second paper aimed to investigate the knowledge of newborn parents about some characteristics associated with AHT, such as the pattern of the infant crying in the first months of life, strategies to deal with the crying baby and the consequences of shaking a baby. The results indicated a lack of knowledge about the severity of shaking a baby, as well as a possible Brazilian belief that babies should not be left crying alone. In this sense, there is a need for these issues to be addressed in AHT prevention efforts. The third paper aimed to investigate the belief of Brazilian parents about corporal punishment to infants, and its possible relation with abusive head trauma. As opposed to the international literature, participants of this study did not consider shaking as an appropriate strategy to discipline the baby, agreeing more with this strategy when it aimed to sooth the baby. Furthermore, the results indicated that the caregivers evaluation about the strategy s harm potential seems to influence its adoption in discipline and soothing contexts. Finally, the last paper describes the evaluation of the effectiveness of three different informational materials to increase knowledge of Brazilian parents about this type of abuse. The materials consisted of a video on abusive head trauma, a pamphlet individually read on the AHT, and a video on child safety, unrelated to AHT and used for comparison purposes. The results suggest that reading the pamphlet could be a useful strategy in prevention programs, since it increased participants' knowledge about the severity of shaking a baby, as well as the likelihood of using strategies to distance themselves from the baby when stressed by the crying. Although less significant, the results of the group who watched the video on the AHT also indicated an increase in knowledge about the average number of daily hours of baby crying. It is hoped that the results found in this dissertation will guide future AHT preventive efforts in Brazil. / A presente dissertação foi escrita no formato de um compêndio de quatro textos científicos. Cada artigo descreve uma etapa do estudo, que teve como objetivo avaliar a eficácia de diferentes materiais informativos para aumentar o conhecimento de pais de recém-nascidos sobre o trauma craniano violento pediátrico. O primeiro artigo descreve uma revisão da literatura nacional e internacional, que teve como objetivo traçar um panorama atual do trauma craniano violento (TCV). De acordo com a revisão, o TCV pode ser definido como a lesão ao crânio ou ao conteúdo intracraniano de uma criança devido a um impacto brusco intencional e/ou a uma sacudida violenta. Ocorre principalmente com bebês e crianças menores de 1 ano de idade e pode resultar em consequências graves ao desenvolvimento infantil, incluindo a morte. Apesar de haver sinais específicos para esta forma de maus-tratos, eles podem se confundir com doenças comuns em crianças ou traumas cranianos acidentais. Deste modo, torna-se imprescindível o preparo clínico dos profissionais de saúde para o diagnóstico correto. Um dos principais fatores associados à sua ocorrência é o choro do bebê, destacando a necessidade de intervenção com pais no sentido de ensiná-los sobre desenvolvimento infantil e estratégias seguras para lidar com o bebê. O segundo artigo visou investigar o conhecimento de pais de recém-nascidos sobre algumas características associadas a esta forma de maus-tratos, tais como o padrão do choro do bebê nos primeiros meses de vida, as estratégias para lidar com o choro e as consequências de sacudi-lo. Os resultados indicaram um desconhecimento dos participantes sobre a gravidade de se sacudir um bebê, bem como uma possível crença brasileira de que os bebês não devem ser deixados chorando sozinho. Neste sentido, destaca-se a necessidade dessas questões serem contempladas nas ações de prevenção do TCV. O terceiro artigo objetivou investigar a crença de pais brasileiros sobre a punição corporal em bebês e sua possível relação com o trauma craniano violento. Diferentemente do que aponta a literatura internacional, os participantes do presente estudo não consideraram o sacudir como uma estratégia adequada para disciplinar o bebê, obtendo maior concordância quando avaliada em seu potencial tranquilizador. Além disso, os resultados indicaram que a avaliação que os cuidadores fazem do potencial prejudicial de determinada estratégia parece influenciar sua adoção no cuidado com o bebê, tanto para acalmá-lo, quanto para discipliná-lo. Por fim, o último artigo descreve a avaliação da eficácia de três materiais informativos diferentes para o aumento do conhecimento de pais brasileiros sobre essa forma de maus-tratos. Os materiais consistiram em um vídeo sobre o trauma craniano violento, um panfleto sobre o TCV e um vídeo sobre segurança infantil, que não abordava o TCV e foi utilizado como comparação. Os resultados sugerem que o e leitura individual do panfleto pode ser uma estratégia útil em programas de prevenção, uma vez que a mesma aumentou o conhecimento dos participantes sobre a gravidade de sacudir um bebê, bem como a probabilidade de utilizarem estratégias de se afastar do bebê, quando estressados pelo choro. Apesar de menos expressivos, os resultados do grupo que assistiu ao vídeo sobre o TCV também indicaram um aumento no conhecimento sobre o número médio diário de horas de choro do bebê. Espera-se que os resultados encontrados na presente dissertação possam fornecer embasamento para futuras ações de prevenção dessa forma de maus-tratos.

