Variation in prevention of child maltreatment by Dutch child healthcare professionals

Practice variation was described with domain scores and item response distributions. Multi-level analysis was used to assess casemix-corrected variance between organizations. Interview participants (n=11) expected suboptimal care in 35 topics which they considered important for prevention of CM, resulting in a 15 minute questionnaire.

Nearly two-thirds of the organizations (n=29) agreed to forward the questionnaire to their employees. The response rate was 42% (n=1104). Suboptimal care and practice variation was found in all domains (i.e. communication, medical expertise, collaboration, involvement in prevention of CMactivity, and improvement opportunities), mostly caused by intra-organization variance.

Significant inter-organization variance was found for collaboration (variance partition coefficient 6-7%) and involvement activity (2-3%). Furthermore, the majority of the respondents (96%) reported fear in acting upon suspicions of CM. Substantial suboptimal care and practice variation in prevention of CM warrant action from authorities, CHC training institutes, CHC organizations, and professionals.