The present study reveals that a stronger and more functional interdisciplinary cooperation, fulfilling the Health Personnel Act (108), would benefit the children at risk, the PDHS and the CWS. A closer collaboration between the CWS and PDHS might provide better services for victimized children and children at risk. Moreover, it might contribute to making dental personnel feel more confident regarding child maltreatment issues and reduce the gap between suspicion and reporting of child maltreatment (1). To exploit the full potential and establish a knowledge-based best praxis, there is a need for future research focusing on the collaboration between the PDHS and CWS.
As seen, several oral health-related factors could be indicators of child maltreatment (33, 36, 37, 53, 54, 72, 73). Hence, in addition to being a detector and reporter, the PDHP can also function as an informant for the CWS in regard to children who are under investigation. The PDHP can detect different aspects regarding a child’s oral health and general condition and might contribute new, valuable information for the CWS. However, for this to happen, the CWS needs to be aware of the PDHS and
their potential to contribute such information. Moreover, in regard to being an informant for CWS, according to the Health Personnel Act (108), the PDHS is only allowed to provide information that has been requested by the CWS. Due to this limitation, to assess the correct and relevant type of information, it is of great importance that the CWS know what kind of information PDHS can provide and what type of questions should be asked. In regard to dental personnel’s role as informants for the CWS, there is a huge lack of knowledge, and hence, more research is needed.
Another aspect of interdisciplinary collaboration relates to those children currently under investigation by CWS. A close collaboration between the services in regard to information sharing and follow up would benefit the children. With the right knowledge regarding a child’s needs, PDHPs are positioned to facilitate oral treatment and conduct closer follow up of the child and, if needed, his or her caretakers. This also relates to children receiving help from the CWS in the form of out-of-home-placement (165). If the PDHS is informed about the address change, their dental colleagues at the child’s new location can continue to follow up the child, help maintain his or her oral health and ensure that he or she receives the oral
treatment and help to which he or she is legally entitled (111). To facilitate a close and comprehensive follow up of maltreated children or children at risk who may have special oral health needs, more research is necessary.
To change behaviour, there is a need to understand and identify targets for behaviour change. To our knowledge, the present study is the first to take advantage of socio-cognition models and advanced statistics aiming to understand reporting behaviour among dental personnel. However, more theory-driven studies are needed in order to predict, understand and change dental personnel’s reporting intention. Further, theory-based research would also be beneficial, making it easier to compare findings between different studies. Theory-based research would also be valuable in
understanding the variation in responses from CWS and the factors influencing the cooperation between PDHP and CWS.
To increase our understanding of the processes involved in the cooperation between CWS and PDHPs, there is an urgent need to provide research involving the personnel working in the CWS.
5 Conclusion
The overall aim of this study was to gain more knowledge regarding the role and potential of dental health personnel in the prevention and identification of child maltreatment and to assess the current situation in Norway. Based on the findings, including the relatively high reporting frequency, it can be concluded that the majority of Norwegian PDHPs strive to fulfil their mandatory reporting obligation and take their professional obligation seriously. The study reveals that PDHPs do suspect and identify most forms of child maltreatment. While the majority of reports of concern are regarding the children’s oral conditions, they also include suspicion of neglect, sexual, physical and psychological abuse. Hence, PDHPs do play an
important role in child maltreatment detection. Despite this importance, the study also shows that there still is potential for improvement. The relatively high number of failures to report suspicion of child maltreatment, together with our knowledge about the potential consequences of child maltreatment, implies that there is a potential and an urgent need for improvement. In regard to cooperation between PDHPs and the CWS, the study reveals that there is a potential and necessity for a closer
interdisciplinary cooperation, as this would benefit both the children at risk and the services. This potential relates to the relatively low number of measures being taken by CWS and the number of reports that lack a response to reporters. This study provides a thorough understanding of the socio-cognitive factors underlying PDHPs’
intention to report suspected child maltreatment, and it thus offers implications for the development of future training and education aiming at strengthening the
reporting intention among dental personnel. While the present study has provided some answers, it has also addressed several new questions. In order to enhance our comprehension, it is important that the dental services, the CWS, educational
institutions, the authorities and researchers cooperate and work continuously on child maltreatment related issues. By working collectively and in a research-based way, fraction by fraction, we might be able to see the whole picture and fulfil the United Nations Convention on the Rights of the Child.