Lärare har i sin dagliga kontakt med barn en unik roll i att upptäcka barn som far illa, de omfattas av en lagstadgad, personlig och ovillkorlig anmälningsskyldighet. Trots detta är anmälningsbenägenheten generellt sett låg och det antas finnas ett stort mörkertal barn som far illa. Syftet med vår studie var att undersöka skolpersonals kunskaper om och attityder till att vid misstanke om att ett barn far illa ingripa på ett lämpligt och konstruktivt sätt. En kvalitativ studie med semistrukturerade intervjuer genomfördes. Genom tematisk analys utvärderades det empiriska materialet och empirin kopplades till tidigare forskning och teoretiska perspektiv och begrepp inom den symboliska interaktionismen. Våra slutsatser är att det finns ett glapp mellan vad skolpersonal enligt skolverket förväntas göra avseende barn som far illa och vad de gör. Vi har identifierat en bristande förmåga att identifiera barn som far illa och en hierarki där lärare kan förhindras att fullfölja sin anmälningsskyldighet. / In their daily contact with children, teachers have a unique role in detecting child-maltreatment, as mandated reporters they are subject to a statutory personal and unconditional notification. Nevertheless, reporting abilities are generally low, and it is assumed that there are a large number of children who are maltreated. The purpose of our study was to investigate school staff’s knowledge and attitudes to act in an appropriate and constructive way if suspicion arises that a child is maltreated. A qualitative study using semi-structured interviews were conducted. The empirical data, evaluated through a thematic analysis and linked to previous research and theoretical perspectives and concepts within symbolic interactionism. Our conclusion is that there is a gap between how teachers act regarding maltreated children and how they are supposed to act according to skolverket. We have identified a lack of ability to identify maltreated children and a hierarchy where teachers can be prevented from completing their mandatory reporting.

Syskonrelationen är den längsta relationen i livet. Därtill utgör syskonrelationen en viktig arena för barns utveckling. Trots detta finns det få studier där syskonrelationen undersöks i relation till barnmisshandel. I följande studie undersöktes skillnader i den självskattade stöd- och konfliktnivån i syskonrelationen, mellan barn som rapporterade svår barnmisshandel och barn i en kontrollgrupp, samt om kön förändrade dessa skillnader. Vidare undersöktes om stöd- och konfliktnivån påverkade den upplevda nivån av psykosomatiska problem hos barn som rapporterade svår barnmisshandel. Studien genomfördes på ett urval av 1 392 pojkar och flickor mellan 15-16 år, med data från projektet Longitudinal Research on Development in Adolescence (LoRDIA). Barn som rapporterade svår barnmisshandel upplevde signifikant lägre stödnivå och signifikant högre konfliktnivå i sin syskonrelation, än barnen i kontrollgruppen. Skillnaderna var signifikanta både för pojkar och flickor, men pojkar upplevde ett signifikant lägre stöd i sin syskonrelation än flickor. Nivån av syskonstöd och syskonkonflikt påverkade emellertid inte nivån av psykosomatiska problem hos barn som rapporterade svår barnmisshandel. Effektstorlekarna var små i majoriteten av resultaten, vilket tyder på att syskonrelationer är komplexa fenomen som vid sidan av barnmisshandel och kön, även påverkas av en rad andra faktorer. Resultaten diskuteras i ljuset av tidigare forskning och i relation till anknytningsteori, kompensationshypotesen, kongruenshypotesen och könssocialisation. / The relation between siblings is one of the longest throughout the life span. Moreover, the sibling relationship constitutes an important context for children’s development. Nevertheless, in the context of child maltreatment, it remains largely understudied. In this study, we examined the differences in self-reported sibling support and sibling conflict, between children who reported severe child maltreatment and children in a control group, as well as if these differences were affected by gender. Furthermore, we examined whether the level of sibling support and sibling conflict affected the extent of psychosomatic problems experienced by children who reported severe child maltreatment. The study was conducted on a sample of 1 392 boys and girls between the ages of 15-16, using data from the research project Longitudinal Research on Development in Adolescence (LoRDIA). Children who reported severe child maltreatment experienced significantly less sibling support and significantly higher sibling conflict than the control group. These differences were significant for both boys and girls, although boys experienced significantly less sibling support than girls. The level of sibling support and sibling conflict, however, did not affect the extent of psychosomatic problems in children who reported severe child maltreatment. Effect sizes were small in the majority of the results, suggesting that sibling relationships is a complex phenomenon that, besides child maltreatment and gender, may be affected by a number of other factors as well. The results are discussed in light of previous research, and in relation to attachment theory, the compensation hypothesis, the congruence hypothesis, and gender socialization.

Bakgrund: Barn har rätt att växa upp under trygga förhållanden utan utnyttjande eller våld. Tyvärr far barn illa på många sätt, vilka är en utmaning att identifiera. Distriktssköterskan har en skyldighet enligt lag att orosanmäla till socialtjänsten då ett barn misstänks fara illa, dock finns det försvårande faktorer som påverkar anmälningsbenägenheten. Det är svårt att identifiera riskfaktorer för barn i fara under korta vårdmöten på vårdcentral. Samtidigt åligger det distriktssköterskan att arbeta på ett familjecentrerat sätt och ta hela familjens mående i beaktande. Syfte: att beskriva distriktssköterskors erfarenheter av att få kännedom om eller misstänka att ett barn far illa. Metod: Kvalitativ intervjustudie med induktiv ansats, som analyserades med konventionell innehållsanalys. Individuella intervjuer över telefon eller video hölls med 12 distriktssköterskor från varierande arbetsplatser inom primärvården, med erfarenhet från vårdcentral. Resultat: I resultatet framkom ett övegripande tema: barn i fara är ett komplext ämne för distriktssköterskan. Två kategorier framträdde i resultatet: distriktssköterskans samlade kompetens om barn som far illa samt faktorer som påverkar anmälningsbenägenheten negativt. Distriktssköterskorna såg orosanmälan som en plikt, ibland saknades dock rätt förutsättningar. Det gjorde att distriktssköterskorna kunde tvivla på bedömningen och undvika orosanmälningar. Ett familjecentrerat arbetssätt underlättade. Slutsats: Inför beslut om orosanmälan behöver distriktssköterskan kartlägga familjens situation och barnets utsatthet, eftersom det oftast inte är tydligt att barnet far illa. För att känna trygghet i professionen behöver distriktssköterskan rätt förutsättningar på arbetsplatsen. Arbetsmomentet underlättas om distriktssköterskan har färdigheter i kommunikationstekniker med barn och föräldrar. Ytterligare insatser i form av samverkan med socialtjänsten behövs för att stärka distriktssköterskans anmälningsbenägenhet.